Okay, my fellow neuropathics: Here's how it went!!!!!!

Upon waking up, took his blood sugar.
This was
8:45 a.m.(fasting from the night before) - 81
Drank the approx 50 grams of glucose tablets ground up in water. Goal was to take his blood sugar every 30 minutes.

9:15 a.m. - 139
9:45 a.m. - 102
10:30 a.m. - 73 (yeah I know, took this reading a little bit late, I was on the phone)
10:45 a.m. - 83
11:15 a.m. - 80
11:45 a.m. - 89

No dizziness, no fainting, no nothing. He felt fine. He is now eating brunch/lunch.


This is my machine. I check it regularly. I used a new lancet each time and a fresh alcohol swab every time.


Oh, just so you can compare to the 3 hour glucose test he took on January 23, here are the results from that one

Fasting Glucose - 80
Glucose 1 hour - 108
Glucose 2 hour - 74
Glucose 3 hour - 38

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So how did he do????? much thanks!!! P.S. I think the 38 reading on January 23 was a mistake on the lab's part. (or maybe a typo???)

Melody

so perhaps he had some freaky lab errors on the other.

I'd get the fasting insulin for sure tho. Is is easy to do and not unlike other
blood draws. It is a one time stick.

Now, we don't know if the 3 hr was a 50 gram or 100 gram load. Unless you
call the lab and ask. So if he had the 100 gram and had the hypoglycemia, then you'd might consider having it done again as a 5 hr GTT. (done with 1/2 hr intervals).

At 1/2 hr his spike is more normal looking than what was reported on the previous
test.

I just phoned the lab and they said for the 3 hour glucose tolerance test, (unless the physician specified) they always use 100. And they don't know if the physician specified it. It would have to be on the prescription.

I told her to look at the last number 38. And she said "yes and if you notice we did call and leave a message on Dr. Goldfarb's answering machine

And sure enough, I looked at the lab test page (of January 23) and underneath the 38 it said: "Left message on answering machine to call back at 2:15 p.m.
Underneath that it read:n RESULTS CALLED TO AND READ BACK BY ZOYA DROBYAK (she's Dr. Goldfarb's assistant). at 9:20 a.m.

So we do know that today Alan took a 50 gram load.

If you think he's going to let me do this again tomorrow, forget it!!!

He's going to the spinal tap on Monday, then we'll go and see Dr. fred and he'll run whatever he wants to run.

Me???? I've got a headache from making all these phone calls and pricking fingers and looking at blood all morning.

Is there a tremendous difference between a 100 gram test and a 50 gram test?.

Should I make Alan re do this tomorrow morning (even if he wants to kill me?)

mel

I don't think you should do the 100 gram at home. I think he should have that
done professionally, if it were to be done. The fasting insulin shows alot, and if elevated can indicate a beginning insulinoma, or insulin resistance.

You just needed to see if he were dipping severely at home.
It is possible he is insulin resistant and has been for a long time, and is
now controlled well with diet. You just don't want to see blood glucose
readings as low as 38 showing up as a surprise. Basically the higher the glucose load, the higher the swing from high to low can be. It is not likely Alan is eating 100 grams of glucose in his meals. So it is not likely he will hit those rock bottom numbers...that we hope. That he didn't hit low lows with the 50 gram load is better..since 50 gr of carbohydrate are conceivable in the diet.
Drinking a 16oz Coke would do it.

What we see here is the typical medical issue of whether doctors ignore something or not.
In your case ignoring the increases of uric acid most likely coming from your
HCTZ drug. And in Alan's case ignoring a strange low # in a test. It is these types of things that bring people to the net..for answers.

You are a real trooper to do the test at home.

I really do have to thank you for all your input. Never could have done any of this without you and the others on the boards.

I did ask Alan if he really wants to go for a spinal tap (I don't think I'd be so willing to do that) but he said "Listen, if it will get me any answers to anything and Dr. Goldfarb thinks I should take it and Dr. Fred says "go for it", I'm going to do it. It's one less test and I'll get it out of the way!!!

So onward and upward.

Right now, he just came home and I just made a batch of cinnamon muffins with blueberries, raisins, pure vanilla extract, a dash of splenda and egg beaters.

If you walked into my kitchen and smelled my muffins, you'd go nuts.

Alan's in heaven!!!!

Will update after the spinal.
Thanks much for all your help.

Melody

P.S. Is it still a good idea if I test his sugar ever morning, or do I do it before he goes to sleep. Thanks, mel

--as it will be a "fasting" level. Take it before he eats anything, and before he starts any exercise.

I agree with Mrs. D--his "informal test" numbers look a lot better. The initial spike was within a normal range for a half-hour. I'm glad you "caught" that 73, even if it was a little late. The fact that he had that drop from 1 to 1.75 hours does corrrespond to a little hypoglycemic reaction, but not one anywhere near large enough to cause symptoms. You'll notice over the next hour his blood sugar normalized to near his usual fasting readings--this is usually what happens to someone who has a bit of insulin resistance. To wit: the body responds to the glucose challenge, but it responds with a bit too much insulin than what's needed, so blood sugar gets driven down somewhat below fasting levels. (It's been speculated this happens due to the body having gotten used to pumping more insulin to drive sugar into resistant cells--that's the definition of insulin resistance.) Then, when the somewhat too low sugar level is detected by the body, the feedback mechanism turns off the insulin spigot, and blood sugar levels rise back to around their fasting levels.

People with insulin resistance of this kind--and considering Alan's previous weight and history, it's very likely he has a degree of it, though probably now well-controlled--often have slightly elevated fasting insulin levels, and it would be good to get that number. It's been estimated that the majority of us who are not ultradistance athletes--and maybe even some of them--get a degree of insulin resistance as we get older and our cells become less permeable. Part of the reason we're more prone to get that "middle-aged spread". With the standard American diet (yes, that high-fructose corn syrup is EVIL, like trans fats)--and the standard American couch-potatoism--it's a wonder we don't all have it. I think, though, with Alan's diet and exercise, he's arrested any progression towards diabetes; I really don't suspect that's what's going on. Now, he may have some nerve damage from earlier impaired glucose tolerance, which he may have had a degree of back when he was so much heavier. But, if I had to put my money on it, I would take a long look at those elevated IgG polyclonal immunoglbulins and the possibility of neuropathy secondary to cryoglobulins. You should mention this again to Dr. G (and you can tell her it came from me, if you want), as the spinal tap would not likely look specifically for this, though it would look for other autoimmune or infectious markers.

Melody (and Glen),

That 73 is normal. At about 1 1/2 hours into the 3 hr. test the blood sugar drops due to a slight insulin over-production. Then by 2hr it comes back up to the normal level for the individual. A long time ago a medical biochemist told me everyone being tested should have a 3hr. GTT. Nowdays it is so much easier.

To: JD3#2. Hi there, thanks for putting the word NORMAL in my day. I needed it.

Glen: Not that I understand one whit about what polyclonals etc. are, I printed out your paragraph and will show it to Dr. Goldfarb.

What will she do, run a different blood test or something. And if they find something, what happens then???

thanks,
Mel

--and they'll probbaly run the immunofixation electrophoresis again along with the test to check for the presence of cryoglobulins.

The diffuse elevated IgG polyclonal proteins they found, as Liza Jane mentioned, might not be from the presence of cryoglobulins; they can be the result of a past antibody response to infection. (The IgG response tends to linger around longer than the IgA or IgM, which the body produces more acutely to infectious agents.)

However, cryoglobulins HAVE been associated with neuropathy--evidently something in those antibodies cross reacts with certain proteins of peripheral nerves.

If they did find cryoglobulins, the probable treatment, other than symptomatic ones, would be immune modulating medications (steroids are often used, and their are other anti-blood-cancer chemo drugs that have been adapted for use if the problem is severe, which it sounds like it isn't). The idea would be to reduce the autoimmune response in order to arrest nerve damage and allow (slow) regeneration.

If no cryoglobulins are found, they may want to perform a polymerase chian reaction (PCR) series on Alan to check for certain viral or bacterial invaders, to see if those may be present, or, given the bodies antibody patterns for certain pathogens, to see if there might have been a molecular mimicry process at some point. This is thought to be behind many "idiopathic" neuropathies. The body fights off an invading "germ", but the "germ's" structure was similar enough to some part of nerve tissue that the now-activated immune system cannot distinguish one's own nerve tissue from the invader and attacks the nerve. (In fact, pathogenic "triggers" and this process may be behind the start of many autoimmune diseases, including Type I diabetes and autoimmune thyroid conditions.)

I'd just want to see if he has any cryoglobulins first, and go from there.

My goodness, polyglobins, anti-globins, anti-bodies, and my favorite one of all, immunofixation electrophoresis.

I dare you to say this 3 times fast.

Jeez. I wish I had taken some kind of medical training. You remind me of Gregory House on HOUSE, only nicer. Dr. House would probably hit me with his cane.

Anyway, Alan is going for his usual set of blood tests at Dr. Fred's office next week before he sees Dr. Fred. I want to ask them to do the insulin level test.

I want to send Dr Fred a fax.

How can I word this fax without sounding like a know-it-all wife who thinks she can tell a doctor what to do. I will of course tell him about the home-made 3 hour glucose tolerance test I did and give him the results. But I want to request that besides all the regular blood tests they run on Alan once every 3 months, I want them to include an insulin level test.
So how would you word this if you were sending a fax to Dr. Fred?

Thanks.
Melody