GTT & Hyperreflexia - two questions!
 

:o

Can anyone tell me if they have come across the term hyperreflexia in connection with their PN? If so, what were the positive/negative associations of hyperreflexia for you?

Also I wanted to ask about the merits of the various GTT (Glucose Tolerance Test) lengths! I have been able to slot an extra appointment in with my Endocrinologist this coming Tuesday & I want to run this whole PN thing past him (ie. the events of the past two - three months) and see if he has any suggestions, either in connection to my other medical condition or otherwise.

If he suggests a GTT, is there one that is better to 'steer' him towards (if indeed a specialist can be steered) such as the two, three, four or five hour GTT? Also is there any merit in having fasting insulin levels done concurrently?

Any other suggestions to help towards a positive outcome for this appointment would be appreciated, as I want this done properly so I can completely lay prediabetes to rest and move on to .... probable idiot-opathy :) - oops idiopathy!

I think
 

a fasting insulin is very useful. Just be sure you do not exercise or walk alot
before it is drawn.

The longer GTT will show reactive hypoglycemia, due to elevated insulin levels.

Since you are there already, staying for a couple more draws is sensible.

Agreed--
 

--with glucose tolerance testing, one does need a longer test (at least three hours after the initial baseline "stick", although I generally do five) to really see the patterns of how the bodily process of digesting/releasing the glucose to one's body causes one's individual glucose regulaiton patterns.

I always have them done not only with a fasting insulin level, but with insulin levels drawn concurrently all the way through. That way, when the results come in, one can trace the insulin reaction to the glucose challenge, see if it is measured or exaggerated (the latter is a sign of insulin resistance) and just how exaggerated (which may result in reactive hypoglycemia, as Mrs. D mentions).

The reason for the longer testing is to cover everybody's varied alimentary speed--by 4-5 hours most people's systems have gone through a complete cycle and are heading bck to baseline readings, and all the insulin/glucose patterns have been cycled through.

Also--while this may make you feel like a pincushion--I have readings taken every half-hour, not every hour. For people with faster systems, taking a reading only every hour may miss some of the rise/fall patterns in glucose and/or insulin that may provide diagnostic clues. (In other words, you want enough "snapshots" taken to see the pattern.)

Oh--
 

--as regards hyperreflexia, or exaggerated reflex response, it can be a feature of certain types of neuropathy, though more often the reflexes are reduced. It is more likely to occur in neuropathies with significant motor neuron involvement (as opposed to predominantly sensory). It can sometimes occur in those with hyperthyroid or hyperparathyroid conditions.

Hyperreflexia is more often associated with spinal cord problems, and is a fairly common symptom of multiple sclerosis, ALS, or degeneration due to B12 deficiency.

Thanks Glenn and MRSD for those responses. They shall be my armour-bearer as I sally forth to visit my endocrinologist! (...or perhaps I better just sit there demurely and let him decide everything and say yes sir, no sir - see below).

Just looking through my results again tonight from last week and wondered if anyone could cast light upon my ANCA result. The comment on the report says: "Unable to determine the presence of ANCA because of the presence of anti neutrophil nuclear antibodies".
However the Proteinase 3-ANCA (the major C-ANCA antigen) was normal at <5 U/mL (range <10),
likewise the Myeloperoxidase -ANCA (the major P-ANCA antigen) was also normal at <5 U/mL (<5)

Would I be correct in assuming that the antibodies are from some previous infection/immune insult and have no bearing on the present?

Also the neurologist who on my second visit basically concluded that she had come to the end of the road with my management wrote in her letter back to my GP....and I quote "The other possibility is that she is developing somatic symptoms secondary to depression or anxiety. I raised this possibility today and she doesn't feel that she is anxious or depressed. Despite this she actually became almost tearful during the consultation". (Yeah sure I did feel shocked when she basically was dismissing me after a couple of minutes in the consultation saying there was no more she could do).

I think it is quite laughable and somewhat embarrassing that she should think that. I did prepare for the consultation quite carefully and had learnt a little bit of the basics in the five weeks from the time of my first visit but I was far from know-it-all! Perhaps she felt that my approach of asking questions and wanting a copy of the results constituted anxiety on my part. It seems to me that doctors can all too readily label people as having psychosomatic causes for their symptoms when they fail to diagnose or manage a patient correctly. Perhaps that's a justification on my part, although I have believed that for a long time as I have observed other people's situations.

And something that can cause either or both (hyporreflexia/hyperreflexia) is B12 deficiency. I can personally vouch for both being possible in the same person. By the time I was diagnosed by the neurologist I finally got to, I had hypo in my elbows and hyper in my knees).

Both are also mentioned in a very long list of possible signs and symptoms, in an unusually accurate (not decades out of date on the B12 subject) medical textbook. Goldman: Cecil.

rose

I don't think--
 

--that's an irrelevant test result at all.

It's interesting that anti-neutrophil nuclear antibodies are mentioned; this is not a common finding, and there's not a lot written about it, though it may render the designations of your ANCA levels inaccurate, as some theorize that these are actually "atypical patterns" of p-ANCA antibodies as shown on stain testing, showing more affinity for the nucleus than for the cell body (cytoplasm):

http://www.inovadx.com/refs/IBD051407.pdf

http://www.kbsm.hr/klinkemija/lectur...nik_cijela.pdf

There's some idea that the pattern may be more closely associated with inflammatory conditions of the bowel (such as Crohn's) or the liver than the typical p-ANCA or c-ANCA patterns, but this seems to be mostly speculative. Nevertheless, it certainly bears further investigation.

I agree that with the GTT, your fasting glucose should be taken beforehand and that subsequent checks should occur no less than once an hour. This was the only thing that showed I had diabetes. My fasting levels were exemplary, but the numbers shot way up after I drank the liquid and didn't come down for two more hours.

I don't know much about reflexes and their meaning, but I had a reflex test on Tuesday. One knee had no reflex at all and the other was so exaggerated that I nearly kicked the doctor! Neither of us were expecting that. :confused:

I've had the same experience with neurologists three times now. Each time that I failed to have an easily diagnosed ailment, the neurologist would decide to send me to a shrink to check for depression or somatoform disorder. The first shrink told me and the neurologist that I was mentally healthy, the second occasion I did not follow up, and the third time I had a neuropsyche exam that showed more problems with cognitive dysfunction than with depression.

Hope you can at least get prediabetes ruled out.

fanfaire
:cool:

Sounds to me like central nervous system problem. Among the various possible causes, B12 is thankfully inexpensive and safe, but others should be checked out of course. The B12 angle is one all neurologists should diagnose but many do not, so when they are puzzled it makes that even more likely.

rose

Update and venting!
 

Thanks everyone for your comments on this thread.

To Glenntaj regarding the ANCA test - I will have to wait now 'til December when I see the new Neurologist before I can pursue this or anything else regarding my PN....but many thanks for your comments.

To fill you in on today's visit with the Endocrinologist who I have been seeing for six years with my adrenal insufficiency and with whom I thought I had some rapport! He just about blasted me and said what did it have to do with him, my diagnosis of PN. I said I was just wanting to pursue any avenues that may relate to my other condition and also eliminate any doubt that a prediabetic state may contribute to the PN. I explained that I had normal random blood glucose's. He said categorically NO he would not order a GTT as the PN definitely could not be related to diabetes.

Then he basically cast doubt upon the PN diagnosis and said I didn't have it and it would all go away. I started to choke up (it was deja vu of three weeks ago with the Neurologist) and I said "so you mean all this burning and the other symptoms will just go away" and he said "yes". Then he said "why are you upset, I thought that would be good news?"...to which I replied something to the effect that it was very good news if it was true.

So I'm totally disillusioned now. His whole manner was not even one of listening first, then speaking his mind - he verbally pounced on me almost as soon as I walked into the room, before I had time to say much at all.

What is wrong with these medical professionals?

Hopefully by December when I am due to see the other Neuro I will be able to cancel the appointment as my PN will have completely gone!!! :)

while you are waiting for your new neuro appointment, you might want to be looking for a new endocrinologist also. We wouldnt take that kind of treatment from anyone else who we pay to provide a service and doctors are no different, though apparantly this one thinks he is.

What Joe said.
 

That does not sound like a good visit at all. (Very condescending.)

And, I don't see why said doc would not order a GTT. It is not a dangerous or even very expensive test, and quite commonly ordered. (Unless said doc feels it might reveal something that would make him look idiotic . . .one would hate to think that, but some of these people have egos the size of Everest . . .)

Anyway--the endo is not he only person who can order this for you. My neuro orders mine, and any general practitioner can as well.

What you may need to do is prin toff some of those links in the Useful Websites that talk about neuroopathy from pre-diabetic impaired glucose metabolism. Here are some to get you started:

http://www.massgeneral.org/neurology...dOaklander.pdf

http://appneurology.com/showArticle....leId=188500771

http://care.diabetesjournals.org/cgi...full/24/8/1448

http://www.neurology.org/cgi/content/abstract/57/9/1701

http://www.medpagetoday.com/Neurolog...rology/tb/3538


The last one specifically speaks to the value of the glucose tolerance test in helping to catch cases of pre-diabetic neuropthy early.

Useful links!
 

Glenntaj, thanks for those urls. I have printed them off and am working my way through them. Any more articles/links that you or anyone else find - particularly research or medical journal type articles (the only ones which have any credence with doctors) I'd be very thankful for. Abstracts are also ok, as I can always go the university medical library and get full text copies if I have to. I used to have remote patron access to all the medical journals from home but don't at the moment!!

What makes my endocrinologist's outright refusal to do this GTT even more - well I was going to say negligent - is that I have been taking oral corticosteroids for many years (since childhood) because of my congenital adrenal gland condition. This in itself puts me at some extra risk of developing insulin resistance and/or type 2 diabetes.

What concerns me mostly was his closed mind on the subject - so even though I probably do not have any whiff of diabetes, I can't believe that it wasn't even an option for him to consider in my case or future cases. Perhaps he has just not read the literature on the studies that have been done with PN people and prediabetes....but what would I know. I didn't feel confident enough to push the point with him about the research that has already been published on this subject.....he made me feel such a worm!

There's nothing more I can do now until December in terms of the PN other than keep reading and learning about PN ....and hope that it all sorts itself out eventually.

An update on ......
 

....today's Endocrinologist visit. Had another visit with my Endocrinologist today to get my regular six monthly blood test results for adrenal insufficiency.

My husband told me that if I felt confident enough to blast him regarding the previous visit (see earlier post in this thread)....and remind him that I am his 'customer' and deserve to be treated better than how he treated me at that visit. Anyway when he called me into his room today he was all sweetness and light but I didn't let him get away with anything.

Guess what his closing line was? "Well I just have a feeling that you are going to have a better six months than what you have had"....to which I replied, "that is a strongly prophetic and very unscientific statement". He said "well we've had enough science for the moment".

So I am still no closer to having an OGTT done -to eliminate any possibility of prediabetes. It just wasn't worth pursuing it with him.

Well, Maybe not
 

Megan,
Can you go to your regular GP and simply tell him that you'd like to have a GTT run? Just to satisfy your mind? Tell him you are playing with an idea in your mind and it would relieve it to have this test done.

Billye

After all, it is YOUR money.