5

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Hack Me: Just Got Lab Results -- Low Insulin?? Very Low Testosterone? Very High SHBG?

Answered on August 19, 2014
Created September 21, 2011 at 8:30 PM

Both my parents and brother are/were type 2 diabetics (mom and brother were obese, dad was thin). My primary goal is to avoid the diabetes monster. My A1C had been inching up steadily over the years to mid-5s so I started testing glucose postprandially and could see that I was spiking from overly large yet very low carb meals -- also dairy seemed to sometimes cause spikes so I've been totally dairy free. My fructosamine was also higher than I'd like so I endeavored to really restrict fruit as well but didn't seem to pay off in terms of fructosamine number. I've cut back to 2 meals generally instead of three and also reduced red meat portions as my ferritin has run high normal and I'm under the 110 weight limit to donate blood. My cheats have been way too many raw almonds (steam pasteurized really) and raw macadamias -- 99% dark chocolate -- the usual. I don't eat second meal until blood is back to fasting. I never snack and have no hunger between meals. Fasting is easy for me. Some things are better in my labs but my HDL is down a bit -- it's usually over 100. I didn't get VAP because test was done by an endo who manages my hypothyroid condition. I take 1 grain armour and 2.5 mcg cytomel -- I'd cut back slightly on cytomel hoping to wean off it entirely and just be on armour. Maybe this is affecting my lipids? I endeavor to push my second meal to earlier and stop eating by 7:30. Because of work, my evening meal has been way too late -- 9:30PM or later! Just turned 48.

Weight: 104 to 106ish depending upon where I am in my cycle. I'm 5'2.5" tall. Total Cholesterol: 239 HDL: 97 LDL Calculated: 132 VLDL: 10 Triglycerides: 49 Glucose: 75 A1C: 5.2 (I'm happy about this as it was edging to 5.6 before I got religion about even lower carb fruits) Fructosamine: 241 (It seems stuck around this number for years with or without fruit. How accurate is this test??) Insulin: Less than 2 (It was flagged "LOW") IS THIS A PROBLEM???? Ferritin: 105 (I'm happy this has dropped from past tests likely due to me cutting back on meat portions and the lab test was taken about a 12 days or so prior to a period which would drop it further.)

TSH: .89 Free T3: 2.68 (2.0 - 4.4 reference) Antibodies were normal this time -- sometimes they elevate slightly especially if I've eaten a lot of seaweed. 25 Hydroxy Vitamin D: 53.5 (This could maybe be higher since we are heading into dark nyc winter -- also, don't know how accurate this lab is --Sunrise Medical?. I have a tan and take 2,500 plus the 400 in my multi.

He tested hormones (this was 12 days before a period --cycles are longish -- 30 to 35 days. This time it came on day 35. At my age, I understand hormones can bounce around. I'm still getting periods -- have huge subserous fibroids but no heavy bleeding and no pain or cramps etc.

Estradiol by TMS: 10 Estrone by TMS: 14.5 Estradiol Serum: 121 Progestoerone: 7.9 DHEA Sulfate: 61 Prolactin 4.9 Testosterone: Less than 20 Lutenizing Hormone: 7.5 FSH: 12.9 Calculated and Free Testosterone : Unable to Calculate (Maybe time to get off my bum and lift weights.) My DHEA has run low normal for over a decade.
SBHG: 243 (Range is 10 - 144) My SBHG is always super high and docs shrug it off??

Any thoughts on how to improve? My goals are to start doing regular strenght training and to push my evening meal back to 7:30 instead of 9:30PM or later!

3c6b4eed18dc57f746755b698426e7c8

(5147)

on September 22, 2011
at 02:55 AM

I too down lots of espresso (but as instant espresso) not using an espresso machine and sans dairy. But then perhaps most people, like Luciano Pavarotti, would think instant espresso is oxymoronic.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on September 22, 2011
at 02:53 AM

Unfiltered coffee, u mean instant coffee? Why would that raise homocysteine? I better check mine then since I switched to instant from filtered since I ditched dairy and instant tastes better without the dairy.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 22, 2011
at 02:18 AM

scared......dont be. You have made the best move.....testing. Now you need to listen to what your doc says and evaluate the info. You can be fixed but there is work ahead.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 21, 2011
at 11:01 PM

The thyroid levels are a big tell.....

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 21, 2011
at 11:00 PM

Hormone free fractions are destroyed because of the shbg levels. Her doc needs to do much work

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 21, 2011
at 10:59 PM

Epigenetics at work here.....

  • 27361737e33ba2f73ab3c25d2699ad61

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4 Answers

1
27361737e33ba2f73ab3c25d2699ad61

(1880)

on September 22, 2011
at 05:23 AM

Thanks again Quilt. Problem is my doc doesn't think I'm broken. He says he's willing to up thyroid meds again because he likes TSH more suppressed but he also points out that I feel great. He says so long as I feel horny and energetic and my hair is not falling out (was falling out prior to meds -- now it's thick and normal again) -- he doesn't want to borrow trouble. Periods are regular and pain-free but they always have been. He was very pleased at the weight gain -- and I think he was correct that I didn't need to cut back on the thyroid meds as my weightloss was likely due to awful period of anxiety so said I can go back up on the cytomel or drop it and try upping the armour. Forgot to mention that I didn't and have never had a reverse t3 issue -- my endo is one of the few around here who always tests that. That horrid period of stress/anxiety and weightloss -- down to scary skeletor 96 pounds - did a job on my brain/thyroid etc.

What caused the stress and anxiety? After getting a clean bill of health at gyno -- a routine ultrasound plus a follow-up showed an issue which was conveyed to me as something requiring immediate emergency surgery. 3 top docs concurred based on the reports without reviewing the CDs. The surgery was going to cost me a fortune as the surgeon I eventually chose would not accept my insurance -- many good docs don't and I don't blame them because they are not reimbursed nearly enough. I was all scheduled and did the pre-op testing and was totally terrified and dropping weight -- down to 96 pounds (another reason I was scared to have surgery for fear that the stress and sudden weight drop would lower my immune system and make me more vulnerable to infection. And don't get me started on the fear of sugar drips and turbocarb hospital food spiking my glucose and also increasing risk of infection). Days before surgery, something inside told me to insist on yet more imaging. I mean I felt fine and my recent physical and annual gyno exam was all fine so how could this happen out of the blue. Everybody said I was crazy to question this top surgeon. I insisted and I paid out of pocket for an MRI and it showed no problem whatsoever! An independent surgeon reviewed the MRI films and confirmed -- NO PROBLEM. The ultrasounds were done at a supposedly top facility here in NYC. So was the MRI. A follow-up ultrasound a few months ago confirmed that there was no problem other than a mistake in the first two ultrasound readings. My endo was shocked and asked if anyone had given me any explanation since I had nearly undergone surgery for absolutely no reason. I said no -- maybe the surgeons were embarrassed. Who knows...who cares.. I was too relieved -- that was seriously the worst experience but also a learning experience. Listen to that little paleo voice in your head.

1
3c6b4eed18dc57f746755b698426e7c8

on September 21, 2011
at 10:24 PM

You have lots of numbers here. For women, diabetes tends to creep up with post-prandial numbers, which are best checked 1-2 hours after your largest meal. Your fasting number (75) isn't as representative as it is for men. Most doc's would say your A1c of 5.2-5.6 is okay, even good. But we do realize that the ideal A1c is something like 4.5 for someone with no trace of insulin resistance. That's equivalent to llike 85 in average BG.

I would track your postprandials (both 1 and 2 hours) or even conduct OGTT tests myself with a safe starch like yams (75g net carbs). See if you're impaired. I'm not familiar with fructosamine numbers, as my endo refused to order those for me when I asked. Your insulin was when your BG was 75, so is 2 really low? I don't know, I'm more familiar with C-Peptide. But your insulin is "on" -- in other words, you are producing insulin but it's meaningless because your FBG is @75. That's why you want to track insulin/c-peptide with an OGTT test, when it's actually deployed.

Your Ferritin is a bit high: For women, it should be under 80. Make sure you have no hemochromatosis -- compare this to your TIBC for serum iron, and also your hemoglobin/RBC turnover (if your turnover is low, your A1c might be overstated, so that's why you need to check post-prandially ... based on your reading, don't think so). If not, the high Ferritin could indeed be an inflammation marker (specifically, coronary risk) for you and you might wanna confirm that to see where the problem is. How high are your liver enzymes: they're a very reliable indicators of inflammation. Usually, on the way to insulin resistance, you get fatty liver and fatty pancreas before being officially diagnosed with diabetes. Liver enzymes going up steadily is a sign that you're steadily on the way to IR. (Acutally, you should be ok; your trigs are low enough).

If your doc/endo is willing to test you on all these, I would bug him and ask for Interleukin 6, HS CRP, fibrinogen, homocysteine, Westergren, VAP, etc. Go full hog with those inflammation markers which are harbingers of impending insulin resistance and other diseases.

Also, ask for an ANA to make sure the source of your inflammation isn't autoimmune. Quilt can comment more on your sex hormones.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 21, 2011
at 11:01 PM

The thyroid levels are a big tell.....

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 21, 2011
at 11:00 PM

Hormone free fractions are destroyed because of the shbg levels. Her doc needs to do much work

0
27361737e33ba2f73ab3c25d2699ad61

(1880)

on September 22, 2011
at 05:43 AM

Hi Namby Pamby - I was drinking unfiltered espresso. I was also eating lots of dark chocolate covered espresso beans. Espresso can raise homocysteine in some people. Not everybody -- your mileage may vary. My relatives are Italian so espresso is like mother's milk -- believe me -- I dig it. But I was drinking huge amounts and I am one of those sensitive individuals because it was the only time I had a homocysteine rise. It went right back down after I stopped it and replaced with usual drip coffe that is filtered. Now I can have an espresso or two a day with no issues. I also drink coffee and teas. The filters used in drip coffee prevent allegedly trap the certain substances in coffee that can raise homocysteine. But your mileage may vary. Also, many docs abandoned the homocysteine theory because lowering it with b vites didn't lower heart attacks. Also, I've read some interesting studies showing how women can have more volatile homocysteine levels when under stress and premenstrually and after weight loss. Who knows. Life is short and espresso is too divine to give up so enjoy. Speaking of caffeine -- just got an email from doc friend telling me it can raise SBHG. So long as I'm horny and have great energy -- I'm not going to freak about the SBHG unless doc is worried. Mine has been high ever since it was first tested decades ago ... maybe it's my norm... Thanks all again for your thoughts and insights ... most appreciated.

0
27361737e33ba2f73ab3c25d2699ad61

(1880)

on September 22, 2011
at 12:14 AM

Thanks Quilt...I think. Your response has me a tad scared.

My TSH is usually lower than this but now I've been on the reduced dose of cytomel for about a year while hoping to ditch it and simply take more armour if necessary. The cytomel was cut after a rapid weight drop (10 pounds) last year following a tremendously stressful period and I wanted to try everything to arrest the weightloss. (Prior to that, I never believed that stress could induce weightloss but boy was I wrong. Maybe my hormone levels are also still recuperating from that period of stress-related weight drop.) My endo has Hashi's himself and generally likes the TSH lower than mine -- so he's certainly open to upping meds. Now my weight is back up to normal and periods are regular again. I've always had pleasant periods -- no cramping -- no heavy bleeding etc. Menopause is approaching but I'll actually miss my periods. I feel great and sex drive is excellent and my musculature is good -- I definitely don't look flabby and people always think I work out way more than I do -- but that's the high fat/ modeate protein/low carb diet -- but most women are stuck in bowels of whole grains etc.

The areas I've slacked off on are eating earlier and not doing enough strength training. I also still go to bed to late but endeavor to change. Quilt's great blog is beyond inspiring -- it's I who have lots of work to do more so than my doc. I need to control my life (mealtimes, sleep etc) and if a busy doc can do it -- I have no excuse. It's really up to me now and I'm fired up. I've rearranged my work schedule for starters and that will make a world of difference. I've also gotten back into daily meditation which both calms and energizes me.

Also thanks to Namby Pamby. I do test glucose post-prandially and made some tweaks -- hence the lower A1C now. I don't eat a meal unless my glucose is back to fasting and keep post-prandials under 110 or so -- often lower depending upon the meal content. I would never eat 75 carbs in a sitting or submit to an ogtt as I've been lowcarbing for over a decade and there is no way I would get a "normal" reading chugging down the glucose drink etc.

The doc who does my regular physical tests most of the tests you recommended but not every year. My hs-crp -- it's usually around .8 or lower -- the ANA is fine as was another autoimmune thing they check periodically. Liver enzymes -- AST and ALT etc have been same for ages and normal at least what my doc and the lab calls normal. No trending upward whatsoever. Homocysteine he stopped checking because mine is always low except for one year when I was downing tons of espresso for months -- unfiltered coffee definitely raises homocysteine in me. When I cut it out -- homocysteine went back down. YMMV. It was never out of range -- but just higher than usual.

I really appreciate everyone's input so much and it's nice to read comments by so many proactively health concious paleos. Thank you all again. Lovin' it!

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on September 22, 2011
at 02:18 AM

scared......dont be. You have made the best move.....testing. Now you need to listen to what your doc says and evaluate the info. You can be fixed but there is work ahead.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on September 22, 2011
at 02:53 AM

Unfiltered coffee, u mean instant coffee? Why would that raise homocysteine? I better check mine then since I switched to instant from filtered since I ditched dairy and instant tastes better without the dairy.

3c6b4eed18dc57f746755b698426e7c8

(5147)

on September 22, 2011
at 02:55 AM

I too down lots of espresso (but as instant espresso) not using an espresso machine and sans dairy. But then perhaps most people, like Luciano Pavarotti, would think instant espresso is oxymoronic.

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