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Re: Any thoughts on IR and if I need further testing??

From: Pat (anonymous@obgyn.net)
Sun, 22 Sep 2002 17:41:36 -0500 (CDT)

Okay, so you have been officially diagnosed with PCOS ? I would think that alone would be an indication for Metformin. What is his rationale for not treating you with Metformin? Are you overweight, and skipping periods ? At the very least, Metformin might make your cycles more regular, and help with weight loss. Of course, starting with a moderate to low carb diet and regular exercise can help also. If you are trying to conceive, then treatment with Metformin is certaintly within the range of normal management. There is an excellent article on ObGyn.net about screening and management for PCOS

[http://www.obgyn.net/pcos/pcos.asp?page=/pcos/articles/lotfi-pcos-protocol] {{It is the article about Protocols}}, and on the American Association of Clinical Endocrinologists about Insulin Resistance and screening for that. 1. http://www.aace.com/pub/BMI/press.php 2. http://www.aace.com/pub/BMI/findings.php

Perhaps you could read those, and then speak with your provider again. If he/she resists your requests, and has no good rationale, then move on to someone who will. Some folks recommend ingesting a high carb diet the days preceeding the FBS and 2 hour test, so that the test will show what the situation is if you were eating 'normally'.

If you are not challeneged with a hight carb diet and insulin not tested, you might not have been appropriately diagnosed. YOu shouldn't need a 5 hour GTT, but you could try a glucose challenge, and 2 hour PP. But, if you have PCOS, I would assume you were IR, and proceed from there. It is doubtful to me that not taking your meds would affect this particular blood test. 

--
Pat Sonnenstuhl, ARNP, CNM, MS
PCOS Support
Editorial Advisor PCOS Pavilion
http://www.obgyn.net/pcos/pcos.asp
http://www.midwivesofwa.org/pcos.htm
http://www.midwivesofwa.org//pcosarticles.htm


At Sun, 22 Sep 2002, Red wrote:
>
>Reposted this with a new title Thanks! Hi I am 27 years old hypothyroid
>and diagnosed PCOS (finally last month).  I have a history of
>hypoglycemia (as low as 40's which at one point sent me to hospital).  My
>infertility doc had a fasting glucose and fasting insulin drawn and they
>say I am not IR, and therefore, despite my array of symptoms I am not
>eligible for metformin.  I don't see how that is possible when I was
>told that I was "overreleasing insulin" years ago before the PCOS
>diagnosis.  Do I need the 5 hour IGTT??? Is it possible this weekend
>when my husband and I were away that my not taking my thyroid meds (so
>hard to remember when they are packed in a suitcase) and restarting my
>meds the morning of testing could have caused my insulin/glucose to be
>screwy?? Also I am in the first weeks of a thyroid med increase! I was
>thinking I should be rechecked next month.  My insulin was 9 and glucose
>was 93 well above 4.5 ratio I have read about! I hope someone can help
>me or share their experiences so I can stop crying - this is all so
>hopeless when you are trying to get pregnant.  Thanks for any and all
>input!
>
>--
>Red Roo
>



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