Re: Any thoughts on IR and if I need further testing??
From: Pat (anonymous@obgyn.net)
Mon, 23 Sep 2002 15:48:07 -0500 (CDT)
You shouldn't really need more than a Fasting and 2 hours after
eating...the 5 hour GTT is long, and involes a lot more blood sticks. AS
noted, it is the 2 hr PP that is significant. Part of the problem is
the diagnosis of insulin resistance is more obscure. Some folks suggest
a heavy carb diet the few days before the test, so that it reflects what
happens when you eat lots of carbs(blood sugar and insulin levels rise).
The Fasting and 2 hour is the most cost effective and rasonable test. If
your doctor feels you need more, ask why, and give him a copy of the two
articles from the AACE. This is NEW stuff, and I doubt very many
providers have seen it. I can't speak to the interaction of the thyroid
medication, and wonder who would know that. I found this site for info
about the Thyroid Resistance Syndrome: http://www.drlowe.com/
Perhaps this is what you are referring to also.
This article has good info about the IR Syndrome and the screening tests
involved:
[http://www.inciid.org/faq/pcos4.html]
It cites the longer test, and expected values. But the 2 hour is
usually sufficient.
This is from one of the references I sighted:
[http://www.aace.com/pub/BMI/findings.php]
. How can the Insulin Resistance Syndrome be detected in clinical
practice?
Individuals at risk for having the Insulin Resistance Syndrome can be
identified by history, physical examination and laboratory evaluation.
The following are the characteristic abnormalities of the Insulin
Resistance Syndrome. Standardized assays for plasma insulin are not
generally available for routine clinical use. It is important to note
that the post-glucose challenge provides a more sensitive indicator of
insulin resistance than fasting plasma glucose measurement.
Plasma Glucose Fasting
120 min
post-glucose challenge (75 g) 110 - 125 mg/dL > 140 mg/dL
Triglycerides* > 150 mg/dL
HDL cholesterol*
Men < 40 mg/dL
Women: < 50 mg/dL
Blood pressure* > 130/> 85 mm Hg
* Levels based upon NCEP/ATP III Guidelines, JAMA, May 16, 2001.
There is more, but this is enough for starters....Pat
At Sun, 22 Sep 2002, Barb wrote:
>
>Pat,
>
>Why would a five hour Igtt not be advised.You mention GTT.
>I thought it was the five hour glucose with simultaneous insulin levels
>that are tested?
>And what is the glucose challenge?Sorry for the questions ,I had a few
>tests already and am confused.Just had the IGTT done and they want
>another one.
>
>As for the thyroid meds...here is an article that I have..my cousin has
>IR and thyroid disease and was told that not taking thyroid meds screw
>up his insulin levels.
>A secondary cautionary note to mention is that there is now recognized
>in the literature a 'thyroid resistance syndrome' similar in character
>to 'insulin resistance'. This manifests as symptoms of low thyroid
>function but normal thyroid blood work. An imbalance of omega-3/omega-6
>fatty acids can contribute to this condition. Lowering omega-6 fats and
>dramatically increasing omega-3 (fish oil NOT flax) has improved or
>normalized thyroid function in some persons.
>
>In addition lithium orotate, as mentioned in the supplement list to
>follow, has been very successful in reversing this syndrome in some
>persons. The dose used is very low (120 mg of lithium orotate
>containing 4.8 mg of lithium), not anywhere near the dose used by
>physicians to treat bi-polar disorders (800-2400 mg of lithium carbonate
>daily). In 'resistance syndrome' lithium is being used as a trace
>element, currently recognized as conditionally essential, to restore
>membrane sensitivity. This information is from the work of Hans
>A.Neiper , M.D. More information is available from the Brewer Science
>Library.
>
>If you decide to try lithium use only the orotate and use only a small
>dose such as the one suggested below or less. More is not better. There
>is some evidence that low dose lithium may also restore membrane
>sensitivity to glucose and insulin in hypoglycemics and diabetics.
>
>YOUR TREATMENT PROTOCOL: Initially your doctor will ask you to increase
>your thyroid medication dose gradually. Your medication will usually be
>raised every 3-4 weeks. Do not raise your dose faster without your
>doctor's permission. When your thyroid's function has been impaired for
>an extended period of time there can be deterioration in many of the
>organ systems in your body, one of the most important being the heart.
>There may also be changes in the central nervous system. Because of
>these changes, increasing your dose too quickly could have serious
>consequences. Even though your maintenance dose may be much higher than
>that with which you start, INCREASE SLOWLY with your doctor's permission
>and monitoring.
>The maintenance dose, arrived at slowly, is 100-300 mcg. of Synthroid
>or Levothroid (T4) or 60-180 mg of Armour or Westhroid (whole thyroid).
>There is a great difference in these doses and blood work is always the
>best indicator that you have reached your ideal dose. 1 grain means
>about 100 mcg of Synthroid or 60 mg of Armour. 1.5 grain (150 mcg
>Synthroid or 90 mg Armour) is a typical maintenance dose. Dose is
>usually increased in increments of 25-50 mcg (15-30 mg whole thyroid)
>until your TSH falls within normal range.
>
>On the correct dose of thyroid you will have stable blood sugar levels;
>normal appetite; energy; normal sleep patterns; no frequent urination; a
>basal temperature of 97.8-98.2; no hair loss; good hair texture-not
>coarse or fine; good circulation-warm hands and feet and the ability to
>warm up quickly when you get cold; good skin texture-not dry and thick
>or thin and oily; good skin color-normal, slightly pink without abnormal
>flushing-the palms of the hands and soles of the feet should not appear
>yellow or orange; normal size tongue-pink with no indentations around
>the edges; no athletes foot; good resistance to infection; normal mucous
>membranes-not excessive or thickened mucous; improvement or elimination
>of environmental and food allergies; normal perspiration patterns-not
>sweating without cause but having the ability to perspire when
>exercising or when the temperature rises; no night sweats; stable
>mood-not depression, having curiosity and a desire to do and to have;
>enjoying exercise and feeling a benefit after working out; good short
>and long term memory; the ability and desire to experience sexual
>satisfaction; a good sense of taste and smell; good reflexes-neither too
>fast nor to slow; no constipation or diarrhea; a normal menstrual cycle
>of 3-5 days without heavy bleeding and without PMS.
>
>Your dose of thyroid is too high if: you experience undo sweating; heart
>palpitations; hunger-eating all the time without weight gain; a resting
>pulse above 80; quick movements; thin/fragile skin; a change in hair
>texture to very fine; a basal temperature above 98.2; eye or vision
>changes; headaches with no apparent reason; nervousness; tremor; unusual
>increase in amount and number of bowel movements per day; diarrhea. Ask
>your druggist for the written material available concerning your
>medication. Read all overdose symptoms and contraindications. The
>normal thyroid converts more thyroxine,T4, into T3 (the active thyroid
>hormone) during stress, in colder weather and when you are ill or
>injured. You may be able to adjust your dose, with your doctor's
>consent, to fit the situation. To be able to do this successfully you
>need a prescription for an incremental dose in addition to your regular
>prescription.
>
>Thyroid hormone consists of several fractions. The most important
>fractions are T3 and T4. Armour contains both, Synthroid contains only
>T4 and Cytomel contains only T3. Some individuals appear to have a
>problem converting the inactive T4 found in Synthroid into the active T3
>. Zinc and magnesium are required for this conversion, as well as other
>nutrients. Your physician can check to see if you have a problem by
>monitoring your free T3 levels.
>
>Please remember your needs change with age, weather, illness and injury.
>What worked in the past may need adjustment today. Watch your symptoms.
>They are your body's way of talking to you.
>
>>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
>>>
>--
>Sincerely,
>Barb C.
>
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