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Suggest Treatment For Symptoms Of Hypoglycemia
Question: I am 75 years old and have had insulin dependent diabetes since 1985. I eat a muffin for lunch most days and take 40 units of humulog for it. This is 2-3 times as much as I normally take for dinner. My endocrinologist, a technocrat, says this could be an indication of hypoglycemia, which in turn could cause a heart attack and, perhaps, death. She says that recent studies verify this even though it may be indirectly. She thinks I should have a six-day monitor, a portal I guess, so she can look at the timing of my blood sugar. Of course I am unequipped to analyze this, but am inclined to to follow doctors' recommendations.
I no longer believe this doctor. She tells me that I cannot go to any lab under Medicare that requires paper lab requests, which I know to be egregious misinformation--she has left a medical group to be independent and I suspect she doesn't want to send business their way, which now requires a paper request from her. She has also started to recommend skin peels, I guess for appearance. I think she wants to branch out to increase revenue. Trust is essential with a doctor, and I am thinking of leaving her--I had to good fortune to be with an endo for 28 years, who was blunt in steering me away from hokum. I have trusted this woman now for four years, but suspect I might be driving a long distance to try a new man.
Sorry for all the soft type explanation. Is there any way I can get information on information of studies bearing on this? I am not asking your opinion about staying with this doctor--I recognize that this must be my decision alone--but I wonder what you might recommend as a course of action otherwise.
Thank you.
I no longer believe this doctor. She tells me that I cannot go to any lab under Medicare that requires paper lab requests, which I know to be egregious misinformation--she has left a medical group to be independent and I suspect she doesn't want to send business their way, which now requires a paper request from her. She has also started to recommend skin peels, I guess for appearance. I think she wants to branch out to increase revenue. Trust is essential with a doctor, and I am thinking of leaving her--I had to good fortune to be with an endo for 28 years, who was blunt in steering me away from hokum. I have trusted this woman now for four years, but suspect I might be driving a long distance to try a new man.
Sorry for all the soft type explanation. Is there any way I can get information on information of studies bearing on this? I am not asking your opinion about staying with this doctor--I recognize that this must be my decision alone--but I wonder what you might recommend as a course of action otherwise.
Thank you.
Brief Answer:
Monitor
Detailed Answer:
The endocrinologists' advice to you to under the diagnostic professional CGM (Continuous Glucose Monitoring) is a good idea.
It will be helpful in understanding the glucose patterns and trends over the course of a week. This will enable insulin dose adjustments as necessary.
Sorry to learn about your bothersome symptoms. When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid) 12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
Monitor
Detailed Answer:
The endocrinologists' advice to you to under the diagnostic professional CGM (Continuous Glucose Monitoring) is a good idea.
It will be helpful in understanding the glucose patterns and trends over the course of a week. This will enable insulin dose adjustments as necessary.
Sorry to learn about your bothersome symptoms. When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid) 12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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