Endocrinology appointment

[Atlantico]

Hi everyone, I have an appt with an Endocrinologist on 1 April. I was diagnosed in 2010 with Post Prandial Reactive Hypoglycaemia with lab reading of 2.1. In 2012 I was diagnosed with Rapid Gastric Emptying.
I am having trouble with energy/muscle shakes followed by my thigh muscles feeling as though they are seizing up and I can't seem to eat sufficient fat/meat type food to stop this happening.
I tried 1/3 small crust of Burgen bread with peanut butter on and I was sound asleep in 40 minutes. BG went from 4.6 to 6.4.
I have seen 3 Endocrinologists so far but they all seem to focus on Rapid Gastric Emptying. I have been on morphine 3 times a day (slows food down). Then Acarbose and finally Octreotide injections. None of these helped my RH.
What tests should I ask for and any questions that might help me?
Thanks.

 

[Lamont D]

Hi @Atlantico,
Hope you are feeling better.

As I don't know what tests you have taken already, gastric dumping is usually controlled by dietary intake, where the good fats and proteins usually slow the digestion process. If this is not working, eating smaller meals more regular may help, as this would offset the rise in glucose levels regardless how slight.
Any tests, should be used to see which foods are the reason you create too much insulin. Diagnostic testing has been done.



Meds often don't help because they are not designed for RH.
The doctors usually insist on carbs, but as you are aware, carbs are the last thing we should eat, they have no insight, as to why carbs triggers the overshoot that causes the rollercoaster ride of hypers, then hypos.
However, sitagliptin has been used as a help to control the effects of the symptoms.
Glucose dumping is caused by insufficient background insulin and insulin response to food.
Sitagliptin helps with the initial insulin response to food, which lowers the rise in glucose levels and to some extent the hyper, thus lowering the possibility of a hypoglycaemic episode, it doesn't stop them completely, but as long as you don't have carbs, it helps with control.
That is also if you don't get the side effects.!

The only other tests I can think of, is allergy tests, or hormonal tests.
As well as insulin and glucose imbalance after eating, you could be getting other hormones that is too high, such as adrenaline.

I would continue with testing foods, it is important to get the balance right, I get the impression you are still struggling in this respect. Finding it difficult to stay in ketosis, but as always, Keto isn't for everyone. This is where intermittent fasting helps, not having to think about food at set meal times, pleasing yourself with one or two meals a day, exercise is also important, walking after eating has helped so much. It helps with blood sugar levels control.

Hope this helps.

Please do let us know how you get on, as we can all learn from everyone's experiences.

My best wishes.

 

[Atlantico]

Thank you Lamont, as always, very helpful.
I have only had the 4 hour GTT and the radiated meal of scrambled egg on toast with the Rapid gastric emptying result. Other than that just the 3 treatments mentioned above.
When I see the Endocrinologist I am going to ask him if he will check my insulin (as this has never been done) and now, with your advice, I will ask him about other hormone/adrenaline tests which may be available.
These are my lipid profile results after 6 months LCHF, what do you think?
Lipids fasting cholesterol 6.8
Triglycer. Fasting 0.4
Total HDL Chol. 3.7
LDL Chol. 2.9
Chol/HDL ratio 1.8
Non HDL Chol. 3.1
If any improvements are necessary what would you suggest?
Regards

 

[Lamont D]

Thank you Lamont, as always, very helpful.
I have only had the 4 hour GTT and the radiated meal of scrambled egg on toast with the Rapid gastric emptying result. Other than that just the 3 treatments mentioned above.
When I see the Endocrinologist I am going to ask him if he will check my insulin (as this has never been done) and now, with your advice, I will ask him about other hormone/adrenaline tests which may be available.
These are my lipid profile results after 6 months LCHF, what do you think?
Lipids fasting cholesterol 6.8
Triglycer. Fasting 0.4
Total HDL Chol. 3.7
LDL Chol. 2.9
Chol/HDL ratio 1.8
Non HDL Chol. 3.1
If any improvements are necessary what would you suggest?
Regards

For once, you have found a test result that is a bit of a mystery to me, my usual conversation with my doctors, dsns, is, are my cholesterol results good?
They have said yes for at least four years!
I did put my results on another thread, but I can't bring them to mind.
I will tag @Brunneria, to see if she can help.

I can't believe you have not had your insulin tested!
Have you not had a c-peptide or GAD tests?

Every time I had a eOGTT, my blood was always tested and sent to a lab, which is a specific tests laboratory. Do ask about c-peptide test, that is important.

Best wishes

 

[Atlantico]

Thanks Lamont. No, I have never had insulin checked or C Pep/GAD tests. These are now top of my list.
I feel that my overall cholesterol is a bit on the high side but I have such painful joints I don't want to add to it by taking Statins.
I have been eating quite a lot of cheese so thought I may try and cut down on that to see if it helps lower cholesterol and maybe reduce inflammation in my joints.
Thank you once again.

 

[DCUKMod]

Thanks Lamont. No, I have never had insulin checked or C Pep/GAD tests. These are now top of my list.
I feel that my overall cholesterol is a bit on the high side but I have such painful joints I don't want to add to it by taking Statins.
I have been eating quite a lot of cheese so thought I may try and cut down on that to see if it helps lower cholesterol and maybe reduce inflammation in my joints.
Thank you once again.

Atlantico, sometimes when the components are good, the total can be what my GP and I have agreed to term "an inconveniently large number". If you have a look on http://www.hughcalc.org/chol.php and put all your components in, the algorithm will provide some basic assessments.

 

[Lamont D]

Thanks Lamont. No, I have never had insulin checked or C Pep/GAD tests. These are now top of my list.
I feel that my overall cholesterol is a bit on the high side but I have such painful joints I don't want to add to it by taking Statins.
I have been eating quite a lot of cheese so thought I may try and cut down on that to see if it helps lower cholesterol and maybe reduce inflammation in my joints.
Thank you once again.

Cheese in moderation is fine and is a good source of good natural fats, which we need on a very low carb diet!
I wish I could eat more cheese to help with my fat intake, but I'm lactose intolerant!
Have you been tested for similar, you never know!
Experimentation is a huge part of finding what foods to eat or not to eat. Test different portion sizes of cheese to see what happens, you may be surprised.

Atlantico, sometimes when the components are good, the total can be what my GP and I have agreed to term "an inconveniently large number". If you have a look on http://www.hughcalc.org/chol.php and put all your components in, the algorithm will provide some basic assessments.

Thanks, much appreciated!

 

[Atlantico]

Atlantico, sometimes when the components are good, the total can be what my GP and I have agreed to term "an inconveniently large number". If you have a look on http://www.hughcalc.org/chol.php and put all your components in, the algorithm will provide some basic assessments.

Atlantico, sometimes when the components are good, the total can be what my GP and I have agreed to term "an inconveniently large number". If you have a look on http://www.hughcalc.org/chol.php and put all your components in, the algorithm will provide some basic assessments.

Thank you for your reply. Very interesting to see the results. Medical advice keeps changing and it now seems the thinking is that high HDL is not as good as previously thought.
Regards. Atlantico

 

[Atlantico]

Cheese in moderation is fine and is a good source of good natural fats, which we need on a very low carb diet!
I wish I could eat more cheese to help with my fat intake, but I'm lactose intolerant!
Have you been tested for similar, you never know!
Experimentation is a huge part of finding what foods to eat or not to eat. Test different portion sizes of cheese to see what happens, you may be surprised.


Thanks, much appreciated!

Thanks Lamont, will check. Cheese seems to be my 'go to' food for meals as well as snacks!
Regards.