Questions to ask my doctor

Hi everyone,

I’m in London, England. 45 years old and female.

My most recent bloods showed fasting glucose as 6.0 mmol/L (range 4.1 - 5.9). My HbA1c, which was measured early May this year, was at 38 / 5.7%. HbA1c was not measured again early August. Based on my elevated glucose of 6.0 early August this year, I’ve decided to wear a blood glucose monitor for 10 days. One piece of white toast with peanut butter made it go up to 8.3. A few bites of Eton mess made it go up to 10.3.

What questions should I ask my doctor? And which tests are good to ask for (I have private insurance so can request anything - not bound by NHS guidelines).

Maybe also good to know: My fecal elastase recently also came back too low, so I’m wondering what’s going on w my pancreas. I had one bout of pancreatitis in 2018 and 2 bouts of pancreatitis in 2022, both after surgery for hyperparathyroidism, which I suffered from for many years - now cured. I don’t drink any alcohol at all.

I’m very new to this so any experiences you’d like to share with me, will be very much appreciated!

In Response said:

Given the accuracy of a Libre, I would not be concerned by these small spikes.
To me they do not look like something that need doctors input.
Everyone will see spikes when they eat high carb/sugary foods.

If you are wearing the Libre, please take a read around this forum about the limitations of Libre (such as bedding in time, compression lows, inaccuracy outside normal levels and factory calibration issues).
Unless you are double checking the occasional Libre reading with finger pricks, it is most useful for trends.

Click to expand...

Thank you. It was a Dexcom G7 monitor. I'd love it if this wasn't diabetes related at all and at the same time can't help but wonder:

1) I have PCOS, which is often linked to insulin resistance.
2) I had hyperparathyroidism (overactive calcium glands) for ages, 10 years at least and more likely 20 years, finally cured last year. This disease goes hand in hand with pancreas issues. I've had 3 bouts of pancreatitis (1 in 2018, 2 last year - I do not drink any alcohol). My fecal elastase has also come back low, again.
3) If my pancreas is indeed underactive, wouldn't it make sense this is causing my reactions to food, due to not enough insulin being present to keep my glucose down at that time? I ate a lot of the same foods that I used to eat and until a few years ago, I didn't have the same reactions as I'm experiencing atm: when my blood sugar spikes, I cannot keep my eyes open, I literally fall asleep. I always thought this happened when my blood sugar was low, but it's definitely happening when it's high.

I appreciate everyone has spikes after eating sugary foods - but should they be this high?

I'm looking for answers and if this is diabetes related - or if it's something else altogether, as long as I know what's going on, I can hopefully do something about it so I can finally start feeling better.

I'm new to this so any input / shared experiences are very much appreciated.

Jaylee said:

Hi

Welcome to the forum…

A “10 days” monitor? Sounds like a Dexcom, to me..

I’ll tag in @Juicyj & @EllieM they know far more about this stuff than I do…

Click to expand...

Thank you Jaylee. It was indeed a Dexcom G7

Jaylee said:

I used a G6 after my Libre2 prescription stuffed up.. I can’t actually knock the Dexy..
but then, i don’t fall “victim” to the “Libre limitations” others profess, either???
Both flavours. (Though I have mere extensive experience with the libre.) did or do what they did on the “tin” for me….

Click to expand...

The readings did appear very consistent with my sugar / carbs intake - but I don't have anything to compare it to, so in that sense, I can't say for sure. I hope the G6 is good and easy to "install" for you, after you couldn't get the Libre 2 anymore :-(

Jaylee said:

Hi,

I’m back on the L2 now.. in what way did you have anything to compare your sensor to?
Trying to define if you also use a classic blood test meter. (Be assured, not trying to catch you out. On what you monitor your bloods with… Not my style.)

Just an attempt at support. (& help?)

Click to expand...

Hi Jaylee, I hope the L2 works well for you in that case (sounds like it does?). I do *not* have anything to compare my Dexcom G7 readings to. I don't do finger prick tests. It would be great to know what to tell / ask my doctor next week, which tests to ask for etc. so yes, I'm looking for help with that

HSSS said:

As to your questions for the dr a comprehensive range of tests might include any outstanding tests for pancreatic function and maybe a scan if relevant. Diabetes blood wise knowing what’s happening insulin production wise could be seen in insulin tests and or c peptide tests, possibly more relevant than for most prediabetics due to the pancreatitis. Maybe they can offer an HOMA-IR to assess insulin resistance (like an extended OGTT with both glucose and insulin readings along the way. Obviously hba1c and fasting glucose.

Click to expand...

Thank you so much for this. I've recently had an abdominal ultrasound, MRI and MRCP and they said my pancreas looks ok on those. Lipase and amylase are both fine. I'm not sure if there are other scans / tests that would be good to request for the pancreas specifically (CT scan? Other pancreas blood markers?), besides the ones you've mentioned, that is Re the insulin test, is that a blood test? And for the C peptide test, should that ideally be tested in the blood or 24h urine, or perhaps both?

EllieM said:

Hi @Dudette I've just started on a G7 recently (moved from a G6) and it does seem accurate,most of the time. But cgms aren't always accurate for all people, so I do check mine against a glucometer. Personally, I find mine tends to read a bit hugh once in double figures, ir it might say I'm 11 when I'm actually at 10. The G7 allows you to calibrate your meter against your glucometer (which are generally considered more accurate).

I had to google fecal elastase but given that is a possible marker for pancreas issues I might ask for .another hba1c and maybe a cpeptide test. The latter measures how much insulin you are producing. T3c is diabetes caused by problems with the pancreas, so my guess is that you might want to see an endocrinologist to get that checked out. The pancreas doesn't just produce insulin and an endocrinologist should be able to advise you on all the possible issues that could be caused by repeated bouts of pancreatitis.

But to be honest your figures don't look too bad to me (disclaimer, am a T1 and not a doctor) so hopefully you are fine.

Click to expand...

Hi EllieM, thank you so much for this. I'd never even heard of T3c, that's so very helpful. I'll definitely mention this to my endocrinologist when I see her. I really hope there's nothing to it, but feel it needs investigating because something is definitely off and I'm bloating like I'm in my second trimester! So whatever is going on, I hope to find out what that is and to then be able to deal with that better

HSSS said:

Yes insulin is a blood test and I’m sorry I’m not sure if c peptide should be blood or urine or the pros and cons of each. Most people in here seem to get blood but that might be an NHS cost issue or a “better” test. Another question for the dr

Click to expand...

Thank you so much. I'll ask the doctor next week about the c peptide and am curious what her thoughts are on all of this.

AndBreathe said:

@Dudette , the rises you report after food aren't particularly alarming, but somewhat meaningless without knowing what your (blood glucose) starting point was. That coupled with your A1cs suggests there is unlikely to be any cause for alarm at the moment.

If you have experienced a handful of bouts of pancreatitis, it could be worth asking your GP about potential for malabsorption issues, just for completeness.

I would suggest if you have concerns about diabetes, it is always useful to be mindful of any unexpected weightloss, often despite an increased appetite, and/or very frequent urination. Those tend to be the most common red flags.

Click to expand...

@AndBreathe Thank you so much. This is all really god to know. Interestingly, after eating sugary foods, I need the bathroom more often than days where I avoid eating sugar / high carb foods. My baseline tends to be just under 6 (5.5 - 5.9 ish) but it of course goes up and down throughout the day. I have been wondering why I need as much magnesium as I do and why I can barely keep my vitamin D in range, if at all - I supplement with calcifediol daily. I do have an increased appetite at times, but then I get so bloated that I can't eat anymore. I especially crave sugary and fatty foods. I do think there are malabsorption issues. I'm in touch with a functional doctor, who used to practice as an MD and we're waiting to hear about my OAT (organic acid test) and GI Map test, which can hopefully tell us more about absorption issues, if any are found. I don't mind so much what we find, as long as something's found so I can hopefully start feeling better