Hello.

Thanks for posting your query.

I do understand that you are a 43 old female, weighing around 184 lbs and currently on metformin and Actos (Pioglitazone).

As per your GTT report, your 2 hour sugar is 181. Any sugar more than 200 is suggestive of Diabetes and values less than 140 is normal. Value between 140 to 200 suggests Impaired Glucose tolerance, as in your case. Impaired Glucose tolerance is a pre diabetic state. The key event in Diabetes is insulin resistance and considering your reports you have Insulin resistance that had caused Impaired Glucose tolerance, which is a prediabetic stage.

Actos is Known to increase weight and your overweight can be related to Actos apart from your eating habits and lifestyle.

Studies have shown that Actos can cause bladder cancer, but final word is not out. Some countries still continue using, while some have stopped it. I feel Actos has to be stopped in your case as you are increasing in weight. I would suggest you to consult Endocrinologist for considering alternative medicine for Actos.

Your bloating and heaviness can be related to Actos. Actos and metformin help to make the insulin that is secreted to act better, there by decreasing your blood sugar. How they increase the insulin action is different for Metformin and Actos.

Your diet contains fat, protein and carbs. It is essential that all these nutrients are balanced for a healthy diet.

Carbohydrates are essentially sugars. The minimum amount of carbohydrate needed to satisfy the glucose requirement of the brain, red blood cell and for muscle tissue. If you do not eat enough carbohydrates, the body will break down its reserves from the liver. When the liver is ‘empty' of carbohydrate stores, it will make more blood glucose at the expense of other tissues, primarily muscle. So in short, too much sugar and you get fat, not enough sugar and you will loose muscle.

Regarding your suspicion of thyroid disease, your thyroid function test report is normal. You can discuss in detail with your Endocrinologist.

As for us weight reduction diets are concerned, very low calorie diets are not recommended as they cause rebound weight gain and the best diet plan would depend on your interaction with your nutritional counselor, considering your lifestyle, eating habits, exercise and your medical problem if any.

You can split your meals into 6 smaller meals at frequent interval to avoid craving and hunger.

I hope, I have answered your query. I will be available for follow up queries if any.

Regards.

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Hello,

Thanks for writing back.

Sure I will put my sincere effort and will provide answers to your questions.

1) Is that true that Actos at 15mg is so low that it would not affect weight gain?

You extra weight gain can be caused by Actos, But if have been obese even before taking Actos that has to be evaluated. Actos can cause weight gain with any dose, even at 15 mg, but generally weight gain is more at higher doses. Mood swings usually does not happen with Actos.

2) I had very low mood and crying spells while on the Actos and it stopped once I quit the Actos could the Actos somehow be affecting my mental state of mind?

Mood changes are not been recorded as side effects of Actos , I would ask you to get evaluated for the same by a psychiatrist.

3) Would you put a family member on the Actos from what you have read about the bladder cancer reports or would you not be concerned?

Bladder cancer with Actos is big debate that's going on. Final word is not out. Choice of prescribing Actos depends on the clinical profile and need of the patient and not whether he is my family member or not.


4) Do you see from my info that Metformin would benefit me? How would it help me with my insulin resistance and impaired glucose?
If you suggest that I do take Metformin how should I deal with the intestinal upset that it causes?
It Metformin harmful in any way for people like me?
Does it help with weight loss or cause weight gain or neither?

Metformin helps your insulin act better at the receptor level and hence helps in diabetes and Impaired glucose tolerance. Metformin is a good drug, but it can cause intestinal upset and you could try taking after food or starting with a low dose and then uptitrating. Metformin can cause weight loss.


5) What do you suggest I do about the reactive hypoglycemia affects and explosive mood, shaking, confusion and irritability that happens after I eat carbs even though I already eat 6 meals a day and am constantly grazing food?
Why are most overweight and diabetic people ale to tolerate eating carbs and do not get this crazy uncomfortable reaction that I get?

About your reactive hypoglycemia, you would require diet with low glycemic index and diet with high fibers, artificial sweetners can some times cause sweet craving and i am sure a nutritional consultant can help you in planning your diet plan.
Its not always true that the overweight and diabetic people can tolerate carbs better than others.

6) When I avoid carbs my mood is balanced. I am awful about 1.5 hours after I eat carbs and wondered if it could have something to do with my gluacogen? What are your thoughts about the gluacogen being connected?
Is ketosis harmful to the body?

Ketosis is definitly harmful to body. High glucagon has been shown to increase blood sugar. Apart fron Insulin , glucagon also has some role in the mechanism of Diabetes.


7) What is the true glucose level that should not be gone over after 1 hour after eating carbs?
What should the glucose level be under after 2 hours of eating carbs?

True glucose level after 1 hour in normal people should be less than 160mg/dl and after 2 hours should be less than 140 mg/dl.

8)Do you completely dislike the Dr. XXXXXXX diet?
XXXXXXX Nutritional Approach is a low-carbohydrate which is a effective one but it has its own negative effects , the deficiency in immediet energy source which are carbs can cause poor daily performance

9) Do you think that artificial sweeteners affect insulin release at all?
What about natural Stevia sweetener does that affect insulin?
Do artificial sweeteners cause sugar cravings?
I am curious if anything sweet triggers insulin spikes or if it is ok to do the artificial sweeteners.

Yes , there are studies which say that there will be insulin release due to artificial sweeteners.
also yes, the artificial sweeteners do cause sweet cravings.

10) Does eating fat like peanut butter or coconut oil affect insulin production in my system negatively? Does it block insulin or restrict it?

No , there is no such direct effect due to peanut butter or coconut oil on insulin.

11) Is it fact or myth that one can exercise right after a meal and move the glucose out of the system and into the muscles to keep levels lower and avoid storing fat? Please explain.

Yes, exercise after a meal will help to mobilize the postprandial blood glucose to glycolysis , There will be massive release of glucose from the liver and that absorbed from the stomach due to initial digestion of carbs. Exercise increase energy usage and thus the thirst for the same in the muscles resulting in mobilization.

12) Does eating jello before a meal help coat the stomach and calm the pancreas?

I do not consider jello dessert does help that way.

13) How many carb grams should I have daily?
Do I need to eat whole grains and natural starches like potatoes and corn and avoid sugars and refined carbs?
What should I avoid and limit?

40 to 50 % of the diet should comprise carbs , in your case anything around that is good.Whole grains are good as they will be accompanied with proteins and fibers which make carbs available
and easily mobilzed.

14) How can I get this weight off and reduce my cravings and hunger and eat like a normal person? I had not been able to fix myself and that Is why I turn to you now.

Well , your mission here surely needs time , do follow a planned diet it will help you better.

15) I understand what you said about disadvantages of eating low carb but wouldn’t I still want to eat low carb to avoid all the disgusting feelings of my carb reaction?

Yes, but food too low in carb quantity would not be recommended.It should always be balanced and planned such that the variations are not much.

16) Is there a couple of antidepressants that you are aware of that do not cause weight gain or slow the metabolism?

There are medications which can suppress hunger, yo may have to consult your treating doctor for the same. Specially after being checked by the psychiatrist for mood disturbances which can interact with medication effects.

17) Is it harmful to take the natural thyroid tablets and adrenal tablets since the Naturopath say doctors may find my levels normal but she still felt they were on the low side?

It is definitly not advisable to take thyroid and adrenal tablets, simply without any clear indication.

18)What could be the cause that I just have not been able to get a proper reason as to why I cannot tolerate carbs and get the hypoglycemic reactions even when constantly eating meals along the way. In your opinion what could have caused the insulin resistance and impaired glucose?

Your Insulin resistance can be related to your obesity and your genes.


19) How can I resolve this weight problem and carb reaction problem that I have?
Can I reverse this or am I stuck living this way? The American associate diet with carbs make me feel sick with the postprandial hypoglycemia side affects.

Your weight problem can definitly be reversed and i am sure your physician and nutritional counseller can help you out. It difficult to for us to suggest anything further without a clinical examination.

Hope I have cleared all your doubts, Please write back if any further queries on the issue. I will always be available.

regards

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Hello,

Thanks for writing back.

The main problem in Diabetes is that;1. The insulin is not able to act properly, 2.There is defective synthesis and deranged release of insulin. Because of this deranged insulin release only you have reactive hypoglycemia.

Every one requires carbohydrate as these are the direct source of glucose that is required to produce energy. In your case, When you eat Carbs there is increased and deranged insulin release and you end up in Hypoglycemia and you start eating to combat the low sugar you end up in hyperglycemia and weight gain. As now we don't have drugs that can exclusively change the pattern of insulin release, but Drugs like acarbose can help to reduce the reactive hypoglycemia.

There is nothing like brain specific hypoglycemia, but you have a term called relative hypoglycemia. When your blood sugars decreases very fast, though your sugars are in normal level, the brain can perceive as hypoglycemia due to rapid decline and this type of hypoglycemia usually does not cause problem.

cinnamon and chromium helps for better insulin action and secretion, but how exactly they work is not known.

Question: Am I making too much insulin or not enough based on my blood work? Why is my insulin not connecting properly with my glucose?

It is very difficult to how much insulin you make, how they act and how they connect to glucose. Some of the research studies like clamp studies will help to find out, but they are not used in routine clinical practice.

Question: Do you currently put any of your own patients on Actos?

Studies have shown that Actos can cause bladder cancer, But wether it is causal or association is not known. Some countries still continue using, while some have stopped it. I have reduced using Actos, But, I still use Actos in select population, if it is required.

Question: What is your take on the fact that my fasting glucose is 75-78 normal?

It is normal and perfectly fine

Question: my A1c1 was 5.5. What are your thoughts on that result in relation to diabetes?

Your A1c of 5.5 is low for diabetes, probably due to recurrent hypoglycemia, your A1c can be low.

Finally after going through your concerns and history drugs like Acarbose will help to combat reactive hypoglycemia, provided you tolerate them.

Hope i had answered your question.

Regards and best wishes

---

Hello.

Thanks for writing again.

Question: Why do you think my fasting glucose is so normal if I am prediabetic?

It is very well known that fasting sugars can be normal in prediabetes.

Question: What are your thoughts on the medicine Respirdal and how to avoid weight gain that comes with it possibly?

Resperidol is an antipsychotic drug that can cause weight gain. Diet and exercise can reduce weight gain. If still weight gain is a issue, you can consider altering the medicine after discussion with your psychiatrist.

Question: If I cannot tolerate the Acarbose then what do you recommend I do to deal with the awful feelings I get from reactive hypo?

You can try drugs like Voglibose or Miglitol.

Question: What does metformin do for me in particular with my problems? When I take metformin I still get reactive hypo, why? So what is the metformin benefit then?

Metformin makes the secreted insulin act better and there by decreases blood sugar. It may not help in reactive hypoglycemia.

Question: If I eat the recommended carbs and keep feeling reactive hypo then isn't my body telling me something is wrong? Since I am so greatly affected by carbs which raise my blood suagar, isn't that disturbing and hurting my precious beta cells?

It is not only carbs that increase your insulin secretion, but also your protein and other intestinal hormones.

Question: How do I protect my beta cells?

Once you had developed prediabetes, 50% of your insulin secretion is reduced, and there is no single drug that totally protect your beta cells. Drugs like Gliptins help protect your beta cells. Even Insulin help protects your betacells.

Question: Do you think it is unesscesary to take any medicine that deals with my gluacogen? Would you not advise me to be on a glucogen med?

Drugs like Gliptins can help reduce your glucagon and you can discuss this issue with your symptoms.

I hope, this helps to solve your your query.

Wish you good health.

Regards.

---

Hello.

Thanks for writing again.

Question: What does Metformin do exactly?

Metformin acts on the level of post receptor through AMP-activated protein kinase (AMPK), an enzyme that plays an important role in insulin signaling, thereby potentiating the action of insulin and decreasing the blood sugar.

Question: How does it exactly help me lose weight? Is it true that taking Metformin can cancel out the negative weight gaining affects that other medicines do to some people?

It has been observed that metformin reduces weight in some people with diabetes. How exactly it helps in weight reduction is not clearly known. One postulated mechanism is that by reducing hyperinsulinemia, it can potentate weight loss. It has to be understood that metformin is not a weight reducing drugs.

question: Does Metformin help prevent pancreatic cancer? If so how?

I think you are referring to the study conducted at M.D. XXXXXXX Cancer Center that showed metformin may protect against pancreatic cancer up to 62% . But how exactly it works it not known and we don't have large prospective study to prove this.


Question: Are small kids ever prescribed Metformin?
Metformin can be used after 10 years of age.

question: Why could I get very mean and irritable after I eat carbs? I become a different person. Why could I get very sleepy after eating carbs? Why is it that whenever I eat carbs I wake up in the middle of the night with a pool of sweat on my chest?

These features can be due to reactive hypoglycemia.

Question: What causes insulin resistance a lot of the time?

Many a times it is post receptor defect.

Question: Don't people who have overeaten on carbs usually burn out a large supply of beta cells? Wasn’t it the overuse of carbs that hurts them?

As long as your beta cells are functioning adequately, your carbohydrates are not going to affect them.

Question: How do you determine if someone should be on 500mg once a day or several times a day?

This depends on your clinical profile and blood sugar value.

Question: Do you like extended release or non extended release better and why?

Both are good, i prefer extended release as the release of drug is more uniform and gastric tolerance is better.

question: How quickly does Metformin start working before it is in full effect?
Metformin usually starts acting immediately, but can vary depending upon absorption.

Question: What happens if you overload on carbs and you are on Metformin?
Does it just make it so the metformin cannot do its job if you overload on the carbs while being on the Metformin?

If you overload with carbohydrate, your pancreas may not be able to secrete insulin for the amount of carbohydrate that you had eaten, in case of diabetes. It is not the problem with metformin.

Question: What does it mean if my sugars go too high and out of range while I am on Metformin? Is it best to keep sugars under 120 most of the time?

It means you may require some more drugs to control diabetes.Yes it is best to keep sugars under 120.

Question: What does it mean after I ate dessert and sweet potatoes fries once and came home and my sugar was 210 that one time only?

This means your sugars are high and not good for your health in long run.

Question: What food groups trigger insulin secretion?

All foods trigger insulin, especially those have carbohydrates and proteins

Question: If my glucose is in normal range does that mean the insulin is normal or not necessarily?

Not necessarily.

Question: What affects insulin secretion? Do berries, nuts or beans affect insulin?

Any food can influence your insulin secretion.

Question: Some doctor told me anything sweet even if it is artificial will trigger insulin release just because it is sweet and the body reacts to the fact that it is sweet. What are your thoughts.

I totally agree with your doctor.

Question: What are some good ways to protect my insulin? What is the best way to be kind to my pancreas?

Regular exercise, balanced diet and stress free life.

question: How do I know if I have adrenal fatigue? How can I be tested for that? What is the benefit in testing my DHEA5-(Dehydroepiandrosterone ) -sulfate and my Free Cortisol?

Your adrenal status can be checked by your 8.00am serum cortisol and also by your DHEAS(Dehydroepiandrosterone ) levels.

Wishing you good health.

Regards

---

Hello,
Thanks for the follow up.

Question: Do my lower leg night cramps have something to do with my condition? What can I do to stop these calf cramps that wake me up at night? I have heard it is a symptom of insulin resistance.

Insulin resistance usually do not cause muscle cramps.

Electrolyte disturbance and dehydration may cause cramping , particularly hypokalaemia and hypocalcaemia.

Stretching, massage, crepe bandage are widely considered to reduce muscle cramps .Application of heat reduces cramps due to electrolyte abnormalities (due to sodium loss and not calcium, magnesium, and potassium ) appropriate fluids and sufficient salt improves symptoms.
Medication like lidocaine, and calcium channel blockers may be effective for muscle cramps.

question: What is happening when I have pools of sweat on my chest at night only if I ate carbs that day? Is it coming from my pancreas? What process is the body going through to make that pool of sweat?
Symptoms of low blood glucose levels (Hypoglycemia) include feeling anxious or confused, feeling numb in the arms and hands, and shaking or feeling dizzy, cranky, tired, sweaty, hungry, confused, and shaky.
With a lack of insulin, the liver will start breaking down glycogen and forming new glucose (gluconeogenesis). Fats will also be released into the blood in the form of free fatty acids. Amino acids will be released into the blood and very little protein synthesis will take place.

The sweat is secreted from the sweat gland that is located in skin and not from the pancreas.

question: Is it related and why do I wake up about three times in the middle of the night to urinate? Is it important to take sips of water in the night to prevent morning stroke or heart failure?

It is not really required to take sips of water at night. In people with low blood sugar, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body.

question: Does baby aspirin at night help with this as well?

Not really.

question: Do stimulants like Ritalin or Vyanse affect the adrenals due to the fight or flight stimulation that is going on? Since I may have adrenal fatigue could that be problematic for my adrenals if I ever take those meds?
Usually not.No it wont.

Question: Since you said all foods affect insulin are there any in particular that bother insulin more than others? With insulin being affected by all foods I feel nervous to even move my insulin and bother it. I wonder what I should avoid to not get it to go crazy.

Foods containing more carbohydrates increase insulin more than other food. Try to avoid them.

Question: Is it possible to feel or know if my insulin is being disturbed or improperly affected?
The fact you have diabetes and reactive hypoglycemia itself says yours insulin has been affected.

Question: Do berries bother the insulin secretion?
Berries have found to increase insulin secretion and also to potentate its action, but not totally proved.

Question: Do birth control pills over the years when you are over forty lower ones testosterone? Does the affect of low testosterone cause low sex drive, increased hunger, mood changes, getting cold easily and hair loss?

When you are over forty there are hormonal changes that prepares you for menopause. This can result in low sexual drives, mood changes and hair loss. Actually Birth control pills that contain estrogen and progesterone (HRT-hormone replacement therapy) are used to combat these features.

Question: What can stop the reactive hypoglycemia problems that I am having every single time I eat any kind of carbs? I cannot continue to carbs as you suggest and feel normal.
I think i had already answered this question above.

Question: With insulin resistance does eating equal amounts of protein with carbs help the way the insulin is secreted and used? There is a book about insulin resistance diet and I do not know if it was true or not what the author was saying about the carb to protein rations and eating them at the same times prevents insulin resistance. She is not a doctor. What are your thoughts? I still get a reactive response regardless.

Diets XXXXXXX in protein can alter your insulin secretion and ratio of carbohydrates to protein can affect your secretion, but how much and how effective is not known.

Question: Are there medicines that help people actually lose weight? I heard something about meds that directly move the glucose out of the blood stream so it is not stored as fat. This was different than Metformin. What are they?

Orlistat is the only weight loss medicine approved by FDA, for long term use.

Why do some people use Metformin as an anti-aging medicine even though they do not have blood sugar problems?

I don't use metformin as a anti aging drug.As we age, we are all becoming diabetic, and some of us are just more diabetic than others. Metformin is a 'metabolic rejuvenator'. It actually restores the individual’s capacity to metabolise carbohydrates. In addition to normalizing blood sugar and insulin, it lowers cortisol, helps to normalize blood pressure, lowers cholesterol and triglycerides, stimulates the release of growth hormone, and enhances the immune system.

Wishing you good health.

Regards

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Hello

Question: How come there are studies that are stating that red meat use can contribute a lot to diabetes?

Red meat does not directly contribute to diabetes but it can increase your lipids and cholesterol, and it can also increase some factors that can affect insulin action.

Question: How beneficial is a multivitamin to ones health? Does omega fatty acid supplements help thin the blood and help diabetics or insulin resistance people in any way?

In a normal person, If you are taking a balanced diet with adequate fruits and vegetables, multivitamin may not be all that required. Taking multivitamin gives a sense of well being to many of our patients. Multivitamin are especially required when you are recovering from any illness. Omega fatty acids help reduce your cholesterol and is useful in diabetes.

Question: I thought that baby aspirin at night helps thin the blood to be preventative for stroke and heart attacks?

Baby aspirin helps thin blood and prevent stroke. It is definitely indicated for patients with ischemic stroke and heart attacks as a secondary prevention. It has to be used with caution and not recommended routinely

Question: Does protein lessen the impact of carbs on the insulin when eaten together vs eating carbs alone?

Yes, it has some impact.

Question: Does lifting weights over 5 lbs. help or hurt insulin resistance people? Or affect the pancreas?

Lifting weight does not affect your pancreas. But any type of exercise helps make your insulin act better.

Question: I just want to confirm that I understand correctly: even if my blood sugar reads at 120 my insulin could still be out of whack? I should not be at ease when my sugar reads in in thinking my insulin is ok. Is that a misconception?

I would agree with you, that even when your sugars are normal, your insulin can still be out of order.

Question: How quickly can ones body show and feel signs of reactive hypoglycemia? I feel nuts after 15-20 minutes? is that still reactive hypo?

Reactive hypoglycemia is usually felt after 2 to 4 hours. It is generally very unusual to have reactive hypoglycemia in 15 to 20mts, But it can still occur at any time and varies form different people.

Question: Can you give me your opinion and description on orlistat?

Orlistat is a drug that inhibits digestion of fat and hence prevents its absorption. Thereby it reduces the weight. It has to be taken ideally three times a day and works better with fat based meal.

Question: Another doc had suggested I sip water in the night to also keeps blood thinned. You disagree with this?

Taking plenty of water and maintaining good hydration is always good for health. It cannot be taken as a alternate to aspirin.

Question: I thought that leg calf cramps and poor night vision were associated with insulin resistance and glucose problems. Also those little flashes I see when I stand up to fast?

These problems are also seen in people with diabetes, but the sugar levels are high, not in the range as you have.

Question: What does potentate its action mean? Berries have found to increase insulin secretion and also to potentate its action, but not totally proved.

It means to augment or increase insulin action.

Question: Regarding the night sweats just on my chest. I had been told that could be a reaction from the pancreas causing the glands to sweat out the toxics directed from the pancreas through the sweat glands.

I dont think so that is true.

Question: Does Ritalin help or hurt the metabolism in any way? I am surprised that it does not bother or stress out the adrenals further. Is there anything I can safely take to speed up my metabolism?

Ritalin (methylphenidate) stimulates the central nervous system. It has to be used with caution if you have Blood pressure, glaucoma, hyperthyroidism and in many more conditions.

Question: Lastly, as far as feeling my insulin being out of whack I meant that I could when my glucose is off physically and is there a sign that I can feel physically knowing my insulin is out of whack as well?

As for us insulin is concerned, you need to know 2 things. One how is it secreted (Pancreatic function) and second how exactly it acts (Insulin sensitivity). When both are normal you can say your insulin is perfect. "The best way to assess these parameters are through your c-peptide, insulin levels and clamp studies" (Done only as a research tool). Some physical signs that say your insulin levels are not acting properly are Acanthosis (Black discoloration in neck) and skin tags.

Hope I have answered your query.

Regards

---

Hello,

Total and Free Testosterone, Progesterone, Estradiol, DHEAS : To assess the androgen and gonadal status both in males and females and normal range is different both in male and female. Estradiol and progesterone fluctuates with your menstrual cycle and again the reference range would vary with the phase of menstrual cycle. If it is taken at 17th day (Luteal phase), it has to be interpreted accordingly, that is provided by your laboratory.

Free T3 (Triiodothyronine): To assess your thyroid status. Not much variation with timing.

CRP (Cardiac Specific): It is a marker of inflammation and high values are associated with increased cardiovascular risk.

Question: What happens if you take the blood one or two days before a menstrual cycle begins? Does that improperly throw off the true results we are trying to read?

Any time between 14 to 26 days may have only small variation. If you are particular you can use a day specific cut-off value in request with your laboratory. But that should not make a big difference.

Question: I have been taking Metformin 500mg ER one a day for 1.5 weeks not. I just ate a piece of high carb sugary cakes and read my blood sugar after 1 hr and it said 85 glucose.How can it be in range like that? Is that because the Metformin kept my glucose from rising up high? I would have always spiked to 170 before I was on the Metformin. Can you explain what the Metformin did here?

It is possible that your metformin has worked. Your metformin would have helped insulin to act better to reduce your blood sugars.

Question: Would the fact that my sugar stayed in range mean that excess insulin was not produced so I will not have excess glucose turn into stored fat? I still feel so postprandial hypo and why could that be?

It does not really mean that way. You can still have post postprandial Hypoglycemia as that is due to deranged insulin secretion or reactive hypoglycemia as discussed earlier.

Question: Does Metformin cause edema or weight gain? I have not been losing weight on it do you have any idea why that could be the case?

It usually does not cause weight gain or edema. It is not a weight reducing drug either. Some people may experience weight loss with metformin and that is individualized.

Question: What are some of the major symptoms of low testosterone in women?
Could low testosterone have anything to do with: increased appetite and or sweet cravings, Irritability and mood swings, Hairloss, Weight gain, Tiredness, Dry skin

Low testosterone can decrease the sexual libido, it can cause mood swings and tiredness but other symptoms that you had described are not usually attributed with low testosterone.

Question: What about thyroid that is below optimal range? Do any of these same symptoms show up in lower thyroid?

Yes, it is possible.

Question: What are some symptoms of low progesterone in women? What about low estrogen in women?

These are mostly related to your menstrual cycle irregularity and fertility.

Question: What are your thoughts with thyroid meds that are natural vs synthetic?
Have your heard or Nature’s Throid NT and Armour thyroid Meds? Do natural thyroid meds really work. I think they are from the thyroid or pigs is that correct?

I use only synthetic thyroid and have seen best results.

Question: After one takes the thyroid meds for low thyroid, when does the medicine usually start working? What should one notice as improvements with the thyroid medication?

The thyroid medicine starts working the same day. Clinical improvement is seen within 1 to 2 weeks.

Question: Do you prefer testosterone creams or sub lingual tablets when prescribing that to patients? How quickly do those begin to show improvements in patients? Do creams properly give the right designed dose to the body?

We generally prescribe oral tablets or parenteral injection. But creams or patches also work better.

Question: Is there a connection between low thyroid and low testosterone? Are they dependent on each other for anything?

All hormonal glands are inter-related some way. It is possible you have a low thyroid and low testosterone.

Question: Is a menstrual cycle that occurs every 21 days a problem at all? Does that mean low or high estrogen?

The menstrual cycle depends on individual profile and can vary from person to person. As long as it is regular and flow is normal, it may not cause any problem. But any how you can discuss with your gynecologist.

Question: Do you believe in Bioidentical hormones for certain patients? What are those exactly? How can they help?

I don't believe and I don't use them.

Hope I have answered your queries.

Regards,

---

Hello,

Question: Does eating protein with carbs may it so the blood sugar impact is not as severe as eating the carbs alone?

Eating proteins with carbohydrates is always better than eating carbohydrates alone.

question: I am trying to figure out why I have been recently aging weight and you do not think it is related to the Metformin?

It may not be related to your Metformin intake.

Question: Could it be related to my 4 week use of Celexa at only 5mg? Could such a low dose of Celexa because me to bloat up and gain weight? Could the Celexa have any impact on slowing my metabolism? Why do many people gain weight on SSRI's antidepressants? Please explain well for me.

Celexa (citalopram) is an antidepressant drug that is used for depression. It acts at the level of serotonin (that is a chemical messenger) in the brain. These serotonin also has some influence in your appetite centers in brain. These SSRI can increase your weight, but it has to be remembered that even mild depression per se can increase your weight.

Question: Is Metformin a medicine that can be harmful to the body or organs at all? Aside from the stomach discomfort?

Any drugs that has an effect can have some side effect. But it is ultimately the balance between risk and benefit. Overall metformin is a very safe tablet and has been in use for many years. It should be avoided in patients with renal failure, heart failure, people with peptic ulcer.

Question: Can I get away with eating higher carb foods and amounts while taking Metformin? Or is that counterproductive? Does the Metformin help stop my body from being insulin resistant?

Metformin does not stop you from being insulin resistant. It just reduces the degree of insulin resistance.

Question : In what situations would one up their dose of Metformin 500mg ER to 2 x per day instead of just one? What are some of the deciding factors?

The recommended dose of metformin is up to 2500gm. Your blood sugar value helps to decide the dose of metformin. Other factors that are also considered are the tolerability of the drug. IF you experience abdominal bloating or discomfort, then we may not increase your dose.

Regards,

---

Hello,

Question: Do you see any obvious reasons I am heavy and have not been able to lose weight and am fatigued all the time?

It is very difficult to comment on this question without having a complete clinical examination done.

Question: I have been told that my testosterone and thyroid show as not in optimal range. They fit in general range but not optimal. What are your thoughts?
I am being told to take testosterone cream and Armour 1.5 thyroid tablets.

Your TSH is normal and I may not prefer to increase your dose of thyroid medication. I do agree your testosterone is on lower side of normal. Whether to treat or not will depend upon other parameters like your sexual function, testis size, androgen deficiency questionnaire (Used to assess your symptoms of low testosterone levels).

Question: Dhea - Sulfate 58.4 was below range.
What does that mean interns of symptoms I could be having that relate to this?

DHEAS usually does not have much clinical relevance. Low levels can cause tiredness, decrease libido. Treatment is individualized.

Question: Insulin 3.0. Does this mean I am not insulin resistance with this result?

If your insulin is high, it denotes you are having insulin resistance. If it is normal it does not mean that you are not insulin resistant.

Question: A1C - 5.0. What are your thoughts here too? Do I still show for impaired glucose as well or prediabetic?

HbA1c (Glycosylated Hemoglobin) of 5 signifies that your sugar is well under control and normal. You can discuss with your physician and can consider stopping metformin as per his advice.

Regards,

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