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Feeling Pain In Kidney, Headache, Dry Mouth And Hay Fever. Could It Be Related To Pre Diabetes?
Question: possible prediabetes?
low o2 level? a nurse recently took pulse and o2 reading was low
tingling OR crawling OR ants OR worms in extremeties sometimes very slight
itching genitals sometimes
gingevitis
dark area on neck like a ring
dull pain near kidney (left) sometimes
left side of body pain or numbness and tension sometimes
headaches sometimes
dry mouth sometimes
fatigue frequently
overweight
hay fever and other airborne allergies
some food allergies
currently taking citalopram (not every day)
on swing shift till 2 AM
height 5' 8'' over 200lb
ps. good blood pressure, nothing in bloodwork last year, but concerned I have beginning stages that don't show up with testing... my question is, can I have PREprediabetes or prediabetes or diabetes that doesn't show up in tests?
thanks for your consideration
XXXXXXX
low o2 level? a nurse recently took pulse and o2 reading was low
tingling OR crawling OR ants OR worms in extremeties sometimes very slight
itching genitals sometimes
gingevitis
dark area on neck like a ring
dull pain near kidney (left) sometimes
left side of body pain or numbness and tension sometimes
headaches sometimes
dry mouth sometimes
fatigue frequently
overweight
hay fever and other airborne allergies
some food allergies
currently taking citalopram (not every day)
on swing shift till 2 AM
height 5' 8'' over 200lb
ps. good blood pressure, nothing in bloodwork last year, but concerned I have beginning stages that don't show up with testing... my question is, can I have PREprediabetes or prediabetes or diabetes that doesn't show up in tests?
thanks for your consideration
XXXXXXX
Hi,
Thanks for writing in.
While you do have symptoms of insulin resistance ( which does predispose you to diabetes), it is unlikely that you have pre-diabetes or diabetes which is not picked up by blood work.
Pre diabetes is basically defined by a set of values for fasting glucose(100-125mg/dl) and gtt glucose values (140-199mg/ dl) measured 2hrs after a 75g glucose load. If you have values in this range it means that there is a 5 percent risk every year of developing diabetes on an average. It does not mean that people always have to develop pre diabetes before they develop diabetes.
There are many risk factors for diabetes
1) age
2) being overweight or obese
3) family history of diabetes
4) sedentary lifestyle
5) ethnicity
If you have multiple risk factors it increases your risk of developing diabetes.
From the detailed history you have given it appears that you do have insulin resistance- the soft area in the neck and possibly below the eye lids are Acanthosis Nigricans and indicate insulin resistance.
If you are at high risk for diabetes it is recommended that you test yourself for diabetes at least once in three years . I suggest you get it done once in 6 months to an year. The good thing about diabetes is that it is easily preventable. You need to lose about 10 pounds in your weight by doing a 500 calorie deficit diet and do regular exercise (at least 150 min of moderate intensity exercise which gets your heart rate to 75% of target heart rate which in your case is about 110/min).
The low O2 level is puzzling I suggest you XXXXXXX a pulmonologist for the same.
You could write back to me with some of your older reports so I can make some better suggestions.
Regards
Anantharaman
Thanks for writing in.
While you do have symptoms of insulin resistance ( which does predispose you to diabetes), it is unlikely that you have pre-diabetes or diabetes which is not picked up by blood work.
Pre diabetes is basically defined by a set of values for fasting glucose(100-125mg/dl) and gtt glucose values (140-199mg/ dl) measured 2hrs after a 75g glucose load. If you have values in this range it means that there is a 5 percent risk every year of developing diabetes on an average. It does not mean that people always have to develop pre diabetes before they develop diabetes.
There are many risk factors for diabetes
1) age
2) being overweight or obese
3) family history of diabetes
4) sedentary lifestyle
5) ethnicity
If you have multiple risk factors it increases your risk of developing diabetes.
From the detailed history you have given it appears that you do have insulin resistance- the soft area in the neck and possibly below the eye lids are Acanthosis Nigricans and indicate insulin resistance.
If you are at high risk for diabetes it is recommended that you test yourself for diabetes at least once in three years . I suggest you get it done once in 6 months to an year. The good thing about diabetes is that it is easily preventable. You need to lose about 10 pounds in your weight by doing a 500 calorie deficit diet and do regular exercise (at least 150 min of moderate intensity exercise which gets your heart rate to 75% of target heart rate which in your case is about 110/min).
The low O2 level is puzzling I suggest you XXXXXXX a pulmonologist for the same.
You could write back to me with some of your older reports so I can make some better suggestions.
Regards
Anantharaman
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Dear Dr. Anantharaman
I have interspersed some questions in the results below. My basic questions are am I "glucose intolerant" or "insulin resistant" or some similar diagnosis. Am I borderline for those problems? If so, what next?
lab reports 10/23/2012:
Total cholesterol 215
LDL 157
HDL 46
Triglycerides 103
Fasting sugar 100
TSH 2.3
Hemoglobin A1C 5.1
PSA 2.5
Vitamin D 26
Stool cards negative
my comments: It seems that fasting sugar of 100 is basically prediabetic
(also called "impaired glucose tolerance").
High cholesterol and LDL especially are not good. Are they signs of "glucose intolerance?" OR "insulin resistance"? Are they "caused by" the glucose/insulin problem? Do they exist alongside the glucose/insulin problem?
My vit D level is not good. Low vitamin D I can take care of with vitamins but is a result of working night shift and avoiding dairy completely. I have reduced acid stomach and "lactose intolerance" by avoiding diary.
Should TSH be monitored along with T3 and T4? Are thyroid levels a controlling factor in these prediabetic stages?
================================
my own blood glucose readings
I bought a meter and tested after eating.
my goal: less than 120 even after meals (noted with a *)
over 140 at any time is too much. (noted with a !)
time after meal reading
15 min 140*!
35 min 158*
45 min 150*
70 min 115
90 min 130*
120 (2 hrs) 136*
130 140*!
180 (3 hrs) 123*
240 (4 hrs) 112
light snack 4 1/2 hrs:
4hrs 45min 115
10:00 PM ate some chocolate:
10:15 160*!
10:30 some yogurt:
10:45 161*!
next morning:
7:45 AM 99 #
(# = before meals should be <95.)
after 1 hour of light exercise:
10:15 97
note the 160 readings after two small peices of chocolate!
perhaps because it was late in the evening.
My work schedule is from 2:30 PM to 12:30 AM near midnight.
I go to bed at 2:00 am.
I consider the 160 readings indications of prediabetes. Is that true?
According to some doctors:
"Goals for blood glucose control
TIME of DAY BLOOD SUGAR [mg/dl]
Fasting 60-90
Before meals <= 95
1-hour after meals <120
0200-0300AM 60-120
If despite diet therapy, fasting blood sugars are > 95 mg/dl and/or the 1-2 hour
post-prandial blood sugars are > 120 mg/dl, treatment will most likely be required XXXXXXX
======================
current diet: changing my diet to more protein and vegetables. Fats are probably increasing because of the meats and cooking fats associated with high protein diet. Should I also consider a "low glycemic index" diet?
I am resisting portion control. For me, portion control means I want to snack more. Currently I am eating a small breakfast with meat or eggs and coffee, and larger lunch with meat/eggs. I eat a snack around 5:00 including boiled eggs or meat and soup. I eat a large meal with meat around 7:00. I eat a snack around 9-10 PM that includes carbs. I go to bed around 2 AM on work days and midnight on non work days.
I am not eating dairy at all because of lactose intolerance and/or allergies to dairy. I have reduced my acid reflux and am no longer taking ranitidine 300mg /day unless needed.
I often feel like taking a nap after meals because of low concentration and grogginess.
current
exercise: Tai Chi 1.5 hour a week lesson, 15 min a day XXXXXXX
Walk the dog 15 min a day
Walking 2-4 miles at work (casino floor).
no increased heartrate.
I can increase exercise, but have little motivation.
Other:
I could try to reduce caffeine, but my job makes staying awake hard. I drink 3 cups approximately a day. When I drink coffee it increases my motivation in the morning, afternoon and at 7 PM.
I take citalopram 40mg / day for mild depression. Perhaps the depression is driving the glucose/insulin problems.
some have recommended looking at testosterone levels.
I can continue to test blood glucose after meals, noting anything above 140-160. I could also test at other times, but glucose after meals seems to be the best indicator for prediabetes I could find. Let me know what you think about that and / or more frequent testing.
Some people have indicated milk products, especially whey, are good at decreasing post prandial glucose levels. Perhaps I can reintroduce cheese or low lactose milk products.
Summary:
I have low energy and motivation, and no one solution seems to increase it. I have a feeling of grogginess almost like being drunk.
Low motivation is a problem when it comes to increasing exercise and decreasing portion control or late evening snacks. It is also a problem for decreasing caffeine. I will consider any and all recommendations. Thank you for your attention and concern.
Sincerely
XXXXXXX
I have interspersed some questions in the results below. My basic questions are am I "glucose intolerant" or "insulin resistant" or some similar diagnosis. Am I borderline for those problems? If so, what next?
lab reports 10/23/2012:
Total cholesterol 215
LDL 157
HDL 46
Triglycerides 103
Fasting sugar 100
TSH 2.3
Hemoglobin A1C 5.1
PSA 2.5
Vitamin D 26
Stool cards negative
my comments: It seems that fasting sugar of 100 is basically prediabetic
(also called "impaired glucose tolerance").
High cholesterol and LDL especially are not good. Are they signs of "glucose intolerance?" OR "insulin resistance"? Are they "caused by" the glucose/insulin problem? Do they exist alongside the glucose/insulin problem?
My vit D level is not good. Low vitamin D I can take care of with vitamins but is a result of working night shift and avoiding dairy completely. I have reduced acid stomach and "lactose intolerance" by avoiding diary.
Should TSH be monitored along with T3 and T4? Are thyroid levels a controlling factor in these prediabetic stages?
================================
my own blood glucose readings
I bought a meter and tested after eating.
my goal: less than 120 even after meals (noted with a *)
over 140 at any time is too much. (noted with a !)
time after meal reading
15 min 140*!
35 min 158*
45 min 150*
70 min 115
90 min 130*
120 (2 hrs) 136*
130 140*!
180 (3 hrs) 123*
240 (4 hrs) 112
light snack 4 1/2 hrs:
4hrs 45min 115
10:00 PM ate some chocolate:
10:15 160*!
10:30 some yogurt:
10:45 161*!
next morning:
7:45 AM 99 #
(# = before meals should be <95.)
after 1 hour of light exercise:
10:15 97
note the 160 readings after two small peices of chocolate!
perhaps because it was late in the evening.
My work schedule is from 2:30 PM to 12:30 AM near midnight.
I go to bed at 2:00 am.
I consider the 160 readings indications of prediabetes. Is that true?
According to some doctors:
"Goals for blood glucose control
TIME of DAY BLOOD SUGAR [mg/dl]
Fasting 60-90
Before meals <= 95
1-hour after meals <120
0200-0300AM 60-120
If despite diet therapy, fasting blood sugars are > 95 mg/dl and/or the 1-2 hour
post-prandial blood sugars are > 120 mg/dl, treatment will most likely be required XXXXXXX
======================
current diet: changing my diet to more protein and vegetables. Fats are probably increasing because of the meats and cooking fats associated with high protein diet. Should I also consider a "low glycemic index" diet?
I am resisting portion control. For me, portion control means I want to snack more. Currently I am eating a small breakfast with meat or eggs and coffee, and larger lunch with meat/eggs. I eat a snack around 5:00 including boiled eggs or meat and soup. I eat a large meal with meat around 7:00. I eat a snack around 9-10 PM that includes carbs. I go to bed around 2 AM on work days and midnight on non work days.
I am not eating dairy at all because of lactose intolerance and/or allergies to dairy. I have reduced my acid reflux and am no longer taking ranitidine 300mg /day unless needed.
I often feel like taking a nap after meals because of low concentration and grogginess.
current
exercise: Tai Chi 1.5 hour a week lesson, 15 min a day XXXXXXX
Walk the dog 15 min a day
Walking 2-4 miles at work (casino floor).
no increased heartrate.
I can increase exercise, but have little motivation.
Other:
I could try to reduce caffeine, but my job makes staying awake hard. I drink 3 cups approximately a day. When I drink coffee it increases my motivation in the morning, afternoon and at 7 PM.
I take citalopram 40mg / day for mild depression. Perhaps the depression is driving the glucose/insulin problems.
some have recommended looking at testosterone levels.
I can continue to test blood glucose after meals, noting anything above 140-160. I could also test at other times, but glucose after meals seems to be the best indicator for prediabetes I could find. Let me know what you think about that and / or more frequent testing.
Some people have indicated milk products, especially whey, are good at decreasing post prandial glucose levels. Perhaps I can reintroduce cheese or low lactose milk products.
Summary:
I have low energy and motivation, and no one solution seems to increase it. I have a feeling of grogginess almost like being drunk.
Low motivation is a problem when it comes to increasing exercise and decreasing portion control or late evening snacks. It is also a problem for decreasing caffeine. I will consider any and all recommendations. Thank you for your attention and concern.
Sincerely
XXXXXXX
Hi,
I think you have more or less figured out that you do have glucose intolerance by yourself. The way to fix that is to do more exercise and do portion control.
These abnormalities in glucose have a 50-80percent chance of becoming normal if you do lose weight and exercise. Your LDL is high it’s going up because of the animal fat in the diet. Try fish and lean poultry cooked by boiling, grilling without too much of additional fat. You can try soy milk if you are lactose intolerant it's a source of protein without excess fat and lactose.
If you do have first degree (parents and siblings) relatives who have had a coronary artery problem before 55 yrs of age you should consider a statin therapy to reduce the LDL. Exercise and weight loss do reduce the LDL.
You should definitely use low glycemic index carbs in your diet- the pastry is pushing you glucose very high. Depression does reduce the motivation to exercise, but generally most people have high inertia levels when trying to start exercise. One way to beat it will be to park your car2 miles before your work place and walk the 2 miles .it kind of forces you to exercise.
Once you do start this for a month or so it becomes easier to start a formal exercise program. Lifestyle modification is easier said than done and it is definitely not easy .But the good thing is whatever you do more than what you are doing is definitely going to help.
The testosterone needs to be done if you have any sexual symptoms like a markedly reduced sex drive or erectile dysfunction. You may be having an obstructive sleep apnea, given the day time sleepiness please XXXXXXX a pulmonologist for the same.
Regards
ANANTHARAMAN R.
I think you have more or less figured out that you do have glucose intolerance by yourself. The way to fix that is to do more exercise and do portion control.
These abnormalities in glucose have a 50-80percent chance of becoming normal if you do lose weight and exercise. Your LDL is high it’s going up because of the animal fat in the diet. Try fish and lean poultry cooked by boiling, grilling without too much of additional fat. You can try soy milk if you are lactose intolerant it's a source of protein without excess fat and lactose.
If you do have first degree (parents and siblings) relatives who have had a coronary artery problem before 55 yrs of age you should consider a statin therapy to reduce the LDL. Exercise and weight loss do reduce the LDL.
You should definitely use low glycemic index carbs in your diet- the pastry is pushing you glucose very high. Depression does reduce the motivation to exercise, but generally most people have high inertia levels when trying to start exercise. One way to beat it will be to park your car2 miles before your work place and walk the 2 miles .it kind of forces you to exercise.
Once you do start this for a month or so it becomes easier to start a formal exercise program. Lifestyle modification is easier said than done and it is definitely not easy .But the good thing is whatever you do more than what you are doing is definitely going to help.
The testosterone needs to be done if you have any sexual symptoms like a markedly reduced sex drive or erectile dysfunction. You may be having an obstructive sleep apnea, given the day time sleepiness please XXXXXXX a pulmonologist for the same.
Regards
ANANTHARAMAN R.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Dr Anatharman
In reply to your recommendations,
Have begun protein diet only after your first reply 1 week ago. Little fat in my diet. Donut 1 time a week. No candy. Have pursued a low sugar / low fat diet for 30+ years. Some bar chocolate or dessert after meals.
No family heart problems.
History of sleep apnea diagnosed but i can't stand the positive airflow mask.
Should TSH be monitored along with T3 and T4? Are thyroid levels a controlling factor in these prediabetic stages?
Do you agree with all these levels?
"Goals for blood glucose control XXXXXXX
TIME of DAY BLOOD SUGAR [mg/dl]
Fasting 60-90
Before meals <= 95
1-hour after meals <120
2-hour after meals. <100
Is a 5 small meal per day plan better than a 3 meal/ day plan?
Is caffeine a negative influence on blood sugar?
Is whey / cheese a positive influence on postprandial blood sugar?
Is meditation and/or a confirmed positive influence on overall blood sugar?
Any reason to continue home blood sugar testing?
Should i ask my doctor for a referral to a specialist?
Should i pursue other tests?
I would appreciate your response to each of these questions for future planning of my life and workday.
Thank you for your help and advice.
Sincerely
XXXXXXX
In reply to your recommendations,
Have begun protein diet only after your first reply 1 week ago. Little fat in my diet. Donut 1 time a week. No candy. Have pursued a low sugar / low fat diet for 30+ years. Some bar chocolate or dessert after meals.
No family heart problems.
History of sleep apnea diagnosed but i can't stand the positive airflow mask.
Should TSH be monitored along with T3 and T4? Are thyroid levels a controlling factor in these prediabetic stages?
Do you agree with all these levels?
"Goals for blood glucose control XXXXXXX
TIME of DAY BLOOD SUGAR [mg/dl]
Fasting 60-90
Before meals <= 95
1-hour after meals <120
2-hour after meals. <100
Is a 5 small meal per day plan better than a 3 meal/ day plan?
Is caffeine a negative influence on blood sugar?
Is whey / cheese a positive influence on postprandial blood sugar?
Is meditation and/or a confirmed positive influence on overall blood sugar?
Any reason to continue home blood sugar testing?
Should i ask my doctor for a referral to a specialist?
Should i pursue other tests?
I would appreciate your response to each of these questions for future planning of my life and workday.
Thank you for your help and advice.
Sincerely
XXXXXXX
Hi XXXXXXX
I'll address your concerns one by one
1) The diet you are on is pretty good a low carbohydrate low fat diet has been shown to produce faster wt loss. But the key really is to consume less calories throughout the day
2) The untreated OSA is a big problem.i think you SHOULD work on it with your pulmonologist and just the CPAP may improve your glucose levels
3) The glucose levels that you have indicated are excellent. If you achieve anything close to these it should be fine
4) The number of meals is not really that important 5 small meals may be better at controlling hunger than 3
5) Caffeine has not been shown to be that great an influence. Your high caffeine use will come down if you treat the OSA well
6) I do not know about whey cheese and its influence on post prandial (PP) blood glucose. Almonds, vinegar have been shown to specifically reduce PP glucose
7)Ideally T4 also needs to be done along with TSH ,this is to not miss the rare cases of central hypothyroidism that we see occasionally. But in most practices it's not done routinely. in your case it's better to get it done during your next blood work
8)Meditation and taichi etc are a good influence on blood pressure and do prevent cv events. there is no robust evidence to say that they actually reduce blood glucose
9) I think you need a referral to a pulmonologist who can treat your OSA . I don't think you will need a endocrinologists referral. A physical trainer and a nutritionist are what you really need at this point.
Regards
ANANTHARAMAN
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Aparna Kohli
Answered by
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