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Inflammation,belching,fatigue,diarrhea,dehydration,pulmonary embolism,diabetes

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General & Family Physician
Practicing since : 2003
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Belching, Extreme tiredness, inflammation feeling especially in upper left side of belly,( Comes and goes)swollen feeling in belly, hand palms look yellow. I didn't notice any yellow in white eyes.
My stool are normal except yesterday morning. I had diarrhea +shivering.
Progression of all the previous symptoms:(the progression is over some weeks)
Firstly, I started to belch very frequently. It was very rare in past...
I never belch so much. I noticed it doesn't seem linked to digestion. I belch at any time of day. Secondly, my tiredness started to increase at steady pace. More recently, I started to feel inflammation feeling especially in upper side of belly.. It comes and goes.My dehydration is more fast. (dry lips and mouth) It's not related to heat. I have air conditioning. In the last three days, my morning blood glucose climbed to 15-17 mmol/l every morning. I tried to increase my insulin. My blood glucose is higher the morning. It was just last days.. My symptomps started several weeks ago. In next part, I will explain you my medical history and my disease. I was diagnosed diabetes type 1 October 25, 2005. (I had pulmonary embolism some days after my diagnostic of diabetes type 1, I had an unknown infection two months after my diagnosis may not linked at all with current problem) The doctors found really strange I developed diabetes type 1 at 23 years old. I tested positive to anti-bodies linked to diabetes type 1 too. (I did anti-bodies test some months afer my diagnosis diabetes type 1) 3 years later, I had the insulin lab test who confirmed hyperinsulinemia . 2.20 times X more than normal maximum level. October 28 , 2008 I had blood glucose test at the same time of insulin test.. It was normal at 6,5 mmol/L.
I had the insulin lab test very early the morning with an empty stomach.
Let me know if you need more information regarding my medical history or my current health condition. As I know, it's really possible you need more information to give me an accurate answer. Hyperinsulinemia is associated with diabetes type 2. So I find it's really strange as diagnosed with diabetes type 1 and anti-bodies, I have hyperinsulinemia. My question is the follow: Could you dress me a list of most probable diagnosis with my current symptoms in order of priority? you could give reasons, you think is possible..
Let me know the tests I need to pass to confirm the diagnostic.. So I could confirm your hypothesis with my doctor locally. Thank you very much for your support! I appreciate a lot.
Posted Sat, 21 Apr 2012 in Digestion and Bowels
Answered by Dr. Deepak Anvekar 12 hours later
Hello and thanks for your query.

For your information, Diabetes type -1 is seen in young individuals and is associated with low or absent insulin production ( not high). Hence with elevated insulin levels it is highly unlikely to be having type 1 Diabetes.

Antibody tests are not specific for Diabetes type 1 , and might be detected in many other autoimmune conditions.

The constellation of symptoms described, indicate the possibility of adrenocortical disorder, that can present with high blood sugars and insulin resistance (which presents as high insulin levels).

The best way forward, would be to do a few Blood tests as mentioned to confirm if you have diabetes

1. Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL on two occasions ( 6.9 mmol/l)

2. Random (nonfasting) blood glucose level -- higher than 200 mg/dL, and the presence of symptoms such as increased thirst, urination, and fatigue (this must be confirmed with a fasting test)

3. Hemoglobin A1c test -
Levels indicate:
Normal: Less than 5.7%
Pre-diabetes: Between 5.7% and 6.4%
Diabetes: 6.5% or higher

In addition testing for adrenocortical disorders (hypercortisolism or cushings syndrome) can be done with Laboratory tests including:-

1. Serum cortisol levels
2. Dexamethasone suppression test
3. 24-hour urine for cortisol.

Presence of such high levels of cortisol, could be the cause of your symptoms.

Other conditions that need to be ruled out include Insulinomas (tumors that produce insulin), which present with recurrent episodes of hypoglycemia.

I hope this helps.

I shall be available to answer any follow up questions that you might be having.
Above answer was peer-reviewed by
Follow-up: Inflammation,belching,fatigue,diarrhea,dehydration,pulmonary embolism,diabetes 8 hours later
I had 10% a1c at my diagnosis. I had 25 mmol/l at my diagnosis with diabetic ketoacidosis + hyperosmolar. I lost a lot of weight.. I'm thin. I always been thin. So, I'm the typical thin diabetes t1. Immediately, they started to treat me with insulin. I noticed a lot of hypoglycemia with insulin treatment at the beginning. Some months after my diagnosis, I had extreme pain in belly area.. It was so intense, I shivered a lot. Currently, I feel inflammation in upper left of belly especially .(it cames and goes) I done c-peptide after my diagnosis.. I was under insulin treatent at the time of test. My fasting c-peptide was 13% of normal low level.
Tests results: fasting test ( all tests done at the same time, 3 years after diagnosis)
Insulin 166 pmol/L (normal range 25 - 75)
Blood glucose 6.5 mmol/L
C-peptide 27 pmol/L ( 200 - 900)
My insulin doses:
11U lantus one time before to sleep
10-13U each meal

How's possible to have hyperinsulinemia and 6.5 mmol/L at the same time?
C-Peptide is low but I'm under insulin treatment at the time of test.
I had high a2c at my diagnosis..
I had all sign of diabetes type 1 in my history but it looks very strange hyperinsulinemia with 6.mmol/L. Moreover, I noticed i'm really prone to hypo unawareness. You mentionned insulinomas. I had recurrent hypo episodes at beginning. I think is less recurrent now... I may just be less aware of hypo.
What's strange, I had 6.5 mmol/L at the same time with hyperinsulinemia.. Is it give you new insight ? Is it linked with adrenocortical or insulinomas or other?
Thank you very much
Answered by Dr. Deepak Anvekar 6 hours later
Hello Again, and thank you for the additional information.

From the additional information, it is suggestive that you might be having a insulin resistance syndrome, probably due to overactive counter regulatory hormones (Eg. cortisol) produced by the adrenocortical gland.

Your presentation of diabetes, seems to be due to acute and transient suppression of insulin production, as a result of immunogical damage to the pancreatic islets (that produce insulin) which produced XXXXXXX diabetic ketoacidosis. This was associated with the detection of anti-insulin antibodies mentioned earlier.

With recovery of the function, the insulin production has resumed, but due to resistance of the cells to the insulin produced, probably due to auto-antibodies to insulin receptors, that block their activation by insulin. In such a situation, though the body produces insulin, it is unable to act, resulting in artificial defienciecy of insulin , and hence symptoms of diabetes.

In addition, stimulation of the counter regulatory hormonesn ( eg glucagon, stress adrenal medullary hormones, etc) , due to excess production of insulin, results in normal to high sugar levels. This is the reason, you might be having high to normal sugar levels inspite of high insulin levels.

With respect to the C peptide levels, a low level is consistant with exogenous supplementation with insulin therapy.

In case of insulinoma, both the C peptide levels and the insulin levels will be equally elevated, and you might have had intractable hypoglycemic episodes. Hence a insulinoma might not be the cause of your symptoms.

The best way forward would be to evaluate for conditions like cushings syndrome, which result in elevated adrenocortical enzymes.

The tests indicated would be :
1. Serum cortisol levels
2. Dexamethasone suppression test
3. 24-hour urine for cortisol.

Based on the reports, further course of action can be determined to provide definitive treatment.

I hope this helps to clear your doubts. I shall be available for clarification of any persisting doubts.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Inflammation,belching,fatigue,diarrhea,dehydration,pulmonary embolism,diabetes 48 hours later

I found a result of serum cortisol at my diagnosis. It was at 466 nmol/L.
So it's a normal result according the range.... So The cortisol hypothesis seems not right in my case.. Do you have any other possible causes of my hyperinsulinemia with 6.4 mmol/L ?
Moreover, I had lipase higher than normal range.
lipase = 77 U/L Normal range = 14-45

Thank you
Answered by Dr. Deepak Anvekar 8 hours later
Hello Silver,

Since most medical conditions, that probably could have been the cause of your high insulin levels, have been ruled out, the other causes which fit your presentation would be Insulin resistance syndrome.

The syndromes of insulin resistance are associated with various endocrine, metabolic, and genetic conditions as well as some immunological diseases.

The mechanisms responsible for insulin resistance syndromes include genetic or primary target cell defects, autoantibodies to insulin, and accelerated insulin degradation.

In clinical practice, no single laboratory test is used to diagnose insulin resistance syndrome. This is a clinical Diagnosis based on clinical findings corroborated with laboratory tests.

Since additional testing and physical examination - has ruled out other causes of hyperinsulinemia ( eg insulinoma, Cushings syndrome, etc), there are no additional testing that might need to be done.

Since C peptide levels are low - insulinoma is ruled out.
Since cortisol levels are normal, hyperadrenalism (Cushings syndrome) is ruled out.

Since, you have already been diagnosed and being treated for type 1 Diabetes, Insulin resistance could be the most probable cause. Such cases are seen in who begin receiving intensive insulin therapy right after their diagnosis.

In addition the cause of your symptoms of bloating, abdominal discomfort, and belching could be due to diabetic gastroparesis.

Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of moving through the digestive tract normally, the food is retained in the stomach.

Gastroparesis may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged after years of high blood glucose, resulting in gastroparesis. In turn, gastroparesis contributes to poor blood glucose control.

Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.

The next step for you would be to treat your current condition and try to reduce the progression of your resistance to insulin and treatment of your symptoms.

You might consult with your gastroenterologist, for a Xray, a Manometry or Barium study to assess the Gastrointestinal motility. Once confirmed treatment can be initiated with dietary changes and medications that promote gastric and intestinal motility.

I hope this helps to clear any doubts.

I shall be available for any follow up questions that you might be having.

Above answer was peer-reviewed by
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