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What Causes Unexplained Weight Loss When Diagnosed With Elevated MCV And MCH?
Question: I had first apt w/oncologist today d/t unexplained weight loss (40 lbs in approx. 6 months) CBC came back normal except for elevated MCV 100 and MCH 33. I also have hx of type I diabetes, fibromyalgia, some unknown autoimmune disease that they are calling undifferentiated inflammatory arthritis. Is it possible I have leukemia or multiple myeloma? I have 6 out of 11 criteria for lupus. Blood sugars have been very difficult to control in last two weeks, but I have been able to bring them down below 200 when they spike. I have had type 1 diabetes for over 30 years. I had a pancreas transplant that failed. On immunosuppresants for 5 years.
Brief Answer:
Clarify, please, you want to stop the weight loss?
Detailed Answer:
Hello, so nice to see you here at HCM. May I ask you some questions to give me a better history of what is going on and how I may best help you?
Please tell me your height, current weight, usual body weight, a list of all medications and supplements, all diagnosis to date, likes/dislikes and give me an idea of how you usually eat.
Did your doctor order B12 and folate since your labs indicate these might be low? Please send all labs you have to date and any new information regarding your diagnosis.
How do you manage your insulin? How were your blood sugars running as you lost that 40 pounds? Have you ever spoke with your endocrinologist about blood sugar control, insulin adjustment and weight loss prior to seeing the oncologist? Could you please send me insulin names, dosage, times of administration.
Dear, it is far too premature to worry about leukemia or multiple myeloma. You gave me no indication of any kind, lab or otherwise, that this may be the case.
The undifferentiated inflammatory arthritis may just very well be related to your score of 6/11 for lupus. You clearly have an autoimmune disease.
How best can I help you? You have a great number of complications that will take the skills of a competent doctor that understands autoimmune diseases, how to manage diabetes and in teaching the patient about their chronic conditions.
Please clarify your question, send me the information I requested and I will see what I can for you. I look forward to knowing you better and trying to help you deal with what seems to be overwhelming problems. Take it one day at a time. Until I hear from you again. . XXXXXXX Shattler, MS,RDN
Clarify, please, you want to stop the weight loss?
Detailed Answer:
Hello, so nice to see you here at HCM. May I ask you some questions to give me a better history of what is going on and how I may best help you?
Please tell me your height, current weight, usual body weight, a list of all medications and supplements, all diagnosis to date, likes/dislikes and give me an idea of how you usually eat.
Did your doctor order B12 and folate since your labs indicate these might be low? Please send all labs you have to date and any new information regarding your diagnosis.
How do you manage your insulin? How were your blood sugars running as you lost that 40 pounds? Have you ever spoke with your endocrinologist about blood sugar control, insulin adjustment and weight loss prior to seeing the oncologist? Could you please send me insulin names, dosage, times of administration.
Dear, it is far too premature to worry about leukemia or multiple myeloma. You gave me no indication of any kind, lab or otherwise, that this may be the case.
The undifferentiated inflammatory arthritis may just very well be related to your score of 6/11 for lupus. You clearly have an autoimmune disease.
How best can I help you? You have a great number of complications that will take the skills of a competent doctor that understands autoimmune diseases, how to manage diabetes and in teaching the patient about their chronic conditions.
Please clarify your question, send me the information I requested and I will see what I can for you. I look forward to knowing you better and trying to help you deal with what seems to be overwhelming problems. Take it one day at a time. Until I hear from you again. . XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by :
Dr. Yogesh D
Yes, definitely want to stop weight loss. I am 5'9" 107 lbs. I have always been on the thinner side. But nothing like this. My appetite has not changed. I have never been a big eater 1-2 small meals a day and snacks to keep blood sugars from getting to low. Not the healthiest eater but it has always worked for me. Have had dieticians tell me do you eat nothing but carbs, protein and fat. I do stay away from complex sugars. Rheumatologist is treating me as if I have lupus and this has helped my joint pain tremendously. I currently take: Humulin N 18 units BID, Humalog sliding scale PRN 1 unit drops me 40, I count carbs and adjust for current blood sugar levels when eating. One unit for 15 grams. of carb. Methotrexate 15 mg weekly, Plaquenil 200 mg BID, Folic Acid 1 mg QD, Cymbalta 60 mg QD, Xanax 0.5 1-3 tabs daily PRN, Fioricet 50-325-40 1 tab q6hrs/prn for tension HAs, very seldom need this. I have talked with my endocrinologist, rheumatologist and PCP about weight loss. They do not feel is d/t my diabetes as even though I am very brittle, I am always able to bring my sugars down on my own. So they do not stay elevated for long periods of time. My A1c's usually run around 8. I am due to get another A1c next month. Sugars have been difficult to control in last 3 weeks. Unsure as to why, nothing has changed. Fatigue has increased greatly
Brief Answer:
Slowly increase calories as adjustments in insulin are made
Detailed Answer:
You do have a complex picture and I will do the best I can to give you ideas on gaining weight safely. As you know, you will lose weight if you spill glucose into your urine and you need tighter control - shooting for a HbA1c of 7% would be reasonable considering you are brittle.
To do this, you may need to change both your diet and insulin regime. You are about 45 pounds underweight, which is significant and according to your BMI you are borderline malnourished. I would like to see you on small, more frequent meals with a slight increase in your protein intake to 20% of your calories using,lean sources such as low calorie Greek yogurt, cottage cheese mozzarella sticks,etc.
Your current caloric needs are 1600 to maintain your low body weight, 1800 to maintain an ideal body weight and 2300 calories to shoot for a gain of one pound per week - slow and steady with minor tweeks in your insulin as you gain weight.
One or two meals makes it impossible to take in all the nutrients you need to keep your body functioning. I suggest a minimum of 2 milk servings per day, whole milk or whole milk yogurt, 6 servings of protein, 6 oat based grain products, 2 fruits and 2 vegetable along with 3 fat servings emphasizing omega-3 fatty acids and other good fats, ghee or margarine, virgin olive oil, olives, canola oil, avocodos, nuts. Spread this out throughout the day which means a different distributition of your insulin. Can you/do you adjust on your own or does the doctor? Whatever, more frequent blood tests, minimum of weekly weights, and reporting to the doctor your values will also help maximize the weight gain process. You are also most probably nutritionally deficient in- Calcium, Vitamin D, Vitamin C, Protein, Zinc, B12, folic acid are some of the top on my list just from listening to how you eat.
Do you think you can make these changes? Increase protein to 20% or around 90g per day given functioning kidneys. Since your intake is small to get the calories,protein nutrients that you need you need to not increase portion size but increase number of small meals. Small, nutrient dense high protein shakes might not hurt using whey protein, whole milk, frozen fruit (blueberries are great!) and a dash of Splenda (if desired).
So, monitor blood glucose daily; 2)monitor and change insulin as required due to caloric manipulation; 3)Increase calories to 1800 and then to 2300, still monitoring religiously; 4) switch to six small meals per day; 5) increase protein ratio; 6) supplement your diet with one high calorie, high protein supplement if kidneys are fine; 7)ask for a copy of your labs and ask if the doctor ordered a folic acid test or B12 deficiency
I am curious as to what your doctors told you about your weight loss and if you were reffered back to the dietitian.Nevertheless, let me know if you can do what I suggested to gain the weight back and if you think this might work for you.
Feel free to write back after you have digested what I suggested.
XXXXXXX Shattler, MS,RDN
Slowly increase calories as adjustments in insulin are made
Detailed Answer:
You do have a complex picture and I will do the best I can to give you ideas on gaining weight safely. As you know, you will lose weight if you spill glucose into your urine and you need tighter control - shooting for a HbA1c of 7% would be reasonable considering you are brittle.
To do this, you may need to change both your diet and insulin regime. You are about 45 pounds underweight, which is significant and according to your BMI you are borderline malnourished. I would like to see you on small, more frequent meals with a slight increase in your protein intake to 20% of your calories using,lean sources such as low calorie Greek yogurt, cottage cheese mozzarella sticks,etc.
Your current caloric needs are 1600 to maintain your low body weight, 1800 to maintain an ideal body weight and 2300 calories to shoot for a gain of one pound per week - slow and steady with minor tweeks in your insulin as you gain weight.
One or two meals makes it impossible to take in all the nutrients you need to keep your body functioning. I suggest a minimum of 2 milk servings per day, whole milk or whole milk yogurt, 6 servings of protein, 6 oat based grain products, 2 fruits and 2 vegetable along with 3 fat servings emphasizing omega-3 fatty acids and other good fats, ghee or margarine, virgin olive oil, olives, canola oil, avocodos, nuts. Spread this out throughout the day which means a different distributition of your insulin. Can you/do you adjust on your own or does the doctor? Whatever, more frequent blood tests, minimum of weekly weights, and reporting to the doctor your values will also help maximize the weight gain process. You are also most probably nutritionally deficient in- Calcium, Vitamin D, Vitamin C, Protein, Zinc, B12, folic acid are some of the top on my list just from listening to how you eat.
Do you think you can make these changes? Increase protein to 20% or around 90g per day given functioning kidneys. Since your intake is small to get the calories,protein nutrients that you need you need to not increase portion size but increase number of small meals. Small, nutrient dense high protein shakes might not hurt using whey protein, whole milk, frozen fruit (blueberries are great!) and a dash of Splenda (if desired).
So, monitor blood glucose daily; 2)monitor and change insulin as required due to caloric manipulation; 3)Increase calories to 1800 and then to 2300, still monitoring religiously; 4) switch to six small meals per day; 5) increase protein ratio; 6) supplement your diet with one high calorie, high protein supplement if kidneys are fine; 7)ask for a copy of your labs and ask if the doctor ordered a folic acid test or B12 deficiency
I am curious as to what your doctors told you about your weight loss and if you were reffered back to the dietitian.Nevertheless, let me know if you can do what I suggested to gain the weight back and if you think this might work for you.
Feel free to write back after you have digested what I suggested.
XXXXXXX Shattler, MS,RDN
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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