5 Steps to prevent Heart Disease

Monday, April 23, 2018

How I got fired by my Endocrinologist.

During Christmas holidays I had a fasting glucose of 240 once when I when I reported my levels on Dec. 21, 2017.
 I was surprised my endocrinologist gave me a pass.
Four months later right after a cataract surgery after fasting but getting IV Ringer's Lactate and then post op I had a small muffin, my glucose was  248 and insulin level 8.4.
My endocrinologist  immediately wanted me to add a  sulfonylurea such as glipizide. 
 I said to her, when I was practicing I got away from sulfonylureas because they eventually milked the liver dry of insulin and the patient had to go on insulin injections.  She agreed that was true. 
I said I would be willing to go on Actos (Pioglitazone) at low dose as it seems to be the best drug for insulin resistance.  She doesn't like Actos and said it has been associated with Osteoporosis and I already have osteopenia.  I remembered thinking that I was surprised to have osteopenia as I have always been heavy and always lifted weights over the years.  However, I had been on Actos.  I went to lunch with Eric Westman MD and he suggested I stop Actos to help my weight loss on Atkins.  Thus a few years ago I stop Actos.  I quickly loss 10 lbs., but my fasting glucose shot up to 300! I said to my endocrinologist that of course that weight loss is just water which is probably why you have to be careful giving it to borderline heart failure patients.  She said no, it was lipid weight.  I'm not sure what that means and I was pretty sure she was wrong but I moved on.  
We agreed that I do 3 or 4 hour post-prandial glucose.  If I was running greater than 180, we would start Actos.  I thought after discussion we reached a good compromise. 
I asked if we should get another DEXA scan as it has been 3 years.  She said she wasn't certain medicare would pay for it.  I said if she wrote that she wanted to make certain I didn't develop osteoporosis by stopping testosterone IM, the DEXA scan would be approved.  She wanted to look it up. 
I asked her if she thought that getting insulin levels with fasting glucose to pick up insulin resistance early in people with FBG of less than 100 is a good idea.  She said "yes" Then I asked can I have an insulin level with my next fasting glucose.  She said no.  I said I have an insulin level of 8.4 with a glucose of 248 after fasting and IV Ringer's lactate for my cataract surgery.  She said I have DM2, I didn't need an insulin level.  I said if I take Actos I want to know if my insulin level will get lower with better glucose control. 
I said my HDLc/triglyceride ratio was less than 3.  My non-fasting TG was 99. 
My systolic BP is 116 on ramipril for DM2 and Diltazem for atrial fibrillation. My waist is 41.5" and I want to try to get it under 40".  My bioelectrical impedance scale says my visceral fat is 14? 
When I do my Liposcience Advanced Lipid Study by NMR, my IR score is in the middle in the 40's.  Not a strong score for IR even though my VLDL was a little high because it was non-fasting.

I know I am DM2, I know am IR even though my insulin level was normal. 
I think I have lost enough beta cells in the pancreas that I can't muster a high insulin level a younger person with IR would have.  DM1 may have a zero insulin level.  I don't want to get there.  I hope by losing more visceral fat, I can increase my adiponectin to help my IR.

I told my Endocrinologist I was in Asia and Hawaii from Jan. 11 to March 18, 2018 and I was running in the high 170's FBS even though I was walking at least 10,000 plus steps a day.  When I came home my Hgb A1c was 7.7.  I tried to stay on Atkins but on vacation I was probably not in NK. I was not taking my serum ketone levels so I can't know for certain.

I have been in Topeka for a month and have had fasting serum ketone greater than 0.4 every day except for O.2 and 0.4 on two separate mornings. My fasting glucose has been in the 140's.

Thus I told my Endocrinologist I thought my Hgb. A1c to be back at 6.5.

We compromised and I would start doing post prandial glucoses as I mentioned above but no insulin levels.   

I told her I knew I maintained my low carb diet because I was in serum NK(nutritional ketosis) each morning in the last month.  She was surprised there was a serum finger stick home test for ketones and didn't know anything about it.  This is a young Endocrinologist out of training a year ago? 

She wanted to fire me because she felt I didn't trust her as I was asking questions.  I said I wanted her to be my Doctor.  I told her I liked and trusted her.  She relented.  

When I got home her nurse called and said she transferred me to another physician.  

Update

4-2-18: 2.5 hours after 3 tacos for lunch: 166 glucose
              
4-25-18: 3.0 hours after 3 eggs/3 slices bacon for breakfast: 149 glucose

             4.0 hours after  Mexican Lamb soup and Premium Clear Protein drink 20 g protein, no carbs for lunch: 145 glucose

Thus on strict low carbohydrate diet I am good on my post-prandial glucose and so far do not need to go on Actos.  My AM ketone level on 4-25-18 was 1.1 

I would still like to get a couple of Insulin levels with fasting glucose.  I hope my next Endocrinologist will allow it.  

                

3 comments:

  1. I'll tell you what I'd say to you. Go zero carb or get another clinician! It mightn't work, but how do you know if you don't try?

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  2. I am going to watch carbs more carefully. Even creme has carbs. I will start doing my post prandial glucoses and see if I go over 180 with the present level of carbs at about 40 g a day. I drink whole milk, I eat a square of dark chocolate a day, I eat yogurt and pistachios an almonds. The carbs add up but I get ketones up to 1.4 to 2.4. I have no hunger with my present diet and meds. This last month I got back down to 205 lb without much exercise. I had cataract surgery.

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  3. Definitely Carnivore.
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