Conflict with doctor over how to interpret insulin results

irishmonk · 04-14-2004, 06:25 PM

A couple months ago, I had a 3 hour insulin test. I'd been dx with PCOS in 2001 using this test, I got pg in March 2002, delivered in Nov, and got back on Met sometime last summer. However, when my OB/GYN (not the one who'd seen me for the original dx, btw) prescribed the Met, she didn't order another insulin test to see how it was working.

So in Jan, I saw yet another doctor (d@mn insurance change...), this time just a GP b/c it's an HMO now, and I told her about my PCOS and how I wasn't feeling like the Met was working very well and that I'd like the 3 hour insulin test. She agreed and ordered the test...or so I thought. First alarm bell: I get to the lab, and the doc had only ordered only a GTT, not the insulin, too. Fortunately, they took the blood for insulin anyway so I wouldn't have to repeat the test if I was right that my doc should have ordered it.

Anyhow, I get a call a week or two later with the results, and the nurse tells me they were "normal." I asked for the specific results, and she gave them to me, as well as the range of normal. This is what I got , with the acceptable range (as told to me by the nurse) in parentheses:

fasting: 18 uiu/mL (4-27)
30 min: 161 (30-230)
1 hr: 216 (42-250)
2 hr: 118 (14-160)

Well, fast forward to now, and my PCOS symptoms are flaring, particularly the sugar cravings and depression. I decided to do some research on PCOS and depression, and in surfing this site, came across a chart on insulin results. For fun, I decided to double check just how "normal" my results were, but instead got quite a shock. According to the table (from INCIID, no less), my numbers are HORRIBLE. Not even CLOSE to normal. So I called right away and the doc wasn't in, but the nurse tries to write me off with this whole argument about different labs using different ranges, but I'm so far out of the range provided, that I can't believe that that is a factor. If it were, how would any website even begin to post normal values? I can understand some small variation, but my numbers are well outside any reasonable margin of error. (And yes, the units used are the same, too - I double checked that.)

So is there any possibility that my doc's office is right? Has anyone EVER seen numbers that would indicate my insulin was indeed normal? What should I do? Their office is being very cagey about referring me to an endocrinologist, and thanks to my HMO, I HAVE to have one.

BTW, here is the addy for the site I got my info from:

http://www.inciid.org/faq/pcos4.html#4.3

Thanks!

nobimbo · 04-14-2004, 08:40 PM

First of all, I want to applaud you for doing your homework. I agree with you that the results of your insulin test are not satisfactory. Your HMO situation certainly complicates things for you. You didn't mention your current dosage of Met. I suggest you ask to speak with the doctor directly, tell her you want to fax or mail her the chart you found, and ask her to up your dose of Met (unless you are already on the maximum amount). If you are already on, say, 2000 mg., then maybe she would be willing to prescribe another med, such as Avandia or Actos, or Avandamet (which is a combo of Met and Avandia). Also, you can request to have the actual lab report mailed (or faxed) to you. You are going to need that if you need to find another doc. Check out the "find a doctor" section here, and/or check out this link to pcos-friendly docs:

http://www.pcosupport.org/membership/professionals.php

Sorry you are having to deal with this. GP's and many gyn's are so pitifully uninformed about PCOS. We have to try to educate them; it shouldn't be that way, but it's our reality.

Linda

irishmonk · 04-14-2004, 10:16 PM

Thanks, Linda. I'm glad I did the research, too, but frustrated that I didn't do it sooner, KWIM? I had a total breakdown on Mon, and I feel like maybe it could have been averted if I were being treated properly.

Anyway, I'm definitely going to talk to the doc directly tomorrow. I took your advice and printed off that chart from INCIID. I hope that will convince her - I found the exact same chart in several other places (I do mean exactly - the comments were verbatim, so I know they were all just copying some original source, and I figure INCIID was the most well known of the sources, so hopefully the most convincing).

I'm currently on 1700mg/day, although I have to admit to only taking 850 a lot of days because I have never been good about taking morning meds. Starting at 17, I took my BCP at bedtime, so I'm very good about the nighttime dose, but that morning one often escapes me, especially b/c as a SAHM, I don't have a regular wake up time. I just follow Maggie's lead.

I took Avandia to get pg with her, but my guess was that it was only working about as well as the met is now. That's based just on my assessment of my symptoms, though, not any bloodwork. And I don't believe I can be on Avandia now since I am still bf'ing...last I checked, there hadn't been any research done on Avandia and bf yet, so I don't feel comfortable taking it.

Unfortunately, none of the docs listed in either of those places is in my neck of the woods, which is frustrating. I really hope I can get my doc to cooperate with me on giving me a referral. In the meantime, I guess I need to start figuring out what I can do to help rein my insulin in that doesn't require meds...

Thanks for your reply!