BRbangle

Hello! I am posting my lab results, in hopes of getting some feedback. I've got some primary concerns, which are listed below the results. This lab work was performed on day 3 of my menstrual cycle, as requested by my RE, and I was fasting.

Insulin 3 UIU/ml (range: 6-27)
Glucose 97 mg/dl (range: 65–100)

Estradiol 15 pg/ml (range: 19–83)
LH 6.1 IU/ml (range: 1.9–12.5)
FSH 3.9 IU/ml (range: 2.5–10.2)
Prolactin 15.5 ng/ml (range: 2.8–29.2)
Testosterone 92 ng/dl (range: 14–76)
DHEA Sulfate 159 ug/dl (range: 35–430)

BUN 14 mg/dl (range: 8–25)
Creatinine 0.8 mg/dl (range: 0.6–1.3)
Calculated BUN/Creatinine 18 mg/dl (range: 6–28)
Sodium 139 meq/L (range: 133–146)
Potassium 5.0 meq/L (range: 3.5–5.3)
Chloride 105 meq/L (range: 97–110)
Carbon Dioxide 23 meq/L (range: 18–30)
Calcium 9.4 mg/dl (range: 8.5–10.5)
Protein, total 7.0 g/dl (range: 6.0–8.4)
Albumin 4.2 g/dl (range: 2.9–5.0)
Calculated Globulin 2.8 g/dl (range: 2.0–3.8)
Calculated A/G Ratio 1.5 g/dl (range: 0.9–2.5)
Bilirubin, total 1.0 mg/dl (range: 0.1–1.3)
Alkaline Phosphatase 47 u/l (range: 30–132)
SGOT (AST) 16 u/l (range: 5–35)
SGPT (ALT) 12 u/l (range: 7–56)

At the time, I was taking 2000 mg Fortamet per day for IR and 100 mcg Synthroid, plus vitamins and supplements--B-complex, calcium/magnesium, Flax oil and a multivitamin. I felt terrible most days, had irregular periods, was very moody with mixed anxiety/depression, and had also gained about 15 pounds. Following these lab results, the RE prescribed birth control pills. I have now been taking Ovcon-35 continuously since August and I have lost 10 pounds without much effort, my moods are more stable, skin clearer, scalp hair growing back... yada yada. (Sorry for the ranting.)

My main concerns which never fully got answered by my RE are these:

1. Am I insulin resistant or not? My glucose is high, but my insulin is below the normal range. I thought people with insulin resistance had high insulin. What's the deal with this?

2. Why was my estrogen low? I'm only 27 years old, which doesn't seem to be old enough to have low estrogen. Could low estrogen have something to do with my high testosterone?

Thanks again! Hail, Cysters!

CarmenSandiego

Do you have a history of higher glucose readings? This interests me only because a relationship between low insulin/high glucose exists not just high insulin/high glucose which we read about frequently....if you don't have enough insulin it can't move glucose into the cells and the glucose pools in the blood, resulting in higher glucose readings...and when the body isn't using glucose well that sound like some form of IR. But it could also be because of the Met...perhaps it's good to follow up in a few months.

What is your diet like??

I'd be curious to see what your lipid panels (cholesterols, triglycerides) show as well.

I agree that it looks low buuuuut I imagine most docs wouldn't be terribly concerned (even below range) because it was so early in the cycle when estradiol *should* be lowest...helpful, I know! I realize that many drs (specifically infertility specialists) like testing on Day 3 or 4 because much of the research uses those dates but the end and early points of the cycle are when levels should be lowest which really wouldn't be a great time to determine if deficiencies exist IMO.

I think the only way to determine if your estradiol levels are indeed low would be to check them when they should be highest. Do you know if you're ovulating?? How long are your cycles usually?? Would your doctor retest around or slightly before mid-cycle? If your estradiol is consistently low and you're not making any progesterone (which testing now might be worthless because of the BCPs), then I could see why your testosterone is so high and working unopposed...but being on the pill will most likely skew any future sex hormone testing because now you shouldn't be ovulating (and the E and P would probably be much lower than normal)... I see you mention hair loss as a symptom, but did you have any other hyperandrogenic symtpoms?

Since your prolactin is mid range and your FSH and LH aren't elevated, it doesn't sound like any kind of pituitary issue or any kind of peri-menopause (and I know that theoretically you should be too young for that but you never know)...but I see you mention synthroid - do you have thyroid numbers you could post?? (Just curious to see what TSH was doing since it's a pit. hormone.) Sadly, a HypoT state can seriously alter sex hormone levels. I know several women formerly with mild hirsutism that resolved it using thyroid meds alone. How do your Free T4/T3 numbers look?

BRbangle

Carmen, you rock! Your information is more helpful to me than you can possibly imagine! I've got many answers; but, first, I wanted to post new fasting insulin/glucose results I just received today. These tests were performed on Monday, which marked a little more than 4 months since starting bcp and a little more than 6 weeks after halfing my daily dose of Fortamet from 2000mg to 1000mg.

Glucose 79 mg/dl (range: 65-100)
Insulin <2 UIU/ml (range: 6-27)

Both levels dropped rather significantly--good for the glucose, but I'm not so sure about the insulin, especially after reading your explanation of the role of insulin. My RE now wants to decrease my Fortamet dose to 500 mg. I am not sure I understand the logic behind this, although I would love to come off Fortamet! Will you please help explain?

I have some fairly recent lipid panel results at home... I will post them this evening. I will say that I have a history of good cholesterol, low blood pressure and normal triglycerides.

I have autoimmune hypothyroidism, which has seemed rather aggressive to-date, in my opinion. (I say that, strictly because I've gone from 75mcg Synthroid to 112mcg within a year, or so.) Anyway, here are the results of my most recent thyroid panel. I was on 100mcg Synthroid at the time; and, after these results came in, my endo increased my dose to 112mcg. (He typically likes to keep my TSH between 1 and 1.5 UIU/ml.)

TSH 2.369 UIU/ml (range: 0.3-5.1)
Free T4 1.47 ng/dl (range: 0.73–2.3)
Free T3 2.65 pg/ml (range: 1.9–5.0)

Thanks again!

BRbangle

Carmen, I don't have a copy of my most recent lipid panel results. (I gave them to my RE without having a backup.) Here's one from March '07, which seems to follow the typical pattern...

Total Cholesterol 153 mg/dl (range: 100-199)
Triglycerides 70 mg/dl (range: 0-149)
HDL Cholesterol 62 mg/dl (range: 40-59)
VLDL Cholesterol Cal 14 mg/dl (range: 5-40)
LDL Cholesterol Cal 77 mg/dl (range: 0-99)
AST (SGOT) 28 iu/l (range: 0-40)
ALT (SGPT) 29 iu/l (range: 0-40)

LitterOf1

I am sorry I don't have a lot to offer on this topic. I just wanted to mention 2 things. Determining IR is not just about how high or low the insulin is... it's how well the body REACTS to insulin and takes care of glucose levels. Therefore some docs think you can have IR regardless of results during a single lab test period.


Secondly, about estrogen, at the day of your cycle that testing was done, it is a good baseline, but you need to compare it to how the estrogen balances with progesterone at different times in your cycle. Looking at it alone won't help much. As I read somewhere, low estrogen in the beginning of a cycle can delay or alter the "signals" to make your body have a typical ovulation cycle. You'd need more info though about the fluctuations of estrogen through the month.

Did I make sense at all? It's been a long day lol.

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BRbangle

Yes, that makes sense, LitterOf1. I'm still a bit confused about IR, though...

So, a low insulin/high glucose ratio does not necessarily mean that the body isn't making enough insulin to take care of the high glucose levels?

The endocrinologist who first prescribed me metformin never checked my fasting insulin levels--only fasting glucose, which was high at the time. The RE I am seeing now is the one who checked my fasting insulin level. And, since the results of my fasting insulin level came back below the normal range, despite a normal-to-high glucose level, he wants to decrease my metformin dosage. I still don't understand the logic behind that.

Would a Glucose Tolerance Test be helpful in sorting out any of this?

me663782

Your insulin is too low thats wy your dr eliminating your MET. Reduce your carbs, esp-ly carbs that you are taking after 6pm.

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