new test results..opinions needed

prunepie · 07-01-2004, 04:30 AM

hi everyone..i have new labs and i would like to hear your opinions...the dr said its most likely that i am not ovulating...and suggested estrogen patch and prometrium

anythoughts on these tests..i am currently on 2000mgs gluc xr.. also...my insulin just wont go any lower..its staying put for 8 months now..sigh

okay..these tests were taking on day 18..luteal phase

insulin 25 ( 6-27)
fsh 3.5 ( 1.1- 8.4)
lh 6.6 (.6-10.8)
- dr said usually in pcos patients the fsh is higher..but my lh is..any thoughts to why??

progesterone 2.99 (3.34-25.56)
estradiol 56 (33-221)
sex hormone binding globulin 18 (18-114)
i am 29 yrs old next month...i feel like i am menopausal with the hot flashes. i do get periods every month but very heavy and painful. i dont know if taking estrogen and progesterone is the right thing to do. i think so, but not sure.
also i asked if it would restore fertility..and he said no..just help symptoms. ughsssss am i infertile accoriding to these recent labs. labs in the past have also show really low estrogen/progesterone.but i havent had the lh and fsh done in years..

thanks for any thoughts xox jenn

Bekah1999 · 07-02-2004, 04:00 PM

I've never had bloodwork done during the luteal phase, only on day 3 except for some cd21 progesterone tests. From my understanding, on cd3 most pcos women have lh levels higher than their fsh. Like mine was 3.55:1 last time I had it done.

HTH,

nobimbo · 07-03-2004, 08:35 AM

Prunepie,

This must be so frustrating for you after being on Glucophage for a while now and still having trouble balancing out your hormones. I know I've brought this up before but I can't help bring it up again: the Atenolol may be inhibiting the Gluc, since it can worsen insulin resistance (despite what your doc may have told you). Maybe your doc could put you on a newer class of beta blocker?

I suggest that you get your hormones rechecked on day 3 or so of your cycle, since on day 18 both your estrogen and progesterone may be lower due to normal fluctuations (just before ovulation, for example, both hormones tend to be lower). If both are still low, maybe your doc can do more tests to check you for adrenal exhaustion? Is the doc you're seeing an endo? An endo would be better able to investigate this for you.

Linda

prunepie · 07-04-2004, 05:37 AM

hi linda...

the atenolol..i remember us talking about it..

on my thryoid board... www.thyroid.about.com ....
they were talking bout beta blockers and thryoid...how beta blockers can hinder the effects of thryoid meds too. but there became a big discussion that atenolol was not one of them..more propanol??sp?? not sure.

ahhhahahaharghs!!!! i honestly do not know what to do anymore. i was once on toprol but it didnt help my heart rate.

have you ever tried not being on a beta blocker at all?? i am wondering if the root cause of my tachycardia is hormone imbalance/thryoid/ir.. yet sooooo scared to go off it.... yet scared to try one of those ace inhibitors? especially since my bp isnt high..i am afraid one of the new ones will give me low blood pressure..especially if my tachycardia is more hormone related.

right now i am moving in a month and wont have insurance for a few months.

linda, what would you do in my situation.?

i agree with you that a trial off of atenolol would be telling if i can lose weight and lower the insulin.

also my old dr ONLY tested on day 18. i still dont understand why...i hear day 3 is much better..

ty xoxoj enn

ps... they say no adrenal exhaustion..in fact my cortisol is on the high side...

nobimbo · 07-04-2004, 08:57 AM

Jen,

When I was first diagnosed with tachyardia 20 years ago, I was put on Verapamil, which is a calcium channel blocker, and have been on it ever since. A calcium channel blocker helps to lower the heart rate, just in a different way than a beta blocker does.

Here is some info about calcium channel blockers and heart rate:

Class IV antiarrhythmic drugs, known as "calcium channel blockers." These medications slow the heart rate by blocking heart cells' calcium channels (transport of calcium across the cell walls) and slowing conduction at the AV node.
In addition to slowing the heart rate, these medications dilate (open up) blood vessels and decrease the force of cardiac contraction. Like beta-blockers, calcium channel blockers are used to control some forms of SVT and ventricular tachycardia and to slow the ventricular rate in people with atrial fibrillation.

Atenolol has been shown in many studies to cause a decrease in insulin sensitivity. Here is a blurb from just one of the studies:

Treatment with metoprolol and atenolol (beta -selective blocking agents) was associated with decreased insulin sensitivity and increased fasting values of insulin and glucose. There were indications of a suppressive effect on insulin secretion during IVGTT; an increase in serum triglycerides and a decrease in serum high-density lipoprotein cholesterol also occurred during these treatments.

As you can see from the blurb, atenolol not only increases insulin resistance, but it also can lower HDL (the good cholesterol).

Finally, here is some info that shows that the newer class of beta blockers do not have this effect on insulin sensitivity:

Many groups have shown that conventional antihypertensive treatment, both with beta-blockers and/or diuretics, decreases insulin sensitivity by various mechanisms. While low-dose diuretics seem to be free of these metabolic effects, there is no evidence for this in the beta-adrenergic blockers. However, recent metabolic studies evaluated the effects of vasodilating beta-blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. None of them decreased insulin sensitivity, as has been described for the beta-blockers with and without beta1 selectivity.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

So what I would do if I were you is ask the doc to switch me to either a calcium channel blocker or a newer type of beta blocker.

Btw, I have had high blood pressure for years, which is why I have always taken more than one bp drug (docs usually like to prescribe more than one). I am currently on the verapamil and an ace inhibitor, Altace. At the time my tachyardia was diagnosed, I had been taking Dexatrim for years, plus I had been yo-yo'ing quite a bit with my weight. I really think my heart rhythm problem stemmed from those things. Don't know if I still have tachyardia or not, but I'm not willing to stop the Verapamil to find out (plus my bp will always need to be controlled with meds).

Good luck!
Linda

prunepie · 07-04-2004, 02:06 PM

is there another name for verapamil?? it sounds familiar to me....

do you have the link to the first blurb you posted ?? i would like to take that to my doc

i know waht you mean..i dont know if i still have it or not..but afraid to find out if i do!! lol

you wouldnt happen to know ,,if there are any long term side effects of taking a beta blocker??? just curious to their action..for example..can your body become acclimated to a certain kind over the years..or are these drugs different than other medicines???

linda.. ty!!!!! xoxo jenn

nobimbo · 07-04-2004, 11:10 PM

Other names for Verapamil (which is generic) are:

Isoptin
Calan
Covera
Verelan

Here's the link for the first blurb:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

If you do a search for "atenolol and insulin sensitivity" you will find many articles. Here is one I just found that summarizes most of the available studies (and it was just published last month); this may be a better one to take to your doc. It discusses how beta blockers such as Atenolol have been shown to actually contribute to the onset of diabetes, and how calcium channel blockers are neutral (they don't worsen insulin-resistance, but they don't decrease it like ace inhibitors can). I can't tell you how mad I was when I first read about this last year; I had been taking Atenolol for many years, and was diagnosed with diabetes two years ago (and continued to take it until I convinced my doc last fall to switch me to an ace inhibitor). Doctors need to be aware of this! Mine wasn't until I brought him research.

I bolded the relevant info here. Btw, I noticed an error in the article and I changed it here, but if you copy it from the website just be aware. In the second sentence of the article, the word "increase" was used instead of "decrease". It is obvious from the summary of the data that the correct word is "decrease":

The choice of antihypertensive agent is important, because of their effects on the metabolic profile. Beta blockers and diuretics decrease insulin sensitivity. In the major clinical trials, there were more cases of new-onset diabetes with beta blockers and diuretics. In contrast, the CHARM trial showed a lower incidence of new-onset diabetes with the angiotensin receptor blocker (ARB) candesartan compared to placebo (6.0 vs 7.4 new cases, p=0.02). The VALUE trial showed a lower incidence of new-onset diabetes with the ARB valsartan.

In the ALLHAT trial comparing the ACE inhibitor and placebo, the incidence of new-onset diabetes is about 1% per year. But, this may be low, because diabetes was usually graded as an adverse effect, not an endpoint of the trial. In the LIFE trial, the incidence of new-onset diabetes was lower in the losartan group than in the atenolol group, with the curves diverging at just 1 year.

In the ALPINE study, conducted by Prof.L. Lindholm, the speaker for this breakfast seminar lecture, the incidence of new-onset diabetes was 84% in the hydrochlorthiazide plus atenolol group, compared to 71% in the candesartan and felodipine group. No crossovers between treatments were permitted by the protocol.

A comparison was made of the long-term effect on glucose, lipid metabolism, and quality of life at 1-year. Included were men and women from 18-75 years, no taking lipid lowering drugs and without diabetes who took a placebo for 4 weeks before randomization. Of the 392 patients in this study in 33 centers in Sweden, 94% were previously untreated for hypertension. The doses were candesartan 16 mg (n=196) and hydrochlorothiazide (n=196) and the goal blood pressure less than 135/85 mmHg. The average age was 55 years, 47% male, BMI 28, and LVH 17%. Only 16% received monotherapy. At 1 year, blood pressure was equally well reduced (22/13 mmHg) in both groups.

In this comparison, candesartan reduced and atenolol increased the change in fasting serum insulin, plasma glucose, and the ratio of serum insulin/plasma glucose. Total cholesterol and total cholesterol were reduced with candesartan plus felodipine compared to hydrochlorothiazide plus atenolol (p=0.06).

In conclusion, hydrochlorothiazide and beta blockers are associated with an aggravated metabolic profile. Calcium channel blockers, ACE inhibitors, and ARBs are considered neutral for effects on the metabolic profile. In clinical trials, hydrochlorothiazide and beta blockers are associated with more new-onset diabetes than calcium channel blockers, ACE inhibitors, and ARBs.
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I also want to repost an article here that I posted and sent you several months ago:

BETA BLOCKERS SIDE EFFECTS

Gabe Mirkin, M.D.

Recent research shows that beta blockers and diuretics, the drugs prescribed most often for high blood pressure, cause high blood sugar levels, weight gain, tiredness and impotence.

Most people with high blood pressure have high blood insulin levels that increase their chances of suffering heart attacks, constant hunger and weight gain. Beta blockers, such as atenolol and propranolol, and diuretics such as hydrochlorothiazide, reduce the body's ability to respond to insulin, causing high blood insulin levels that increase risk for heart attacks, diabetes and weight gain. Because of this, drug companies have developed newer beta blockers such as dilevalol, carvedilol and celiprolol that do not raise insulin levels and therefore do not increase a person's chances of suffering heart attacks, diabetes and weight gain.

Most other drugs used to treat high blood pressure, such as angiotensin converting enzyme or ACE inhibitors, have no impact on or even improve insulin resistance and help to prevent heart attacks and control diabetes. In the near future, most cases of high blood pressure will be treated with the newer beta blockers or other drugs in place of the older beta blockers and diuretics.

1) S Jacob, K Rett, EJ Henriksen. Antihypertensive therapy and insulin sensitivity: Do we have to redefine the role of beta-blocking agents? American Journal of Hypertension 11: 10 (OCT 1998):1258-1265. Recent metabolic studies found beneficial effects of the newer vasodilating beta-blockers, such as dilevalol, carvedilol and celiprolol, on insulin sensitivity and the atherogenic risk factors. In many hypertensive patients, elevated sympathetic nerve activity and insulin resistance are a deleterious combination. Although conventional beta-blocker treatment was able to take care of the former, the latter got worse; the newer vasodilating beta-blocker generation seems to be capable of successfully treating both of them.

2) R Fogari, A Zoppi, L Corradi, A Mugellini, L Poletti, P Lusardi. Sexual function in hypertensive males treated with lisinopril or atenolol: A cross-over study. American Journal of Hypertension 11: 10 (OCT 1998):1244-1247.

http://www.drmirkin.com/heart/7642.html
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I don't know of any long-term effects of beta blockers (other than decreasing insulin sensitivity, tiredness, and metabolic resistance to weight loss). They have been used for many years and they are generally considered very safe for long-term use.

HTH,
Linda