What Do My Glucose And Sugar Levels Indicate?
BLOOD GLUCOSE (FASTING) 83.00 mg/dL 60 - 100
BLOOD GLUCOSE (POST-PRANDIAL) 120.00 mg/dL
GLYCOSYLATED HAEMOGLOBIN [HBA1C] 5.40 %
*Mean Plasma Glucose 115 mg/dl
SERUM FERRITIN LEVEL 158.51 ng/mL
PLASMA INSULIN LEVEL ( FASTING ) 10.00 μIU/mL
PLASMA INSULIN ( POSTPRANDIAL) 65.70 uIU/mL
You are not insulin resistant.
Detailed Answer:
Hi XXXX,
Welcome to HCM. I had gone through your question and understand your concerns.
Do you have overweight? Do you have black thick skin in the back of your neck (Acanthosis nigricans)?
If you are overweight and you are having acanthosis nigricans, you have clinical features of insulin resistance. That may be the reason why your doctor has ordered these blood tests.
But don't worry. Your blood tests are not showing insulin resistance. You’re fasting, after food glucose and insulin levels, and HbA1C are well within normal limits.
There is calculation for insulin resistance from these blood reports (HOMA IR). That is also normal in your case.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
I have asked you a follow up question. Kindly confirm if it has been received at your end.
Many Regards
XXXX
Is this regarding your attached blood reports?
Detailed Answer:
Hi XXXX,
I have not received any followup question. Is it regarding your attached blood reports.
If yes, let me explain your lab reports.
1. Complete blood count and blood picture
Normal. No evidence of infection, anaemia or any other illness
2. Fasting , post prandial glucose and HbA1C
Normal. No evidence of diabetes. HbA1C is 3 months average blood glucose - normal is less than 5.7, more than 6.5 is diabetes, between 5.7 and 6.5 is pre diabetes (increased chance of diabetes). Your value of 5.4 is normal
3. Insulin levels
Fasting insulin levels should be less than 25 uiu/ml after food can go above 100 uiu/ml depending on blood glucose. Your value is normal
High insulin values are seen in insulin resistance and early cases of type 2 diabetes. You don't have that.
So in short: all your blood investigations uploaded are normal. There is no diabetic tendency or insulin resistance
Regards
Dr Ajish TP
Thank you so much for your reply. I am happy to know that I am not insulin resistant.
No, I do not have Acanthosis Nigricans. My height is 5 feet 10 inches with a weight of 73.5 kgs, So I believe I am within the limits.
I am presently having Sporanox and thereafter, my dermatologist has prescribed me to have Glycomet SR 500 mg - 1 tab daily after breakfast for 10 days, then increase to 1 tab twice daily after breakfast and dinner.
Q - If I am not insulin resistant , should I consume this medicine?
Q - Does this medicine has any side effects?
Q - get red acne like eruptions around my neck/throat shaving area which has been diagnosed by the dermatologist as folliculitis due to insulin resistance. Can insulin resistance cause folliculitis? (If you want I can send you the pictures of those eruptions)
Q - My dermatologist has prescribed me to avoid all dairy products like milk, paneer etc. Since last 5 months, I am not consuming them except for a glass of milk once in a week and 100 gm paneer once in a week. Does intake of milk or dairy products aggravate the insulin resistance conditions ? Does it make a insulin resistant patient more prone to diabetics?
Q - As per my dermatologist, the following reading is on the higher side and I am insulin resistant.
Is this correct ?
What does it signify and what is the usual range for this?
Do you see any of the readings in my report on the higher side?
INSULIN [ECLIA]( POSTPRANDIAL)
PLASMA INSULIN ( POSTPRANDIAL) 65.70 uIU/mL
Doctor, kindly answer the above questions. It would be a big help to me.
Thanking you once again and eagerly awaiting your reply.
Many Regards
XXXX
See the detailed answers
Detailed Answer:
Hi XXXX,
Welcome back.
I understand your concerns.
It would be great if you upload the images.
Do anyone in your family have diabetes?
1. Though I have not examined you, your reports clearly say that you don't have insulin resistance. So consult a physician/ endocrinologist before starting on medications
2. Metformin is not with much side effects. Some patients find it difficult to take due to the size of the tablet and gastritis. We usually give it for diabetes, pre diabetes, poly cystic ovarian disease etc. But the main issue in your case is whether to start it or not.
3. Folliculitis is seen in diabetes and so in insulin resistance. But classic skin lesions in insulin resistance without diabetes is acanthosis nigricans and skin tags (small wart like lesions).
4. Increased consumption of dairy products will increase the chance of obesity and there by insulin resistance. Not a straight forward link. Most dermatologist suggest decreased dairy consumption to prevent protein allergy from cows milk that may aggravate skin lesions.
5. The investigations you have send is normal. You can get a second opinion from a physician or endocrinologist. The insulin levels fasting can be up to 25 miu/ml and after food can be above 100 miu/ml. Your values are below that.
But the diagnosis of insulin resistance is based on multiple factors. Fasting insulin, fasting plasma glucose, waist circumference, family history, etc are also considered on treatment.
Hope this will answer your questions. Please consult a physician or endocrinologist before starting treatment
Regards
Dr Ajish TP
Consultant Endocrinologist
Thank you so much for such a detailed reply.
No one has diabetics in my family, both in the maternal and paternal side. Even at the age of 75 years, my father is absolutely Ok. My waist circumference is 33.5 cm, Height is 5 feet 10 inches and weight is 73.5 Kgs.
I have sent you 2 more blood test reports. SRL and XXXXXXX hospital. Also sent you the pictures of the eruptions in my beard area. Some experts have opined that it is Sychosis Barbae.
The SRL blood tests was done at the instructions of the dermatologists in the month of March, 2014. However, off late the dermatologist was not happy with the findings of the SRL Lab related to sugar fasting, insulin etc, because the findings could not establish his diagnosis of insulin resistance. Therefore, the latest tests were done at a different lab (Dr Dang) which I have already shared with you. As per the latest findings in the Dang Report, he is convinced that I have tendency of insulin resistance because the below readings are higher in the Dr. Dang's report compared to SRL report.
Dr Dang
INSULIN [ECLIA]( POSTPRANDIAL)
PLASMA INSULIN ( POSTPRANDIAL) 65.70 uIU/mL
SRL
* INSULIN, SERUM (POST-PRANDIAL)
INSULIN 25.93 mU/L
However, you have already said that even 65.70 uIU/mL is well within the limits.
Also, if you look at the SRL lab report it shows tendency of thyroid, so I met a general physician at XXXXXXX Hospital. He physically examined me but did not find any signs of weakness or any other typical symptoms for Hypothyroidism. So he was not convinced with the findings of the SRL Lab and on his advice, I went through a detailed test at the XXXXXXX Hospital. I have sent you the report of the same. I was told that I do not have Hypothyroidism. Request you to kindly take a look at these reports and confirm the same.
Also, can you please take a look at the SRL report and highlight if there are any other adverse findings in the same.
Is there a possibility that if I do not have insulin resistance and I consume the medicines Glycomet SR 500 mg, I can get diabetic tendencies. I have already consumed ACNONAC TABLET (Nexgen Company) (1 tablet a day) for several months (3-4). I have stopped taking this since November. Is this a anti- insulin resistance medicine? Will this have any adverse side effect on me?
Should I continue avoiding dairy products?
Doctor, I cannot even begin to express that how helpful you have been in guiding me. Thank you once again.
I will certainly consult another doctor.
Many regards
XXXX
Investigations are normal except low vitamin D
Detailed Answer:
Hi XXXX,
Welcome back
I have gone through the entire reports.
My comments:
1. Thyroid function ok - No need for treatment
2.No insulin resistance - No treatment needed
3. Vitamin D deficiency- needs replacement with vitamin D.
One report is showing mild elevation in TSH- 6. But your doctor has done a detailed thyroid antibodies and lipid profile which are normal. So no treatment is needed. Repeat TSH is normal.
Fasting insulin is standardised - most labs give less than 25 or 30 miu/ml as normal. Post prandial is not standardised. So most labs won't give normal values.
Post prandial insulin accepted normal:
1 hr after food : 18-276 miu/ml
2 hr after food : 16-166 miu/ml
(Reference from XXXXXXX text book - which supposed to be a Bible in endocrinology)
So your values are well normal - both labs.
I have seen your photographs. It doesn't look like that of insulin resistance. The image look like sycosis barbae. But I'm not an expert in this subject. You can post the photo to dermatologists in HCM to get a second opinion.
Acnonac tablets is not of much side effects. Alone it has no effect of insulin resistance. In combination with Metformin it improves insulin resistance.
Regarding dairy products- nothing to do with insulin resistance. If you are not showing any benefits of stopping dairy products, then you can restart taking it.
Your weight, waist circumference etc are normal.
Hope I have covered everything
Good health
Dr Ajish TP
Consultant Endocrinologist
Thank you so much for your patience and the detailed reply. I am taking vitamin D to make good the deficiency.
So, you are concluding that neither I have a tendency of being insulin resistant nor I am insulin resistant.
Do you see any problem with the Kidney Profile, Serum and Liver Profile in the SRL Lab Report? As per my limited understanding, neither of them are within the standard limits. Please clarify.
However, I am still confused as to how come the Dermatologist is so convinced that I am insulin resistant, although experts like you and even my brother, who also happens to be a doctor, has ruled out any possibility of insulin resistance.
If I choose to continue with his line of treatment for next few more months, lets say 3-4 months, I hope there should not be any cause of worry for me, in terms of consuming medicines like Glycomet SR 500 mg or similar medicines.
For the time being, I am refraining from consumption of dairy products.
Suppose post 3-4 months, if there are no positive results and the dermatologist insists to continue his treatment on the diagnosis of insulin resistance, would you suggest me to discontinue visiting him? I know at the end of the day this would be my personal decision, yet I seek your valuable guidance on this.
If I click on the tab which says that "Close discussion and review doctor", do I need to make further payment to review a doctor? Please clarify.
Thanking you once again.
Many regards
XXXX
All blood tests are in normal limits
Detailed Answer:
Hi XXXX,
Welcome back.
Regarding the SRL reports
Kidney function:
Urea and creatinine are in fact on the lower side. Higher values are suggestive of kidney diseases. Your values are well normal.
Liver function:
SGPT is normal, SGOT is borderline elevated. We take 3 times upper limit of normal (>120) as abnormal; requiring further evaluation. You can repeat the liver function after 2-3 months and see.
Lipid profile:
HDL (good cholesterol) : slightly low
LDL (Bad cholesterol) : also low - so no treatment needed.
Every blood tests will have some minor alteration from normal values. But we should know when to treat or observe. In the end of the day we treat patient and not their lab reports. Here all your blood tests are below treatment cutoff. So no need to worry.
To be true with you, if I do my blood tests and get a lab report similar to what you have got, I will be a very happy man...
I feel confident that nothing will happen to you if you follow same medical treatment for another 3-4 months. Regarding changing dermatologist, it's your choice. But it is always better to get a second opinion.
Dairy products - the choice is yours.
To share a medical fact, if you do good aerobic exercise (30 minutes a day for 6 days a week) you will get same benefit as Metformin for the treatment of insulin resistance.
Sorry for last question - "Close discussion and review doctor" I don't know the answer. You can contact the "report a problem" link and our customer care group will guide you.
Hope this clears all your queries
Good health,
Dr Ajish TP
Consultant Endocrinologist
Thank you so much for your reply. You have dispelled many of my apprehensions.
Your analysis that you would have been really happy if you would have got a blood test report like mine, was really reassuring and if I may say so even hilarious.
But the problem remains that since last 13 years I have been chasing doctors in XXXXXXX First, for the eruptions around my beard area (may be Sychosis barbae) and secondly, for the eruptions that I get around the buttock region (Acne Vulgaris). First issue remains eternal but the second one erupts primarily between June-September, when the humidity is at its peak in XXXXXXX I also used to get Acne Vulgaris on my forehead and upper back. But miraculously, they gradually disappeared without any medication.
But the other two issues are continuing and so is my tryst with the dermatologists. To be honest, I have spent time, money and efforts, but they have mostly turned out to be futile. These problems are certainly not fatal and to some it may even sound trivial. But come XXXXXXX month I cannot even sit properly on a chair and this beard eruptions, for which I cannot even shave or trim, together have a tremendous nuisance value and affects the quality of the life. May be as a last try, if you can suggest some doctor in XXXXXXX if you are aware of, it would be a great help to me.
Rest, certain things in life have to be accepted as it is. I should also realize this point in my life and make peace with it.
Thanks once again for all your time.
Best regards
XXXX
Details of doctors
Detailed Answer:
Hi XXXX,
Welcome back.
I can understand your problems.
Sorry for a delayed reply as I had to discuss with my friends in XXXXXXX Few prominent names they suggested were Dr XXXXXXX Parasher from XXXXXXX XXXXXXX XXXXXXX Hospital, Dr XXXXXXX XXXXXXX of Derma world clinic and Dr XXXXXXX Kubba of Kubba skin clinic.
I think it's worth getting their opinion. I won't be surprised if you have already met them all.
If you are not getting enough help from the big names, go to XXXXXXX or Safdarjung Hospital and meet a Junior resident in Dermatology, who has just finished their MD training. They will surely be able to help you. In medicine it always works. In my practice also if there are areas where I can’t help the patient I give that case to my junior residents and they will search every option to come up with a meaningful diagnosis.
Wishing you a speedy recovery
Regards
Dr Ajish TP