To Plantscraper

Discussion in 'Fibromyalgia Main Forum' started by Applyn59, Jun 7, 2003.

  1. Applyn59

    Applyn59 New Member

    Hi,

    My PCOS was diagnosed by my gyn. I have several
    blood filled cysts on my ovaries that I have to
    monitor. Funny though, they are not related to PCOS.
    People who have cysts on their ovaries from pcos
    tend to have what looks like a string of pearls in
    the ovary. Some do not. The symptoms vary
    greatly from individual to individual.
    She diagnosed me with a simple fasting insulin
    test. She also tested my estrogen.

    She then sent me to an endocrinogist. He specializes in the endocrine system - hormones, adrenals,
    etc. He ran more tests on other hormones,etc.
    He did not run the c-peptide test. He also wanted
    to rule out Cushing's disease so I had a 24 hour
    urine collection (fun, fun). The symptoms of
    PCOS, CUshings, and FMS are quite similar.
    Hope this helps. If you have more questions,
    ask.

    Here is some info on c-peptide that I found for you:


    C-peptide
    Also known as: Insulin C-peptide, Connecting peptide
    Related tests: Insulin, Glucose email this page print this article
    The Test ------------------------------------------------------------------------
    How is it used?
    When is it ordered?
    What does the test result mean?
    Is there anything else I should know?
    How is it used?
    When a patient has newly diagnosed type 1 or type 2 diabetes, C-peptide can be used to help determine how much insulin the patient’s pancreas is still producing and whether or not that insulin is being used effectively.

    Type 1 diabetes is an autoimmune process that often starts in early childhood and involves the almost complete destruction of the beta cells over time. Eventually, little or no insulin (or C-peptide) is produced, leading to a complete dependence on exogenous insulin.

    In type 2 diabetes, often called “adult-onset diabetes,” a combination of factors leads to decreased insulin production and increased insulin resistance, along with some beta cell damage. Type 2 diabetics usually are treated with oral drugs to stimulate their body to make more insulin and/or to cause their cells to be more sensitive to the insulin that is already being made. Eventually, type 2 diabetics may make very little insulin and require injections. Any insulin that the body does make will be reflected in their C-peptide level; therefore, the C-peptide test can be used to monitor beta cell activity and capability over time and to help your doctor determine when to begin supplementing your insulin.

    C-peptide measurements also can be used in conjunction with insulin and glucose levels to help diagnose the cause of documented hypoglycemia and to monitor its treatment. Symptoms of hypoglycemia may be caused by excessive supplementation of insulin, alcohol consumption, inherited liver enzyme deficiencies, liver or kidney disease, or insulinomas (tumors of the islet cells in the pancreas that can produce uncontrolled amounts of insulin and C-peptide).

    When is it ordered?
    C-peptide levels may be ordered if you have newly diagnosed diabetes, as part of an evaluation of your “residual beta cell function” (how much insulin your beta cells are making). With type 2 diabetes, the test may be ordered if your doctor wants to monitor the status of your beta cells and insulin production over time and to determine if/when insulin injections may be required. C-peptide blood and urine levels also may be monitored to check your renal function and C-peptide clearance rate.
    C-peptide levels may be done when there is documented acute or recurring hypoglycemia. Symptoms include sweating, palpitations, hunger, confusion, visual problems, and seizures, although these symptoms also can occur with other conditions. The C-peptide test may be used to help separate excessive insulin production from excessive administration and to help diagnose insulinomas.
    If you have had your pancreas removed or are one of the few patients to have had pancreas islet cell transplants (in order to restore your ability to make insulin), your C-peptide levels may be monitored to verify the effectiveness of treatment and continued success of the procedure.

    What does the test result mean?
    High levels of C-peptide generally indicate high levels of insulin. This may be due to excessive insulin production, a response to high levels of blood glucose caused by glucose intake and/or insulin resistance. (With insulin resistance, the body’s cells do not use insulin normally to transport glucose inside the cell. The cells become “starved for glucose,” interpret that as a lack of insulin, and signal the body to make more.) High levels of C-peptide also are seen with insulinomas and may be seen with hypokalemia, pregnancy, Cushing’s syndrome, and renal failure. During a glucose tolerance test (GTT), there will often be a temporary 5 to 6 fold increase in C-peptide levels.
    Low levels of C-peptide are seen when insufficient insulin is being produced by the beta cells or when production is suppressed by exogenous insulin or with suppression tests that involve substances, such as epinephrine. Diuretics and alcohol intake also may cause low levels in some cases.
    In most cases, test results are reported as numerical values rather than as "high" or "low", "positive" or "negative", or "normal". In these instances, it is necessary to know the reference range for the particular test. However, reference ranges may vary by the patient's age, sex, as well as the instrumentation or kit used to perform the test. To learn more about reference ranges, please see the article, Reference Ranges and What They Mean. To learn the reference range for your test, consult your doctor or laboratorian.

    Is there anything else I should know?
    C-peptide testing is not widely used and may not be available in every laboratory. There are two main methods of doing the C-peptide test: RIA (radioimmunoassay) and ICMA (immunochemiluminometric assay). These two methods have different normal ranges, as well as sensitivities and specificities, and are not interchangeable. If you are going to have a series of C-peptide tests performed, they should be done at the same laboratory using the same method.
    Even though they are produced at the same rate, C-peptide and insulin leave the body by different routes. Insulin is processed and eliminated by the liver, while C-peptide degrades and is removed by the kidneys. Since the half-life of C-peptide is about 30 minutes to insulin’s 5 minutes, normally there will be about 5 times as much C-peptide in the bloodstream as insulin. Add to this the fact that a person’s kidneys and/or liver may not be clearing insulin and C-peptide out efficiently and you end up with an inherent imprecision in the C-peptide test. It can give your doctor important information about your beta cells and insulin production, but it is not perfect.
    You will need to fast for a C-peptide blood test if the results will be used to evaluate hypoglycemia.
  2. Plantscaper

    Plantscaper New Member

    Hi there,

    I really appreciate all the info you found..By simple fasting insulin test, do you mean a GTT.. I had one a long time ago, and was diagnosed with Hypoglycemia..but to my knowledge (not been tested for hyperinsulinism).

    My doc (who is a PCP, Family Physician) wants me to take this C-Peptide Test..but I have wondered if I should just go straight to the Endocrinologist for all of this, as I do not think she has a lot of expertise in this area..and the people I have talked with,that have PCOS and insulin resistance have never heard of the C-Peptide test..Does it not look like a test for Diabetes, primarily, which I don't think I have, yet? Don't have health insurance, so have to judicious in my medical decisions..

    Thanks for all of your help...I am not very computer literate..Where do you guys get all of this info?.Do you just do a search on it, or what? (do not know how to copy and paste, either..tried one time, but no success)

    Thanks so much...
    Plantscaper

  3. Applyn59

    Applyn59 New Member

    Plantscaper (sorry about that earlier),

    I think you should see an endocrinologist if you
    don't think your dr. is very smart. Since you have
    no insurance though, if you can get him to run
    the test for you you can then decide if you want
    to see an endocrinologist.

    As I said, my gyn just ran two tests : estrogen
    and fasting insulin. Just a simple blood drawing
    like any other test you get after you after eaten.

    My endo then sent me for the GTT.. UGH!!! That
    drink made me so sick!!!!! I had a two hour fasting
    for glucose and I made him do insulin checks
    at each point he did the glucose. He never heard of it
    but I was told it would be a good idea so I asked him.
    On all of those, my insulin was really high - but
    he said that those tests are not relliable so I don't
    know what to make of it. The fasting insulin
    test should be sufficient just to see if you are insulin
    resistant. I always thought I was hypoglycemic and
    was shocked I wasn't. I mean, if I don't have food in me I am miserable. I perk right up when I eat, too. It is
    like I took an upper! LOL I need more of that perking
    up, though.

    I am a computer nerd so don't feel badly that you
    are not computer "literate" as you say. You
    can go to google and just type in what you are
    interested in. Lots of sites will show up.
    If you need more info on PCOS, I have plenty
    and also websites to recommend if you need
    them.

    Hope this helps,
    Lynn

  4. Applyn59

    Applyn59 New Member

  5. Plantscaper

    Plantscaper New Member

    I just wonder why noone else has been tested for insulin resistance with the C-Peptide test,if that is the definitive testing method...and have already been diagnosed with Hypoglycemia many years ago..

    She said nothing about the a fasting insulin test...Sometimes, in the past, I have been sent for unnecessary testing and not the right one for diagnosing what was important..but, I will figure it out at some point.

    Thanks for your help,
    Plantscaper
  6. Applyn59

    Applyn59 New Member

    I think a few people on a pcos list I am on have
    been tested with C-peptide. I was not. I love
    my endocrinologist and he is very smart. I would
    think the fasting insulin test would be sufficient
    and if your dr. is smart then let her do it.

    What I really don't understand is why all doctors
    don't test people who are overweight .
    I believe there is a law that if you are a certain
    weight, you have to be tested for diabetes.
    However, those with insulin resistence, can
    possibly prevent diabetes with meds and diet.
    My neighbor is a prime example. SHe has really
    bad diabetes. She can barely get her sugar under
    control. It's in the 350's at fasting! She just got
    it down to 150 for the past few days. Now, had she
    known that she was insulin resistant years ago,
    it is very possible that she would not currenlty
    have diabetes. I find it appalling that this test
    is not mandatory.

    Good luck in your quest.

    Here is some info for you with suggested tests
    at the end. My gyn just tested fasting insulin
    and estrogen to see if I had PCOS. The endo
    then did more testing of hormones. I guess if
    you don't want to see an endo then you should
    ask your dr. to to the tests listed at the bottom
    of this information I have included.

    I don't know your age, but PCOS doesn't go away
    or not exist after menopause and having ovaries
    removed is of no help.

    2.5 How should PCOS be diagnosed?

    PCOS should be diagnosed based on physical exam, ultrasound of the ovaries, and the results of various blood tests. Diagnosis is made based on having several of the symptoms listed above. There is some disagreement in the medical community about the diagnostic criteria to be used. Some doctors suggest that at least three of the symptoms must be present to diagnose PCOS, others may make the diagnosis on the basis of fewer criteria (often emphasizing lack of ovulation), while others believe that PCOS is a diagnosis of exclusion — meaning if there are hormonal abnormalities for which no other explanation can be found, PCOS is presumed. Since there is no consensus as to how PCOS is defined or diagnosed, there should be little surprise when a variety of opinions emerge on how this problem should be treated!

    2.6 How are polycystic ovaries diagnosed by ultrasound?

    An ultrasound of the ovaries is usually done transvaginally — where a probe is placed into the vagina to gain view of the ovaries. In some cases, an abdominal ultrasound may be needed as well, but this tends not to give as clear a view.
    A classic PCOS ovary is enlarged and has a "string of pearls" appearance, where the pearls are the cysts. Usually ultrasound diagnosis of polycystic ovaries is made if there are at least 8-10 cysts that are less than 10mm in size on each ovary. It is not known how long each individual cyst will last, or what caused the arrested development of the follicle leading to the formation of the cyst in the first place. The polycystic ovary tends to be enlarged to 1.5-3 times the size of a normal ovary and often has an increase in the stromal tissue in the center of the ovary and around the follicles. Both the cysts and the stroma produce hormones, so the more cysts and the more stroma, the more likely one is to have other signs and symptoms of PCOS.

    2.7 Is it possible to have polycystic ovaries without having the syndrome?

    About 20-30 percent of women will have the appearance of polycystic ovaries, while only an estimated 5-10 percent of women would be diagnosed as having Polycystic Ovary Syndrome as based on signs and symptoms. It may be best to consider the finding of polycystic ovaries as a possible sign of PCOS, but not to rely on this as the sole criterion in making a diagnosis.
    A large percentage of women with polycystic ovaries have at least some subtle hormone alterations, even if they do not clearly exhibit other signs of the syndrome.

    2.8 Is it possible to have PCOS without having cysts?
    This is another area of some disagreement among medical professionals. Most women with PCOS will in fact have the polycystic ovaries for which the syndrome is named, but it is possible to be diagnosed with the syndrome without this particular symptom. Some doctors diagnose PCOS based on the appearance of other physical symptoms or hormone abnormalities, regardless of ultrasound findings.

    It is difficult to make a firm diagnosis of PCOS without the presence of either an increased number of small cysts or ovarian enlargement. Polycystic ovaries may not have been recorded as an official finding on an ultrasound even though they were seen. Often ultrasounds have been performed to exclude pathology and may not have diagnosed minor increases in cystic structures or ovarian enlargement. Some ultrasonographers may consider the milder forms of PCOS as variations of normal. Ovarian enlargement is not always associated with ovarian cyst development, but still can be a variant PCOS. In other words, if one has the signs and symptoms of PCOS it is likely that there is some alteration in the appearance of the ovary, even if it has not been recognized.
    TOP
    2.9 What blood tests should be done to diagnose PCOS?

    Much of the bloodwork that should be done in diagnosing or ruling out PCOS is the same as a basic fertility workup; however, there are a couple of additional tests for insulin resistance that should be added, as well as some cholesterol screening to evaluate general health status because of the future risks associated with PCOS.

    A good basic screening would include:

    * Fasting comprehensive biochemical and lipid panel;
    * 2-hour GTT with insulin levels (also called IGTT);
    * LH:FSH ratio;
    * Total testosterone;
    * DHEAS;
    * SHBG;
    * Androstenedione;
    * Prolactin and
    * TSH


    PS: In answer to your other question about GTF
    for chromium, it is from brewer's yeast.
    I have yet to take it for that very reason. I would
    never take the chrom. picolinate though. It
    was reported in the news to cause health
    problems.
    [This Message was Edited on 06/08/2003]
  7. Plantscaper

    Plantscaper New Member

    I am perimenopausal...I am going to do a little research on it, too..tomorrow...Are you happy with the drugs used to treat insulin resistance?

    Plantscaper