Tag Archives: diagnosis

How were you diagnosed?

28 May

I am very curious, readers: how were you diagnosed with PCOS?

My diagnosis came after I had very low milk supply after the birth of my first child. It seems that a lot of women are diagnosed when they have trouble getting pregnant. Informal poll: leave a comment and tell me what led your doctor to diagnose you with PCOS.

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insulin resistance: how to be tested and what to do if you have it

4 Mar

If you suspect that you have insulin resistance (and if you have PCOS, carry extra weight around your midsection, acanthosis nigricans (darkening of some parts of the skin, such as the neck or underarms), and/or high blood pressure, it is likely that you do), you may want to ask your doctor about testing for the condition.

Personally, I think that it isn’t always necessary, because the best treatment is lifestyle change to more healthful eating and exercise, and those are good for you anyway–but especially if you’re considering medication, you may want to have the lab work done.

Here are the things that your doctor might do in order to make or rule out a diagnosis of IR. What these lab values really measure is whether you are pre-diabetic; there is no formal diagnosis of IR to be made by these tests, as far as I know.

The Lab Tests

Since the hyperinsulinemic euglycemic clamp, the most accurate test for IR, is not a test that’s readily available, most doctors order either a glucose tolerance test or a fasting glucose test. The GTT–which will be familiar to most women who have had a pregnancy–is a fairly unpleasant test, though it’s not painful. The patient fasts for at least 8 hours (usually this is scheduled for the morning, so that you would fast overnight).

When you arrive at the lab, you’re given a sugary drink and then you wait; blood draws are conducted over the next two hours to see how your blood sugar responds to the sweet drink. It’s unpleasant because a) the drink is vile and b) most people don’t feel spectacular when they get a shot of sugar and nothing else for breakfast. After two hours, a glycemia of greater than 7.8 mmol/dl (140 mg/dl) indicates impaired glucose tolerance (a.k.a. pre-diabetes) or diabetes.

If your doctor prefers to order the fasting glucose test, you just go in the morning or after at least 8 hours of fasting, and the lab draws blood to measure the glycemia. Fasting glucose levels above 100 mg/dL indicate a problem; over 125 indicates diabetes. Most doctors seem to prefer the GTT, though.

Other Methods of Diagnosis

A lot of patients prefer to take a single lab test–it seems so cut and dried–but for insulin resistance, as with PCOS, the history of the patient is the best diagnostic tool. As the National Diabetes Information Clearinghouse says, any three of these symptoms indicates insulin resistance (also called metabolic syndrome or Syndrome X):

* waist measurement of 40 inches or more for men and 35 inches or more for women
* triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride levels
* HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels
* blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels
* fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glucose levels

As you can see, getting your blood lipid panel done can give you diagnostic info, as can knowing your blood pressure.

The Bottom Line: Healthy Habits Are the Best Treatment
The main thing is, if you are in doubt, do something about it. Improve your diet. Squeeze in some exercise. Insulin resistance can not only be treated–it can be reversed. Weight loss doesn’t have to be dramatic to show major improvements, either: the Diabetes Prevention Program, a major study of diabetes treatments and outcomes, showed that a loss of only 5-7% of your body weight can improve your chances of staying diabetes-free by a whopping 60%. (For perspective, if you weigh 200 pounds, that’s a loss of 10-14 pounds–no one is suggesting you have to be a size 2!)

Other Treatments
In addition to making changes to your lifestyle, you may want to consider medications that can help prevent diabetes. The most commonly prescribed one of these, for PCOS sufferers, is Metformin. You can talk to your doctor about the advantages and disadvantages of Met. I will also be posting a discussion of its merits and problems here on the blog soon!