Do I have hypochondria?

Background

In the past months, maybe year I have been increasingly feeling sick 1-2 hrs after eating. I get shaky and clammy, sweaty and uncoordinated. I have to lie down and eat something to feel better, but I never really feel normal. This sounds kind of like hypoglycemia [1]. The result is I typically delay eating for as long as possible and then eat every 2 hrs thereafter.

I didn’t have a primary care doctor for unrelated reasons. So I found one off a list somehow and had an appointment. She said my symptoms were not possible, gave me a basic metabolic panel to shut me up, and sent me on my way.

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Doctor’s office empty, probably should have taken that as a warning sign.

I felt so depressed. Am I a hypochondriac? That little insecure girl in me wanted to hide and cry. The scientist in me said this is stupid, go read some papers and do experiments to make science & evidence based conclusions. MDs just follow flow charts to diagnose.

Hypotheses

After a couple days of depression, I did some reading [2,3] and formulated a couple hypotheses:

  1. too much insulin, extended insulin, or hypersensitivity to insulin causes lowered blood glucose
  2. hypersensitivity to epinephrine or too much epinephrine causes hypoglycemic symptoms in the absence of lowered blood glucose
  3. hypoglycemic symptoms can also be brought on by fast fall in blood glucose, regardless of actual glucose values

Experimental Plan

To test these hypotheses, I went and bought the cheapest blood glucose meter at Target and some strips. Happens I worked on the research and development on the product my first job put of college. Cool!

I chose two tests to emulate [4]:

  • fasting glucose
  • time course after meal

The fasting glucose will give me a baseline, to understand whether a sharp rate of change is responsible for symptoms (3).

The post-meal time course will show me whether or not blood glucose is actually lowered when I feel symptoms (1) or (2).

Taking the time course is important to me, in case there are some dynamic differences from normal that can be informative. Many patient oriented informational sites only list high end values and single time points. So I had to do some digging to find some normal values to compare my results to (fig 1).

Figure 1. Normal blood glucose after eating a meal. Average in blue, 2 standard deviations from the mean upper and lower bounds in brown.  From http://www.phlaunt.com/diabetes/16422495.php.
Figure 1. Normal blood glucose after eating a meal. Average in blue, 2 standard deviations from the mean upper and lower bounds in brown. From http://www.phlaunt.com/diabetes/16422495.php.

Methods

Meter accuracy – test blood glucose twice in a row to see variance inherent to assay.

Fasting – after 8 hrs no food first thing in the morning I measured my blood glucose.

Meal – after meal take measurements 15 min to 3 hrs, half hour intervals and then 15 min intervals after 2 hrs when I expect to feel sick.

Results

Two subsequent measurements yielded the same blood glucose value, suggesting accuracy of testing equipment.

Fasting blood glucose is 122mg/dL.

Meal blood glucose rose to 200mg/dL shortly after lunch and peaked at 223mg/dL approximately 60min post meal. Blood glucose fell about 100mg/dL between 60 and 120min. Hypoglycemic symptoms onset at 120min coincided with sharp fall, but a normal range reading of 125mg/dL. Readings in 15 min intervals thereafter showed some additional decrease but relative stabilization of blood glucose levels. The lowest reading was at 96mg/dL (fig 2).  The experiment was stopped prior to the planned 3 hr time course because I had to eat something.

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Figure 2. My post meal blood glucose time-course. Meal included hot & sour soup, eggroll, tofu, green beans, and white rice. Blood glucose peaked just before 1hr, and then fell sharply by almost 100mg/dL by 2 hrs.

Discussion

I was expecting to find hypoglycemic readings, but instead found that my blood glucose is high to the point of possible pathology accompanied by high variability.

My fasting level of 122mg/dL is near the top end of the prediabetic range at 125mg/dL [5]. Fasting blood glucose greater than 125mg/dL indicate diabetes has developed, rather than pre diabetes condition. I do not meet this criteria for full diabetes, although I am approaching this threshold.

My peak blood glucose level at 223mg/dL 1hr post meal is in the diabetic range and exceeds prediabetic levels [5].

However, I am able to reduce blood glucose levels from peak back into a normal range. This dynamic pattern is consistent with prediabetes rather than full diabetes [6].

It is possible that my blood glucose falls into the hypoglycemic range at times due to the sharp fall in blood glucose from peak [7], but hypoglycemic blood glucose values were not observed here. Likely hypoglycemic symptoms are often due to the high rate of change rather than actual hypoglycemic blood glucose.

A prediabetic condition is supported by the post meal dynamics and most blood glucose measurements. Only my peak post meal blood glucose at 1 hr is alarmingly hyperglycemic supporting full diabetes.

This dynamic pattern suggests a loss of first phase insulin release, which occurs within 2 minutes of first food intake in normal people and prevent rise over 140mg/dL [7]. The second, sustained insulin release appears to be intact which explains the fall in my blood glucose between 1 & 2 hrs. However, overcompensation in the second insulin release due to hyperglycemic conditions at 1hr could explain the subsequent sharp fall in blood glucose and hypoglycemic symptoms [7].

Loss of the first insulin response is a feature of prediabetes or Impaired Glucose Tolerance [7]. Asians are reported to have higher incidences than Caucasians of developing diabetes, 95% of whom develop type 2 diabetes [8]. Many, if not all, develop type 2 diabetes through loss of first phase insulin response which causes subsequent beta cell loss or dysfunction, impairment of the second insulin release, and insulin resistance in other tissues [7,8]. Loss of both phases of insulin release characterizes full diabetes [7].

I probably have prediabetes and need to see an endocrinologist for proper diagnosis and treatment. I will probably not return to the primary care doctor who thought I was a hypochondriac.  I will probably repeat these experiments for a total of 3 times to demonstrate reproducibility [UPDATE: this doesn’t seem possible because stabbing my finger 1-4x per time point to get enough blood hurts].

I have a lot of reading to do to better understand the normal physiology, pathological physiology, disease progression, underlying mechanisms, population incidences, existing treatments, and relevant drug development pipeline.

Understanding my particular disease development and its treatment may be a challenge because my BMI is 19 and I have hovered on this cusp of underweight for my entire adult life.  Most diabetes information and prediabetes treatments focus on slowing disease development by losing weight.  It is likely my disease onset is caused by a factor other than obesity-related lifestyle choices since I am not obese, so modifying my lifestyle may have no effect on my disease progression.  An additional impediment for me to this common  method of treatment is that I cannot really lose weight.

In conclusion, do I have hypochondria?  Sadly it doesn’t seem so.

References

  1. Hypoglycemia, Wikipedia
  2. Blood sugar regulation, Wikipedia
  3. Reactive hypoglycemia site
  4. American Diabetes Association diagnosis
  5. American Diabetes Association
  6. Blood sugar chart
  7. The beta cell and first phase insulin secretion, Medscape
  8. Joslin Asian American Diabetes Initiative

* I do not necessarily endorse or believe all information contained in the references above.

More kitchen space by removing baseboard heat

We’ve been rehabbing our kitchen this year slowly*.  Some little things like painting the cabinet faces, changing out the hardware, remove wallpaper, new appliances! Ok maybe not so little things.  As these things things have been in progress, we come to realize what we really need is more space (and more money but that’s a different problem).

The more kitchen space thing really began when we got a fancy new refrigerator which we love and for which we installed a new water line. The new water line was required to move the refrigerator to a new location. There were two problems with the old location, (1) it was adjacent to the dishwasher which gets hot while refrigerator makes cold = energy waste + bad for refrigerator life, and (2) more counter space would be nice. The new location is along a wall with nothing on it, except a baseboard heater.  We can remove the baseboard heat and reclaim the entire wall, thus fixing both energy waste problem and kitchen space problem.

The space reclaimed by removing the baseboard heat effectively doubles the working space in our kitchen!!

Great, but the problem with removing the baseboard heat is that then there is no heat. In Hawaii this isn’t a problem. In New England, no heat is a BIG problem.

* Before diving into the answer to this heat problem, I must put in a plug here for myself :D.  The Mr. in  the “we” situation here, or shall I say Dr., has been at the start disagreeable to all of this.  The Me in our “we” has had to be quite crafty, in addition to leveraging my engineering training, to convince Mr. Dr. to do any of this.  First, why don’t we paint the cabinets it is cheap and not too hard?  Second, changing the hardware only needs a screwdriver surely we can do that.  Next, these appliances are on sale your mom will disapprove of the old ones and love the new ones.  Well, now we have this beautiful new fridge with all your beers we can’t put it next to the dishwasher!  But now it’s in front of the heaters!  Gah!

In our house, we have oil fuel and hydronic baseboard heat. We have an oil tank in the basement, and a boiler that burns the oil to heat water. The heated water is pumped through 3 loops, (1) into the adjacent hot water tank for our household running water, (2) in a loop of pipes that run along the baseboards to heat our first floor, and (3) in a loop of pipes that run along baseboards to heat our second floor. Baseboards are just the hot water pipes surrounded by metal fins that increase heated surface area in contact with air. The problem with baseboards is you can’t really put permanent furniture blocking them because they heat the back of the furniture rather than heating the room. Couches are ok to pull out a couple inches from the baseboards, but kitchen cabinets and refrigerators definitely can’t go in front of baseboards.

Whats to do? Convert the lost baseboard into a toekick heater says the internets. Rather than having a whole wall of hot pipe to heat the room, drop that pipe under the floor and bring just a little loop up into the kitchen to feed a little toekick heater. The toekick fits under just a single cabinet and heats the entire room. Toekicks heat the same room while taking up less space by adding an electric fan to actively blow warm air off the hot metal pipe & fins.

More internets later, there are a handful of toekick manufacturers**. We ended up  buying a Myson Whispa Kickspace III 7000EZ from Houseneeds.com.  Here were my shopping criteria:

  • We went with the Myson because internets says they have access panels that make servicing the unit later easy.  I figured this would be important since someday permanently installed cabinets would be on top of this little guy.
  • We bought from Houseneeds because they were shipping from Vermont, which isn’t too far from New Hampshire.
  • We got the 7000 model based on the length of baseboard we were replacing.  We were at the high end for the 5000 or low end for 7000 model, so we went with 7000.  One could also calculate BTUs needed for room size, but that seemed too difficult (there’s only three sizes of kickspace and our kitchen is not that big (which is why we need the toekick)).
  • We went for the EZ model because it comes with the hookup hoses.  It also says it has plugin electrical, although it isn’t clear from the web descriptions or the product manual whether the non-EZ models have plugin-type or hardwire electrical.

** I wish I could cite some internets sources here for completeness, but my records are quite crap and I can’t really say which forums were actually any good anyways because I am not an expert in this field so I recommend doing ones own research also.

I did call a plumber to get an idea of cost, and he quoted me $800 including the cost of the toekick unit.  We would have to use the toekick manufacturer he provided (don’t recall which), he would need access to run pipes below, and he didn’t do the electrical for the toekick fan which was hardwired.   I figured, since we didn’t exactly have access below (garage ceiling is sheetrocked) if we hired out the entire job we would need 3 professionals, (1) handyman to create access below, (2) plumber to do the heating system, (3) electrician to wire the toekick unit.  My guess is the total price to hire out would be easily over $1000.

Thinking we were so wonderful after doing the refrigerator line ourselves, we decided to do the toekick conversion ourselves.  This was an adventure and is not for the faint of heart.  I will write about this experience in another post…

My favorite iPhone browser iCab is back!!

My iCab layout
My iCab layout

The other day my favorite iPhone browser, iCab Mobile, was updated to version 8.5 and I couldn’t be happier. It has even occurred to me that it’s absence was contributing to my prior dislike for my new iPhone 6.

ICab is a super functional, no-frills workhorse. I can’t possibly talk about all its features, but here’s what I love the most.

Why I like iCab over Safari and everything else

My bottom menu
My bottom menu

ICab has ad blocking, including those annoying ads that underline word’s randomly in text and look like legitimate links. This feature is indispensable, can’t live without it.

Real file uploads on almost any website, with any file. Grab any kind of file, not just photos, from your Dropbox or PDF app or wherever. Use ‘open in iCab’ and then the file shows up in iCab’s ‘Downloads’ list. From there upload it on any website. Real life saver.  No other iOS browser I’ve tried has file uploads.  This feature alone makes the iPhone and iPad keep me from having to lug around my laptop all the time.

Super customizable UI, move any button anywhere and change menu entries for any menu. Choose your search engine, search suggestion engine, browser ID, practically everything. Also full screen. I do wish I could export and save my settings file for posterity. Or post settings to share because maybe I haven’t figured out the optimal configuration but somebody else has?

Continue reading “My favorite iPhone browser iCab is back!!”

My iPhone 6 takes all the doggy pictures

So I did originally feel at best ambivalent about my new iPhone 6. It was really hard to adjust to the bigger size. I still miss my iPhone 5 size.

Some new things have gotten better, and aren’t really unique to the iPhone 6. And some new things are iPhone 6 only and I don’t think I could go back now.

Before anything further, I have to say the new iOS 8 and maybe the iPhone 6 has bugs. Way more than I was used to and they are annoying. Mostly screen rotation gets stuck sideways and Bluetooth doesn’t work right or at all. I tried calibrating the compass to fix the screen rotation issues, not sure it helped but maybe.

Here is wot I LOVE:
– it is fast!
– camera takes great pictures, focuses fast
– 128 gb holds all the doggy pictures!
– TouchID is amazing
– TouchID with 1Password is amazing

I also kind of like seeing more on the bigger screen. But I hate holding the bigger screen so I won’t admit that one.

Now that my favorite apps are getting updated and maybe less buggy things are getting happier!

Here are the apps I’ve been using:
– iCab Mobile
– Fleksy keyboard
– 1Password
– ProCamera

And others that aren’t so terribly exciting to me today.

All in all, getting happier with my new phone. Let’s be honest, because it’s all about the doggy pictures :D.

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