I had quite possibly the worst doctor’s appointment this past week. I was so excited to see my A1C after all the hard work I put in these past few months. Good news, it was down (6.1%, my lowest ever), but I expected a bit lower. I have some figuring out to do.
But onto the real point of this post. First of all, a bit of back story. My internist is new to me (definitely not the trade). On my first appointment I felt rushed. He did not look at or take my file I offered him. I was disappointed, but thought I’d give it one last chance. So this appointment was the last chance. It did not go well. During my appointment I asked how my blood work was and he said he was pleased. There it was, I was judged by one number – my A1C. I asked the admin for a copy of my labs as I always do, and what I saw shocked me! I had some very scary results:
- Two high LFT’s
- Significant hypothroidism
So…A1C aside I was mortally terrified. I was also gobsmacked that he didn’t mention any of this to me. I managed to stop him before he went to another appointment and I got some handwaving about how the eGFR was fine so he wasn’t worried, and that he did not know my previous microalbumuria numbers, so he said it may not even be new (it isn’t, I’ve always had undetected levels). He still didn’t want to follow up in less than 6 months. So I went home and spent a few hours freaking out that my kidney’s were failing, etc etc. You know, usual diabetes complication panic.
Then rational set in and I spent time googling and comparing old labs and new. Then I got thinking – what’s different, why is my labwork so different. Then it dawned on me – I had a home blood draw and ran a vigorous 10k 30 minutes before the draw (including a 1 km uphill finish). Surely that can’t cause problems, can it?
Yes, it can!
It turns out liver function tests can be impacted by vigorous exercise. Furthermore, TSH (and my hypothroid result) could also have been impacted by aerobic exercise. Finally, a short burst of maximal exercise can create urine albumin: creatine ratios above the microalbuminuria threshold. Now, if only my internist A) had pointed out these crazy results B) had kept a copy of my file to know this isn’t normal and C) ask me about my lifestyle to see if these were false positives. I was frustrated, but I learned something – schedule blood draws during rest days, or even better – the morning after a rest day! Some of these numbers can stay elevated 24-48 hours post exercise. At least I learned that.
Now to find a new internist.