AIBU to want a third medical opinion?

[EmeraldScorn]

I've posted once before RE a health issue and I'm now wanting opinions on something related but I'll give you a condensed background first;

I'm early 30's, I've not had children yet and for the last number of months I have been "out of sorts".... Fatigue, severe bone pain (both hands/arms, left knee, left collarbone, chest area, upper back), wheezing (from my throat), a relentless cough, intense pain on the bone behind my left ear and a growing firm lump, tingling sensations etc. I've also been bleeding between periods mostly without pain and recently I've had a few nosebleeds and the top knuckle on my middle finger (left hand) has been swollen for 5-6 weeks and there is a hard lump growing under the skin on the palm side. I have broken blood vessels appearing all over my skin, upper arms, stomach, thighs etc and I had a number of tiny red blood dots on my chest and face but they have since cleared.

Anyway I'd been seeing my GP; Initially she diagnosed me as asthmatic (I don't agree), she put me on an inhaler and ordered blood tests. The tests mostly came back clear other than my white cell count, it was slightly higher than normal.

She put me on antibiotics which didn't help, so she then put me on a different antibiotic and a course of steroids. None of this helped! I was booked in to have a smear test (twice) both of which were cancelled by the nurse because she understandably couldn't do it when I was bleeding. (I am now bleeding from my bum too on and off).

My GP then tested for thyroid issues and for diabetes (I was tested for diabetes over a year ago as I have a family history and it was fine).... This time the results came back as "borderline" for an underactive thyroid and a "slight concern" with blood glucose so I was told to do a fasting blood test and that result came back as 7.4, I then had to do another fasting test which came back at 9.8 - I got frustrated with the GP never making eye contact with me when I was talking to her, she literally spent every consultation staring at her phone/computer so I went to a different doctor.

The new GP wanted to retest for diabetes but using a different test (HbA1c test), thyroid and a number of other things (This was quite recent). I also had a urine test. The GP phoned me on Thursday to say the HbA1c was "consistent with diabetes" and my thyroid is "definitely low, not borderline" but my urine sample didn't have glucose/ketones in it. We had a brief conversation and he asked me to book an appointment to come back to see him.

The thing is I'm not overweight and there's no sign of glucose etc in my urine but my doctor seemed on the phone to be leaning towards a type 2 diagnosis - Other than my grandmother and aunt having had diabetes I don't really have any of the other risk factors seemingly associated and they were type 1. I'm not ignorant or judgemental, I know that diabetes does not only affect people with weight issues.

Still I'm uncomfortable with the diagnosis and after hours spent researching on Google there's a lot of conflicting information; Granted most of my symptoms fit perfectly with both diabetes/thyroid problems but I can't find anything about bone pain being prevalent with either (and it's this pain that worries me the most).

I think my concern is that diabetes/thyroid is what has been latched onto because it's the most obvious given the blood results. Would I be unreasonable to ask the doctor to be referred for an MRI? He did look at the swelling on my hand and the lump behind my ear and said at the time he would wait for the blood results before deciding what course of action to take but I'm worried he will casually gloss over it now that it looks like I'm diabetic.

Would I be rude to ask him to do a third test to definitely be certain of a diabetic status? I don't want to be pushy but I can't stop thinking what if something is missed and I don't have "health anxiety" before someone kindly suggests it (Lol).

You could ask to check for antibodies and cpeptide to determine whether you are producing sufficient insulin.

It's not as straightforward as T1 / T2 , have you heard of LADA and MODY?

I would want further investigation if the lumps (which could be enlarged lymph nodes) and the high white cells. Have they screened you for blood abnormalities?

You have had 3 tests consistent with diabetes. I'd say you have diabetes.

Not to say you haven't something else going on too.

have you mentioned the bleeding from your back passage to your GP?

allowIisthinkalot No I've never heard of those (I will Google) and yes that's a good idea I could ask him to check for antibodies/cpeptide, thank you.

Veterinari I was "silently" concerned that they were enlarged lymph nodes. No my blood hasn't been screened for anything other than the obvious stuff, such as B12.

ChestyNut You're probably right!

MissAdaSmith No it took me ages to mention the bleeding between periods but I eventually did, I haven't mentioned the back passage bleeding yet because he's male and I'm a bit embarrassed - I will tell him about it though at my next appointment.

Thank you everyone, really appreciated - My boyfriend has spent the weekend mocking my concern, so actual helpful input even from strangers is valued.

Just to say please don't be embarrassed to tell the dr anything you need to, Op. they've heard it all before, a million times with bells on.

Good luck getting diagnosed.

Is it dark red and mixed with poo or bright red when you wipe?

Please don't be embarrassed the GP has these sort of conversations all the time and will have forgotten it straight away

I think you need to write a list of all your symptoms, especially the (hard) signs like bleeding and lumps and give it to your Dr. Its not clear what is going on but 2 endocrinology problems at the same time (thyroid and diabetes) might suggest an endocrinology opinion could be an idea. They are good generalists. plus Bleeding should never be ignored, please tell your Dr. That may be one separate pathway.
I think someone needs to have a think about whether everything is linked together or separate issues.

Have they checked you for Lupus?

An MRI of what?
You can always ask to see someone else but you do have a reasonable explanation for your symptoms.

Are your platelets ok? Some symptoms fit thrombocytopeania (sp?)

Applebite Thank you.

ChestyNut It's dark and sometimes looks clumpy.

Nimisha Thank you, a list isn't a bad idea, I'll do that for my next appointment.

Jalopy No I haven't been checked for Lupus, I don't think I even know what that is?

PlanetPluto I disagree to be honest, I don't think diabetes/thyroid is a "reasonable explanation" for unusual bleeding and bone pain but of course I'm not a doctor so I might very well be wrong.

Willyoujustbe I don't think my platelets have been checked (They may have been but I don't remember it being mentioned at any point) but I will ask the GP to see if they have been checked and if not ask for it to be done.

Thanks everyone.

i agree with Jalopy. You should get tested for SLE (Lupus).

My husbands family have a lot of hypothyroidism. The range of symptoms my FIL, BIL and GMIL experienced was really wide, and often really random! I know it can affect fertility so the bleeding between periods could be related.

Op, what was your hba1c? Do you know?

The thing is, diabetes when uncontrolled can make you feel awful. Swelling is quite common I think? Well, not unheard of. And having been type 1 for 25 years, I have definitely had bone pain at some time or another. A friend of mine is having massive bone issues and is diabetic. The dr has said it's a diabetic complication. Also, uncontrolled diabetes can definitely cause your lymph nodes to be up due to infection usually. But I would have thought the antibiotics would have helped. I have had cysts appear when my sugars are high over a prolonged period of time. These are often very painful.

I think though it sounds like two separate issues. You must be honest with your GP. Out of all your symptoms, the rectal bleeding is the most concerning and is the one you have not disclosed.

go back to your gp

Marmalady Thanks, I will suggest it to the doctor.

PlanetPluto That's quite interesting, I'd never have thought it could cause such widespread symptoms, thanks for sharing that information.

User Sorry I should have said what my HbA1c result was, it was 9.4. No the antibiotics really were a waste of time because I felt no better (Amoxicillin first and then Doxycycline). Is it normal for someone who is diabetic not to have glucose in their urine? I would have thought that if a person was diabetic then they would definitely have it but I don't. You've raised some very good points (thanks) and yes I will speak to the doctor about the bleeding.

Thank you!

9.4!!!! You are definitely diabetic. I'm sorry, but that is really high and would make you feel horrendous. I don't think mine has been that high in 20 years and I have had awful control at times.

You really need some treatment. You need the c-peptide test if you want to know if it's type 1 (slow onset) or 2.

With re to the sugar in urine. It depends. You say your fasting was 7.4 when you saw the gp. So, there would be unlikely to be sugar in your urine. You're not high constantly, so sugar wouldn't be always in your urine. Whenever I was tested in pregnancy, I never showed up as having sugar in my urine. But I promise you I was diabetic! Just that my blood sugar wasn't high at that moment. If the urine tests are when you haven't eaten, so have been 'fasting', there would be no sugar.

You can have diabetes and still have a random urine sample that is clear of glucose. Glucose only spills in to the urine when your blood sugar level is above the "renal threshold". The "average" value is 10mmol/l. If you blood sugar had been less than this in the hours before you produced the sample, your urine would be negative for glucose. An HbA1c of 9.4 represents significantly raised average blood sugar levels and it seems unlikely that you don't have diabetes. Bear in mind that steroids impair glucose tolerance so the course of steroids you mention may have pushed you over from being borderline. How long were you on the steroids, and at what dose?

I think you need to start with treating the obvious. You have two diagnoses which are both things that can cause an enormous range of symptoms. Get those things back in balance first and see what happens with the other symptoms. There may be other things going on, but you need to start addressing the known issues in order to help get a better picture, if that makes sense.

BUT - you do need to mention the bleeding from your back passage. Your GP definitely can't get to the bottom of what is going on without knowing every symptom.

You are diabetic. You will prob feel a lot better when that is treated. You can reassess symptoms after that.

Can you say why you don't agree you have asthma? Wheezing, slightly high white count, sounds a lot like asthma.

Have you told the GP about your inter-menstrual bleeding? Or just book a smear? The investigation for someone who has symptoms is NOT a smear. Smears are only for people who have no symptoms to diagnose changes that may turn into cervical cancer in the future. They are not for women who already have a symptom.

And please tell your GP about the rectal bleeding. He can't help you if you don't reveal all the information.

Dark blood in stools implies bleeding somewhere in the small/large intestine (as it has had time to clot and oxidise. It is a serious red flag and needs following up, even if it turns out to be nothing. If I have lots of symptoms sometimes I write them down and give doc a list so I can't forget anything. Agree with chestynut that you likely have diabetes but you may not only have diabetes.

Another one thinking sle/lupus!
Get your vitamin d checked too..could explain the bone pain too!

When you see your GP you really should book a double appointment, or two different appointments. It sounds as if you have several problems to discuss (the diabetes, thyroid, rectal bleeding and intermenstrual bleeding) and it will not be possible to deal with all those safely, or with any satisfaction for you in one appointment. Why don't you see the male gp to discuss the blood test results and book in with a female gp if you're more comfortable to discuss the other two problems?

I hope you get the answers you want. Please update us when you do.

OP doesn't particularly have the classic signs of lupus. She clearly isn't well. I don't know much about diabetes or thyroid disease. Is there a more experienced GP in your practice?

User109, 9.4 isn't ridiculously high for a type1?
I am also type 1, yes it's out of range but it can easily hit that within 2 hrs of eating before coming back down again.
If you were type 1 OP your blood glucose would be in the 20's without insulin, and it's a very sudden onset where yous become very ill very quickly.

Wicks - the 9.4 was a HbA1c Not random glucose. Also may. It be type 1. Impossible to tell how many of your symptoms are down to the diabetes and thyroid, best bet is to get both under control and see what remains. In the meantime though do have a candid discussion with GP about the bleeding. Rectal and vaginal bleeding should both be investigated and a proper history taken.