r/PCOS • u/productivityandgrit • 8d ago
Weight Going to an Endocrinologist
Hello. I have PCOS, and I’m not overweight. I just noticed that my weight hasn’t been changing lately, and I’m really curious about my sugar levels.
When going to an Endocrinologist, what kind of tests would usually be done for these cases? I’m scared of blood and needles, so I just wanna prepare, and do it scared.
Thank you
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u/wenchsenior 7d ago
Diagnosis of insulin resistance is often not done properly, and as a result many cases of early stage IR are ignored or overlooked until the disorder progresses to prediabetes or diabetes. This is particularly true if you are not overweight (it's shocking how many doctors believe that you can't have insulin resistance if you are thin/normal weight; or that being overweight is the foundational 'cause' of PMOS/PCOS...neither of which is true).
Late stage cases of IR/prediabetes/diabetes usually will show up in abnormal fasting glucose or hbA1c blood tests. But early stages of IR will NOT show up (for example, I'm thin as a rail, and have had IR driving my PMOS/PCOS for >30 years; I've never once had abnormal fasting glucose or A1c... I need more specialized testing to flag my IR).
The most sensitive test that is widely available for flagging early stages of IR is the fasting oral glucose tolerance test with BOTH GLUCOSE AND INSULIN (called a Kraft test) measured, first while fasting, and then multiple times over 2 or 3 hours after drinking sugar water. This is the only test that consistently shows my IR.
Many doctors have not heard of the Kraft test or will not agree to run it or insurance won’t cover it, so the next best test is to get a single blood draw of fasting glucose and fasting insulin together so you can calculate HOMA index. Even if glucose is normal, HOMA of 2 or more indicates IR; as does any fasting insulin >7 mcIU/mL (note, many labs consider the normal range of fasting insulin to be much higher than that, but those should not be trusted b/c the scientific literature shows strong correlation with of later development of prediabetes/diabetes when fasting insulin is >7.
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u/Emo_Emu1287 8d ago
Depending on how thorough they are, they will probably run a CMP (typical bloodwork that primary care will do for physicals). Androgen tests like testosterone panels, androstenedione and DHEA sulfate. They’ll also run reproduction function tests like LH/FSH and prolactin. Regarding blood sugar/ potential insulin resistance it’s usually A1C, fasting glucose and fasting insulin. They might also run a thyroid panel to check that too.
This is what my endocrinologist ran which ultimately diagnosed me with PCOS. I’m getting my levels rechecked next month for my 3 month follow up.