September 9, 2019
[Email sent to Dr. Prabaharan on 9/3/19]I got a message from your office letting me know that I need to come to the lab for my 6-month A1C test. Which I will do.
I would like to know if you could order a TSH (or T3,T4) as I am having symptoms of what I think might be low thyroid. I sleep too much and I am gaining weight at a lb. a day for the last 10 days.
My next concern is the albumin/creatinine ratio (done 3/8/19) which was alarmingly (to me) high. I’m concerned that my meloxicam may be damaging my liver and/or kidneys.
I’d like to have a vitamin D test again to make sure I’m still taking the correct dosage.
Finally, can I ask for another c-peptide test? Same reason, to confirm my insulin levels. Does Kaiser ever do tests for fasting insulin?
I will await your response. Thank you for your help.
From Dr. Prabaharan, 9/4/19
Hi,
I have ordered the Laboratory tests. These are not usually done every 6 months.
But I have put the orders in for the tests.
Lab is open 7 AM to 7 PM on weekdays and 7 AM to 12 noon on the weekends. The order is already in your chart.
Sincerely,
Velummylum Prabaharan, MD FACP
Lab Tests, Blood Draw
September 9, 2019
This Monday was bright, cool, and sunny. And, because I had figured out that none of my blood tests had to be fasting, I made plans to go to the San Leandro Kaiser lab late morning or early afternoon. It turned out to be the latter.
The lab was amazingly empty for a Monday! Or so I thought. Maybe the worst of the Monday crowd had already come earlier in the day. Or maybe they had skipped Monday altogether. I barely had time to snap one picture before my number was called. The receptionist asked if I was prepared to give a urine sample. I am! This time, I am.
The phlebotomist was on her cell phone but ushered me to her station, as she continued her cell phone conversation. There was the quick sting of the butterfly needle piercing the big vein in my left inner elbow, and I watched at the red liquid spurted from my body into the glass vials. It was over it a matter of seconds, and she put a cotton ball over my wound entrance as she pulled the needle out then secured the cotton with tape. No instructions about leaving it on for 30 minutes as she continued her cell phone conversation. She wasn’t rude or neglectful, she worked carefully, but she just was not mindful.
So I ended with a trip to the restroom to deliver the rest of my fluid specimens to the lab for testing, and hoped that it would be a better test result than last time.
Test Results came back on 9/11/19:
| TEST | My Value | Normal Range |
| Hgb A1c % | 5.9 % | <=5.6 % |
| ESTIMATED AVERAGE GLUCOSE | 123 mg/dL | 85 – 126 mg/dL |
| TSH | 2.1 uIU/mL | 0.4 – 5.0 uIU/mL |
| Free T4 | 1.1 ng/dL | 0.8 – 1.7 ng/dL |
| T3, Total | 55 ng/dL | 50 – 170 ng/dL |
| C-peptide | 1.8 ng/mL | 0.5 – 6.3 ng/mL |
| VITAMIN D, 25-HYDROXY | 96 ng/mL | 20 – 79 ng/mL |
| Albumin/creatinine ratio,ur,qn | 22.3 ug/mg | 0.0 – 29.9 ug/mg |
| Protein, urine, qn | 13.2 mg/dL | mg/dL |
| Creatinine, urine | 92 mg/dL | mg/dL |
| Protein/creatinine, urine | 0.14 mg/mg | <=0.19 mg/mg |
XIAONAN XUAN MD
Received:09/11/2019
I am covering for VELUMMYLUM PRABAHARAN MD who is away from the office.
Your thyroid function is normal. Your average blood sugar has improved. Your vitamin D level is on the high side. I think we should cut down the dosage. Other lab results look good. Please keep up the good work.
Sincerely,
Nancy Xuan MD
RACHEL ORIBELLO WHITE RN
Received: 09/11/2019
My name is Rachel White, a Diabetes nurse working with Doctor Prabaharan.
Congratulations! Your diabetes A1C test is at your goal of 7%.
HGBA1C % 5.9 09/09/2019
Your diabetes is under control with your current medications. Continue working on eating appropriate carbohydrate portions and exercise regularly! Please e-mail or call 510-248-3998 if you notice any change in your blood sugar control or low blood sugars less than 70s. Thanks and take care!
Sincerely,
Rachel White, Diabetes Nurse
510-248-3998
MY REPLY to RACHEL ORIBELLO WHITE RN (since I couldn’t reply to Dr. Nancy Xuan MD)
Thank you for your message. I realize that I failed to discontinue vitamin D3 for 3 days before the blood draw (as I was told to do), so I’m wondering if the 92 is a false high and whether I should repeat the test. I’m currently taking 10,000 IU/day. I’ve read that vitamin D3 toxicity begins at levels of 60,000 IU/day.
What is your professional opinion? Should I repeat the test? Or should I just take 5,000 IU/day? And, if so, should I repeat the vitamin D test in 6 months?
I will await your response.
RACHEL ORIBELLO WHITE RN
Received:09/13/2019
Please follow up with Dr. Prabaharan regarding your question about vitamin D3 and the lab test.
I, however, had a question for you about your Diabetes medications. Are you still taking NPH insulin? If so, how many units and when do you take the insulin? Are you having any low blood sugars less than 70?
Sincerely,
Rachel O. White, MSN, RN, CDE
Certified Diabetes Educator
510-248-3998 Phone
My Response:
Okay, I’ll discuss vitamin D with Dr. Prabaharan at my annual physical (sometime this month).
Yes, I am still taking HumulinN. The frequency and dosage varies, based on my daily blood glucose numbers. I learned how to titrate the dosage many years ago when my previous PCP referred me to a PharmD to manage my insulin.
Individual doses range from 15u to 50u and I do not take it every day. Just whenever I need it to lower my BG to 100 mg/dL. Most often, this will be in the morning since I don’t want to risk going low overnight. However, I never have lows (below 70 mg/dL). I typically test my BG 3 times a day, as instructed.
The only diabetes medication that I take is berberine (500 mg twice a day), because metformin gives me “daily diarrhea.” Dr. Prabaharan knows this.
RACHEL ORIBELLO WHITE RN
Received:09/13/2019
Thank you for your response.
Would you be able to provide me with some blood sugars along with the amount of insulin and timing of the insulin (when insulin is given)? Please send me blood sugars in 1 week.
My concern is that your insulin dose is variable and given infrequently, which may lead to low blood sugars. I’m glad to hear that you’re not having any low blood sugars.
If you have any questions or concerns, please let me know. Thank you!
Sincerely,
Rachel O. White, MSN, RN, CDE
Certified Diabetes Educator
510-248-3998 Phone
