Why is My Blood Sugar So High?

Pharma / TRT Testosterone Replacement
1

I started TRT in early August 2016 after lurking here for a while and absorbing the stickies. I did the temp test for Thyroid before starting (and was low) and did a course of Iodoral which brought it up to spec during the first couple of weeks of my TRT.

60 years old
5’10 185lbs, 25% bf

current blood work:

CBC With Differential/Platelet
WBC 4.9 3.4-10.8 x10E3/uL
RBC 4.89 4.14-5.80 x10E6/uL
Hemoglobin 15.3 12.6-17.7 g/dL
Hematocrit 46.6 37.5-51.0 %
MCV 95 79-97 fL
MCH 31.3 26.6-33.0 pg
MCHC 32.8 31.5-35.7 g/dL
RDW 14.0 12.3-15.4 %
Platelets 189 150-379 x10E3/uL
Neutrophils 48
Lymphs 40
Monocytes 10
Eos 2
Basos 0
Neutrophils (Absolute) 2.3 1.4-7.0 x10E3/uL
Lymphs (Absolute) 2.0 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL
Comp. Metabolic Panel (14)
Glucose, Serum 113 HIGH 65-99 mg/dL
BUN 21 8-27 mg/dL
Creatinine, Serum 1.09 0.76-1.27 mg/dL
eGFR If NonAfricn Am 73 >59 mL/min/1.73
eGFR If Africn Am 85 >59 mL/min/1.73
BUN/Creatinine Ratio 19 10-22
Sodium, Serum 137 136-144 mmol/L
Potassium, Serum 4.2 3.5-5.2 mmol/L
Chloride, Serum 99 97-106 mmol/L
Carbon Dioxide, Total 23 18-29 mmol/L
Calcium, Serum 9.2 8.6-10.2 mg/dL
Protein, Total, Serum 6.7 6.0-8.5 g/dL
Albumin, Serum 4.5 3.6-4.8 g/dL
Globulin, Total 2.2 1.5-4.5 g/dL
A/G Ratio 2.0 1.1-2.5
Bilirubin, Total 1.3 HIGH 0.0-1.2 mg/dL
Alkaline Phosphatase, S 63
AST (SGOT) 22
ALT (SGPT) 19

Testosterone, Total, LC/MS 1117 348 - 1197 ng/dL
Free Testosterone (Direct) 19.2 7.2 - 24.0 pg/mL
Estradiol (Roche ECLIA) 7.0 7.6-42.6

The first two months went pretty much as expected. I started out at 200mg Test-Cyp per week split into two shots. I also take 500iu HCG with each shot and 0.5mg of Anastrozole.

I don’t think the doc is keeping close enough eye on things so I’ve been doing my own private labs every 30 days.

First set of private labs after a month showed me >1500 so I backed off to 140mg per week where I am now. Still the same HCG and Anastrozole. On my first private lab at one month my estradiol was about 25 and a month later was 27. This last set it crashed to 7. I have some of the classic low E2 symptoms (feel flat, slight depression, cranky, brain fog, etc) but I know how to fix that by titrating the Anastrozole.

The problem that concerns me is that my blood sugar (which I’ve never had any problem with) is now crazy. In the next lab (above) it is 113, so I started checking my fasting blood sugar in the mornings. It is consistently over 120. This morning it was 135! Can the low E2 cause this?

My diet is fairly slow carb, nothing that should cause crazy fluctuations. I used to be nearly keto, but eased up after starting the TRT. The first two months I gained about 6lbs of muscle (according to BIA, which I know, is only a rough guess) and lost about 10lbs of fat. I’ve been in a slight calorie deficit lately to lose some more fat and it looks like a little of the muscle may have come off with its but losing weight is much easier than before the TRT.

I work out lifting three times a week until recently (minor injury that I’m trying to recover) and I swim on days that I don’t lift.

Thanks to this forum (and KSMan’s excellent advice) I think I’ve avoided a lot of time wasting and I caught this early…

2

Do not see what would drive up fasting glucose.
Metformin is cheap, effective and generally good for everyone.

How long on TRT?

If E2=11 and goal is 22pg/ml, cutting anastrozole dose by 11/22 will get you there. I think that you know that. You appear to be an anastrozole over-responders. Change anastrozole in proportion to T dose changes too, you can stack both corrections.

Weight loss and metabolic balance discussion hangs on thyroid.
Any thyroid labs?
Oral body temperatures?
Outer eyebrows sparse?
Have always used iodized salt?

This is one of the most intelligent opening posts!

RBC seems a bit low for a TRT guy. HTC just slightly so.

Labs:
TSH
fT3
fT4
PSA OK?
had a recent DRE?

Try whey protein shakes when you are hungry and that will satisfy and help keep diet clean and avoid carb snacking.

Muscles and strength can build up a lot faster than avascular connective tissues. So you need to take things slower to avoid injury while connective tissue takes months or years to get strong.

3

Thanks for the comments KSman. I’m an engineer, so I would like to keep a tight closed loop on this stuff.

I’ve heard Metformin is probably good for everyone to take, and I may look into it, but I’m not there yet. I did see some stuff online that implied that estradiol is involved in insulin metabolism, but couldn’t find much specific about how it is involved. My doc didn’t seem to think an E2 of 7 was something to be concerned about. Doctors, amirite?

I started TRT around the first of August, so I’ve been on for three months now. Like I said, the first two were progressing nicely, then the last month went off the rails. I’ll try taking 1/3 of my Anastrozole and see where that puts my E2. I think I’ll skip a dose as well to kick start the new level. I guess I’ll need to try out your vodka titration method to get this right. That sounds like an outstanding way to get your AI…

I didn’t do any thyroid labs other than TSH, which initially was about 2.1 (a little high) but I already knew my temps were off at that point and I was already on the IR train. I haven’t repeated the temp log since then though, so I’ll do that for the next few days and see if they are still ok. I should be getting enough iodine and selenium from my multi and I take a 6.5mg bolus each week as well for maintenance.

PSA was 2.1 on my first lab, which is a bit higher than my usual 1.4 or so, but I’ve heard it can be stimulated by recent activity (henh!) and the DRE from a few months before was negative.

I really don’t think this is a diet thing. I eat fairly clean with no sugar and almost all low glycemic carbs and tend to go heavier on fat and protein. Also, I don’t see much of a postprandial spike when I’ve checked. BC just seems to stay in the 120-140 range all the time.

I definitely hear you about the connective tissue. I had been stuck at a 140 bench for several weeks when I started TRT and as soon as I started it went up 5ibs a week 6 weeks in a row. I felt a little twinge so I backed off and decided to go for higher reps until the ligaments catch up.

4

You can also test A1C at some point.

With TRT, E2 as suggested and good thyroid function, you should be able to loose fat.

MaSC Mech Eng here

5

I think this was a case of some bad test strips. I went and had A1C tested and it came back at 5.6 which is within normal range. Also glucose was at 100 which was a little borderline, but far from the labels I was seeing on the meter.