# Hypoglycaemia?



## alp1950 (5 Oct 2008)

Interesting observation today. Newbie to road cycling and I've been building my distances over the last month. This week I've have ridden a total of 150 miles. Today, two thirds of the way through a 30 mile run which included a substantial climb I was aware of a mild sensation of disorientation. Difficult to describe, legs felt fine (ie no significant drop off in power) but slightly lightheaded so didn't feel quite so mentally sharp and perhaps a minor feeling of loss of coordination. 

Stopped off to buy some (actually quite a lot ) of sweets and the symptoms settled. Since returning home I've had the munchies & have been stuffing my face. I suspect I was mildly hypoglycaemic & wondered whether this is a well recognised phenomenon in cycling?


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## Fab Foodie (6 Oct 2008)

Yep, it's well recognised, we call it the 'bonk' or 'bonking'. It's the point when you have pretty much exhausted your body's store of glycogen. Hence the craving for sugar... or the 'munchies' as it's known to replenish the lost glycogen.
The further and faster you ride, the more attention you need to spend on fuelling your body. The body can burn both fat and sugar, at lower to moderate intensities more fat is utilised in the fuel mix, at higher intensities the body switches to almost all glycogen. Make sure you have a good carb meal the night before the ride, a good breakfast and then keep nibbling as you ride. I can just about much manage 40 miles at a reasonable on just water when properly fuelled but will have a real crash If I dont get food on board pretty quickly... then I'll eat a whole candy store!

Either use an energy drink or keep nibbling something sweet from the off, jelly babies are good! Malt-loaf and Flap jacks are good slow-release enrgy foods favoured by cyclists. You'll soon find what works for you.


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## Twenty Inch (6 Oct 2008)

And don't drink too much coffee. The caffeine stimulates the pancreas, which produces more insulin, which removes blood sugar quicker, which leads to the bonk.


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## yello (6 Oct 2008)

You know, I don't think I've ever bonked. I say I don't think I have because I have felt pretty spent on occasions but nothing like the descriptions I've read of full on bonk. 

I've done rides up to 250km, put in some pretty hard rides - by my standards - too (100km with 1200m climbing in a little over 4 hours, for instance) and I can't honestly say that I follow the rules to the letter for re-fuelling etc either. I have ridden 100's on nothing more than porridge for breakfast and 750ml of water.

So I reckon peoples' different body chemistries have a huge part to play in this too.


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## domtyler (6 Oct 2008)

I have bonked quite a few times, normally my own fault for doing fifty milers on half a bottle of water and no breakfast! 

Last time it happened I was just passing a pub!  Four pints of beer and large plate of sausage and mash sorted the problem  but the ride home was still a struggle after that and didn't fee right again for three or four days.

Fortunately it is less likely to happen as you get fitter and more used to cycling long distances but, as above, it is possible for anyone to suffer if you do not take adequate measures to keep your blood sugar up.


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## alp1950 (6 Oct 2008)

Twenty Inch said:


> And don't drink too much coffee. The caffeine stimulates the pancreas, which produces more insulin, which removes blood sugar quicker, which leads to the bonk.



Touche.


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## Fab Foodie (6 Oct 2008)

domtyler said:


> Fortunately it is less likely to happen as you get fitter and more used to cycling long distances but, as above, it is possible for anyone to suffer if you do not take adequate measures to keep your blood sugar up.



This is very true. You'll learn to listen to your body's needs and also your body will become better conditioned to this kind of effort. A further good tipis a pint of milkshake as soon you get homew, best recovery product for almost no money, Nesquick and milk, fab.


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## Abitrary (7 Oct 2008)

alp1950 said:


> Difficult to describe, legs felt fine (ie no significant drop off in power) but slightly lightheaded so didn't feel quite so mentally sharp and perhaps a minor feeling of loss of coordination.



I had a similar burnout whilst touring, doing about 60 miles a day, but my head / coordination was fine, but my legs just went, and it took me about 3 hours to get 10 miles to a hotel.... I just couldn't move them.

I reckon that is more in line with what the 'bonk' is perceived to be, and if I'm honest you should get yourself checked for diabetes. Are you overweight?


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## Bodhbh (7 Oct 2008)

Abitrary said:


> my head / coordination was fine, but my legs just went.... I just couldn't move them.
> 
> I reckon that is more in line with what the 'bonk' is perceived to be, and if I'm honest you should get yourself checked for diabetes. Are you overweight?


General have what I've been assuming is the 'bonk' after about 60 miles, sometimes more than once on long runs if not shovelling down enough. Like Alp, for me the most notable thing is going very lightheaded, although generally physically tired too, it's the lightheadeness that makes me stop as it doesn't feel so clever to be riding like this in traffic when my attention to the road starts getting very slapdash.


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## LLB (7 Oct 2008)

Being Diabetic, I know a little bit about this. Nesquick works well because it is made from Glucose - the body doesn't have to convert it from other sugars found in foods like Sucrose, Lactose or Fructose.

Many Diabetics (and people working out very hard) get into trouble when they drink heavily as the alcohol suppresses the Liver function where the Glucose is stored as Glycogen. What this means is that they have a big night on the razzle and in the night their BG (blood Glucose) levels drop without the reserve capacity which the liver provides, and in their sleep they lapse into a diabetic coma (Hypoglycaemia).

Something similar could happen to a healthy person if they hit the bottle hard and did a 50 miler on their bike.

Flapjacks work very well for endurance because they provide an instant sugar hit with the syrup to get you going, and then provide the slow release carbs through the oats.

I have to keep a fairly close eye on the BG levels when cycling as I don't have the same ability to regulate as I should do, and feel the comparative drop in BG levels as I run highrer that a non diabetic without actually going into hypo (false hypo). I can also run very high BG levels and feel very tired as well as a lack of insulin doesn't allow the cells to take up the Glucose in the blood.


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## peanut (7 Oct 2008)

domtyler said:


> Last time it happened I was just passing a pub!  Four pints of beer and large plate of sausage and mash sorted the problem  but the ride home was still a struggle after that and didn't fee right again for three or four days.



thats the feeblest excuse i've seen yet for scoffing sausage & mash and quaffing 4x pints 
Hope it was real ale and home made sausages


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## domtyler (7 Oct 2008)

peanut said:


> thats the feeblest excuse i've seen yet for scoffing sausage & mash and quaffing 4x pints
> Hope it was real ale and home made sausages



It sure was!  Those first two pints were the quickest I have ever drunk beer in my life! Didn't even touch the sides. I could barely muster the strength to push my bike over to the pub and make it to the bar I felt so weak, I was almost grabbing the glass out of the barmaids hand before she had even finished pulling it! 

Seriously, bonking is a pretty unpleasant experience, I was really lucky to have been where I was because it was really in the middle of nowhere, and a very hilly nowhere at that.


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## peanut (7 Oct 2008)

domtyler said:


> Seriously, bonking is a pretty unpleasant experience, .



its all in the technique lol


I occasionally get the shakes and wobbly legs in the mornings. I feel faint and very anxious ....weird!
I have to stuff loads of sugary stuff in my face pronto and its half an hour before I stop shaking and feel normal again.


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## domtyler (7 Oct 2008)

peanut said:


> its all in the technique lol
> 
> 
> I occasionally get the shakes and wobbly legs in the mornings. I feel faint and very anxious ....weird!
> I have to stuff loads of sugary stuff in my face pronto and its half an hour before I stop shaking and feel normal again.



Tut!  There's always one who has to drag the conversation down to the level of the gutter isn't there?


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## LLB (7 Oct 2008)

peanut said:


> its all in the technique lol
> 
> 
> I occasionally get the shakes and wobbly legs in the mornings. I feel faint and very anxious ....weird!
> I have to stuff loads of sugary stuff in my face pronto and its half an hour before I stop shaking and feel normal again.



Pre or post ride ?


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## peanut (7 Oct 2008)

LLB said:


> Pre or post ride ?



neither really ,it just happens very occasionally out of the blue around 10-11am in the mornings and I always eat a cereal bfast


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## LLB (7 Oct 2008)

peanut said:


> neither really ,it just happens very occasionally out of the blue around 10-11am in the mornings and I always eat a cereal bfast



It may be worth you popping along to your GP to get checked over.


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## peanut (7 Oct 2008)

LLB said:


> It may be worth you popping along to your GP to get checked over.



thanks LLB . I have already but he was not the slightest bit interested. 

Had to request a referral to a different quack just to get a blood test. They found my liver isn't working properly apparently but despite having a scan have never heard back from quacks. bluddy opeless they are.

I reckon as long as you can walk in to the surgery they reckon you must be ok!


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## peanut (7 Oct 2008)

domtyler said:


> Tut!  There's always one who has to drag the conversation down to the level of the gutter isn't there?



start in the gutter and work up  that way you're never disapointed


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## LLB (7 Oct 2008)

peanut said:


> thanks LLB . I have already but he was not the slightest bit interested.
> 
> Had to request a referral to a different quack just to get a blood test. They found my liver isn't working properly apparently but despite having a scan have never heard back from quacks. bluddy opeless they are.
> 
> I reckon as long as you can walk in to the surgery they reckon you must be ok!



I self diagnosed my diabetes after going hypo on a lazy sunday morning then having to get a wriggle on as I had to get round my parents.

It took 3 months of tests before they confirmed the diagnosis.

I'd be looking at a glucose tolerance test in your position as this gives the definitive answer but this has to be requested and done at the hospital.

In the mean time, stay off the sweets if you can and eat slow release carbs like brown bread, pasta cereals etc etc, cut out processed sugars in your drinks (coke zero is ok)

And if you do have a problem you will feel much better in yourself for it in the mean time.


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## peanut (7 Oct 2008)

LLB said:
 

> I self diagnosed my diabetes after going hypo on a lazy sunday morning then having to get a wriggle on as I had to get round my parents.
> 
> It took 3 months of tests before they confirmed the diagnosis.
> 
> ...



thank you for your concern and good advice.

I will need to change surgery and GP again which I have been putting off.
I have had several comprehensive blood tests earlier this year which apparently revealed Liver problems and Hepatitus . .When I requested a print out of my bloods 2x batches of results mysteriously went missing !

Two of my Uncles have died of diabetes so I suppose it is a risk to me but so far they have not found any evidence of a significant problem.
I'll have to make the effort to go back on thyroxin I guess.

How are you coping with diabetes ?


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## LLB (7 Oct 2008)

peanut said:


> thank you for your concern and good advice.
> 
> I will need to change surgery and GP again which I have been putting off.
> I have had several comprehensive blood tests earlier this year which apparently revealed Liver problems and Hepatitus . .When I requested a print out of my bloods 2x batches of results mysteriously went missing !
> ...



I'm coping fairly well with it ATM and my yearly checkup measured me right in the healthy zone  . There have been times when it has just knocked the stuffing out of me though (low insulin levels make you very lethargic as your body can't absorb the glucose).

There is a genetic link on my part as my father, uncle and brother all have problems with it. One of my sisters has Hyperthyroidism as well, and there is a defined link between the diseases.

Many people trundle along for years with the symptoms and when your BG levels are high, you feel fine, but this is where the risks to heart attacks, strokes, eye problems etc etc (it is the lows which make you feel shyte)

The problem with GPs is that many are a jack of all trades and master of none.

There should be a Diabetic specialist in your surgery who you need to see, otherwise, move to one which has one. Mine is very good, but I had to move last year as the last place was a bit of a joke and very slapdash with the healthcare


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## peanut (7 Oct 2008)

interesting you should mention the eye link. My vision as gone from 20/20 to 3.5+ in just 3 years and my eyes frequently feel dry and itchy and very light sensitive usually at the same time as I get a urinary tract infection.I'm so exhausted all the time that I frequently sleep for 9-12 hours and have started to fall asleep at work 

I'll take your advice and see if I can find a good GP 

sorry to hyjack this thread for my health care problems


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## LLB (7 Oct 2008)

peanut said:


> interesting you should mention the eye link. My vision as gone from 20/20 to 3.5+ in just 3 years and my eyes frequently feel dry and itchy and very light sensitive usually at the same time as I get a urinary tract infection.I'm so exhausted all the time that I frequently sleep for 9-12 hours and have started to fall asleep at work
> 
> I'll take your advice and see if I can find a good GP
> 
> sorry to hyjack this thread for my health care problems



No problem , Until they come back with some result to give you answers one way or the other, keep chasing them.

Signs of uncontrolled diabetes are wanting to go to the loo regularly (body trying to get rid of the glucose through the kidneys), Thirstyness (sp),blurred vision & tiredness but this could also come from the thyroid problem.

Good luck.


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## Jonathan M (12 Oct 2008)

peanut said:


> thank you for your concern and good advice.
> 
> I will need to change surgery and GP again which I have been putting off.
> I have had several comprehensive blood tests earlier this year which apparently revealed Liver problems and Hepatitus . .When I requested a print out of my bloods 2x batches of results mysteriously went missing !
> ...



all the symptoms that you describe can be attributed to thyroid disease, you make reference to making an effort to go back onto thyroxine, so surely concordance with that treatment would be the first step, and then once the doses have been titrated to your TFT results if your symptoms show no improvement further investigations would be indicated.

Regarding diabetic eye disease (diabetic retinopathy) the initial stages don't alter visual accuity, the damage is occuring to the blood supply to the retina. This is why people with diabetes undergo an annual retinal screening using digital imaging, as by the time retinopathy effects vision it is usually far advanced. But uncontrolled hypothyroidism can cause visual disturbances.

The link between diabetes & hypothyroidism is pretty much proven in type 1 diabetes, as they are both autoimmune conditions. Other autoimmune conditions associated with T1DM are coeliac & addisons (adrenal insufficiency). 

Type 2 diabetes is much more of a metabolic condition, with lots of precursors such as abnomal lipids, etc, and in general diabetes overall is treated as a metabolic disorder nowadays, so it isn't viewed as just an endocrine, glucose metabolism problem, but a multi system condition requiring treatment and preventative actions.

Diabetes itself doesn't kill, but the complications of the condition (both acute & chronic) are what cause the long term health problems and ultimately premature death. There is still much that needs to be researched with respect to diabetes & its prevention & management, but the last 20 years have seen significant advances in treatment, tighter diagnostic criteria, and better screening for long term complications for people with diabetes.

If you want to read more about signs & symptoms then go to www.diabetes.org.uk


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## peanut (12 Oct 2008)

thank you Jonathan for your very helpful advice.My current practice made it so difficult to get repeat prescriptions every month that you would think I was on heroin not thyroxin . 
With a former daily commute to work of 3 hours I could never get home in time to get to the surgery before they shut at 5.30pm!

My GP is such an ignorant unhelpful *%$#* and I had to jump through hoops and consult another GP to get a referral for an MRI scan recently.

I'll make another appointment with a different GP and restart the thyroxin treatment. Can't go on like this . I slept 11 hours last night and woke feeling exhausted this morning, Can't concentrate on anything, forgetful, and very depressed. 
Really appreciate your kind advice thanks


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## Jonathan M (12 Oct 2008)

peanut said:


> thank you Jonathan for your very helpful advice.My current practice made it so difficult to get repeat prescriptions every month that you would think I was on heroin not thyroxin .
> With a former daily commute to work of 3 hours I could never get home in time to get to the surgery before they shut at 5.30pm!
> 
> My GP is such an ignorant unhelpful *%$#* and I had to jump through hoops and consult another GP to get a referral for an MRI scan recently.
> ...



For a long term condition they should really be more accomodating, and so long sa your thyroxine dose is stable they should be willing to issue prescriptions for longer periods of time if it improves your ability to take the medication.


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## LLB (12 Oct 2008)

Jonathan M said:


> all the symptoms that you describe can be attributed to thyroid disease, you make reference to making an effort to go back onto thyroxine, so surely concordance with that treatment would be the first step, and then once the doses have been titrated to your TFT results if your symptoms show no improvement further investigations would be indicated.
> 
> Regarding diabetic eye disease (diabetic retinopathy) the initial stages don't alter visual accuity, the damage is occuring to the blood supply to the retina. This is why people with diabetes undergo an annual retinal screening using digital imaging, as by the time retinopathy effects vision it is usually far advanced. But uncontrolled hypothyroidism can cause visual disturbances.
> 
> ...




You sound like a doctor (or someone who takes a keen interest in the condition). All looks like good sound advice. I know little about the effects of Hyperthyroidism, so I wouldn't want to comment on any.

However, the effects of 'Hyperglycaemia' and blurred vision are well documented, and often reported on in the diabetes.org.uk forum you referred too (I'm a member there also)
The problem with this condition is lack of control. The body never wants to stay in the healthy zone, and it is much easier to stay high and risk the problems than it is to try and balance around the 4.0 to 7.0 mark.

I attended a DESMOND course last year, and one of the people who also turned up (old chap about 80+) stated his Blood sugars were around the 27.0 mark (and he felt fine with it  )


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## Jonathan M (13 Oct 2008)

LLB said:


> However, the effects of 'Hyperglycaemia' and blurred vision are well documented, and often reported on in the diabetes.org.uk forum you referred too (I'm a member there also)



Indeed they are, but itchy, gritty eyes as peanut describes are certainly a recognised symptom of hypothyroidism, whereas I'm unaware of this sensation occuring due to hyperglycaemia.

While Peanut certainly does describe symptoms that could be attributed to undiagnosed diabetes, they can also be signs of uncontrolled hypothyroidism, and as Peanut has a supply problem with thyroxine, then that certainly needs addressing first & foremost. The four textbook signs & symptoms of diabetes are thirst, excessive urine production, weight loss, lethargy. It's extremely easy to rule out, a fasting glucose would do the job, if this isn't conclusive then maybe an OGTT, but Peanut needs to find a way of encouraging his GP to meet his current needs.


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## peanut (13 Oct 2008)

Thank you for spending some time to think about my symptoms and offer some advice . I really appreciate it. My GP has been so non-commital that I have been left to get on ith it for over a year now.

I have been convinced that I was suffering from some sort of chronic virus for several years now.Periodically I get a UTI which lasts for a couple of months at a time .
It starts with itchy ,light sensitive eyes then frequent urination and very smelly urine followed by extreme exhaustion and difficulty concentrating.

. My Chiropracter suggested Reiters syndrome which seems to have all the right symptoms.When I mentioned this to my GP he looked straight through me like I was talking a foreign language

If I could afford it I would go for a private consultation at Bupa etc 

I will contact the surgery tomorrow and request an appointment with a different GP They will probably think I'm making a fuss over nothing but at least I'll get to start a thyroxin treatment again. It should help my immune system and give me back some energy.
Thanks for your support its given me some motivation to do something about my poor health


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## LLB (13 Oct 2008)

Jonathan M said:


> Indeed they are, but itchy, gritty eyes as peanut describes are certainly a recognised symptom of hypothyroidism, whereas I'm unaware of this sensation occuring due to hyperglycaemia.
> 
> While Peanut certainly does describe symptoms that could be attributed to undiagnosed diabetes, they can also be signs of uncontrolled hypothyroidism, and as Peanut has a supply problem with thyroxine, then that certainly needs addressing first & foremost. The four textbook signs & symptoms of diabetes are thirst, excessive urine production, weight loss, lethargy. It's extremely easy to rule out, a fasting glucose would do the job, if this isn't conclusive then maybe an OGTT, but Peanut needs to find a way of encouraging his GP to meet his current needs.



I don't doubt what you are saying for a moment Re the Thyroid problem, and agree with the above 100% as I've suffered all of these prior to being treated for my own diabetes.

The thread was titled Hypoglycaemia, and I offered my take on the symptoms.

I am happy to bow to your greater wisdom 

The important thing is that he gets this problem turned around so he can get his life back on track


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## Jonathan M (14 Oct 2008)

LLB said:


> The important thing is that he gets this problem turned around so he can get his life back on track



I agree wholeheartedly with you. Good luck Peanut,nil illegitimi carborundum


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## peanut (14 Oct 2008)

thanks . I'm hoping to get an appointment on Friday evening although I'll have to leave work early to get there by 5pm  

I am still trying to find out who is the best person to see in the practice. I'm hoping that one of the GP's will take me seriously enough to help me turn my health around.
I started a regular cyling program a few weeks ago which is going well. I am going to renew my gym membership and am currently working out a 12 week menu and exercise program. 

I've got to break out of this dreadful depression/ lethargy cycle I've been in lately. Hopefully the exercise and thyroxin will do that after a few weeks.
Looking forward to feeling like my normal positive self soon .
Thanks for the positive encouragement its really made a diffence 
Nick


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## LLB (15 Oct 2008)

My sister is on Thyroxin and is exempt from paying prescription charges (as am I). If you were getting it before, I am amazed that they are reluctant to start prescribing it again


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## Noodley (15 Oct 2008)

I have been following this thread with interest. I had blood taken last week, and phoned for the results today: the receptionist informed me that the doc had not noted anything so therefore they were okay, but sometimes they don't look properly so she'll check with him. If I don't hear anything then I am to take it nothing was found  Does not inspire much confidence....But my own doc is off this week so I'll phone him next week when he gets back.

Lethargy, sore gritty eyes, watery eyes, tiredness (sometimes extreme inability to stop myself fallingasleep), but also sometimes insomnia, poor concentration, irritable, cramps, dizziness, and have been susceptible to just about every lurgy for the past few months. 

I suppose there could be lots of things which fall into that, so I'll just have to pay another visit. It's bloody annoying whatever it is.


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## Twenty Inch (15 Oct 2008)

I've had underactive thyroid in the past. Thankfully it cleared up of its own accord. However it's worth noting that even when thyroid levels are in the normal range *they can be low enough to leave you feeling awful*. My doc pointed this out and didn't put me on thyroxine as once on, you rarely come off.

Cabbage, pears and almonds all depress thryoid activity, and iodine, zinc and fish help it, so I adjusted my diet accordingly and it seems to have helped.


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## peanut (15 Oct 2008)

Noodley said:


> I had blood taken last week,.



You've been sleeping with the window open again ?

None of my problems were apparent because whenever my bloods were taken the GP didn't ask for a full spread. They very rarely do apparently .

A full spread of bloods require something like 10 tubes full 

This was only done because I insisted on a referral when my usual GP was on hols.

They found my liver is not function properly! god knows how long thats been the case.

The sore gritty eyes and all the other symptoms you mention are the same as mine including the irritablity well more like temper explosions really. I can see it happening to me and its terrifying.
I've been wondering if it is some sort of virus
. Let us know what you find


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## LLB (15 Oct 2008)

peanut said:


> You've been sleeping with the window open again ?
> 
> None of my problems were apparent because whenever my bloods were taken the GP didn't ask for a full spread. They very rarely do apparently .
> 
> ...



Low sugar levels put me on a very short fuse


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## Noodley (15 Oct 2008)

LLB said:


> Low sugar levels put me on a very short fuse



No, driving your 4x4 does that


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## Noodley (15 Oct 2008)

peanut said:


> A full spread of bloods require something like 10 tubes full



I had 4 tubes taken.

Anyone have any idea what kind of thing would that cover test-wise?


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## LLB (16 Oct 2008)

Noodley said:


> No, driving your 4x4 does that



I'd like to say that I feel really wired behind the wheel of it, but 105bhp in a 2.5 tonne car with the aerodynamics of a breeze block and dragging a 4wd transmission around doesn't make for an adrenalin fueled drive Noodley. You just resign yourself to the knowledge that virtually every other vehicle on the road is going to be sat impatiently on your bumper waiting for an opportunity to get past, and motorway cruising is best done at between 55 and 60mph.

The only time it becomes really good fun is at between 5mph & 20 mph when being driven off road.


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## Noodley (16 Oct 2008)

Noodley said:


> I have been following this thread with interest. I had blood taken last week, and phoned for the results today: the receptionist informed me that the doc had not noted anything so therefore they were okay, but sometimes they don't look properly so she'll check with him. If I don't hear anything then I am to take it nothing was found :?:



Today I received the following letter:

Dear Mr Noodley

I would be grateful if you would contact the Surgery and arrange an appointment with one of the Doctors regarding the result of your recent blood test....

...well at least it would appear they re-checked. So, I shall phone tomorrow and see what the results say.


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## peanut (16 Oct 2008)

Noodley said:


> Today I received the following letter:
> 
> Dear Mr Noodley
> 
> ...



They are probably wanting some more blood !

My surgery don't even make a phone call. You have to ring them


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## Noodley (16 Oct 2008)

peanut said:


> They are probably wanting some more blood !



<tony hancock> That's very nearly an armful! <tony hancock>


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## yello (16 Oct 2008)

peanut said:


> You have to ring them



I had the same thing happen to me. A first test showed I had a low white cell count so a 2nd test was made. I was a little concerned obviously but heard nothing. I went into the surgery to be told "oh, we had the results last week". I was a bit annoyed to be honest. It would have taken no time to call me and put my mind at rest. 

I still have a low white cell count but it's apparently "acceptably low".


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