Posts belonging to Category 'Diabetes Mellitus'

Why, Why, Why???

Question:

Eddie: > I cannot understand what it is going to take in order to get my morning FBG down. I have great numbers all day except for my morning reading > Last night, I went to bed with 5.3 > I purposely didn’t have a snack before bedtime. > I woke up at 4:00am with 7.3 > I went back to bed and got up again and checked at 8:00am. It was 8.4 now!

This reply is not a suggestion to help with your morning bg readings, but rather to put them into perspective. There are a few sentences in the following article that I find of interest pertaining to morning bg readings. "Among individual time points, afternoon and evening PG (postlunch, predinner, postdinner, and bedtime) showed higher correlations with HbA1c than the morning time points (prebreakfast, postbreakfast, and prelunch)." Source: Defining the Relationship Between Plasma Glucose and HbA1c – Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial http://care.diabetesjournals.org/cgi/content/full/25/2/275 This is not to say that morning bg readings are not important, but that that status does not dominant or predict what a person’s HbA1c results subsequently become. Notice that there are seven times in the day when the bg readings were taken. The mean bg (average of that days bg readings) was also compared to HbA1c of that day. A closer mean bg would have been the seven times for about thirty days to the HbA1c of the last day of the series of tests. (Open this article and toggle back and forth to this post or printout one or both and compare information.) You may have heard it said that a picture speaks louder than a thousand words. So toggle to your browser and enlarge figure 1 of the above article. The units on this graphic are in those used in Canada and most of the world. This grapic is called a scatter diagram. Each data point represents the information (test results) of 1,441 subjects. The vertical axis is the mean bg in mmol/l and the horizontal axis is the mean HbA1c in percent. For the Americans, the vertical axis scale 5 mmol/l = 90 mg/dl, 10 = 180, 15 = 270, etc. The interesting thing about this scatter diagram is that the readings for the 5 percent club are on the extreme bottom and left of the scatter diagram (near the normal range). Bear in mind the "DCCT was a multicenter, randomized clinical trial designed to compare intensive and conventional therapies and their relative effects on the development and progression of diabetic complications in patients with type 1 diabetes. … The results of the Diabetes Control and Complications Trial (DCCT), published in 1993, and the U.K. Prospective Diabetes Study, published in 1998, established the relationship between HbA1c levels and risks for diabetic complications in patients with type 1 and type 2 diabetes, respectively. Based on the results of the DCCT, the American Diabetes Association (ADA) has published recommendations for HbA1c and plasma glucose (PG) levels that are widely used. However, it is important that the relationship between daily patient-monitored blood glucose determinations and HbA1c be clearly defined to enable patients and their health care providers to set appropriate daily PG testing goals to achieve HbA1c levels representing low risks for adverse outcomes." It is OK to have the "why" questions, but as Jennifer said concerning angst, try not to be as anxious about it. I hope this helps. Cheers, Frank

Response:

> Two points I want to add: > a. There is another fuel tank, the muscles. AFAIK, we store enough > glucose within the muscles somehow to fuel an average male for 24 hours. > Exercise and metformin encourage "topping off" that "tank".

Al, Here are some numbers which might help, taken from a chart in Ellenberg & Rifkin’s "Diabetes Mellitus" (5th Ed.) —– Fuel Storage in humans Estimates for a overnight-fasted male weighing 70kg Source grams Kcal Liver glycogen 75 300 Muscle glycogen 400 1600 Blood glucose 20 80 Adipose tissue triglyceride 15000 141000 Protein 6000 24000 —– The source is credible, but I don’t understand the value for blood glucose. If the average BG is 100mg/dL (1.0g/L), this hypothetical 70kg male would have to have either 20L of blood (instead of the 5L we non-hypothetical males have), or have a fasting BG of 400 mg/dL. Jim

Response:

Hi all, I cannot understand what it is going to take in order to get my morning FBG down. I have great numbers all day except for my morning reading Last night, I went to bed with 5.3 I purposely didn’t have a snack before bedtime. I woke up at 4:00am with 7.3 I went back to bed and got up again and checked at 8:00am. It was 8.4 now! I’ve tried having a bowl of cherrios……doesn’t help (in fact I discovered that it spiked me, so cherrios is now gone from life) I’ve tried some unsalted nuts…….doesn’t help number but not substantially My Doctor said that I should try a walk after dinner time each night. Does anyone else think that this will help my morning FBG get lower??? Any suggestions would be sincerely appreciated. Eddie Type 2

Response:

Geez that’s a puzzler. Right off the top of my head I’d have to say that maybe you need a bigger snack. I have 2 granola bars or a Gulcerna snack bar. — t2_lurking geabbottATabbottandabbottDOTcom Do not mail to t2_lurking (auto-delete)

– Hide quoted text — Show quoted text -> Hi all, > I cannot understand what it is going to take in order to get my morning FBG > down. I have great numbers all day except for my morning reading > Last night, I went to bed with 5.3 > I purposely didn’t have a snack before bedtime. > I woke up at 4:00am with 7.3 > I went back to bed and got up again and checked at 8:00am. It was 8.4 now! > I’ve tried having a bowl of cherrios……doesn’t help (in fact I discovered > that it spiked me, so cherrios is now gone from life) > I’ve tried some unsalted nuts…….doesn’t help > number but not substantially > My Doctor said that I should try a walk after dinner time each night. Does > anyone else think that this will help my morning FBG get lower??? > Any suggestions would be sincerely appreciated. > Eddie > Type 2

Response:

I’d go for the walk. I used to have high numbers in the AM. When I increased my exercise and started taking a walk after dinner it started going down in the AM. Now I rarely get a reading above 80. It also may start to level off over time. Some people never get rid of the dawn phenomena. Add the walk and concentrate on keeping your numbers in line the rest of the day. How soon in the AM do your numbers start to go back down? — c website http://www.plazaearth.com/philo

Response:

My numbers start to come down below 6 about 2 to 3 hours after my morning meds and breakfast…… — Edward Partito, C.E.T. Eddie’s Drafting & Design Services Limited 319 MacIntosh Drive Stoney Creek, Ontario, CANADA L8E 4E1 Phone: (905) 662-4032 Fax: (905) 662-7736 Website: www.eddiesdrafting.com

Response:

> My Doctor said that I should try a walk after dinner time each night. Does > anyone else think that this will help my morning FBG get lower???

It might or might not help, but can it hurt? Exercise can have an effect even hours afterward. Particularly vigorous exercise can affect your bg even 24-48 hours later! Regular exercise should be a part of any diabetic’s regimen if possible. And considering the types & levels & vigor of exercises that can be done, it’s (IMO) pretty hard for it to be completely impossible unless there’s some really nasty medical contraindication. bj

Response:

– Type 2 http://users.bestweb.net/~jbove/

My morning fasting is often the highest reading of the day. I find that I must have a snack before bed or the number is higher still. The best snack for me seems to be mashed potatoes with cheese mixed in. Last night I had 13 organic blue corn chips with some spicy cheese sauce. I awoke to 138. While this is not a good fasting number, it is better than it had been, so I’m not complaining. Right now, I’m happy to wake up <140. My numbers throughout the day are usually fine, so I’m less concerned about the morning fasting. I used to eat popcorn as a bedtime snack. This used to work well for me, but it suddenly stopped working. So now I only eat it if I’ve been really active and even then, I must severely limit my portion size. As for the exercise after dinner, that’s a good idea. I don’t know if it will help with your morning numbers or not. I’ve found that I must exercise after lunch and dinner or my numbers will be too high. I can occasionally skip the exercise if I’m on a roll and I’ve had several days in a row of numbers that are lower than usual. But for the most part, I do try to get some sort of exercise. — Type 2 http://users.bestweb.net/~jbove/

Response:

- Hide quoted text — Show quoted text – >Hi all, >I cannot understand what it is going to take in order to get my morning FBG >down. I have great numbers all day except for my morning reading >Last night, I went to bed with 5.3 >I purposely didn’t have a snack before bedtime. >I woke up at 4:00am with 7.3 >I went back to bed and got up again and checked at 8:00am. It was 8.4 now! >I’ve tried having a bowl of cherrios……doesn’t help (in fact I discovered >that it spiked me, so cherrios is now gone from life) >I’ve tried some unsalted nuts…….doesn’t help >number but not substantially >My Doctor said that I should try a walk after dinner time each night. Does >anyone else think that this will help my morning FBG get lower??? >Any suggestions would be sincerely appreciated. >Eddie >Type 2

Fasting bG is a fundamental measure of the balance between your Insulin Resistance and your ability to generate insulin. That’s one reason why the doc likes a record, the trends tell him how the T2 is progressing and how your meds are doing. AFAIK, there are 4 major techniques for fighting high FbG 1. Set your alarm for 3 am, eat some peanuts/walnuts/almonds. This is the trick many Oby-Gyn use for their gestational diabetic ladies. 2. Get some really vigorous and sustained exercise in the evening, e.g. two hours of tennis, hour of Step Aerobics, multi-Km run. Long walks may do it but my personal experience is that more than walking is required, i.e. won’t work for me unless I "push". 3. Start taking anti-Insulin Resistance meds or increase the dose of any currently used. (2500 mg/day metformin or max Actos) 4. Finally, if 1-3 don’t work, start on insulin injections at bedtime. Insulin at bedtime is the "default". It always works. Two common options are: a. One shot of NPH (Insulatard, Lilly N, Novolin N) at bedtime (Easy to fine tune, works the first or second morning, but doesn’t help bG control during the daylight hours) b. One shot of Lantus or Beef Lente in the evening (Hard to fine tune, takes more than 3 days to see total effect, can do wonders for bG control during the following daylight hours) AFAIK, manipulating your bedtime snack has some effect but it’s not as powerful as one would like. Regards Old Al

Response:

In my four plus years as a diabetic, I have not been able to get my FBG in line. However, my A1cs have all been under 5.5. I suggest you keep trying, but stop angsting. Jennifer – Hide quoted text — Show quoted text – > Hi all, > I cannot understand what it is going to take in order to get my morning FBG > down. I have great numbers all day except for my morning reading > Last night, I went to bed with 5.3 > I purposely didn’t have a snack before bedtime. > I woke up at 4:00am with 7.3 > I went back to bed and got up again and checked at 8:00am. It was 8.4 now! > I’ve tried having a bowl of cherrios……doesn’t help (in fact I discovered > that it spiked me, so cherrios is now gone from life) > I’ve tried some unsalted nuts…….doesn’t help > number but not substantially > My Doctor said that I should try a walk after dinner time each night. Does > anyone else think that this will help my morning FBG get lower??? > Any suggestions would be sincerely appreciated. > Eddie > Type 2

Response:

Eddie: > Hi all, > I cannot understand what it is going to take in order to get my morning FBG > down. I have great numbers all day except for my morning reading

You are still at the beginning of your therapy. You seem to be doing pretty good for just a few months. There is a psychological factor that we have to deal with when we don’t progress as fast as we would like or if we seem to slip backwards. Sometimes I have some dawn effect, but not most of the time. Every once in a while I will hit a very good streak and have FBG readings in the low 80s (4.6 or so) for some unknown reason. If you need to make a trip to the bathroom in the early morning (4 AM) or simply wakeup try having a small snack. (Maybe the wife will kick you out of the bed for eating crackers.) Frank

Response:

lol Eddie Type 2

Response:

Angst is a state of anxiety. Angsting would be constantly worrying over something. So stop worrying, but keep trying. Jennifer – Hide quoted text — Show quoted text – > lol > Eddie > Type 2 > In my four plus years as a diabetic, I have not been able to get my FBG > in line. > However, my A1cs have all been under 5.5. > I suggest you keep trying, but stop angsting. > Jennifer >Hi all, >I cannot understand what it is going to take in order to get my morning > FBG >down. I have great numbers all day except for my morning reading >Last night, I went to bed with 5.3 >I purposely didn’t have a snack before bedtime. >I woke up at 4:00am with 7.3 >I went back to bed and got up again and checked at 8:00am. It was 8.4 > now! >I’ve tried having a bowl of cherrios……doesn’t help (in fact I > discovered >that it spiked me, so cherrios is now gone from life) >I’ve tried some unsalted nuts…….doesn’t help >number but not substantially >My Doctor said that I should try a walk after dinner time each night. > Does >anyone else think that this will help my morning FBG get lower??? >Any suggestions would be sincerely appreciated. >Eddie >Type 2

Response:

>I suggest you keep trying, but stop angsting. >Jennifer

Angsting? Cool new word! I just started taking Lantus to try to get my FBG in line. Sometimes the magic works, sometimes it doesn’t. Of course I have been experimenting with dosages, and injection times, until I find what works best for me. My A1cs have been 5% club for a year and a half, So stop angsting! A lot of people have great overall control, but have lousy FBGs. Don’t stop trying to find an answer. Yours may still be out there. Sleepy Support bacteria. They’re the only culture some people have

Response:

Sleepy, Where do you come up with these tag lines? The one you’re using now is a stitch! — c website http://www.plazaearth.com/philo

– Hide quoted text — Show quoted text ->I suggest you keep trying, but stop angsting. >Jennifer > Angsting? Cool new word! > I just started taking Lantus to try to get my FBG in line. Sometimes > the magic works, sometimes it doesn’t. Of course I have been > experimenting with dosages, and injection times, until I find what > works best for me. My A1cs have been 5% club for a year and a half, > So stop angsting! A lot of people have great overall control, but have > lousy FBGs. Don’t stop trying to find an answer. Yours may still be > out there. > Sleepy > Support bacteria. They’re the only culture some people have

Response:

No place special. I just run accross things in my travels, and save them for future use. Sleepy >Sleepy, >Where do you come up with these tag lines? The one you’re using now is a >stitch!

Support bacteria. They’re the only culture some people have

Response:

Hi, my name is Bonnie. I have been reading this ng for awhile now. I have learned a lot. This is a question I might be able to help with. A dietician I went to told to try light yogart as a night time snack to keep my bg low in the morning. It works for me, maybe it will work for you Eddie. Good Luck!!!

Response:

When I was talking to my endo last week about something-or-other in my control regimen, she said "I sense your angst." I wasn’t so much worried as fed up/pissed/bored/wanting to try something different/different eating pattern — or at least have the options at times. bj

– Hide quoted text — Show quoted text -> Angst is a state of anxiety. > Angsting would be constantly worrying over something.

Response:

Before the Internet was in vogue, there were newsgroups to TRADE tag lines, there would be files and files of different topics, and news readers/mail programs all and the random sig thing incorporated into them to USE the text file list of them.. >Sleepy, >Where do you come up with these tag lines? The one you’re using now is a >stitch!

Diabetics are sweet people

Response:

You should have told her it wasn’t angst. Options are good. And you do have them! Jennifer – Hide quoted text — Show quoted text – > When I was talking to my endo last week about something-or-other in my > control regimen, she said "I sense your angst." I wasn’t so much worried as > fed up/pissed/bored/wanting to try something different/different eating > pattern — or at least have the options at times. > > bj >Angst is a state of anxiety. >Angsting would be constantly worrying over something.

Response:

report back Nice to have you jump out from the lurking bushes! Eddie Type 2

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> You should have told her it wasn’t angst. > Options are good. And you do have them!

Actually, in a way it was (is). I’m of mixed mind about it all — e.g. stick with what works, but can be inconvenient and prevents me from enjoying certain "occasions", or experiment with, say, the "short-sulfs", and learn to deal with a new batch of variables, and decide when to use them, etc.. She’s pretty much left the ball in my court about providing the bg info, and whether or not I want to pursue this course, whether now or later. Maybe — "angst lite"? bj

Response:

[snip] >number but not substantially >My Doctor said that I should try a walk after dinner time each night. Does >anyone else think that this will help my morning FBG get lower??? >Any suggestions would be sincerely appreciated. >Eddie >Type 2

I have a similar problem with my morning BG and have been trying to sort it out for ages. I have discovered that I can but it’s pretty hit and miss at the moment. For ages it seems to hover about the 6.9 – 7.4 mark then it drops to 5.1 – 5.8 I am not 100% sure why but there does seem to be a correlation to other factors other than just the diet the preceding 24 hrs. I have a feeling that it is a cumulative effect which reflects on a longer term staus of my ‘fuel supply system’. I think of it this way – blood = ready fuel, liver = reserve tank. Reserve tank has a predefined level below which the body tops up to keep it ready to deliver the goods when it thinks I need it. [when it percieves low BG - even mistakenly] If I allow my reserve to fall below the nominal level and I do this by irregular eating habits, getting hungry, excessive exercise without allowing for energy drain and so on…….then my body has to keep topping up the reserve and maintain my BG level. Because during the day i am active [usualy quite] and because my diet is restricted, there is little supply to keep both the reserve and the ‘runing fuel’. consequently what goes in is used during the day and the reserve is kept deficient. When this is happening my BG in the morning is usually in the 5.4 – 6.5 range. however, if I have over eaten either in bulk or in content type and or have had insufficient exercise, then my ready to use fuel [in my blood] is too high [higher BG]. This leaves capacity for the reserve to get topped up. During the night if i have been eating too much in the 24 hrs precedeing, then my reserve is topped up and overnight there is a spill over resulting in high BG in the morning. 7.4 + I have experimented over the last few months and have come to the conclusion that i have been exercising/working at such a level that the grub i have consumed gets used up so that sometime about 3am my BG is perceivd as going below the required level and my liver dumps. However, if my reserve is also low, the result is a low morning BG of 5.2 – 5.6 ish. The last three mornings it has been 5.2 5.4 5.4 I am messing with the following concepts to try and see what i can use to deliberately produce a decent FBG. 1] ensure that my evening meal is mostly veg/green/fish and no red meat [takes 8 hours to process / white or fish = 4] 2] before bed [1 hour or so bu three after evening meal] I have a snak. Usually peanut butter on some Fincrisp. 3] I go to bed at a fixed time. 4] I get up at a fixed time 5] I take my meds at a fixed time. 6] During the day I do muscle type work equating to at least four hours. I walk about ten mile as part of my job anyway. I have discovered certainly in my case that stress does power up my BG. If I drive for any distance i deliberately go slow and take my time – for example. I think you might find that the problem is not necessarily just one or two things that are happening but a combination. Perhaps an irregular routine, stress [even if you don't think you are your body might disagree]. Though you might be eating ok are you eating a lot of red meat or other stuff which takes quite a time to digest? Also, I have found that making changes to my FBG requires at least a week of effort. I usualy see godd FBG about 5 – 7 days after making a determined effort. I don’t think you will see any improvement following changes you make, within 4/5 days. It’s a slow process and I think it has to do with allowing your body to reset it’s datum points chemically. sorry this is long. HTH Pete Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide + Asprin 210lbs at Dx to 170 lbs 02/08/03 target 161.

Response:

- Hide quoted text — Show quoted text – >I have a similar problem with my morning BG and have been >trying to sort it out for ages. I have discovered that I can >but it’s pretty hit and miss at the moment. >For ages it seems to hover about the 6.9 – 7.4 mark then it >drops to 5.1 – 5.8 I am not 100% sure why but there does >seem to be a correlation to other factors other than just >the diet the preceding 24 hrs. I have a feeling that it is a >cumulative effect which reflects on a longer term staus of >my ‘fuel supply system’. >I think of it this way – blood = ready fuel, liver = >reserve tank. Reserve tank has a predefined level below >which the body tops up to keep it ready to deliver the goods >when it thinks I need it. [when it percieves low BG - even >mistakenly] >If I allow my reserve to fall below the nominal level and I >do this by irregular eating habits, getting hungry, >excessive exercise without allowing for energy drain and so >on…….then my body has to keep topping up the reserve and >maintain my BG level. >Because during the day i am active [usualy quite] and >because my diet is restricted, there is little supply to >keep both the reserve and the ‘runing fuel’. consequently >what goes in is used during the day and the reserve is kept >deficient. When this is happening my BG in the morning is >usually in the 5.4 – 6.5 range. >however, if I have over eaten either in bulk or in content >type and or have had insufficient exercise, then my ready to >use fuel [in my blood] is too high [higher BG]. This leaves >capacity for the reserve to get topped up. During the night >if i have been eating too much in the 24 hrs precedeing, >then my reserve is topped up and overnight there is a spill >over resulting in high BG in the morning. 7.4 + >I have experimented over the last few months and have come >to the conclusion that i have been exercising/working at >such a level that the grub i have consumed gets used up so >that sometime about 3am my BG is perceivd as going below the >required level and my liver dumps. However, if my reserve is >also low, the result is a low morning BG of 5.2 – 5.6 ish. >The last three mornings it has been 5.2 5.4 5.4 >I am messing with the following concepts to try and see what >i can use to deliberately produce a decent FBG. >1] ensure that my evening meal is mostly veg/green/fish and >no red meat [takes 8 hours to process / white or fish = 4] >2] before bed [1 hour or so bu three after evening meal] I >have a snak. Usually peanut butter on some Fincrisp. >3] I go to bed at a fixed time. >4] I get up at a fixed time >5] I take my meds at a fixed time. >6] During the day I do muscle type work equating to at least >four hours. I walk about ten mile as part of my job anyway. >I have discovered certainly in my case that stress does >power up my BG. If I drive for any distance i deliberately >go slow and take my time – for example. >I think you might find that the problem is not necessarily >just one or two things that are happening but a combination. >Perhaps an irregular routine, stress [even if you don't >think you are your body might disagree]. Though you might be >eating ok are you eating a lot of red meat or other stuff >which takes quite a time to digest? >Also, I have found that making changes to my FBG requires at >least a week of effort. I usualy see godd FBG about 5 – 7 >days after making a determined effort. I don’t think you >will see any improvement following changes you make, within >4/5 days. It’s a slow process and I think it has to do with >allowing your body to reset it’s datum points chemically. >sorry this is long. >HTH >Pete >Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide >+ Asprin 210lbs at Dx to 170 lbs 02/08/03 target 161.

Not too long at all. There is a newsgroup etiquette "suggestion" that one should trim a post when replying. I often do that, was going to do it to your post, and couldn’t. find enough to trim. I have seen your hypothesis in action in my own body. It was most apparent when I still played tennis, I can still notice it after heavy exertion days. Two points I want to add: a. There is another fuel tank, the muscles. AFAIK, we store enough glucose within the muscles somehow to fuel an average male for 24 hours. Exercise and metformin encourage "topping off" that "tank". b. Since I am T1, I eat more carb than the strictly compliant T2. That means all my "tanks" are topped off on quiet days. I suspect that this ready reserve, primarily the muscle reserve, makes me more hypo-competent. (I have bicycled home from Step Aerobics and discovered that the reason for a level road seeming to be uphill all the way was a 44 mg/dL bG) Regards Old Al

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Very informative Pete! Thanks for taking the time to post it. You’ve raised some interesting points that I need to experiment with. Thanks, Eddie Type 2

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Category Categories: Diabetes Mellitus | No Comments »

insulin and T2 nice article

Question:

Diabetes & Endocrinology Ask The Expert Insulin Therapy in Type 2 Diabetes Posted 08/12/2003 from Medscape Diabetes & Endocrinology Question When should insulin therapy be considered in type 2 diabetes patients? Response from Zachary T. Bloomgarden, MD, 08/12/2003 The short answer is, "When patients are hyperglycemic and cannot achieve recommended levels of control with appropriate use of lifestyle modification and oral pharmacologic treatment." Further, it should be recalled that the goal for HbA1c is not 8%, as was suggested by earlier American Diabetes Association (ADA) guidelines, but rather 7% according to current ADA guidelines and 6.5% according to both the American Association of Clinical Endocrinologists and the European Association for the Study of Diabetes. The United Kingdom Prospective Diabetes Study[1] has put to rest the notion that insulin treatment might be disadvantageous and cause increased risk of complications. There is extensive evidence that insulin is effective when administered in combination with oral agents, typically in a fashion much more readily implemented than the multiple doses of long- and rapid-acting insulin required for control of type 1 diabetes. Insulin has been best studied in combination with sulfonylureas[2,3] but is also effective when administered with thiazolidinediones, metformin, and acarbose.[4] One study suggests that the most effective combination may be insulin with metformin,[5] particularly in terms of weight, with metformin decreasing weight gain both in insulin-naive and previously insulin-treated persons.[6] The topic of approaches to insulin treatment has been recently reviewed.[7] —- References United Kingdom Prospective Diabetes Study Group: Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352:837-853. Abstract Landstedt-Hallin L, Arner P, Lins PE, Bolinder J, Olsen H, Groop L. The role of sulphonylurea in combination therapy assessed in a trial of sulphonylurea withdrawal. Scandinavian Insulin-Sulphonylurea Study Group Research Team. Diabet Med. 1999;16:827-834. Abstract Riddle MC. New tactics for type 2 diabetes: regimens based on intermediate-acting insulin taken at bedtime. Lancet. 1985;1:192-195. Abstract Buse J. Combining insulin and oral agents. Am J Med. 2000;108(suppl 6a):23S-32S. Abstract Yki-Jarvinen H, Ryysy L, Nikkila K, Tulokas T, Vanamo R, Heikkila M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1999;130:389-396. Abstract Yki-Jarvinen H. Combination therapies with insulin in type 2 diabetes. Diabetes Care. 2001; 24:758-767. Abstract DeWitt DE, Dugdale DC. Using new insulin strategies in the outpatient treatment of diabetes. JAMA. 2003;289:2265-2269. Abstract About the Panel Members Zachary Bloomgarden, MD, Associate Clinical Professor of Medicine, Mount Sinai Medical School, New York, NY — — The things that come to those who wait, may be the things left by those who got there first.

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– Hide quoted text — Show quoted text -> Diabetes & Endocrinology Ask The Expert > Insulin Therapy in Type 2 Diabetes > Posted 08/12/2003 > from Medscape Diabetes & Endocrinology > Question > When should insulin therapy be considered in type 2 diabetes patients? > Response > from Zachary T. Bloomgarden, MD, 08/12/2003 > The short answer is, "When patients are hyperglycemic and cannot achieve > recommended levels of control with appropriate use of lifestyle modification > and oral pharmacologic treatment." Further, it should be recalled that the > goal for HbA1c is not 8%, as was suggested by earlier American Diabetes > Association (ADA) guidelines, but rather 7% according to current ADA > guidelines and 6.5% according to both the American Association of Clinical > Endocrinologists and the European Association for the Study of

Diabetes. (snip) Thanks for posting the article. I’d be interested in hearing from some Type 2’s who have been on oral meds long term. Does there ever come a time when they no longer work or become less effective? If so, can diet and exercise prevent or slow this from happening? Disclaimer: I’ll take as many meds as becomes necessary (including insulin) with a smile– I’m not anti-medication, just curious kaci Type 2 dx 4/29/03 Glucovance 5/500, D&E, 2nd A1c: 7.2

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hi, I’m a T2 considering going on insulin therapy. My A1C’s have steadily crept up from low 6’s, next year 7’s, next year 8’s, and now 9’s. I’ve tried almost everything there is available to diabetics except insulin. These test results are not acceptable and mean long term damage already. I’m not fighting this weakly anymore. If I need insulin, then so be it. I need to do whatever it takes to get my blood free of excess glucose. I just wish I’d have gone on insulin a long time ago. Bonita

– Hide quoted text — Show quoted text – message > Diabetes & Endocrinology Ask The Expert > Insulin Therapy in Type 2 Diabetes > Posted 08/12/2003 > from Medscape Diabetes & Endocrinology > Question > When should insulin therapy be considered in type 2 diabetes > patients? > Response > from Zachary T. Bloomgarden, MD, 08/12/2003 > The short answer is, "When patients are

hyperglycemic and cannot > achieve > recommended levels of control with appropriate use of lifestyle > modification > and oral pharmacologic treatment." Further, it should be recalled > that the > goal for HbA1c is not 8%, as was suggested by earlier American > Diabetes > Association (ADA) guidelines, but rather 7%

according to current ADA > guidelines and 6.5% according to both the American Association of > Clinical > Endocrinologists and the European Association for the Study of > Diabetes. > (snip) > Thanks for posting the article. I’d be interested in hearing from some > Type 2’s who have been on oral meds long term. Does there ever come a > time when they no longer work or become less

effective? If so, can > diet and exercise prevent or slow this from happening? > Disclaimer: I’ll take as many meds as becomes

necessary (including – Hide quoted text — Show quoted text -> insulin) with a smile– I’m not anti-medication, just curious > kaci > Type 2 dx 4/29/03 > Glucovance 5/500, D&E, 2nd A1c: 7.2

Response:

> hi, I’m a T2 considering going on insulin therapy. My > A1C’s have steadily crept up from low 6’s, next year > 7’s, next year 8’s, and now 9’s. I’ve tried almost > everything there is available to diabetics except > insulin. These test results are not acceptable and > mean long term damage already. > I’m not fighting this weakly anymore. If I need > insulin, then so be it. I need to do whatever it takes > to get my blood free of excess glucose. I just wish > I’d have gone on insulin a long time ago.

Hi Bonita, Have your eating habits stayed constant from the A1c of 6’s until the present? I share your attitude– whatever it takes and wish you good health. Just wonder if insulin is inevitable for all of us? kaci

Response:

per eating habits, yes, they’ve stayed pretty much the same. Bonita

– Hide quoted text — Show quoted text -> hi, I’m a T2 considering going on insulin therapy. My > A1C’s have steadily crept up from low 6’s, next year > 7’s, next year 8’s, and now 9’s. I’ve tried almost > everything there is available to diabetics except > insulin. These test results are not acceptable and > mean long term damage already. > I’m not fighting this weakly anymore. If I need > insulin, then so be it. I need to do whatever it takes > to get my blood free of excess glucose. I just wish > I’d have gone on insulin a long time ago. > Hi Bonita, > Have your eating habits stayed constant from the A1c of 6’s until the > present? I share your attitude– whatever it takes and wish you good > health. Just wonder if insulin is inevitable for all of us? > kaci

Response:

> per eating habits, yes, they’ve stayed pretty much the > same. > Bonita

Have you tried modifying your diet? Have your BG readings gone up as well? It may just be natural progression. There are really only a few things you can do; 1) Change your diet. Principally reduce carbohydrates in your diet. 2) Increase activity. Principally get more exercise. 3) Increase (change) you medications. There are lots of options here. I include Insulin in this. — K’neH’a'Iw Uncloaking, Shields up.

Response:

Category Categories: Diabetes Mellitus | No Comments »

This is not to gloat

Question:

Homocysteine is another blood "marker" that can indicate future heart disease. I’ve been watching my homocysteine levels since dx… I had read an article that piqued my interest and asked my doc to do a test. The good thing about homocysteine, is that it is VERY easy to lower, and that lowering it doesn’t mean a change in diet or exercise (finally something that doesn’t require those twins!) A bad thing is that taking Metformin (which so many of us do) can raise your level. At dx (four years ago) I had a homocysteine level of 14, which is the high end of normal. But as with everything else with this disease, lower is better. I added 400mcg of folic acid, 100mg of B6 and 100mcg of B12 to my supplements and within 3 months, my level was 6 (the lowest end of normal) and has stayed their for all four years. Another good thing, they are not expensive vitamins. It is also very important if you are taking Glucophage or Glucovance. The Metformin in those meds deplete your body of B vitamins and can raise your homocysteine levels. Here’s an article I found. Jennifer Metformin Shown to Increase Homocysteine Levels Coronary artery disease is the leading cause of mortality for those with Diabetes. Some studies show higher levels of normal fasting and postmethionine load levels of plasma homocysteine in diabetic subjects, particularly in those with nephropathy and microalbuminemia. The use of metformin and low plasma B vitamin levels increase the risk of hyperhomocysteinemia in these diabetic subjects. Metformin can cause vitamin B12 malabsorption. It has been shown that up to 2,000 mg per day of metformin can increase total homocysteine levels and decrease vitamin B12 and folate levels. In one study at 12 and 40 weeks, total homocysteine levels were increased moderately but significantly by 7.2% and 13.8%, respectively, in the metformin group, while serum vitamin B12 levels were decreased by 13.4% and 17.7%, respectively. Serum folate levels were unaffected at 12 weeks, but after 40 weeks, there was an 8.0% reduction in the metformin group. Supplementation with B vitamins can lower homocysteine levels and may be recommended in Type 2 diabetic patients to lower cardiovascular risk. "Homocysteine and Cardiovascular Risk in Patients With Diabetes Mellitus," Yeromenko Y, Lavie L, Levy Y, Nutr Metab Cardiovasc Dis, 2001;11:108-116. 38288 Note: Metformin, or Glucophage, is an insulin-sensitizer and is one of the more frequently utilized agents for Type 2 diabetes. It has also recently been suggested to be of benefit in polycystic ovarian syndrome. This study has shown that metformin can increase homocysteine levels in diabetics. This may be due to its effect on reducing the absorption of vitamin B12 and possibly folate. Therefore, the data suggests that if you are going to use metformin for your patients, you might also want to recommend that they take vitamin B6, vitamin B12 and folic acid, depending on the patient’s homocysteine status. Also, a good test to perform on a patient who is taking metformin would be a fasting homocysteine level. – Hide quoted text — Show quoted text – > G’day G’day Loretta, > Double congratulations. That A1c is fantastic. Another figure you > might not have noticed but which I’m glad your doctor has included is > your homocysteine levels. Now is 8.2 good? > I should say so. OK, I had to look up some stats. Memory is an > unreliable thing where numbers are concerned. > Homocysteine CVD Mortality per 100 000 > Spain 7.4 250 > Germany 9.2 400 > Finland 10.8 530 > What that all means is that you have a lower risk of having nasty > little pot holes in the arteries that cholesterol wants to pave over.

Response:

This post not CC’d by email >I just returned from the endo and for a sick woman, I am the healthiest >person I know >cholesterol 142 >hdl 51 >ldl 50 >ratio 2.8 >tris 200 a little high >homocystein 8.2 >and the biggie >A1C 4.9

G’day G’day Loretta, Double congratulations. That A1c is fantastic. Another figure you might not have noticed but which I’m glad your doctor has included is your homocysteine levels. Now is 8.2 good? I should say so. OK, I had to look up some stats. Memory is an unreliable thing where numbers are concerned. Homocysteine CVD Mortality per 100 000 Spain 7.4 250 Germany 9.2 400 Finland 10.8 530 What that all means is that you have a lower risk of having nasty little pot holes in the arteries that cholesterol wants to pave over. >I am in shock I dont know how that happened except that I test test >test. I am eating fruit again and that is the great. >Of course for me it is portion control and the number one reason is that >I have this group to come to every day to learn, and participate and to >get and give support, Thansk to all of you. >Loretta

Today the A1c; tomorrow the world. We’ll be here for you when you go on to conquer the triglycerides. Best wishes, — Quentin Grady ^ ^ / New Zealand, >#,#< [ / / "… and the blind dog was leading." http://homepages.paradise.net.nz/quentin

Response:

>I just returned from the endo and for a sick woman, I am the healthiest >person I know

Go ahead and gloat!! This is great!! WOW. 4.9!! Dana "Live as though there is no tomorrow, Love as though you have never been hurt, Dance as if no one is looking…" Satchel Paige

Response:

: I just returned from the endo and for a sick woman, I am the healthiest : person I know : cholesterol 142 : hdl 51 : ldl 50 : ratio 2.8 : tris 200 a little high : homocystein 8.2 : and the biggie : A1C 4.9 : I am in shock I dont know how that happened except that I test test : test. I am eating fruit again and that is the great. : Of course for me it is portion control and the number one reason is that : I have this group to come to every day to learn, and participate and to : get and give support, Thansk to all of you. : Loretta : — : In tribute to the United States of America and the State : of Israel, two bastions of strength in a world filled with strife and : terrorism. Mazal Tov Loretta, You get two Snoopy Happy Dances from me:-) This is really great! Just out of interest, have you lost any weight recently? That could account for the ability to once again eat fruit. Wendy

Response:

Way to go Ben! We must be doing something right. Keep it up, my friend. — Chuck -

Category Categories: Diabetes Mellitus | No Comments »

Evening Primrose Oil Question

Question:

I’ve heard people say that evening primrose oil helped with hot/cold sensations of neuropathy. What is the usual dosage you take? I’m willing to try anything at this point!!!

Response:

> I’ve heard people say that evening primrose oil helped with hot/cold > sensations of neuropathy. What is the usual dosage you take? I’m willing > to try anything at this point!!!

2,000 mg each morning and another 2,000 mg each evening. Costco is the cheapest source. You can buy from them online if you’re not a member. — Type 2 http://users.bestweb.net/~jbove/

Response:

>I’ve heard people say that evening primrose oil helped with hot/cold >sensations of neuropathy. What is the usual dosage you take? I’m willing >to try anything at this point!!!

Dave Stampe, Ph.D, a Professor at the Univ. of Toronto, had good luck with Evening Primrose Oil and posted regularly on it. You can search Google Groups for many of his discussions. A specific post of use to you would be: Newsgroups: alt.support.diabetes > Just yesterday I read info on Evening Primrose Oil/Finger and Toe > Numbness in this site … and today I can’t find the discussion. > I would like to know more about it. So, without belaboring the point > any longer … do I hear any testimonials out there? > How much to take? When to take it? How long does it take before you > notice a difference?

Short answers to a short question: to start with take 2 to 4 grams a day (1 to 2 grams twice a day is best, taken with a meal). It will probably take anywhere from 2 weeks to a month to start affecting peripheral neuropathy, and its effects will fluctuate for at least the first month. You may notice some "hot flashes" (sweating, feeling warm, and flushed) 3 or 4 hours after taking it. It will probably cause an increase in any inflammation you may have, so once you have gotten improved sensation (if it works for you, nothing’s certain) then you may want to cut back some. I had good results with greatly improved (although still not normal) temperature, touch, and pain (as in pinch or burn avoidance) sensation to fingers and feet. I had to cut back to 500mg/day because of problems with inflammation. but I still have far better sensation now than 6 years ago. Dave Stampe, Ph.D. (EE & Cog Sci) Type 1, 25+ yr, pump+humalog, food allergies Compl: 2xPRP laser, kidney, tendonitis Last Hb1Ac: 5.2 (6.0 typical) Good Luck Old Al

Response:

This post not CC’d by email >It will probably cause an increase in any inflammation you may >have, so once you have gotten improved sensation (if it works for you, >nothing’s certain) then you may want to cut back some.

G’day G’day Al, It is a bit awkward replying to Dave but I feel the above statement requires some comment. The gamma linolenic acid, GLA in evening primrose oil is anti-inflammatory. So is the dihomo gamma linolenic acid, DGLA formed from it. However the arachidonic acid, AA formed from that is inflammatory. So Dave is referring to a really possibility sometimes called "spill over" that can occur when people take excess GLA. Anti-inflammatory Anti-inflammatory Inflammatory. The GLA to DGLA step doesn’t require an enzyme. Fortunately the DGLA to AA step does. I say fortunately because enzymes can be inhibited. Two foods that inhibit the DGLA to AA step are turmeric (strongly) and sesame (less strongly). As it happens I have seen inflammation caused by "spill over" A secretary had been taking large amounts of evening primrose and experienced redness between the fingers which subsided once she stopped taking the evening primrose oil. GLA is more potent if converted to ascorbyl-GLA. Simply taking Vit C and GLA together on an empty stomach will achieve almost the same effect. However, be even more aware of the spill over effect. Al, I’m sure you will enjoy the following Power Point presentation … if you have access to Power Point. www.lapinskas.com/pubs/3679.ppt If not there is always a Google search with the search string ascorbyl-GLA Best wishes, — Quentin Grady ^ ^ / New Zealand, >#,#< [ / / "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin

Response:

> I've heard people say that evening primrose oil helped with hot/cold > sensations of neuropathy. What is the usual dosage you take? I'm willing > to try anything at this point!!!

I've heard that alpha lipoic acid helps neuropathy a great deal and that taking it with Evening Primrose oil makes the ALA even more effective. Sorry, can't advice on dose. E

Response:

- Hide quoted text -- Show quoted text - >This post not CC'd by email >It will probably cause an increase in any inflammation you may >have, so once you have gotten improved sensation (if it works for you, >nothing's certain) then you may want to cut back some. >G'day G'day Al, > It is a bit awkward replying to Dave but I feel the above statement >requires some comment. >The gamma linolenic acid, GLA in evening primrose oil is >anti-inflammatory. So is the dihomo gamma linolenic acid, DGLA formed >from it. However the arachidonic acid, AA formed from that is >inflammatory. So Dave is referring to a really possibility sometimes >called "spill over" that can occur when people take excess GLA. >Anti-inflammatory Anti-inflammatory Inflammatory. >The GLA to DGLA step doesn't require an enzyme. >Fortunately the DGLA to AA step does. I say fortunately because >enzymes can be inhibited. Two foods that inhibit the DGLA to AA step >are turmeric (strongly) and sesame (less strongly). >As it happens I have seen inflammation caused by "spill over" A >secretary had been taking large amounts of evening primrose and >experienced redness between the fingers which subsided once she >stopped taking the evening primrose oil. >GLA is more potent if converted to ascorbyl-GLA. Simply taking Vit C >and GLA together on an empty stomach will achieve almost the same >effect. However, be even more aware of the spill over effect. >Al, I'm sure you will enjoy the following Power Point presentation ... >if you have access to Power Point. >www.lapinskas.com/pubs/3679.ppt >If not there is always a Google search with the search string >ascorbyl-GLA >Best wishes, >-- >Quentin Grady ^ ^ /

Nice stuff to know. I have some questions on the subject also. a. I always thought the "inflammatory" remark referred to arthritis pain. I have been avoiding EPO because arthritis is an important part of my life lately. b. Do you are anybody know what happened to Dr. Stampe? He wasn't in good health, I hope he's still with us. (BTW: I can't get the ppt to load though I have powerpoint on my computer) Regards Old Al

Response:

- Hide quoted text -- Show quoted text -> I've heard people say that evening primrose oil helped with hot/cold > sensations of neuropathy. What is the usual dosage you take? I'm > willing > to try anything at this point!!! > I've heard that alpha lipoic acid helps neuropathy a great deal and > that taking it with Evening Primrose oil makes the ALA even more > effective. Sorry, can't advice on dose. > E

ALA isn't cheap, and has a halflife in the blood of about 30 mins., so it is advisable to take a timed-release version. AFAIK, there are only two timed-release versions available, one from Jarrow and one from Lipoic. I find that the cheapest is the 300mg Jarrow from iherb.com . EPO preparations seem to have varying percentages of GLA. I've been taking a 1300 mg gelcap, which claims a 10% GLA content (130mg). Stan Angilley did the research that lead to the following: http://www.geocities.com/bsy53/dn/neuropat.html . He has also done some posting here recently. Works for me. Jim -- Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org --- /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

This post not CC'd by email >Nice stuff to know. > I have some questions on the subject also. > a. I always thought the "inflammatory" remark referred to arthritis >pain. I have been avoiding EPO because arthritis is an important part of >my life lately.

G'day G'day Al, I have been reading papers on GLA recently. See what I can come up with. > b. Do you are anybody know what happened to Dr. Stampe? He wasn't in >good health, I hope he's still with us.

I hope so too. Sorry can't help with information on his health. >(BTW: I can't get the ppt to load though I have powerpoint on my computer)

I wondered if the Power Point representation was on a more recent version eg XP if you were running Windows 2000 or 98. Unfortunately I haven't found anything in "properties" to indicate what version it is. >Regards > Old Al

-- Quentin Grady ^ ^ / New Zealand, >#,#< [ / / "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin

Response:

Quentin and Al: >(BTW: I can't get the ppt to load though I have powerpoint on my computer) > I wondered if the Power Point representation was on a more recent > version eg XP if you were running Windows 2000 or 98. Unfortunately > I haven't found anything in "properties" to indicate what version it > is.

I got the show to upload and I use Windows 98 and Netscape 4.72. Frank

Response:

This post not CC'd by email >I got the show to upload and I use Windows 98 and Netscape 4.72. >Frank

G'day G'day Frank, I'm a bit of a novice at Power Point though I love it for brain storming. Since each slide can take a limited number of words it forces one to be succinct. Also, a slide show presentation forces one to sequence one's thoughts. For those who wonder what we are referring to, I'm sure you will enjoy the following Power Point presentation ... if you have access to Power Point. www.lapinskas.com/pubs/3679.ppt Take a particular look at the slide showing the interactions between Vit C and GLA. Best wishes, -- Quentin Grady ^ ^ / New Zealand, >#,#< [ / / "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin

Response:

You can get a free viewer for powerpoint formatted presentations at http://www.microsoft.com/office/000/viewers.asp

Response:

Hello Quentin: > www.lapinskas.com/pubs/3679.ppt > Take a particular look at the slide showing the interactions between > Vit C and GLA.

It looks like slides 33-36 cover this topic. The topic moved from the interaction of GLA and ARI (which must be the acronym for aldose reductase inhibitors) to the Vit C and GLA interaction. It is interesting that a combination of GLA and ascorbyl is a fat soluble product. The appears to be some some simularity with ascorbyl palmitate (another fatty acid vitamin C combination). The transmission of signals across the nerves is called conductance. Aaron Vinik discussed this topic in a Medscape article presented earlier in the year. He also discussed the topic at the American Diabetes Association 63rd Scientific Sessions. "In a small pilot study, the anticonvulsant topiramate appeared to induce the growth of new nerve fibers and relieve symptoms of peripheral neuropathy while also improving components of metabolic syndrome ... . Topiramate improves both symptoms and objective measurements of peripheral neuropathy while also lowering levels of total cholesterol, blood glucose, and blood pressure and promoting significant weight loss..." Source: http://www.medscape.com/viewarticle/457287_print [Note: Aldose reductase inhibitors - one of those terms that you tend to avoid until it starts to mean something to you. Somehow this topic connects with oxidative stress and antioxidants. This is vaguely in my memory in regards to an article in one of my post in the almond thread. "Aldose reductase (AR), a member of the aldo-keto reductase superfamily, has been implicated in the etiology of secondary diabetic complications." Kinetic and Structural Characterization of the Glutathione-binding Site of Aldose Reductase http://www.jbc.org/cgi/content/full/275/28/21587] Frank

Response:

> [Note: Aldose reductase inhibitors - one of those terms that you tend to > avoid until it starts to mean something to you. Somehow this topic > connects with oxidative stress and antioxidants. This is vaguely in my > memory in regards to an article in one of my post in the almond thread. > "Aldose reductase (AR), a member of the aldo-keto reductase superfamily, > has been implicated in the etiology of secondary diabetic > complications."

I went back and found my referenced that referrred to aldose reductase inhibitors in the almonds thread: "The complications of diabetes mellitus are believed to result from either the intracellular accumulation of sorbitol or the nonenzymatic glycoxidation of proteins or both. With respect to the abnormal cellular accumulation of sorbitol, vitamin C supplementation has been shown to be effective in several studies of adults with diabetes; the situation regarding the prevention of protein glycoxidations by supplementation is presently unclear. The roles of ASC as an aldose reductase inhibitor and a water soluble antioxidant in body fluids are potentially very important as adjuncts to tight glycemic control in the management of diabetes. Tissue saturation and maximal physiologic function in IDDM may require supplemental vitamin C intake." Source: The Glucose/Insulin System and Vitamin C: Implications in Insulin-Dependent Diabetes Mellitus http://www.jacn.org/cgi/content/full/17/2/105 Excerpt: "There appears to be a particular enzyme implicated in the corruption of these cell structures. It is called aldose reductase. Aldose reductase is responsible their corresponding alcohols namely sorbitol. Since a diabetes patient has higher than normal serum glucose levels, susceptible cells exposed to aldose reductase accumulate larger amounts of these converted alcohols. It is known as the polyol pathway.[v] This process creates an imbalance within the cell, causing a loss of electrolytes and other minerals and ultimately leading to the collapse of its architecture. There has been continuing research in developing aldose reductase inhibitors that will reduce this enzyme’s affects and hopefully the complications associated with it. Unfortunately, every drug developed so far as an inhibitor has had very questionable efficacy and safety concerns.[vi] All of the cellular interactions we have discussed thus far have been the result of varying forms of oxidation. Both types of diabetes patients show a higher level of oxidative damage to their DNA than euglycemic patients. [vii] One of the possible pathways of this damage is through non-enzymatic advanced glycosylation end products (AGE).[viii] Source: Glycosylation http://www.diabetesincontrol.com/features/feature59.shtml (There are some good references at the end of this article). http://diabetes.diabetesjournals.org/cgi/reprint/48/10/2045.pdf "These observations suggest that NO maintains AR in an inactive state and that this repression is relieved in diabetic tissues. Thus, increasing NO availability may be a useful strategy for inhibiting the polyol pathway and preventing the development of diabetes complications." Source: Nitric Oxide Prevents Aldose Reductase Activation and Sorbitol Accumulation During Diabetes http://diabetes.diabetesjournals.org/cgi/content/abstract/51/10/3095 (arginine ?) A list of references to a website: http://www.survivediabetes.com/refs.htm Diabetes without Complications! – Jonathan Christie http://www.survivediabetes.com/ Frank

Response:

This is an addendum: >[Note: Aldose reductase inhibitors – one of those terms >that you tend to avoid until it starts to mean >something to you. Somehow this topic connects with >oxidative stress and antioxidants.

This continues the topic of Quentin’s link to Evening Primrose Oil (GLA) slide show. It wouldn’t hurt to go back and look at the slide show again since many of the same terms keep popping up, i.e. polyol pathway, aldose reductase, ascorbic acid (Vitamin C), antioxidants, hyperglycemia, etc. "Aldose reductase, also known as alditol: NADP+ oxidoreductase, is the first enzyme of the polyol pathway. Hyperglycemia enhances the flow rate of the polyol pathway and this has been linked to such diabetic complications as cataracts, retinopathy, neuropathy and nephropathy. Quercetin is known to inhibit aldose reductase. … Finally, quercetin has been shown to inhibit aldose reductase, the first enzyme in the polyol pathway. Experimental data link glucose metabolism via this pathway to long-term diabetic complications, such as cataract, nephropathy, retinopathy and neuropathy. Again, whether inhibition of aldose reductase will have any relevance in humans remains to be proven by well-controlled clinical trials." Source: http://www.gettingwell.com/drug_info/nmdrugprofiles/nutsupdrugs/que_0… "Effect of Accelerated Polyol Pathway … Under normoglycemic conditions, polyol pathway accounts for approximately 3% of glucose utilization, whereas more than 30% of glucose is metabolized through this pathway under hyperglycemia. The increased flux of glucose through this pathway and consequent expenditure of cofactors for aldose reductase (NADPH) and sorbitol dehydrogenase (NAD+) lead to a redox state change and a cascade of interrelated metabolic imbalances. Substantially affected are activities of glutathione reductase and nitric oxide (NO) synthase because of the depletion of the cofactor NADPH. As glutathione reductase is an antioxidative enzyme that maintains the level of tissue glutathione, the overall effect would be the increased susceptibility to oxidative stress under diabetic conditions. Indeed increased susceptibility to H2O2 along with a reduced level of glutathione was reported in the endothelial cells cultured in high glucose medium. Similarly, the production of NO from L-arginine by NO synthase is suppressed resulting from the depletion of NADPH, thereby reducing the release of NO to elicit microvascular derangement and the slowing of nerve conduction." Source: Aldose Reductase in Glucose Toxicity: A Potential Target for the Prevention of Diabetic Complications http://pharmrev.aspetjournals.org/cgi/content/full/50/1/21 Involvement of Hydrogen Peroxide in Collagen Cross-linking by High Glucose in Vitro and in Vivo http://www.jbc.org/cgi/content/full/271/22/12964 Kinetic and Structural Characterization of the Glutathione-binding Site of Aldose Reductase http://www.jbc.org/cgi/content/full/275/28/21587 I did not attempt to find the links to the following: Costantino L, Rastelli G, Gamberini MC, et al. 1-Benzopyran-4-one antioxidants as aldose reductase inhibitors. J Med Chem. 1999; 42:1881-1893. Ferry DR, Smith A, Malkhandi J, et al. Phase I clinical trial of the flavonoid quercetine: phonmacokinetics and evidence for tyrosine kinase inhibition. Clin Cancer Res. 1996; 2:659-668. Varma SD, Kinoshita JH. Inhibition of lens aldose reductase by flavonoids. Their possible role in the prevention of diabetic cataracts. Biochem Pharmacol. 1976; 25:2505-2513. Frank

Response:

Category Categories: Diabetes Mellitus | No Comments »

Brand New Type 2

Question:

If you’re not on meds at all and have an A1C < 9.9, you can get a certificate without any difficulty. If you’re on meds and have no hypoglycemic events and that same <9.9 A1C you can apply for a Special Issuance Authorization from the FAA to give you a First Class medical, which would allow you to fly as an Air Transport Pilot. Insulin is a disqualifying factor for a First or Second class medical, however, it’s possible to get a Third Class medical with an SIA. You’re certainly not GROUNDED as many believe, but it’s not possible to fly commercially. More details here: http://www.aviationmedicine.com/diabetes.htm — Will you sponsor me in the Tour de Cure? http://main.diabetes.org/site/TR?pg=personal&fr_id=1058&px=1626087

– Hide quoted text — Show quoted text ->> this applies to all 50 states even if the driver does not leave the >> state? if so I know some diabetics that must be falsifying their >> records. >Correct sir. The FAA reg is _very_ similar. If you’re an insulin using T1, >you’re GROUNDED! >Not that there haven’t been attempts by newly diagnosed T1s to pull the wool >over a new AME’s eyes and try to pass their physical. > You mean a Type 2, like myself, not on orals or insulin, could become > a commerical pilot and fly for Southwest Airlines?

Response:

I am not one that takes things wrong that way. Your only trying to help out and I think that is great. I am sure in time I will get many and adjustment to the diet. Right now they are working with me on many other things also but I am making it in the long run. Thanks again. Bill " – Hide quoted text — Show quoted text -> Don’t take this wrong.. but.. you may want to check that diet plan > with a bunch of people here who have been doing this for years and > have fantastic A1C’s. > I’m new too, only 4 mos now. When I was first diagnosed I did the > regular plan… I did okay.. but didn’t feel a whole lot better, still > got sleepy after meals and so on. I also wasn’t losing weight very > well. > Then I came here and started reading all the different posts from > different people. I also attended a diabetes ed class. (That was > great, btw, EXCEPT for the diet parts). > I started lowering my carbs, slowly but surely. I started feeling > better, and started losing weight. I think I have now lost 20 lbs > since starting the low carb thing. It’s hard to say, it seems that > each scale I weigh myself on is different. I’ve dropped two (would be > three if I could afford it – lol) pants sizes. Lost many inches. > I feel better! I have less hypos. I have a LOT more energy and I > look better. I mean.. more healthy, even. > I have to go chase my grandson now, so I’m thankful for the energy! > <G> I encourage you to look into the low carb thing. It sure can’t > hurt to give it a shot. My last A1C was 4.9. > Linda > Bushisms: > "We ended the rule of one of history’s worst tyrants, > and in so doing, we not only freed the American people, > we made our own people more secure." > -George W. Bush, Crawford, Texas, May 3, 2003 > Join us in the Diabetic-Talk Chatroom on UnderNet > /server irc.undernet.org — /join #Diabetic-Talk > More info: http://www.diabetic-talk.org/

Response:

> this applies to all 50 states even if the driver does not leave the > state? if so I know some diabetics that must be falsifying their > records.

Correct sir. The FAA reg is _very_ similar. If you’re an insulin using T1, you’re GROUNDED! Not that there haven’t been attempts by newly diagnosed T1s to pull the wool over a new AME’s eyes and try to pass their physical. Regards, James the Elder

Response:

>Thanks for all the info. I printed it out and will go over it when I can. >I have a diet plan here and it is a little different then what you have said >it still should work for sure. Thanks again for yout time and will be >watching all I can. >Bill

Bill, Don’t take this wrong.. but.. you may want to check that diet plan with a bunch of people here who have been doing this for years and have fantastic A1C’s. I’m new too, only 4 mos now. When I was first diagnosed I did the regular plan… I did okay.. but didn’t feel a whole lot better, still got sleepy after meals and so on. I also wasn’t losing weight very well. Then I came here and started reading all the different posts from different people. I also attended a diabetes ed class. (That was great, btw, EXCEPT for the diet parts). I started lowering my carbs, slowly but surely. I started feeling better, and started losing weight. I think I have now lost 20 lbs since starting the low carb thing. It’s hard to say, it seems that each scale I weigh myself on is different. I’ve dropped two (would be three if I could afford it – lol) pants sizes. Lost many inches. I feel better! I have less hypos. I have a LOT more energy and I look better. I mean.. more healthy, even. I have to go chase my grandson now, so I’m thankful for the energy! <G> I encourage you to look into the low carb thing. It sure can’t hurt to give it a shot. My last A1C was 4.9. Linda Bushisms: "We ended the rule of one of history’s worst tyrants, and in so doing, we not only freed the American people, we made our own people more secure." -George W. Bush, Crawford, Texas, May 3, 2003 Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

There is no one diabetic food plan that works for all… I’m glad you found one you’re comfortable with. You can use the testing schedule I described to see how your food plan is controlling your blood glucose. The numbers listed are not specific to any food plan, but rather where we should all aim. Best of luck! Jennifer – Hide quoted text — Show quoted text -> Thanks for all the info. I printed it out and will go over it when I can. > I have a diet plan here and it is a little different then what you have said > it still should work for sure. Thanks again for yout time and will be > watching all I can. > Bill >Hi Will… >Welcome to our little corner of the web. >It sounds like you’ve got ample motivation to get this under control… >and the good news is, with a little investigative work on your part, you >can. The triangle plan is food/meds/exercise. Once you figure out >those three legs, you’ll have a plan you can live and WORK with. >Here’s the advice I give to all newbies: >There is so much to absorb… you don’t have to rush into anything. Begin >by using your best weapon in this war, your meter. You won’t keel over >today, you have time to experiment, test, learn, test and figure out just >how your body and this disease are getting along. The most important >thing you can do to learn about yourself and diabetes is test test test. >The single biggest question a diabetic has to answer is: >What do I eat? >Unfortunately, the answer is pretty confusing. >What confounds us all is the fact that different diabetics can get great >results on wildly different food plans. Some of us here achieve >great blood glucose control eating a high complex carbohydrate diet. >Others find that anything over 75 – 100g of carbs a day is too >much. Still others are somewhere in between. >At the beginning all of us felt frustrated. We wanted to be handed >THE way to eat, to ensure our continued health. But we all >learned that there is no one way. Each of us had to find our own path, >using the experience of those that went before, but still having >to discover for ourselves how OUR bodies and this disease were coexisting. >Ask questions, but remember each of us discovered on our own what works > best >for us. You can use our experiences as jumping off points, but eventually >you’ll work up a successful plan that is yours alone. >What you are looking to discover is how different foods affect you. As > I’m >sure you’ve read, carbohydrates (sugars, wheat, rice… the things our >Grandmas called "starches") raise blood sugars the most rapidly. Protein >and fat do raise them, but not as high and much more slowly… so if > you’re >a T2, generally the insulin your body still makes may take care of the > rise. >You might want to try some experiments. >First: Eat whatever you’ve been >currently eating… but write it all down. >Test yourself at the following times: >Upon waking (fasting) >1 hour after each meal >2 hours after each meal >At bedtime >That means 8 x each day. What you will discover by this is how long >after a meal your highest reading comes… and how fast you return to >"normal". Also, you may see that a meal that included bread, fruit or >other carbs gives you a higher reading. >Then for the next few days, try to curb your carbs. Eliminate breads, >cereals, rices, beans, any wheat products, potato, corn, fruit… get all >your carbs from veggies. Test at the same schedule above. >If you try this for a few days, you may find some pretty damn good >readings. It’s worth a few days to discover. >Eventually you can slowly add back carbs until you see them affecting your >meter. >The thing about this disease… though we share much in common and we >need to >follow certain guidelines… in the end, each of our bodies dictate our >treatment and our success. >The closer we get to non-diabetic numbers, the greater chance we have of >avoiding horrible complications. The key here is AIM… I know that >everyone is at a different point in their disease… and it is > progressive. >But, if we aim for the best numbers and do our best, we give ourselves the >best shot at heath we’ve got. >That’s all we can do. >Here’s my opinion on what numbers to aim for, they are non-diabetic > numbers. >FBG under 110 >One hour after meals under 140 >Two hours after meals under 120 >or for those in the mmol parts of the world: >Fasting Under 6 >One hour after meals Under 8 >Two hours after meals Under 6.5 >Recent studies have indicated that the most important numbers are your >"after meal" numbers. They may be the most indicative of future >complications, especially heart problems. >Listen to your doctor, but you are the leader of your diabetic >care team. While his /her advice is learned, it is not absolute. You >will end up knowing much more about your body and how it’s handling >diabetes than your doctor will. Your meter is your best weapon. >Just remember, we’re not in a race or a competition with anyone but >ourselves… Play around with your food plan… TEST TEST TEST. Learn > what >foods cause spikes, what foods cause cravings… Use your body as a > science >experiment. >You’ll read about a lot of different ways people use to control their >diabetes… Many are diametrically opposed. After awhile you’ll learn that >there is no one size fits all around here. Take some time to experiment >and you’ll soon discover the plan that works for you. >Best of luck! >Jennifer >>Hi there all. As the subject says I have just found out that I have > type 2 >>diabetes. The way I found out was I went for my DOT Physical and found > 1000 >>mg of sugar in my urine. This take me off the road until I can get it > under >>control. I just finished my first class and have been on glyburide >>2.5/metformin 500 for a week now. Most of the time when I take my blood >>sugar in the am the numbers are in the low 100’s but I can see I have a > lot >>of work to do for my numbers in the evening about 1.5 hours after I eat > are >>very high. The highest was 333 and lowest was 194. I have having some >>problems with wanting to give up some things but I know I have to. I am >>walking 30 min a day and controling what and when I eat. Right now I am >>having a hard time not being able to work. I can’t go back on the road >>until I have no sugar in the urine and have my heg a1c under 7. Last > a1c >>was 11.6. >> I can use all the help I can and hope to be here at least once a day > to >>read all that I can. Thanks >>William Kinmond > William >>Kinmond Truck Driver ICQ#: 5167519 Current ICQ status: ( Home Tel#: 716 >>297-9527 ( Work Tel#: 716 4714802 7 Fax#: None + More ways to contact me

Response:

> I forgot to mention that Accuchek gives away their meter for Free is > you ask. Call 1-800-858-8072 and request a Advantage or Compact at no > cost to you. I did that last week and got an Advantage.

Did you have to turn in an old meter? I called them this morning and they wouldn’t send me a new meter unless I turned in my old meter. — Best wishes Louise Type 2 since 2000, controlling by diet and exercise

Response:

– Hide quoted text — Show quoted text – >Mack, >> I thought a diabetic couldn’t drive an 18 wheeler? You are a >> diabetic. Once a diabetic, always a diabetic. I wish diabetes was >> like a light bulb that could be turned on and turned off with a flip >> of a switch. See Sig to record BG’s. It’s Free. > we can’t, if we have to cross state lines. if we do not cross state > lines the regs depend on the state you work in. >I thought the DOT regs mimicked the FAA regs in that the limitations for T1s >are _much_ more restrictive than for T2s. >This the CFR reg for CDL drivers. >391.41(b)(3) >A person is physically qualified to drive a commercial motor vehicle if that >person: >Has no established medical history or clinical diagnosis of diabetes >mellitus currently requiring insulin for control. >There is no provision in the Federal Motor Carrier Safety Regulations >(FMCSRs) for an exemption from the minimum physical requirement with respect >to the insulin-using diabetic. Diabetes mellitus is a disease which, on >occasion, can result in a loss of consciousness or orientation in time and >space. Individuals who require insulin for control have conditions which can >get out of control by the use of too much or too little insulin, or food >intake not consistent with the insulin dosage. Incapacitation may occur from >symptoms of hyperglycemic or hypoglycemic reactions (drowsiness, >semiconsciousness, diabetic coma, or insulin shock). >The administration of insulin is, within itself, a complicated process >requiring insulin, syringe, needle, alcohol sponge and a sterile technique. >Factors related to long-haul commercial motor vehicle operations, such as >fatigue, lack of sleep, poor diet, emotional conditions, stress, and >concomitant illness, compound the diabetic problem. Because of these >inherent dangers, the FMCSA has consistently held that a diabetic who uses >insulin for control does not meet the minimum physical requirements of the >FMCSRs. >Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic >individuals to help stimulate natural body production of insulin. If the >condition can be controlled by the use of oral medication and diet, then an >individual may be qualified under the present rule. >Not trying to be argumentative Mack, just trying to give all the info. >Regards, >James the Elder

this applies to all 50 states even if the driver does not leave the state? if so I know some diabetics that must be falsifying their records. Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

Response:

Low 100’s mean below 120 at least for right now and well I have to say when the blood sugar levels have been high Yes I know why. I have cheated in one way or another. Like the last time I was at 333 I had cheated and ate 2 donunt holes a glazed one and a sugar cin. one. I know I have to stop that but it is hard sometime not to just pick up something and eat it. Bill

– Hide quoted text — Show quoted text -> William > Sorry to see you need to join us, but we’re glad you are here - > hopefully you can find help here as many of us have. > What do you mean by ‘low 100’s’ – 100-105 ? 120 ? Since your after > meal BGs are fairly high, I was not sure what low might mean. > Can you describe the type of meal you are eating when you wind up with > these blood glucose levels ? > There are different thoughts on what a diabetic can and should eat, > but it tends to focus on carbohydrates. Some (many ?) people here eat > reduced carbohydrate diets, and have had success in managing their BG > levels. There are many people who will challenge this and tend to try > different options and with meds, have also brought their BGs into > control. There is no single solution. You and your Drs need to decide > what you want to do, but it’s always good to know the alternatives. . > Some folks prefer only testing BGs after meals to see when they are > high (or in control) as well as in the morning, when I was first > diagnosed i tended to test before a meal, and then after, I decided > that knowing I had a high BG after a meal (or a low one) did not tell > me much if I did not know what I started out with. > The good news is that with the right combination of changes to eating, > meds, exercise, many people here have had a great deal of luck > bringing their numbers into control, although it’s not always an easy > process. > MrBill >Hi there all. As the subject says I have just found out that I have type 2 >diabetes. The way I found out was I went for my DOT Physical and found 1000 > <snipped for brevity>

Response:

Thanks for all the info. I printed it out and will go over it when I can. I have a diet plan here and it is a little different then what you have said it still should work for sure. Thanks again for yout time and will be watching all I can. Bill

– Hide quoted text — Show quoted text -> Hi Will… > Welcome to our little corner of the web. > It sounds like you’ve got ample motivation to get this under control… > and the good news is, with a little investigative work on your part, you > can. The triangle plan is food/meds/exercise. Once you figure out > those three legs, you’ll have a plan you can live and WORK with. > Here’s the advice I give to all newbies: > There is so much to absorb… you don’t have to rush into anything. Begin > by using your best weapon in this war, your meter. You won’t keel over > today, you have time to experiment, test, learn, test and figure out just > how your body and this disease are getting along. The most important > thing you can do to learn about yourself and diabetes is test test test. > The single biggest question a diabetic has to answer is: > What do I eat? > Unfortunately, the answer is pretty confusing. > What confounds us all is the fact that different diabetics can get great > results on wildly different food plans. Some of us here achieve > great blood glucose control eating a high complex carbohydrate diet. > Others find that anything over 75 – 100g of carbs a day is too > much. Still others are somewhere in between. > At the beginning all of us felt frustrated. We wanted to be handed > THE way to eat, to ensure our continued health. But we all > learned that there is no one way. Each of us had to find our own path, > using the experience of those that went before, but still having > to discover for ourselves how OUR bodies and this disease were coexisting. > Ask questions, but remember each of us discovered on our own what works best > for us. You can use our experiences as jumping off points, but eventually > you’ll work up a successful plan that is yours alone. > What you are looking to discover is how different foods affect you. As I’m > sure you’ve read, carbohydrates (sugars, wheat, rice… the things our > Grandmas called "starches") raise blood sugars the most rapidly. Protein > and fat do raise them, but not as high and much more slowly… so if you’re > a T2, generally the insulin your body still makes may take care of the rise. > You might want to try some experiments. > First: Eat whatever you’ve been > currently eating… but write it all down. > Test yourself at the following times: > Upon waking (fasting) > 1 hour after each meal > 2 hours after each meal > At bedtime > That means 8 x each day. What you will discover by this is how long > after a meal your highest reading comes… and how fast you return to > "normal". Also, you may see that a meal that included bread, fruit or > other carbs gives you a higher reading. > Then for the next few days, try to curb your carbs. Eliminate breads, > cereals, rices, beans, any wheat products, potato, corn, fruit… get all > your carbs from veggies. Test at the same schedule above. > If you try this for a few days, you may find some pretty damn good > readings. It’s worth a few days to discover. > Eventually you can slowly add back carbs until you see them affecting your > meter. > The thing about this disease… though we share much in common and we > need to > follow certain guidelines… in the end, each of our bodies dictate our > treatment and our success. > The closer we get to non-diabetic numbers, the greater chance we have of > avoiding horrible complications. The key here is AIM… I know that > everyone is at a different point in their disease… and it is progressive. > But, if we aim for the best numbers and do our best, we give ourselves the > best shot at heath we’ve got. > That’s all we can do. > Here’s my opinion on what numbers to aim for, they are non-diabetic numbers. > FBG under 110 > One hour after meals under 140 > Two hours after meals under 120 > or for those in the mmol parts of the world: > Fasting Under 6 > One hour after meals Under 8 > Two hours after meals Under 6.5 > Recent studies have indicated that the most important numbers are your > "after meal" numbers. They may be the most indicative of future > complications, especially heart problems. > Listen to your doctor, but you are the leader of your diabetic > care team. While his /her advice is learned, it is not absolute. You > will end up knowing much more about your body and how it’s handling > diabetes than your doctor will. Your meter is your best weapon. > Just remember, we’re not in a race or a competition with anyone but > ourselves… Play around with your food plan… TEST TEST TEST. Learn what > foods cause spikes, what foods cause cravings… Use your body as a science > experiment. > You’ll read about a lot of different ways people use to control their > diabetes… Many are diametrically opposed. After awhile you’ll learn that > there is no one size fits all around here. Take some time to experiment > and you’ll soon discover the plan that works for you. > Best of luck! > Jennifer > Hi there all. As the subject says I have just found out that I have type 2 > diabetes. The way I found out was I went for my DOT Physical and found 1000 > mg of sugar in my urine. This take me off the road until I can get it under > control. I just finished my first class and have been on glyburide > 2.5/metformin 500 for a week now. Most of the time when I take my blood > sugar in the am the numbers are in the low 100’s but I can see I have a lot > of work to do for my numbers in the evening about 1.5 hours after I eat are > very high. The highest was 333 and lowest was 194. I have having some > problems with wanting to give up some things but I know I have to. I am > walking 30 min a day and controling what and when I eat. Right now I am > having a hard time not being able to work. I can’t go back on the road > until I have no sugar in the urine and have my heg a1c under 7. Last a1c > was 11.6. > I can use all the help I can and hope to be here at least once a day to > read all that I can. Thanks > William Kinmond William > Kinmond Truck Driver ICQ#: 5167519 Current ICQ status: ( Home Tel#: 716 > 297-9527 ( Work Tel#: 716 4714802 7 Fax#: None + More ways to contact me

Response:

Thanks for the warm welcome. I will be here as much as I can so that I can learn everything I can about how to keep this under control. I have learned alot from friends I have had in the past and am still learning today. I try to keep myself open and keep learning. Thanks and I hope one day I will be able to help some one here also. Bill

– Hide quoted text — Show quoted text -> Will welcome to ASD, although we are sorry you have to join, You have > found a place where you will get information and support, Ask all the > questions you want and we will certainly try to answer them although we > do not take the place of doctors. Sometimes though, we know more than > them. lol > I am sure you will be hearing from Jennifer soon who will give you > advice for newbies. > Please stay with us and learn about this disease, Right now, we can win > battles, but the war is still ongoing. > Loretta > — > In tribute to the United States of America and the State > of Israel, two bastions of strength in a world filled with strife and > terrorism.

Response:

Thanks for all the help and Kind words. I know I will have to change someday what work I do but it is hard giving up everything all at once. I need at least some hope that I can do what I love. I love to drive and will find it ver hard to give that part of my life up. I am doing what I can to find out all I can. I am just starting to take my blood sugar levels so only have 4 days worth of info to work with. I see trends all ready and have taken steps to improve myself. Was 101 this morning fasting and for me that is great. I have made a lot of changes in the past 3 months and well it seems to be working. Bill – Hide quoted text — Show quoted text -> Type 2 diabetes is a progressive disease which **can** ultimately result > in a need for insulin injections. > I don’t think you will be able to drive if you progress that far. > One freezes the progression by: > a. Losing Fat lb > b. Gaining muscle lb > c. Exercising regularly and vigorously, the more the better > d. Taking anti-Insulin Resistance meds: Metformin and Actos > You may have trouble with DOT if you can’t get off Glyburide. > I think Metformin and Actos are OK. > Metformin seems to work best when taken at 1500 mg/day or more. However, > they have to walk it up slowly because it causes stomach upsets and worse > metfartin ? ?) > BTW: metformin seems to be an anti-heart attack med for Type 2 diabetics. > There is a condition called Glucose Toxicity which strikes folks who have a > string of high blood sugar days, usually because nobody noticed that they > were diabetic. It is a temporary condition which amplifies all the > Diabetic symptoms. One knocks it out with extra insulin which is what the > Glyburide is doing for you. > My guess is that you have no idea of what your "normal diabetic state" is > right now. I think that you are still in Glucose Toxicity which is > "hiding" your true condition. . .so cheer up, it will get better. > However, your long-term eligibility for your CDL may depend on your ability > to vigorously attack your Insulin Resistance (i.e. freeze the Progression) > via the lose fat-gain muscle-exercise vigorously technique. We have > posters who pulled it off. They come back now and then to tell the > newcomers that it will work. (Richard Morris, Marco Polo) > Keep coming back. Reading these newsgroups every night has resulted in > significant improvements in my health and quality of life. > Old Al > (A retired engineer who shares his experiences)

Response:

Yes we can still drive with diabetes as long as we are not on Insulin shots. If just on the pill and under control we can still drive. Thanks for the warm welcome.

– Hide quoted text — Show quoted text ->Hi there all. As the subject says I have just found out that I have type 2 >diabetes. The way I found out was I went for my DOT Physical and found 1000 >mg of sugar in my urine. This take me off the road until I can get it under >control. I just finished my first class and have been on glyburide >2.5/metformin 500 for a week now. Most of the time when I take my blood >sugar in the am the numbers are in the low 100’s but I can see I have a lot >of work to do for my numbers in the evening about 1.5 hours after I eat are >very high. The highest was 333 and lowest was 194. I have having some >problems with wanting to give up some things but I know I have to. I am >walking 30 min a day and controling what and when I eat. Right now I am >having a hard time not being able to work. I can’t go back on the road >until I have no sugar in the urine and have my heg a1c under 7. Last a1c >was 11.6. > I can use all the help I can and hope to be here at least once a day to >read all that I can. Thanks > I thought a diabetic couldn’t drive an 18 wheeler? You are a > diabetic. Once a diabetic, always a diabetic. I wish diabetes was > like a light bulb that could be turned on and turned off with a flip > of a switch. See Sig to record BG’s. It’s Free. > http://www.tcainternet.com/retired/index.html

Response:

– Hide quoted text — Show quoted text -> Hi there all. As the subject says I have just found out that I have type 2 > diabetes. The way I found out was I went for my DOT Physical and found 1000 > mg of sugar in my urine. This take me off the road until I can get it under > control. I just finished my first class and have been on glyburide > 2.5/metformin 500 for a week now. Most of the time when I take my blood > sugar in the am the numbers are in the low 100’s but I can see I have a lot > of work to do for my numbers in the evening about 1.5 hours after I eat are > very high. The highest was 333 and lowest was 194. I have having some > problems with wanting to give up some things but I know I have to. I am > walking 30 min a day and controling what and when I eat. Right now I am > having a hard time not being able to work. I can’t go back on the road > until I have no sugar in the urine and have my heg a1c under 7. Last a1c > was 11.6. > I can use all the help I can and hope to be here at least once a day to > read all that I can. Thanks

I presume you have seen a dietician? If not, you should. If you have, you might consider a second visit. You probably don’t have to give up your favorite foods, but you will have to control your portions. Sometimes a portion for you might only be one bite. You really do need to get your BG under control because if you don’t, you could get Neuropathy. That’s a kind of nerve damage. If you have it, you could have a really hard time driving because of loss of sensation in your feet and legs. I was once driving and the car began to slow down, then stop. I pressed my foot on the gas, thinking there was some sort of problem. There was! The problem was that my foot wasn’t on the gas. It was merely on the floor. But I couldn’t tell. Other times I couldn’t tell the difference between the gas pedal and the brake without looking down or using my other foot to aid me. I would have to tap around with my left foot at the side of the brake pedal to tell where it was. A mere 2 mile trip to the grocery store was a big ordeal for me! I can’t imagine trying to drive a truck like that. Your vision can get wacky too. Don’t be surprised to have trouble seeing as your BG stablizes. It will get better, but you might have a rough couple of weeks. Stick around here! This is a great group! — Type 2 http://users.bestweb.net/~jbove/

Response:

Hi welcome I am a type 2 also and I am on Glucophage XR 500 mg two tabs twice a day and Glucotrol XL 5 mg two tabs twice a day and also Lantus 25 U at night. Whew that was alot to type LOL. Welcome to the group. I am glad to see you are trying really hard. I know it is very hard to do but with the help of many here I think you will do great and be back on the road again. :-) I love that saying. My hubby is a Class A driver hauling steel. You really may not have to stop eating what you want but maybe try cutting back until you see what is taboo for you. I myself have only a few things I had to completely give up but I do have once in a while and that is potatoes, oatmeal,bananas and bread. Most things I can still eat but in small quantity. I follow a low carb diet of about 50 carbs or lower a day. Anyways, nice to have you here and looking forward to sharing with you and ask all the questions you need to as someone here will be lots wiser than I and can answer them for you. I am just the welcome wagon LOL Diana – Hide quoted text — Show quoted text -> Hi there all. As the subject says I have just found out that I have type 2 > diabetes. The way I found out was I went for my DOT Physical and found 1000 > mg of sugar in my urine. This take me off the road until I can get it under > control. I just finished my first class and have been on glyburide > 2.5/metformin 500 for a week now. Most of the time when I take my blood > sugar in the am the numbers are in the low 100’s but I can see I have a lot > of work to do for my numbers in the evening about 1.5 hours after I eat are > very high. The highest was 333 and lowest was 194. I have having some > problems with wanting to give up some things but I know I have to. I am > walking 30 min a day and controling what and when I eat. Right now I am > having a hard time not being able to work. I can’t go back on the road > until I have no sugar in the urine and have my heg a1c under 7. Last a1c > was 11.6. > I can use all the help I can and hope to be here at least once a day to > read all that I can. Thanks > William Kinmond William > Kinmond Truck Driver ICQ#: 5167519 Current ICQ status: ( Home Tel#: 716 > 297-9527 ( Work Tel#: 716 4714802 7 Fax#: None + More ways to contact me

Response:

Welcome William, Sorry your found out you are T2, get over it! Rather blunt but it is a life long disease. I know it is a shocker, been there. The group here is fantastic. There is so much to learn. I am a T2 diag. Dec. 2000 Glucophage xr 500mg twice a day And I thought I would never get under control. But, I am, and thanks to all those in the group that were patient but persistant with me. I have several truck drivers in my wife’s family, Have a blessed day Ira — — Happy moments, praise God Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

– Hide quoted text — Show quoted text -> Welcome Will. You have come to the right place for info, support and > advice to get you back on the road if at all possible. This is a group of > great people who never fail to amaze me in their intelligence, knowledge of > diabetes and the care they show for others. Listen, ask, learn and keep > coming here. You will need to share your meals, etc. get prepared..:) > Best and Bless. Memory

Response:

William Sorry to see you need to join us, but we’re glad you are here - hopefully you can find help here as many of us have. What do you mean by ‘low 100’s’ – 100-105 ? 120 ? Since your after meal BGs are fairly high, I was not sure what low might mean. Can you describe the type of meal you are eating when you wind up with these blood glucose levels ? There are different thoughts on what a diabetic can and should eat, but it tends to focus on carbohydrates. Some (many ?) people here eat reduced carbohydrate diets, and have had success in managing their BG levels. There are many people who will challenge this and tend to try different options and with meds, have also brought their BGs into control. There is no single solution. You and your Drs need to decide what you want to do, but it’s always good to know the alternatives. . Some folks prefer only testing BGs after meals to see when they are high (or in control) as well as in the morning, when I was first diagnosed i tended to test before a meal, and then after, I decided that knowing I had a high BG after a meal (or a low one) did not tell me much if I did not know what I started out with. The good news is that with the right combination of changes to eating, meds, exercise, many people here have had a great deal of luck bringing their numbers into control, although it’s not always an easy process. MrBill >Hi there all. As the subject says I have just found out that I have type 2 >diabetes. The way I found out was I went for my DOT Physical and found 1000

Response:

Welcome Will. You have come to the right place for info, support and advice to get you back on the road if at all possible. This is a group of great people who never fail to amaze me in their intelligence, knowledge of diabetes and the care they show for others. Listen, ask, learn and keep coming here. You will need to share your meals, etc. get prepared..:) Best and Bless. Memory

Response:

Will welcome to ASD, although we are sorry you have to join, You have found a place where you will get information and support, Ask all the questions you want and we will certainly try to answer them although we do not take the place of doctors. Sometimes though, we know more than them. lol I am sure you will be hearing from Jennifer soon who will give you advice for newbies. Please stay with us and learn about this disease, Right now, we can win battles, but the war is still ongoing. Loretta — In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

Response:

Hi Will… Welcome to our little corner of the web. It sounds like you’ve got ample motivation to get this under control… and the good news is, with a little investigative work on your part, you can. The triangle plan is food/meds/exercise. Once you figure out those three legs, you’ll have a plan you can live and WORK with. Here’s the advice I give to all newbies: There is so much to absorb… you don’t have to rush into anything. Begin by using your best weapon in this war, your meter. You won’t keel over today, you have time to experiment, test, learn, test and figure out just how your body and this disease are getting along. The most important thing you can do to learn about yourself and diabetes is test test test. The single biggest question a diabetic has to answer is: What do I eat? Unfortunately, the answer is pretty confusing. What confounds us all is the fact that different diabetics can get great results on wildly different food plans. Some of us here achieve great blood glucose control eating a high complex carbohydrate diet. Others find that anything over 75 – 100g of carbs a day is too much. Still others are somewhere in between. At the beginning all of us felt frustrated. We wanted to be handed THE way to eat, to ensure our continued health. But we all learned that there is no one way. Each of us had to find our own path, using the experience of those that went before, but still having to discover for ourselves how OUR bodies and this disease were coexisting. Ask questions, but remember each of us discovered on our own what works best for us. You can use our experiences as jumping off points, but eventually you’ll work up a successful plan that is yours alone. What you are looking to discover is how different foods affect you. As I’m sure you’ve read, carbohydrates (sugars, wheat, rice… the things our Grandmas called "starches") raise blood sugars the most rapidly. Protein and fat do raise them, but not as high and much more slowly… so if you’re a T2, generally the insulin your body still makes may take care of the rise. You might want to try some experiments. First: Eat whatever you’ve been currently eating… but write it all down. Test yourself at the following times: Upon waking (fasting) 1 hour after each meal 2 hours after each meal At bedtime That means 8 x each day. What you will discover by this is how long after a meal your highest reading comes… and how fast you return to "normal". Also, you may see that a meal that included bread, fruit or other carbs gives you a higher reading. Then for the next few days, try to curb your carbs. Eliminate breads, cereals, rices, beans, any wheat products, potato, corn, fruit… get all your carbs from veggies. Test at the same schedule above. If you try this for a few days, you may find some pretty damn good readings. It’s worth a few days to discover. Eventually you can slowly add back carbs until you see them affecting your meter. The thing about this disease… though we share much in common and we need to follow certain guidelines… in the end, each of our bodies dictate our treatment and our success. The closer we get to non-diabetic numbers, the greater chance we have of avoiding horrible complications. The key here is AIM… I know that everyone is at a different point in their disease… and it is progressive. But, if we aim for the best numbers and do our best, we give ourselves the best shot at heath we’ve got. That’s all we can do. Here’s my opinion on what numbers to aim for, they are non-diabetic numbers. FBG under 110 One hour after meals under 140 Two hours after meals under 120 or for those in the mmol parts of the world: Fasting Under 6 One hour after meals Under 8 Two hours after meals Under 6.5 Recent studies have indicated that the most important numbers are your "after meal" numbers. They may be the most indicative of future complications, especially heart problems. Listen to your doctor, but you are the leader of your diabetic care team. While his /her advice is learned, it is not absolute. You will end up knowing much more about your body and how it’s handling diabetes than your doctor will. Your meter is your best weapon. Just remember, we’re not in a race or a competition with anyone but ourselves… Play around with your food plan… TEST TEST TEST. Learn what foods cause spikes, what foods cause cravings… Use your body as a science experiment. You’ll read about a lot of different ways people use to control their diabetes… Many are diametrically opposed. After awhile you’ll learn that there is no one size fits all around here. Take some time to experiment and you’ll soon discover the plan that works for you. Best of luck! Jennifer – Hide quoted text — Show quoted text -> Hi there all. As the subject says I have just found out that I have type 2 > diabetes. The way I found out was I went for my DOT Physical and found 1000 > mg of sugar in my urine. This take me off the road until I can get it under > control. I just finished my first class and have been on glyburide > 2.5/metformin 500 for a week now. Most of the time when I take my blood > sugar in the am the numbers are in the low 100’s but I can see I have a lot > of work to do for my numbers in the evening about 1.5 hours after I eat are > very high. The highest was 333 and lowest was 194. I have having some > problems with wanting to give up some things but I know I have to. I am > walking 30 min a day and controling what and when I eat. Right now I am > having a hard time not being able to work. I can’t go back on the road > until I have no sugar in the urine and have my heg a1c under 7. Last a1c > was 11.6. > I can use all the help I can and hope to be here at least once a day to > read all that I can. Thanks > William Kinmond > Kinmond Truck Driver ICQ#: 5167519 Current ICQ status: ( Home Tel#: 716 > 297-9527 ( Work Tel#: 716 4714802 7 Fax#: None + More ways to contact me

Response:

Mack, > I thought a diabetic couldn’t drive an 18 wheeler? You are a > diabetic. Once a diabetic, always a diabetic. I wish diabetes was > like a light bulb that could be turned on and turned off with a flip > of a switch. See Sig to record BG’s. It’s Free. > we can’t, if we have to cross state lines. if we do not cross state > lines the regs depend on the state you work in.

I thought the DOT regs mimicked the FAA regs in that the limitations for T1s are _much_ more restrictive than for T2s. This the CFR reg for CDL drivers. 391.41(b)(3) A person is physically qualified to drive a commercial motor vehicle if that person: Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control. There is no provision in the Federal Motor Carrier Safety Regulations (FMCSRs) for an exemption from the minimum physical requirement with respect to the insulin-using diabetic. Diabetes mellitus is a disease which, on occasion, can result in a loss of consciousness or orientation in time and space. Individuals who require insulin for control have conditions which can get out of control by the use of too much or too little insulin, or food intake not consistent with the insulin dosage. Incapacitation may occur from symptoms of hyperglycemic or hypoglycemic reactions (drowsiness, semiconsciousness, diabetic coma, or insulin shock). The administration of insulin is, within itself, a complicated process requiring insulin, syringe, needle, alcohol sponge and a sterile technique. Factors related to long-haul commercial motor vehicle operations, such as fatigue, lack of sleep, poor diet, emotional conditions, stress, and concomitant illness, compound the diabetic problem. Because of these inherent dangers, the FMCSA has consistently held that a diabetic who uses insulin for control does not meet the minimum physical requirements of the FMCSRs. Hypoglycemic drugs, taken orally, are sometimes prescribed for diabetic individuals to help stimulate natural body production of insulin. If the condition can be controlled by the use of oral medication and diet, then an individual may be qualified under the present rule. Not trying to be argumentative Mack, just trying to give all the info. Regards, James the Elder

Response:

>I thought a diabetic couldn’t drive an 18 wheeler?

My understanding is that it’s just those on insulin who are restricted. Bev Remove the "SpamFree" for email, please. Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

>Hi there all. As the subject says I have just found out that I have type 2 >diabetes. The way I found out was I went for my DOT Physical and found . . . >. . .(snip). . . > I can use all the help I can and hope to be here at least once a day to >read all that I can. Thanks >William Kinmond

Type 2 diabetes is a progressive disease which **can** ultimately result in a need for insulin injections. I don’t think you will be able to drive if you progress that far. One freezes the progression by: a. Losing Fat lb b. Gaining muscle lb c. Exercising regularly and vigorously, the more the better d. Taking anti-Insulin Resistance meds: Metformin and Actos You may have trouble with DOT if you can’t get off Glyburide. I think Metformin and Actos are OK. Metformin seems to work best when taken at 1500 mg/day or more. However, they have to walk it up slowly because it causes stomach upsets and worse metfartin ? ?) BTW: metformin seems to be an anti-heart attack med for Type 2 diabetics. There is a condition called Glucose Toxicity which strikes folks who have a string of high blood sugar days, usually because nobody noticed that they were diabetic. It is a temporary condition which amplifies all the Diabetic symptoms. One knocks it out with extra insulin which is what the Glyburide is doing for you. My guess is that you have no idea of what your "normal diabetic state" is right now. I think that you are still in Glucose Toxicity which is "hiding" your true condition. . .so cheer up, it will get better. However, your long-term eligibility for your CDL may depend on your ability to vigorously attack your Insulin Resistance (i.e. freeze the Progression) via the lose fat-gain muscle-exercise vigorously technique. We have posters who pulled it off. They come back now and then to tell the newcomers that it will work. (Richard Morris, Marco Polo) Keep coming back. Reading these newsgroups every night has resulted in significant improvements in my health and quality of life. Old Al (A retired engineer who shares his experiences)

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– Hide quoted text — Show quoted text ->Hi there all. As the subject says I have just found out that I have type 2 >diabetes. The way I found out was I went for my DOT Physical and found 1000 >mg of sugar in my urine. This take me off the road until I can get it under >control. I just finished my first class and have been on glyburide >2.5/metformin 500 for a week now. Most of the time when I take my blood >sugar in the am the numbers are in the low 100’s but I can see I have a lot >of work to do for my numbers in the evening about 1.5 hours after I eat are >very high. The highest was 333 and lowest was 194. I have having some >problems with wanting to give up some things but I know I have to. I am >walking 30 min a day and controling what and when I eat. Right now I am >having a hard time not being able to work. I can’t go back on the road >until I have no sugar in the urine and have my heg a1c under 7. Last a1c >was 11.6. > I can use all the help I can and hope to be here at least once a day to >read all that I can. Thanks >I thought a diabetic couldn’t drive an 18 wheeler? You are a >diabetic. Once a diabetic, always a diabetic. I wish diabetes was >like a light bulb that could be turned on and turned off with a flip >of a switch. See Sig to record BG’s. It’s Free. >http://www.tcainternet.com/retired/index.html

we can’t, if we have to cross state lines. if we do not cross state lines the regs depend on the state you work in. Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

Response:

Hi there all. As the subject says I have just found out that I have type 2 diabetes. The way I found out was I went for my DOT Physical and found 1000 mg of sugar in my urine. This take me off the road until I can get it under control. I just finished my first class and have been on glyburide 2.5/metformin 500 for a week now. Most of the time when I take my blood sugar in the am the numbers are in the low 100’s but I can see I have a lot of work to do for my numbers in the evening about 1.5 hours after I eat are very high. The highest was 333 and lowest was 194. I have having some problems with wanting to give up some things but I know I have to. I am walking 30 min a day and controling what and when I eat. Right now I am having a hard time not being able to work. I can’t go back on the road until I have no sugar in the urine and have my heg a1c under 7. Last a1c was 11.6. I can use all the help I can and hope to be here at least once a day to read all that I can. Thanks William Kinmond Kinmond Truck Driver ICQ#: 5167519 Current ICQ status: ( Home Tel#: 716 297-9527 ( Work Tel#: 716 4714802 7 Fax#: None + More ways to contact me

Response:

Category Categories: Diabetes Mellitus | No Comments »

interesting synthroid info

Question:

Tamera The readings for TSH are in reverse. A low TSH indicates HYPERthyroidism, a high TSH indicates HYPOthyroidism. Your readings appear just fine as most people do very well with a TSH under 1. A complication can be if you have secondary HYPOthyroidism (which I have) you will have a low TSH with low T4 and T3 readings. If you were HYPER this also can produce fatigue. If possible see if you can obtain the readings of your T3 and T4 levels. You can pose the same question at alt.support.thyroid if your levels seem low. Howard

– Hide quoted text — Show quoted text -> Oh now this intrigues me. I’m a T2- just started Glucophage XR 500 mg once > daily. My HBA1c is 5.8 and my FBG average is 99. I just had my bloodwork done > and my thyroid came back at 0.74 on a scale of 0.4-5.0.(mine is very low > normal) (Is there a correlation between T2 and hypothyroidism?? Should I > pursue this further. I certainly have the fatigue factor of hypothyroidism. > thanks

Response:

Oh now this intrigues me. I’m a T2- just started Glucophage XR 500 mg once daily. My HBA1c is 5.8 and my FBG average is 99. I just had my bloodwork done and my thyroid came back at 0.74 on a scale of 0.4-5.0.(mine is very low normal) (Is there a correlation between T2 and hypothyroidism?? Should I pursue this further. I certainly have the fatigue factor of hypothyroidism. thanks

Response:

– Hide quoted text — Show quoted text ->while the Barnes book on hypothroidism is interesting, >it’s also very old, and a lot of it is outdated > Well sure but it isn’t as if people themselves change that much. >if you have any *recent* books on hypothyroidism, you >might try looking up anything pertinent on "insulin" and >"diabetic" and posting it to *both* newsgroups. :) > Well I do post to alt.support.thyroid some but I can’t post the same thing to > both without going to a lot of trouble because AOL doesn’t allow crossposting. >iow, i suspect that both you and don stevens are >at best in a minority or even flat out incorrect. :) > Add Charles Evans wife to that. Then you get Julie, who is taking less and > less Synthroid yet needing more and more insulin as she reduces

this stuff is complicated with lots of ifs ands and buts i’d also take anything that CE said with a very big grain of salt. meaning that you appear (to me) to be guilty of either misinterpreting it or even blowing it way out of proportion. :(( i see that you re-posted one of CE’s old posts to me (on m.h.d.). i’ll read it but doubt that i’ll comment on it. again, this stuff is complicated with lots of ifs ands and buts fwiw, while looking thru a writeup on Levoxyl for another reason (Levoxyl is pure synthetic T4), i found another similar comment that matches my own experience and also the comment that i posted from Shomon’s book (see p.s.) bill p.s. in a 10 page pdf writeup on Levoxyl (from their web site) had "Associated endocrine disorders" with sub-head "Autoimmune polyglandular syndrome" with this wording: <<"Occasionally, chronic autoimmune thyroiditis may occur in association with other autoimmune disorders such as adrenal insufficiency, pernicious anemia, and insulin-dependent diabetes mellitus. Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens when treated with levothyroxine (see PRECAUTIONS, Drug Interactions).">> and under PRECAUTIONS, Drug Interactions/Miscellaneous was: <<"Antidiabetic Agents - Biguanides Addition of levothyroxine to antidiabetic or insulin - Meglitinides therapy may result in increased antidiabetic agent - Sulfonylureas or insulin requirements. Careful monitoring of diabetic - Thiazolidediones control is recommended, especially when thyroid therapy - Insulin is started, changed, or discontinued.">>

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Category Categories: Diabetes Mellitus | No Comments »

THE TROUBLE THAT IS TUBERCULOSIS

Question:

The trouble that is tuberculosis By B. K. Sharma The Tribune Sunday, July 15, 2001 Tuberculosis (TB) has over the centuries been referred to as ‘consumption’ as its cause was not known. Perhaps it was referred to as such because it consumes the patient slowly. In 1882, the German microbiologist, Dr Robert Koch (who was given the Nobel Prize in 1907 for his discoveries) proved that mycobacterium tuberculosis was the cause of this disease. This was a historic scientific discovery. However, no definite treatment was available till the middle of the previous century and people would go to a sanatorium located in a clean and cool environment (Kasauli, Dharampur, Tanda and others), where good nutrition, cod liver oil and the clean air was expected to cure the disease. The first effective drug for TB, streptomycin, was discovered by Wakesman in 1945, PAS was added in 1948 and other drugs came subsequently. The disease has assumed an alarming proportion in the past few years. The National Tuberculosis Control Programme was started in 1962 by the Government of India, but it has not achieved its goal. The revised National Tuberculosis Control Programme was introduced from 1993 in a phased manner and it is hoped that it will fare better. Incidence in India India has about 10-12 million TB patients and every year, nearly 1.5 million new cases are added and nearly half a million patients die. This means that one patient is dying every minute of a disease that is curable. These figures relate to pulmonary tuberculosis which is easily diagnosed. Perhaps, the incidence of tuberculosis involving the lymph nodes, bones, joints, gastrointestinal tract, and the brain is much the same. At the global level the picture is not better. In the annual report on global tuberculosis issued by the WHO on the eve of World TB Day March 24, it has been estimated that 8.4 million people contracted TB in 1999 and the biggest rise in number of cases was in sub-Saharan Africa, where the high incidence was due to the combination of HIV and TB. About 2 million people die of TB and half a million die with concurrent HIV infection. The report goes on to say that although TB is curable only 23 per cent of the people with active TB have access to satisfactory treatment. How does TB spread The disease is caused by a tiny bacteria which can be seen under the oil immersion lens of the microscope. It is the size of 2-4 millimicron and gives a beaded appearance. It can be seen after a special stain in which one of the steps is discolouration of the stain with acid. These bacteria are resistant to discolouration with acid and therefore known as acid fast bacilli. Doctors often refer to this disease as caused by AFB to avoid mentioning TB in the presence of a frightened patient. The infection takes place by inhalation of small droplets containing 3-5 bacteria. The bacteria are blown into the air by a patient of lung TB through coughing, sneezing and even talking. Paradoxically, it is a small droplet which is far more infectious as it keeps floating in the area even after drying as compared to a big droplet which settles on the floor. Good ventilation therefore, is very essential to prevent the spread of TB. Even talking closely to a known patient of TB should be avoided. A tissue paper or a mask helps to reduce transmission of the disease. Dark, damp, closed housing units, which are also overcrowded, are the breeding grounds of TB. Unfortunately, it is not essential to be an inmate of these houses to get the infection. One may get infection during a casual encounter with a patient in a bus, train,market place, cinema hall, social gathering, school or a business place. Predisposition It has long been recognised that having TB infection is not synonymous with the having the disease. Otherwise all doctors and paramedical persons would get TB. It has been estimated that one-third of the world population gets infected with this bacteria at one time or the other but only a few people contrast the disease. The secret, therefore, lies in the state of immunity of the person. When the infection is acquired, initially it remains dormant. But the main disease occurs later when the immunity or the resistance of the patient, for some reason, goes down and the disease starts its active course. Anything that impairs the immunity of an individual, therefore, increases the risk of active TB. This is why AIDS, which cripples the immunity of an individual, poor nutrition, administration of strong immunosuppressive drugs, as in the patients of organ transplantation, smoking and diabetes mellitus, all predispose a person to TB. Multidrug-resistant TB A new development that is causing anxiety in our own country and to the world community is the multidrug resistant disease, which is difficult and very costly to treat. The multidrug resistant disease is defined as the disease caused by bacteria which are resistant to the two best-known drugs — isoniazid and rifampacin. This has occurred over the years and has now assumed very serious proportion. It has resulted from half-hearted treatment as a result of ignorance of the patients and the medical profession as well as poor implementation of the TB eradication programme at the community level. The patients often do not complete the treatment suggested to them and stop it the moment they feel better symptomatically. Besides, physicians also do not follow the rules of the game and in spite of well-formulated drug regimes at the national level as well as those prescribed by the WHO, every doctor seems to follow his own plan. Somebody has aptly said that there are as many TB treatment plans as there are doctors. The bacteria also have their own methods of resistance to drugs and they undergo genetic mutation and develop resistance to drugs. Once a person is infected with this kind of TB, the treatment has to be carried out with what are known as the ’second-line drugs’ which are costlier, more toxic and not easily available. The treatment may cost as much as Rs 200-400 a day for these patients as compared to Rs 22-25 a day for an ordinary patient of TB. What can be done The problem is under active consideration at all levels. At the national level, the revised National TB Control Programme has been started in a phased manner and different blocks in different states are being covered by what is known as the DOTS programme. Primarily, this meant that since patients do not seem to take drugs regularly they should be given drug’s under observation. But this programme means much more than just giving drugs to the patients. It means surveillance of the area, monitoring their progress and providing them drugs under direct supervision. The Tuberculosis Research Centre, Madras, under the ICMR has done a tremendous job in the field. This centre is also responsible for the concept of DOTS. Somehow, the formulations of this centre have not been translated into field programmes effectively. A gigantic effort would be needed to stem this epidemic and a sociological, educational, economical and medical effort would be needed to make a dent in this. Read the complete news at: http://www.tribuneindia.com News Plus http://www.mantra.com/newsplus Jai Maharaj http://www.mantra.com/jai Om Shanti Panchaang for 9 Jyeshtth 5104, Sunday, June 8, 2003: Shubhanu Nama Samvatsare Uttarayane Nartana Ritau Vrishabh Mase Shukl Pakshe Bhanu Vasara Yuktayam Uttaraphalguni-Hasta Nakshatr Siddhi-Vyatipat Yog Balav-Kaulav Karan Navami Yam Tithau Hindu Holocaust Museum http://www.mantra.com/holocaust Hindu life, principles, spirituality and philosophy http://www.hindu.org http://www.hindunet.org The truth about Islam and Muslims http://www.flex.com/~jai/satyamevajayate o Not for commercial use. Solely to be fairly used for the educational purposes of research and open discussion. The contents of this post may not have been authored by, and do not necessarily represent the opinion of the poster. The contents are protected by copyright law and the exemption for fair use of copyrighted works. o If you send private e-mail to me, it will likely not be read, considered or answered if it does not contain your full legal name, current e-mail and postal addresses, and live-voice telephone number. o Posted for information and discussion. Views expressed by others are not necessarily those of the poster.

Response:

>The trouble that is tuberculosis >By B. K. Sharma >The Tribune >Sunday, July 15, 2001

[snip] – Hide quoted text — Show quoted text ->How does TB spread >The disease is caused by a tiny bacteria which can be >seen under the oil immersion lens of the microscope. It >is the size of 2-4 millimicron and gives a beaded >appearance. It can be seen after a special stain in which >one of the steps is discolouration of the stain with >acid. These bacteria are resistant to discolouration with >acid and therefore known as acid fast bacilli. Doctors >often refer to this disease as caused by AFB to avoid >mentioning TB in the presence of a frightened patient. >The infection takes place by inhalation of small droplets >containing 3-5 bacteria. The bacteria are blown into the >air by a patient of lung TB through coughing, sneezing >and even talking. >Paradoxically, it is a small droplet which is far more >infectious as it keeps floating in the area even after >drying as compared to a big droplet which settles on the >floor. Good ventilation therefore, is very essential to >prevent the spread of TB. Even talking closely to a known >patient of TB should be avoided. A tissue paper or a mask >helps to reduce transmission of the disease. Dark, damp, >closed housing units, which are also overcrowded, are the >breeding grounds of TB. Unfortunately, it is not >essential to be an inmate of these houses to get the >infection. One may get infection during a casual >encounter with a patient in a bus, train,market place, >cinema hall, social gathering, school or a business >place.

What is not mentioned is that if a TB sufferer *Spits* on the ground the bacteria may dry out and become mixed with dust. The dust raised by scuffing feet, sweeping and other, may cause the bacterium laden dust to be inhaled. Within the moist warm lung the bacterium is revitalised and grows. I was informed long ago that this was the reason why spitting is seriously frowned upon as a social taboo in many western cultures. It is curious to note that the areas of high incidence today, contain cultures in which spitting is seen as common place. JMO [snip] Diagnosed 20/03/03 Type II D&E + Metformin

Response:

> I was informed long ago that this was the reason why > spitting is seriously frowned upon as a social taboo in many > western cultures. It is curious to note that the areas of > high incidence today, contain cultures in which spitting is > seen as common place. JMO

This is one of the major reasons that the government of China has begun to crack down on public spitting, besides cleaning things up for the upcoming Olympics. The Chinese are inveterate spitters and you’ll find yourself up to your ankles on buses and in the "hard class" railcars. Regards, James the Elder

Response:

GROSS!!! Sadly, that’s the case around here, too. ::shudder:: – Hide quoted text — Show quoted text -> I was informed long ago that this was the reason why > spitting is seriously frowned upon as a social taboo in many > western cultures. It is curious to note that the areas of > high incidence today, contain cultures in which spitting is > seen as common place. JMO >This is one of the major reasons that the government of China has begun to >crack down on public spitting, besides cleaning things up for the upcoming >Olympics. >The Chinese are inveterate spitters and you’ll find yourself up to your >ankles on buses and in the "hard class" railcars. >Regards, >James the Elder

Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

– Hide quoted text — Show quoted text -> I was informed long ago that this was the reason why > spitting is seriously frowned upon as a social taboo in many > western cultures. It is curious to note that the areas of > high incidence today, contain cultures in which spitting is > seen as common place. JMO >This is one of the major reasons that the government of China has begun to >crack down on public spitting, besides cleaning things up for the upcoming >Olympics. >The Chinese are inveterate spitters and you’ll find yourself up to your >ankles on buses and in the "hard class" railcars. >Regards, >James the Elder

Quite so, but there is a social thing about it going back many years. The belief that a ‘devil’ was in the throat etc causing runny noses coughs etc was widely held. In some levels of Chinese society those beliefs are hard to dispel. They view a European who blows his nose into a piece of cloth and then places it in a pocket to be very unhygienic and in the same vein as we perhaps view spitting or nose content throwing. Pete Diagnosed 20/03/03 Type II D&E + Metformin

Response:

> Quite so, but there is a social thing about it going back > many years. The belief that a ‘devil’ was in the throat etc > causing runny noses coughs etc was widely held. In some > levels of Chinese society those beliefs are hard to dispel.

Actually, it runs across all class lines once you’re out of the larger cities, but you’re correct as to the original intent. > They view a European who blows his nose into a piece of > cloth and then places it in a pocket to be very unhygienic > and in the same vein as we perhaps view spitting or nose > content throwing.

To be quite honest, so do I! Always did as it was not the accepted practice in our house when I was growing up. Watching some classmate vigorously decant his snot-locker into a fine piece of linen and then studiously fold and place the results in their pocket made me give them a wide berth in fear of overflow. Having suffered with sinusitis all of my life I always considered myself quite the accomplished spitter, especially as I chose a life at sea which was NOT conducive to a drying of sinus membranes. But during one of my first visits to Hong Kong many years ago I was left in absolute awe by a wizened old Amah as she rooted noisily and deeply in her shrunken chest for some weeks old gob that, when ultimately dispatched, rivaled a desert sunrise for it’s technicolor splendor! Regards, James the Elder

Response:

– Hide quoted text — Show quoted text -> Quite so, but there is a social thing about it going back > many years. The belief that a ‘devil’ was in the throat etc > causing runny noses coughs etc was widely held. In some > levels of Chinese society those beliefs are hard to dispel. >Actually, it runs across all class lines once you’re out of the larger >cities, but you’re correct as to the original intent. > They view a European who blows his nose into a piece of > cloth and then places it in a pocket to be very unhygienic > and in the same vein as we perhaps view spitting or nose > content throwing. >To be quite honest, so do I! Always did as it was not the accepted practice >in our house when I was growing up. Watching some classmate vigorously >decant his snot-locker into a fine piece of linen and then studiously fold >and place the results in their pocket made me give them a wide berth in fear >of overflow.

ROTFLMFAO >Having suffered with sinusitis all of my life I always considered myself >quite the accomplished spitter, especially as I chose a life at sea which >was NOT conducive to a drying of sinus membranes. But during one of my first >visits to Hong Kong many years ago I was left in absolute awe by a wizened >old Amah as she rooted noisily and deeply in her shrunken chest for some >weeks old gob that, when ultimately dispatched, rivaled a desert sunrise for >it’s technicolor splendor! >Regards, >James the Elder

Oh for F*** Sake!!!!!!1 Now I am going to have to wash me keyboard you pillock! [Spluttered coffee over it] Thanks for that its the firs belly laught I have had for ages. I feel really great now. 10/10 for hitting the humour button smack on. Bit of a word wizard eh? BTW we had an Amah called Atille [I think that's how it is spelt] a Philipino by birth. My wife hired her saying she was more likely to be adept at her trade than some other younger ‘thing’. Atille was as ugly as sin so much so she made my stomach churn. But she had a hart of gold and worked hard [much harder than I thought she ought given her age]. But she could not cope with suble things like not pressing a Mohair sweater or cleaning silver plate with Brasso. Ah well, that’s life. What year were you there? I was resident 1980 – 1983 Pete Diagnosed 20/03/03 Type II D&E + Metformin

Response:

please edit out the non-diabetic groups when replying to any posts from the known troll and religious basher jai aka jay stevens. in regards to the upcoming olympics, if something isn’t done about SARS there might be a change of venu. Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

Response:

> Oh for F*** Sake!!!!!!1 > Now I am going to have to wash me keyboard you pillock! > [Spluttered coffee over it]

Sorry, guess I should have given you a coffee and cat warning! > Bit of a word wizard eh?

Well……. yeah. I get paid for each of them normally, although most aren’t for public consumption. > What year were you there? I was resident 1980 – 1983

First visit was in 1963 at the tender (and impressionable!) age of 16 with my freshly minted AB certificate and Z card. I’ve never been fortunate enough to be resident in the area (other than a government backed sojourn in sunny Viet Nam!) with the exception of some months in Korea and the Philippines, but I used to make trips to the area 2 to 3 times per year, even after I left the sea. Two years ago my wife and I made the whole Beijing, Great Wall, Xian, Yangtze/Three Gorges Cruise, etc., etc. tour and have been looking forward to returning ever since. I’ve been talking to some boating friends about shipping our boats to Shanghai and then cruising up the Yangtze to Chongqing via the Three Gorges Dam shiplift. A la’ the great GMC/Airstream tour of China in the mid 80’s. Biggest holdback to date (BION) is the inability to get other than the local high-sulphur diesel fuel on the river. Regards, James the Elder

Response:

> please edit out the non-diabetic groups when replying to any posts > from the known troll and religious basher jai aka jay stevens.

Done Mack, thanks for the reminder. > in regards to the upcoming olympics, if something isn’t done about > SARS there might be a change of venu.

Ummmm….. the "upcoming" Olympics are in Greece! The Beijing games aren’t until 2008 and one would hope we have a handle on SARS by then. Regards, James the Elder (Whose younger daughter is in training for Athens 2004!)

Response:

– Hide quoted text — Show quoted text -> please edit out the non-diabetic groups when replying to any posts > from the known troll and religious basher jai aka jay stevens. >Done Mack, thanks for the reminder. > in regards to the upcoming olympics, if something isn’t done about > SARS there might be a change of venu. >Ummmm….. the "upcoming" Olympics are in Greece! The Beijing games aren’t >until 2008 and one would hope we have a handle on SARS by then. >Regards, >James the Elder >(Whose younger daughter is in training for Athens 2004!)

I’m not overly optimistic about it happening. Hence the change of venue comment. Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

Response:

Category Categories: Diabetes Mellitus | No Comments »

Ketones (acetoacetic acid) in Urine

Question:

Ok… ketones.. The body stores its excess energy as Fat. If the body finds it is starving (because you are on a diet perhaps or you haven’t any insulin and are not getting energy from food) it will turn to its fat stores and convert the fat back into energy for consumption by the cells. When this conversion is done it breaks down a molecule which contains the energy and a ketoacid (apparently). This ketoacid is lost through urine or sometimes through your lungs.. The relevance to diabetics: Firstly a small number of ketones in the urine indicates that the body is burning fat. If yoiu are on a weight reducing diet then this is exactly what you should find! However, there is a condition called Diabetic Ketoacidosis (DKA) which is mostly an issue for T1s. Consider this… you produce no insulin, so you cannot use the food you digest. So you have all this energy (ie glucose) running around your sysem waiting to be used by your cells. Insulin would do this but you don’t have any. You could inject some and this would get the sugar in your blood used and things would be fine. Suppose you don’t. Ok the body thinks "i’m starving" as you are not burning energy, so it turns to its fat stores and converts fat to energy… releasing it into your blood. This actually raises your blood sugar further and makse things worse! This becomes a circle of rising blood sugars. Secondly as your body is breaking down fat to no avail it is releasing huge amounts of ketoacids (or ketones) that need to be got rid of. Eventually you are losing them through urine and your lungs and it is acidising your body. All of this is dangerous and it can strike very quickly. The condition can be fatal. So there you go, a ketone is a by product of the conversion of a fat molecule into energy. Hope you can understand all that. It is actually much more complex than that but I can understand it as i put it! YOu were treated I suspect for a DKA! Martin.

– Hide quoted text — Show quoted text -> > Does anyone know how to explain the Ketones in Urine it’s purpose? > and > > what it means if a lot is found or none is found? I just got out > of the > > hospital because my BG went down to 32 and I was cold clammy > shaken and > > confused, they injected 4 tubes of dextrose in my IV along with > > potassium which burned like hell, they said my potassium was very > low! > > and they ran for bags of that in my arm with the glucose IV bag, > They > > said they just wanted to keep me over night because after getting > a > > large dose of dextrin I felt fine then about an hour later it > would drop > > back down, well they tried to keep me another night and my BG was > 121 > > when I left, I had more important things that needed to be done > last > > tuesday, like closing on our new home and my appointment with my > pain > > doctor. They mentioned peptide’s and Ketones in Urine, I need > someone to > > explain in Lamense term what Ketones in the urine even means or > > represents? > > Thanks for those who replied to my wife’s post since she > > didn’t even know how to run a computer, I walked her through it > > on the phone. > > Anyway an easily understanding detailed information that I can > > understand about Ketones and there purpose I would feel gratefully > > in your Debt. I have so much to learn and for me a type II > diabetic > > having low BG sure was strange to me? and it still sometimes goes > low > > after a high 230 after eating a balanced meal. > > Prayers and many thanks, > > Doug > Hi there Doug, > I went looking for answers to your questions. I wanted to get as > close as I could to a medically accurate description of what is > happening to you. > First up I looked in The Merck Manual for what they had on Reactive > Hypoglycemia. It’s mentioned in a chapter that mostly has to do > with hypoglycemia generally. If you like to read it for yourself, > the link is: > http://www.merck.com/pubs/mmanual/section2/chapter13/13e.htm > There’s not much there that is helpful, there seems to be little > info on adult T2 reactive hypoglycemia, > "Reactive hypoglycemia associated with early-onset type II DM is > characterized by adrenergic symptoms occurring 4 to 5 h after eating > and is associated with an abnormally low plasma glucose level after > an initial period of postprandial hyperglycemia. This is ascribed to > a delayed and exaggerated rise in plasma insulin. " > That means that you get a very low bg some hours after eating, after > initially having a very high reading – sounds just like what you > described. > but then goes on to say, > "Some practitioners question its existence." > Well, there’s plenty of folks here who definitely know it exists! > Looks like you just joined their ranks. > The best strategy/treatment is pretty much what the sufferers here > usually recommend, ie > "….. managed with frequent small feedings of a high-protein, > low-carbohydrate diet." > Perhaps you might like to read this page, as there *are* some other > possible causes that you may wish to consider. One I found > intriguing was an "allergic reaction" to some substances found in > certain fruits. Just don’t go all hypochondriac on us, hey? > Now as for the ketones, here is what I found, from a Medline > article, see; > http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm > "Ketones (beta-hydroxybutyric acid, acetoacetic acid, and acetone) > are the end-product of rapid or excessive fatty acid breakdown. As > with glucose, ketones are present in the urine when the blood levels > surpass a certain threshold. Fatty acid release from adipose tissue > is stimulated by a number of hormones including glucagon, > epinephrine, and growth hormone. The levels of these hormones are > increased in starvation (whether related to excess alcohol use or > not), uncontrolled diabetes mellitus, and a number of other > conditions. " > So what that means is that your body acts like it is starving, > because the bg has dropped so low, and starts converting your > body’s store of fats (and sometimes proteins) into ketones, to get > energy to fuel the brain. The brain CAN use ketones in an > emergency. This shows up in your urine. Peptides are also elevated. > For some reason, you are producing too much insulin. A T1, for > example, who has no insulin to speak of, has a very LOW peptide > reading. > People who eat a very low carbohydrate diet may also show ketones in > their urine. > From what others have reported, the trick is to eat just enough > slow acting carbs at fairly frequent intervals to stop that from > happening, and make sure your intake of fats and protein are > adequate so that you don’t get hungry. Teh ones to avoid or limit > are the dense, high level carbs, like the sugars and starchy foods. > "Grazing" on vegetables almost all day is one way of doing that, > with a little extra carb at mealtimes, with your proteins and > fats/oils. A good intake of fibre is important. It *does* seem to > stop the "roller coaster" from getting going. What you call a > "balanced meal", is not working for you – going to a bg of 230 is a > BIG spike! I don’t call that "balanced" for someone with > diabetes. > You really are going to have to examine your diet and your exercise > routines, and perhaps discuss your current meds/insulin dosages > with your doctor. But I guess you know that now. > Take care, > Annette > Thank You so much Annette, Your information sounds like what my doctor > was trying to say, He did also mention something about Peptides in my > blood and I was in the ER all confused, they said II had no potassium in > my blood and its bad on the heart so they ran 4 bags IV of Potassium and > it felt kinda like a hot pack being applied to my arm as it went in. > Thanks for your time also to those links, very beneficial, still a lot > to learn and understand? I guess no two Diabetic’s are exactly alike? > Prayers, > Doug

Response:

Doug.. I have this too. I’ve had a 32 and below on lots of occasions, usually during exercise. Not anymore, though, because I figured out what to do during exercise. Let me rephrase, someone here helped me with a suggestion… anyway.. I have the same problem.. I have to eat low carbs.. it helps a LOT! I am now down to around 60 to 75 g a day. Until I did that.. I had daily hypos. Since doing that, I haven’t even had to test as often. I also eat 3 meals, and 3 snacks. Small meals, good snacks. It’s pretty much like eating 6 meals a day, instead of 3. Anyway.. that’s just me, but I wanted to suggest that. Oh! Terrell’s suggestion for exercise (or times of lots of physical stuff, like it’ you’re running around a lot), 8 ounces of gatorade in about 33 ounces of water is what I do for about 2 hours of exercise. That supplies 14 g of carbs over the 2 hours. It works for me.. you can do just little shots of gatorade, too, I imagine. Anyway.. good luck! Hypoglycemia STINKS!! Linda .. off to read Annette’s posted info.. – Hide quoted text — Show quoted text -> Does anyone know how to explain the Ketones in Urine it’s purpose? >and > what it means if a lot is found or none is found? I just got out >of the > hospital because my BG went down to 32 and I was cold clammy >shaken and > confused, they injected 4 tubes of dextrose in my IV along with > potassium which burned like hell, they said my potassium was very >low! > and they ran for bags of that in my arm with the glucose IV bag, >They > said they just wanted to keep me over night because after getting >a > large dose of dextrin I felt fine then about an hour later it >would drop > back down, well they tried to keep me another night and my BG was >121 > when I left, I had more important things that needed to be done >last > tuesday, like closing on our new home and my appointment with my >pain > doctor. They mentioned peptide’s and Ketones in Urine, I need >someone to > explain in Lamense term what Ketones in the urine even means or > represents? > Thanks for those who replied to my wife’s post since she > didn’t even know how to run a computer, I walked her through it > on the phone. > Anyway an easily understanding detailed information that I can > understand about Ketones and there purpose I would feel gratefully > in your Debt. I have so much to learn and for me a type II >diabetic > having low BG sure was strange to me? and it still sometimes goes >low > after a high 230 after eating a balanced meal. > Prayers and many thanks, > Doug >Hi there Doug, >I went looking for answers to your questions. I wanted to get as >close as I could to a medically accurate description of what is >happening to you. >First up I looked in The Merck Manual for what they had on Reactive >Hypoglycemia. It’s mentioned in a chapter that mostly has to do >with hypoglycemia generally. If you like to read it for yourself, >the link is: >http://www.merck.com/pubs/mmanual/section2/chapter13/13e.htm >There’s not much there that is helpful, there seems to be little >info on adult T2 reactive hypoglycemia, >"Reactive hypoglycemia associated with early-onset type II DM is >characterized by adrenergic symptoms occurring 4 to 5 h after eating >and is associated with an abnormally low plasma glucose level after >an initial period of postprandial hyperglycemia. This is ascribed to >a delayed and exaggerated rise in plasma insulin. " >That means that you get a very low bg some hours after eating, after >initially having a very high reading – sounds just like what you >described. >but then goes on to say, >"Some practitioners question its existence." >Well, there’s plenty of folks here who definitely know it exists! >Looks like you just joined their ranks. >The best strategy/treatment is pretty much what the sufferers here >usually recommend, ie >"….. managed with frequent small feedings of a high-protein, >low-carbohydrate diet." >Perhaps you might like to read this page, as there *are* some other >possible causes that you may wish to consider. One I found >intriguing was an "allergic reaction" to some substances found in >certain fruits. Just don’t go all hypochondriac on us, hey? >Now as for the ketones, here is what I found, from a Medline >article, see; >http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm >"Ketones (beta-hydroxybutyric acid, acetoacetic acid, and acetone) >are the end-product of rapid or excessive fatty acid breakdown. As >with glucose, ketones are present in the urine when the blood levels >surpass a certain threshold. Fatty acid release from adipose tissue >is stimulated by a number of hormones including glucagon, >epinephrine, and growth hormone. The levels of these hormones are >increased in starvation (whether related to excess alcohol use or >not), uncontrolled diabetes mellitus, and a number of other >conditions. " >So what that means is that your body acts like it is starving, >because the bg has dropped so low, and starts converting your >body’s store of fats (and sometimes proteins) into ketones, to get >energy to fuel the brain. The brain CAN use ketones in an >emergency. This shows up in your urine. Peptides are also elevated. >For some reason, you are producing too much insulin. A T1, for >example, who has no insulin to speak of, has a very LOW peptide >reading. >People who eat a very low carbohydrate diet may also show ketones in >their urine. >From what others have reported, the trick is to eat just enough >slow acting carbs at fairly frequent intervals to stop that from >happening, and make sure your intake of fats and protein are >adequate so that you don’t get hungry. Teh ones to avoid or limit >are the dense, high level carbs, like the sugars and starchy foods. >"Grazing" on vegetables almost all day is one way of doing that, >with a little extra carb at mealtimes, with your proteins and >fats/oils. A good intake of fibre is important. It *does* seem to >stop the "roller coaster" from getting going. What you call a >"balanced meal", is not working for you – going to a bg of 230 is a >BIG spike! I don’t call that "balanced" for someone with >diabetes. >You really are going to have to examine your diet and your exercise >routines, and perhaps discuss your current meds/insulin dosages >with your doctor. But I guess you know that now. >Take care, >Annette

Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

- Hide quoted text — Show quoted text -> Does anyone know how to explain the Ketones in Urine it’s purpose? > and > what it means if a lot is found or none is found? I just got out > of the > hospital because my BG went down to 32 and I was cold clammy > shaken and > confused, they injected 4 tubes of dextrose in my IV along with > potassium which burned like hell, they said my potassium was very > low! > and they ran for bags of that in my arm with the glucose IV bag, > They > said they just wanted to keep me over night because after getting > a > large dose of dextrin I felt fine then about an hour later it > would drop > back down, well they tried to keep me another night and my BG was > 121 > when I left, I had more important things that needed to be done > last > tuesday, like closing on our new home and my appointment with my > pain > doctor. They mentioned peptide’s and Ketones in Urine, I need > someone to > explain in Lamense term what Ketones in the urine even means or > represents? > Thanks for those who replied to my wife’s post since she > didn’t even know how to run a computer, I walked her through it > on the phone. > Anyway an easily understanding detailed information that I can > understand about Ketones and there purpose I would feel gratefully > in your Debt. I have so much to learn and for me a type II > diabetic > having low BG sure was strange to me? and it still sometimes goes > low > after a high 230 after eating a balanced meal. > Prayers and many thanks, > Doug > Hi there Doug, > I went looking for answers to your questions. I wanted to get as > close as I could to a medically accurate description of what is > happening to you. > First up I looked in The Merck Manual for what they had on Reactive > Hypoglycemia. It’s mentioned in a chapter that mostly has to do > with hypoglycemia generally. If you like to read it for yourself, > the link is: > http://www.merck.com/pubs/mmanual/section2/chapter13/13e.htm > There’s not much there that is helpful, there seems to be little > info on adult T2 reactive hypoglycemia, > "Reactive hypoglycemia associated with early-onset type II DM is > characterized by adrenergic symptoms occurring 4 to 5 h after eating > and is associated with an abnormally low plasma glucose level after > an initial period of postprandial hyperglycemia. This is ascribed to > a delayed and exaggerated rise in plasma insulin. " > That means that you get a very low bg some hours after eating, after > initially having a very high reading – sounds just like what you > described. > but then goes on to say, > "Some practitioners question its existence." > Well, there’s plenty of folks here who definitely know it exists! > Looks like you just joined their ranks. > The best strategy/treatment is pretty much what the sufferers here > usually recommend, ie > "….. managed with frequent small feedings of a high-protein, > low-carbohydrate diet." > Perhaps you might like to read this page, as there *are* some other > possible causes that you may wish to consider. One I found > intriguing was an "allergic reaction" to some substances found in > certain fruits. Just don’t go all hypochondriac on us, hey? > Now as for the ketones, here is what I found, from a Medline > article, see; > http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm > "Ketones (beta-hydroxybutyric acid, acetoacetic acid, and acetone) > are the end-product of rapid or excessive fatty acid breakdown. As > with glucose, ketones are present in the urine when the blood levels > surpass a certain threshold. Fatty acid release from adipose tissue > is stimulated by a number of hormones including glucagon, > epinephrine, and growth hormone. The levels of these hormones are > increased in starvation (whether related to excess alcohol use or > not), uncontrolled diabetes mellitus, and a number of other > conditions. " > So what that means is that your body acts like it is starving, > because the bg has dropped so low, and starts converting your > body’s store of fats (and sometimes proteins) into ketones, to get > energy to fuel the brain. The brain CAN use ketones in an > emergency. This shows up in your urine. Peptides are also elevated. > For some reason, you are producing too much insulin. A T1, for > example, who has no insulin to speak of, has a very LOW peptide > reading. > People who eat a very low carbohydrate diet may also show ketones in > their urine. > From what others have reported, the trick is to eat just enough > slow acting carbs at fairly frequent intervals to stop that from > happening, and make sure your intake of fats and protein are > adequate so that you don’t get hungry. Teh ones to avoid or limit > are the dense, high level carbs, like the sugars and starchy foods. > "Grazing" on vegetables almost all day is one way of doing that, > with a little extra carb at mealtimes, with your proteins and > fats/oils. A good intake of fibre is important. It *does* seem to > stop the "roller coaster" from getting going. What you call a > "balanced meal", is not working for you – going to a bg of 230 is a > BIG spike! I don’t call that "balanced" for someone with > diabetes. > You really are going to have to examine your diet and your exercise > routines, and perhaps discuss your current meds/insulin dosages > with your doctor. But I guess you know that now. > Take care, > Annette

Thank You so much Annette, Your information sounds like what my doctor was trying to say, He did also mention something about Peptides in my blood and I was in the ER all confused, they said II had no potassium in my blood and its bad on the heart so they ran 4 bags IV of Potassium and it felt kinda like a hot pack being applied to my arm as it went in. Thanks for your time also to those links, very beneficial, still a lot to learn and understand? I guess no two Diabetic’s are exactly alike? Prayers, Doug

Response:

– Hide quoted text — Show quoted text -> Does anyone know how to explain the Ketones in Urine it’s purpose? and > what it means if a lot is found or none is found? I just got out of the > hospital because my BG went down to 32 and I was cold clammy shaken and > confused, they injected 4 tubes of dextrose in my IV along with > potassium which burned like hell, they said my potassium was very low! > and they ran for bags of that in my arm with the glucose IV bag, They > said they just wanted to keep me over night because after getting a > large dose of dextrin I felt fine then about an hour later it would drop > back down, well they tried to keep me another night and my BG was 121 > when I left, I had more important things that needed to be done last > tuesday, like closing on our new home and my appointment with my pain > doctor. They mentioned peptide’s and Ketones in Urine, I need someone to > explain in Lamense term what Ketones in the urine even means or > represents? > Thanks for those who replied to my wife’s post since she > didn’t even know how to run a computer, I walked her through it > on the phone. > Anyway an easily understanding detailed information that I can > understand about Ketones and there purpose I would feel gratefully > in your Debt. I have so much to learn and for me a type II diabetic > having low BG sure was strange to me? and it still sometimes goes low > after a high 230 after eating a balanced meal. > Prayers and many thanks, > Doug

Hi there Doug, I went looking for answers to your questions. I wanted to get as close as I could to a medically accurate description of what is happening to you. First up I looked in The Merck Manual for what they had on Reactive Hypoglycemia. It’s mentioned in a chapter that mostly has to do with hypoglycemia generally. If you like to read it for yourself, the link is: http://www.merck.com/pubs/mmanual/section2/chapter13/13e.htm There’s not much there that is helpful, there seems to be little info on adult T2 reactive hypoglycemia, "Reactive hypoglycemia associated with early-onset type II DM is characterized by adrenergic symptoms occurring 4 to 5 h after eating and is associated with an abnormally low plasma glucose level after an initial period of postprandial hyperglycemia. This is ascribed to a delayed and exaggerated rise in plasma insulin. " That means that you get a very low bg some hours after eating, after initially having a very high reading – sounds just like what you described. but then goes on to say, "Some practitioners question its existence." Well, there’s plenty of folks here who definitely know it exists! Looks like you just joined their ranks. The best strategy/treatment is pretty much what the sufferers here usually recommend, ie "….. managed with frequent small feedings of a high-protein, low-carbohydrate diet." Perhaps you might like to read this page, as there *are* some other possible causes that you may wish to consider. One I found intriguing was an "allergic reaction" to some substances found in certain fruits. Just don’t go all hypochondriac on us, hey? Now as for the ketones, here is what I found, from a Medline article, see; http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm "Ketones (beta-hydroxybutyric acid, acetoacetic acid, and acetone) are the end-product of rapid or excessive fatty acid breakdown. As with glucose, ketones are present in the urine when the blood levels surpass a certain threshold. Fatty acid release from adipose tissue is stimulated by a number of hormones including glucagon, epinephrine, and growth hormone. The levels of these hormones are increased in starvation (whether related to excess alcohol use or not), uncontrolled diabetes mellitus, and a number of other conditions. " So what that means is that your body acts like it is starving, because the bg has dropped so low, and starts converting your body’s store of fats (and sometimes proteins) into ketones, to get energy to fuel the brain. The brain CAN use ketones in an emergency. This shows up in your urine. Peptides are also elevated. For some reason, you are producing too much insulin. A T1, for example, who has no insulin to speak of, has a very LOW peptide reading. People who eat a very low carbohydrate diet may also show ketones in their urine. From what others have reported, the trick is to eat just enough slow acting carbs at fairly frequent intervals to stop that from happening, and make sure your intake of fats and protein are adequate so that you don’t get hungry. Teh ones to avoid or limit are the dense, high level carbs, like the sugars and starchy foods. "Grazing" on vegetables almost all day is one way of doing that, with a little extra carb at mealtimes, with your proteins and fats/oils. A good intake of fibre is important. It *does* seem to stop the "roller coaster" from getting going. What you call a "balanced meal", is not working for you – going to a bg of 230 is a BIG spike! I don’t call that "balanced" for someone with diabetes. You really are going to have to examine your diet and your exercise routines, and perhaps discuss your current meds/insulin dosages with your doctor. But I guess you know that now. Take care, Annette

Response:

Does anyone know how to explain the Ketones in Urine it’s purpose? and what it means if a lot is found or none is found? I just got out of the hospital because my BG went down to 32 and I was cold clammy shaken and confused, they injected 4 tubes of dextrose in my IV along with potassium which burned like hell, they said my potassium was very low! and they ran for bags of that in my arm with the glucose IV bag, They said they just wanted to keep me over night because after getting a large dose of dextrin I felt fine then about an hour later it would drop back down, well they tried to keep me another night and my BG was 121 when I left, I had more important things that needed to be done last tuesday, like closing on our new home and my appointment with my pain doctor. They mentioned peptide’s and Ketones in Urine, I need someone to explain in Lamense term what Ketones in the urine even means or represents? Thanks for those who replied to my wife’s post since she didn’t even know how to run a computer, I walked her through it on the phone. Anyway an easily understanding detailed information that I can understand about Ketones and there purpose I would feel gratefully in your Debt. I have so much to learn and for me a type II diabetic having low BG sure was strange to me? and it still sometimes goes low after a high 230 after eating a balanced meal. Prayers and many thanks, Doug

Response:

Category Categories: Diabetes Mellitus | No Comments »

About Carbs

Question:

Hi, I have just recently in the past month and half been dieting to lose weight, bring my bg in control and to basically feel better. I am so confused even after four years of battling this diabetes. My question is: I thought your glucose only goes up if eating carbs. I just today found out that even if you eat no carbs it goes up so do I have to starve now? I have been eating stuff I hate for two months now and my bg is in control now but this morning I had NO carbs for breakfast and I tested 1-2 hours after and I had jumped from 112 FBG to PP of 145. Here I thought I had this all figured out and now I know that I don’t. I have no clue how to eat right. I admit it didn’t go up as much as if I had eaten carbs but it was very disheartening to see it went up at all. Thanks for listening and any suggestions are welcome Diana

Response:

– Hide quoted text — Show quoted text – > Hi, > I have just recently in the past month and half been dieting to lose weight, > bring my bg in control and to basically feel better. I am so confused even > after four years of battling this diabetes. > My question is: I thought your glucose only goes up if eating carbs. I just > today found out that even if you eat no carbs it goes up so do I have to > starve now? > I have been eating stuff I hate for two months now and my bg is in control > now but this morning I had NO carbs for breakfast and I tested 1-2 hours > after and I had jumped from 112 FBG to PP of 145. Here I thought I had > this all figured out and now I know that I don’t. I have no clue how to eat > right. I admit it didn’t go up as much as if I had eaten carbs but it was > very disheartening to see it went up at all. > Thanks for listening and any suggestions are welcome

Any food you metabolize will ultimately result in glucose in your blood. If it didn’t, you would starve to death without carbs, and we know that won’t happen since the native peoples of the far north have lived for generations eating almost exclusively protein and fat. Carbs will just do it more dramatically. Your liver will also release glucose if it thinks you need it (liver dump). It’s also harder to avoid *all* carbs than one thinks. What did you eat that had no carbs in it? Priscilla — "I don’t feel comfortable with a boot with my name on it on the throat of the rest of the world." – Alan Winston in rec.arts.sf.fandom

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BG is not just related to what you eat. Many other things affect it, such as stress, hormone levels, and illness. Just curious. What did you eat for breakfast? And how in the world did you manage to eat things that you hate? I just can’t bring myself to do that. I swear I would starve before eating something I hated. — Type 2 http://users.bestweb.net/~jbove/

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Thank you for the fast reply I had sausage links and two eggs fried in a PAM spray. I just can’t seem to get this WOE right. I try so hard and it is paying off but I had really hope to do better. Thanks again for such a fast reply. Diana

– Hide quoted text — Show quoted text -> Hi, > I have just recently in the past month and half been dieting to lose weight, > bring my bg in control and to basically feel better. I am so confused even > after four years of battling this diabetes. > My question is: I thought your glucose only goes up if eating carbs. I just > today found out that even if you eat no carbs it goes up so do I have to > starve now? > I have been eating stuff I hate for two months now and my bg is in control > now but this morning I had NO carbs for breakfast and I tested 1-2 hours > after and I had jumped from 112 FBG to PP of 145. Here I thought I had > this all figured out and now I know that I don’t. I have no clue how to eat > right. I admit it didn’t go up as much as if I had eaten carbs but it was > very disheartening to see it went up at all. > Thanks for listening and any suggestions are welcome > Any food you metabolize will ultimately result in glucose in your blood. > If it didn’t, you would starve to death without carbs, and we know that > won’t happen since the native peoples of the far north have lived for > generations eating almost exclusively protein and fat. Carbs will just > do it more dramatically. Your liver will also release glucose if it > thinks you need it (liver dump). It’s also harder to avoid *all* carbs > than one thinks. What did you eat that had no carbs in it? > Priscilla > — > "I don’t feel comfortable with a boot with my name on it on the throat > of the rest of the world." – Alan Winston in rec.arts.sf.fandom

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Hi Julie, Thanks for your quick answer. I had two eggs fried in PAM that non stick stuff and sausage links. I have been eating raw veggies and I hate veggies. I am eating cottage cheese that has only four carbs per serving. Tons of sugar free jello and that is stuff in the daytime of the evening I am having Cod and I hate fish unless it is Mcdonalds or Frisches LOL and more vegetables only steamed this time. No bread, pasta, crackers, sugar , cereals, nothing I really like. Diana

– Hide quoted text — Show quoted text -> Hi, > I have just recently in the past month and half been dieting to lose > weight, > bring my bg in control and to basically feel better. I am so confused even > after four years of battling this diabetes. > My question is: I thought your glucose only goes up if eating carbs. I > just > today found out that even if you eat no carbs it goes up so do I have to > starve now? > I have been eating stuff I hate for two months now and my bg is in control > now but this morning I had NO carbs for breakfast and I tested 1-2 hours > after and I had jumped from 112 FBG to PP of 145. Here I thought I had > this all figured out and now I know that I don’t. I have no clue how to > eat > right. I admit it didn’t go up as much as if I had eaten carbs but it was > very disheartening to see it went up at all. > Thanks for listening and any suggestions are welcome > BG is not just related to what you eat. Many other things affect it, such > as stress, hormone levels, and illness. Just curious. What did you eat for > breakfast? > And how in the world did you manage to eat things that you hate? I just > can’t bring myself to do that. I swear I would starve before eating > something I hated. > — > Type 2 > http://users.bestweb.net/~jbove/

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> Thank you for the fast reply > I had sausage links and two eggs fried in a PAM spray.

Sausage and eggs both contain carbs. Now granted, eggs have minute amounts, but the amount for sausages can vary. They almost always have some sort of fillers in them. And some have sweeteners. <snip> — Type 2 http://users.bestweb.net/~jbove/

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Oh ok. I was going by what was on the packages. Thanks Julie ! But if that little few carbs made me spike that high I dare think what more carbs would do. I know about three weeks ago I had one slice rye toast which the bag said was 12 carbs and I went up over 200. I guess it is back to the drawing board for me. Thanks again Diana Diana

– Hide quoted text — Show quoted text -> Thank you for the fast reply > I had sausage links and two eggs fried in a PAM spray. > Sausage and eggs both contain carbs. Now granted, eggs have minute amounts, > but the amount for sausages can vary. They almost always have some sort of > fillers in them. And some have sweeteners. > <snip> > — > Type 2 > http://users.bestweb.net/~jbove/

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> Hi Julie, > Thanks for your quick answer. > I had two eggs fried in PAM that non stick stuff and sausage links.

I replied above about the carbs in those. > I have been eating raw veggies and I hate veggies. I am eating cottage > cheese that has only four carbs per serving. Tons of sugar free jello and > that is stuff in the daytime of the evening I am having Cod and I hate fish > unless it is Mcdonalds or Frisches LOL and more vegetables only steamed this > time. No bread, pasta, crackers, sugar , cereals, nothing I really like.

I guess I’m lucky that I love veggies. I could eat those and nothing else. Love cottage cheese too! The only fish I can bring myself to eat is tuna, and only occasionally and prepared either as a tuna salad, tuna salad sandwich or tuna casserole. Actually, I once had a tuna pizza and it was good. No WAY could I gag down Cod. My parents went through a Weight Watcher’s phase some years ago and we had some kind of white fish 5 times a week. Liver once a week and hamburger patties once a week. You couldn’t pay me to eat any of those things now. Actually I did used to eat fish sticks, but they had to be smothered in mashed potatoes or I couldn’t eat them. I don’t much like crackers. Hate cereal. Could live without bread, but then I’d have nothing to eat for breakfast! *L* Can do without sugar. But I still eat pasta and it works for me. My diet is very limited. People hate to dine out with me because there are so few places I’ll eat at. But I found a diet that works for me and includes foods I like. Are there any vegetables at all that you like? I’ve found that I can do all sorts of things with canned green beans. I don’t really like them, but I don’t dislike them either. I can eat them every day. I add them to soup, casseroles and all sorts of things. And they’re always onhand. — Type 2 http://users.bestweb.net/~jbove/

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> Oh ok. I was going by what was on the packages.

It could be that the sausages you have contain no carbs. I usually buy the brown and serve kind and they have anywhere from 2-5g of carbs. Can’t remember if that’s per link or per serving. I was surprised by the eggs. I thought they had no carbs until someone else here told me otherwise. I looked it up and sure enough, they do! > Thanks Julie ! But if that little few carbs made me spike that high I dare > think what more carbs would do.

I wouldn’t call 145 a spike. A bit too high, yes. But not a spike. It is a bit surprising that you went from 112 to that with so little food though. >I know about three weeks ago I had one slice > rye toast which the bag said was 12 carbs and I went up over 200. I guess it > is back to the drawing board for me.

Wish I could be of more help. I thought I was doing better until yesterday when I woke up to a nice 179. Ate only 1/4 cup of cottage cheese for breakfast. That and exercise brought me down only to 140. Salad for lunch brought me up to 156. :( Did more exercise and was down to 104 before dinner. Didn’t bother to test after dinner. The way things were going, it didn’t seem like anything I did or didn’t do was going to matter. — Type 2 http://users.bestweb.net/~jbove/

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>I have been eating stuff I hate for two months now and my bg is in control >now but this morning I had NO carbs for breakfast and I tested 1-2 hours >after and I had jumped from 112 FBG to PP of 145. Here I thought I had >this all figured out and now I know that I don’t. I have no clue how to eat >right. I admit it didn’t go up as much as if I had eaten carbs but it was >very disheartening to see it went up at all.

It’s a liver dump, Diana. It happens when your body decides that your bg is too low. Your liver then dumps a bunch of glucose into your bloodstream to keep you from keeling over. At least it was only that amount. The other day it dumped a ton into mine, and I wound up at 307. So.. I guess they key is.. eat more carbs for breakfast if you are going to have the same activity level… and also… it helps to eat snacks between meals. I’ve learned all this very quickly but… Someone a lot more knowledgeable than me will no doubt be along pretty quickly. I’m learning mine from experience. I think my liver has been working overtime dumping glucose for the past few weeks. I’m still "finding that balance". Like you, I want to lose this weight! ((hugs)) Linda

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>Hi Julie, >Thanks for your quick answer. >I had two eggs fried in PAM that non stick stuff and sausage links. >I have been eating raw veggies and I hate veggies. I am eating cottage >cheese that has only four carbs per serving. Tons of sugar free jello and >that is stuff in the daytime of the evening I am having Cod and I hate fish >unless it is Mcdonalds or Frisches LOL and more vegetables only steamed this >time. No bread, pasta, crackers, sugar , cereals, nothing I really like. >Diana

Geez… Diana, if I ate like this with NO carbs whatsoever… I’d be in hypo land for life, I think. I’ve been experimenting like you wouldn’t believe.. going through test strips like crazy.. all with carbs vs exercise etc. I tried the no carbs for breakfast. It was hypo/liver dump city. I couldn’t get stabilized until I figured out how many carbs I did need to eat. Now I started with 30 g as a base. I do about 35 to 90 minutes per day. On my 30 minute days, I’m now down to about 10 to 15 g, and actually doing okay. I haven’t gotten my 90 minute days exactly right, yet, but I will… I read that you have to have =some- carbs… to fuel your body so that you can burn the fat. I’m no expert on low-carbing, though. I guess it all depends on your energy level and how you metabolize the foods. The rye bread may have had sugars in it. For me, it also depends on the KINDS of carbs, not just the carbs. I do better with light bread, for instance. Whole grain, lots of fiber. If I drink milk, though, I spike, just like you. 4 oz sent me to 187 the other day. GAH! I guess it’s all individual. If it were me, I’d add some carbs.. maybe 15-30 g to my meals and then, if that works out okay, you can maybe step down… at least that’s what I did.. oh, and snacks. I do 15 g for my snacks. I sometimes add one at night, if my bg is below 110 or so (which it usually is). I’ve had really good luck keeping my bg’s down. The only time I’ve had problems is when I’ve tried to cut them too far down, and increase exercise at the same time.. so.. Oh! Also.. with the exercise and even with 30g meals, I’m losing inches! Also.. weight. I just fit into a bra that I’ve =never= fit in to, and I bought it about 4 or 5 years ago.. so that’s good!! A few carbs won’t keep you from losing weight.. that was my fear, too. Just watch the kind of carbs… check the Glycemic Index, and just watch what spikes you, and what doesn’t. Keep in mind.. I’m new, but… I’ve been studying this intensely since I was dx’d.. this is what works for me… dunno if it’ll work for you.. but I do hope it helps… ((hugs!)) PS: Do you exercise? Linda

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> Thank you for the fast reply > I had sausage links and two eggs fried in a PAM spray. > I just can’t seem to get this WOE right. I try so hard and it is paying off > but I had really hope to do better.

Try 5 gr carb with the meal and see if it breaks the fast. An all protein meal sometimes doesn’t cut it and the liver will dump. You are doing very well Di, proud of ya!

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Hi Julie I do like asparagus, kale, spinach and green beans but the green beans only if have all that fat like bacon in them LOL. I like tuna but only in sandwich form same as salmon. I also like brussel sprouts. I guess what I meant was raw veggies is what I mainly dislike but before dx I didn’t eat many veggies at all. Diana

– Hide quoted text — Show quoted text -> Hi Julie, > Thanks for your quick answer. > I had two eggs fried in PAM that non stick stuff and sausage links. > I replied above about the carbs in those. > I have been eating raw veggies and I hate veggies. I am eating cottage > cheese that has only four carbs per serving. Tons of sugar free jello and > that is stuff in the daytime of the evening I am having Cod and I hate > fish > unless it is Mcdonalds or Frisches LOL and more vegetables only steamed > this > time. No bread, pasta, crackers, sugar , cereals, nothing I really like. > I guess I’m lucky that I love veggies. I could eat those and nothing else. > Love cottage cheese too! The only fish I can bring myself to eat is tuna, > and only occasionally and prepared either as a tuna salad, tuna salad > sandwich or tuna casserole. Actually, I once had a tuna pizza and it was > good. No WAY could I gag down Cod. My parents went through a Weight > Watcher’s phase some years ago and we had some kind of white fish 5 times a > week. Liver once a week and hamburger patties once a week. You couldn’t > pay me to eat any of those things now. Actually I did used to eat fish > sticks, but they had to be smothered in mashed potatoes or I couldn’t eat > them. > I don’t much like crackers. Hate cereal. Could live without bread, but > then I’d have nothing to eat for breakfast! *L* Can do without sugar. But > I still eat pasta and it works for me. My diet is very limited. People > hate to dine out with me because there are so few places I’ll eat at. But I > found a diet that works for me and includes foods I like. > Are there any vegetables at all that you like? I’ve found that I can do all > sorts of things with canned green beans. I don’t really like them, but I > don’t dislike them either. I can eat them every day. I add them to soup, > casseroles and all sorts of things. And they’re always onhand. > — > Type 2 > http://users.bestweb.net/~jbove/

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Yea the 145 was strange to me too. I was shocked. I told Dale looked like I would not be able to eat anything. I am on four Glucophage XR a day and Lantus at night. Now the Lantus is a dream come true. I have never since dx come up with great numbers in the morning as I do now. You are more help than you think. Thanks Diana

– Hide quoted text — Show quoted text -> Oh ok. I was going by what was on the packages. > It could be that the sausages you have contain no carbs. I usually buy the > brown and serve kind and they have anywhere from 2-5g of carbs. Can’t > remember if that’s per link or per serving. I was surprised by the eggs. I > thought they had no carbs until someone else here told me otherwise. I > looked it up and sure enough, they do! > Thanks Julie ! But if that little few carbs made me spike that high I dare > think what more carbs would do. > I wouldn’t call 145 a spike. A bit too high, yes. But not a spike. It is > a bit surprising that you went from 112 to that with so little food though. >I know about three weeks ago I had one slice > rye toast which the bag said was 12 carbs and I went up over 200. I guess > it > is back to the drawing board for me. > Wish I could be of more help. I thought I was doing better until yesterday > when I woke up to a nice 179. Ate only 1/4 cup of cottage cheese for > breakfast. That and exercise brought me down only to 140. Salad for lunch > brought me up to 156. :( Did more exercise and was down to 104 before > dinner. Didn’t bother to test after dinner. The way things were going, it > didn’t seem like anything I did or didn’t do was going to matter. > — > Type 2 > http://users.bestweb.net/~jbove/

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Diana. I too used to eat the green beaqns with all the bacon grease, etc. I now love them with a lot of chopped onion, a drip of liquid smoke and pepper—(canned gr. beans). They are wonderful. A little liquid smoke goes a long way–be careful. I think the secret is plenty of onion. Memory

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- Hide quoted text — Show quoted text -> My question is: I thought your glucose only goes up if eating carbs. I just > today found out that even if you eat no carbs it goes up so do I have to > starve now? > Any food you metabolize will ultimately result in glucose in your blood. > If it didn’t, you would starve to death without carbs, and we know that > won’t happen since the native peoples of the far north have lived for > generations eating almost exclusively protein and fat. Carbs will just > do it more dramatically. Your liver will also release glucose if it > thinks you need it (liver dump). It’s also harder to avoid *all* carbs > than one thinks. What did you eat that had no carbs in it?

Recently I came upon some research on proteins and glucose. "… it also has been demonstrated that ingestion of proteins results in little or no increase in circulating glucose concentration in nondiabetic people or in people with type 2 diabetes mellitus. The reason for this remains unclear. In normal young men, we previously have reported that the lack of a rise in glucose is due to the production of less glucose than predicted. Subsequently, we wanted to determine whether this also was the case in people with type 2 diabetes. The present data indicate that even less glucose is produced in these subjects." Source: Effect of Protein Ingestion on the Glucose Appearance Rate in People with Type 2 Diabetes http://jcem.endojournals.org/cgi/content/full/86/3/1040 (It is interesting the the impact of water was not neutral. Control subjects in this study had no food other than water.) "Insulin-mediated suppression of hepatic glucose production was impaired in diabetic patients with high protein intake, but not in patients with normal protein diet. Gluconeogenesis … was increased in individuals on a high protein diet. We conclude that a normal protein diet is accompanied by delayed progression of the continuous loss of endogenous insulin in IDDM. This phenomenon is possibly due to decreased insulin demand on the B cells and/or reduced hepatic glucose production favoring enhanced insulin sensitivity." Source: Effect of Dietary Protein Intake on Insulin Secretion and Glucose Metabolism in Insulin-Dependent Diabetes Mellitus http://jcem.endojournals.org/cgi/reprint/81/11/3938.pdf Other finds in Clinical Endocrinology & Metabolism using words "protein" "glucose" as search criteria. http://intl-jcem.endojournals.org/cgi/search?volume=&firstpage=&DOI=&… Frank

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Diana… some days you do everything by the book, but your body doesn’t cooperate. I would only worry if this was a regular pattern… meaning if you ate very low carb meals and most of the time your BG went up. If this was an isolated incidence, just let it go. Also, if I get a number that seems inconsistent with the meal I’ve eaten, I always wash my hands and check again. I can’t tell you the number of times, that the second test is "normal". Jennifer – Hide quoted text — Show quoted text – > Hi, > I have just recently in the past month and half been dieting to lose weight, > bring my bg in control and to basically feel better. I am so confused even > after four years of battling this diabetes. > My question is: I thought your glucose only goes up if eating carbs. I just > today found out that even if you eat no carbs it goes up so do I have to > starve now? > I have been eating stuff I hate for two months now and my bg is in control > now but this morning I had NO carbs for breakfast and I tested 1-2 hours > after and I had jumped from 112 FBG to PP of 145. Here I thought I had > this all figured out and now I know that I don’t. I have no clue how to eat > right. I admit it didn’t go up as much as if I had eaten carbs but it was > very disheartening to see it went up at all. > Thanks for listening and any suggestions are welcome > Diana

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Diana <(H)(U)(G)(S)> quoth: >Oh ok. I was going by what was on the packages. >Thanks Julie ! But if that little few carbs made me spike that high I dare >think what more carbs would do. I know about three weeks ago I had one slice >rye toast which the bag said was 12 carbs and I went up over 200. I guess it >is back to the drawing board for me.

Diana, I don’t remember if you’re on meds or not. You might need more meds. Also, there are other things that can mess with BG numbers — like infection, stress, other meds, time in your hormonal cycle, etc. Priscilla — "I would listen to Priscilla. Her advice is excellent!" – Frankenmel (Sharon) on alt.support.menopause

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Diana <(H)(U)(G)(S)> quoth: >Hi Julie >I do like asparagus, kale, spinach and green beans but the green beans only >if have all that fat like bacon in them LOL.

So why not cook them that way? Sounds good. Priscilla — "I would listen to Priscilla. Her advice is excellent!" – Frankenmel (Sharon) on alt.support.menopause

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Just when we think we know it all, Diana, something like this comes along and we are rigtht back where we started from. Were you stressed, Perhaps since you had no carbs, starchy kind, maybe the liver had to send glucose into your cells which they need, That is all I can think of. Loretta — In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.

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> Diana <(H)(U)(G)(S)> quoth: >Hi Julie >I do like asparagus, kale, spinach and green beans but the green beans only >if have all that fat like bacon in them LOL. > So why not cook them that way? > Sounds good.

I think she’s on a low fat diet. — Type 2 http://users.bestweb.net/~jbove/

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> I think she’s on a low fat diet.

Oh, ok. Di! It is not good to do both low fat and low carb, girl. By all means cut the sat fats but please add some back in the form of olive oil, say as a salad dressing, to stir fry some veges, whatever. Or eat olives, do you like avocado?

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Diana, I’ve been reading your posts for about a year or so now. And aside from your undying loyalty to your friends, your ability to offer support to anyone, one of the things I admire so much about you is how hard you are working to get well. I just love to see your name up there in the author line of my news reader. I can’t offer too much in the way of advice. Just a hand in support for all you try and do.

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> Hi, > I have just recently in the past month and half been dieting to lose weight, > bring my bg in control and to basically feel better. I am so confused even > after four years of battling this diabetes. > My question is: I thought your glucose only goes up if eating carbs. I just > today found out that even if you eat no carbs it goes up so do I have to > starve now?

Not ture, ALL food containing fat, carbs, protien and / or alcohol provide energy. Any of these foods can raise your BG, carbs tend to make the rise faster than the others because many carbs are converted to energy much faster than the others. > I have been eating stuff I hate for two months now and my bg is in control > now but this morning I had NO carbs for breakfast and I tested 1-2 hours > after and I had jumped from 112 FBG to PP of 145. Here I thought I had > this all figured out and now I know that I don’t. I have no clue how to eat > right. I admit it didn’t go up as much as if I had eaten carbs but it was > very disheartening to see it went up at all.

It’s very simple, as a diabetic you WILL almost certainly spike after a meal. Your goal should be to control the height and duration of the spike…the top diabetes associations (ADA, CDA..etc) have a target of < 180 for a 2 hour post prandial, many here have lower targets but that should be a matter for discussion between you and your doctor. You may need meds to help with this control….personally I don’t put too much stock in PP readings other than to manage my meals, I use my HbA1c as my overall control indicator. – Hide quoted text — Show quoted text -> Thanks for listening and any suggestions are welcome > Diana

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Category Categories: Diabetes Mellitus | No Comments »

novice question about thirst, etc

Question:

<snip> > I seem to have a CBC reasonably often, as chronic pain and/or medication > side effects make me feel so awful my dr worries that I might have some > non-obvious infection that needs to be treated. But I don’t know what > CMP means. Can you explain? > Thanks, > Adrian

A CMP is a Complete Metabolic Panel ( as opposed to a Basic MP ). The CMP adds additional measurements of blood components to the CBC, including electrolytes, proteins, liver enzymes, and kidney related tests. I suggested it because someone with your symptoms may be urinating away important electrolytes. In addition, the BUN and creatinine components, along with the UA (urinalysis), will help your doc decide if your kidneys are working properly. Obviously, your kidneys are intimately related to excessive urination. A good online guide to typical medical tests is at http://www.labtestsonline.org . Jim — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

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> After all this background rambling, here are my questions: > 1) Is the excessive thirst a symptom of diabetes itself, or is > it a symptom of uncontrolled diabetes? High or low blood sugar?

Uncontrolled diabetes, specifically blood sugar above your renal threshold for long periods of time. The kidneys don’t excrete any glucose unless your blood glucose exceeds a particular level, which varies from person to person and is usually somewhere between 180 and 220 mg/dl. Excessive thirst is actually caused by excessive urination which in turn is caused by excessive glucose excretion by the kidneys (the high level of glucose in the glomerular filtrate inhibits reabsorption of water in the tubules). > 2) Does it indicate that the disease has progressed pretty far > without anyone noticing, or is it an early symptom? If I have > diabetes now, I’m wondering if it’s new, or if I had it last > August and fasting blood sugar just couldn’t detect it.

It’s possible for diabetes to come on in that period of time. > 3) How much water is it safe to drink? I walk 2-4 miles/day > (now that I’m off the low-carb diet, and have energy), but I > don’t do seriously sweaty exercise. I’d really like to drink > more than 2 gallons/day, but I read scare stories about > hyponatremia in the paper.

Hyponatremia has been overly hyped. It’s not really caused by "drinking too much water" except in very rare cases; it’s usually caused by losing large amounts of both salt and water (usually from heavy sweating, sometimes from vomiting or diarrhea) and then replacing the lost water without replacing the lost salt. OTOH, *why* do you want to drink that much water? Unless you’re losing large amounts of water, it will have no particular benefits. If it’s because you’re thirsty all the time, you have a problem that needs looking into.

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>> Thanks for your suggestions, Jim. I’d like to clarify that this > problem with the extreme thirst is a very new thing. It’s been > really bad for the past month, and might have been developing for > a few weeks before that. I certainly did not have it when I saw > the endocrinologist 8 months ago. >>It doesn’t appear that you have diabetes mellitus, based on your FPG >>readings. But there is another rare type of diabetes called diabetes >>insipidus. This is caused by the lack of a hormone called ADH >>(anti-diuretic hormone) which is secreted by the hypothalmus in the >>brain. The symptoms are pretty spot on to yours.

Based on further evidence, I’m inclined to agree with this. I finally decided that shelling out the (substantial, on my current budget) money for a blood sugar meter and test strips would be less bad than continuing to worry about this without adequate information. I’ve been deliberately eating high-carb treats and testing frequently to see if my blood sugar spikes. It’s usually between 85 and 120. I got a single reading of 140 about 40 minutes lunch (sandwich with plenty of good bread, AND fruit, AND a brownie.) But it was down to 98 half an hour later. I know I’m not using the standard testing intervals…I’ve been testing during my bathroom breaks at work, as I’d just as soon not share my health concerns with my colleagues. > This would imply there was nothing wrong with my blood sugar > regulation? Rather than that my blood sugar was ok back in > August, and started going bad suddenly at the end of March? >Unless I have missed something here, you have no clinical evidence of a >problem with blood sugar regulation. While it is true that elevated TGs, >and LDL *can* herald early Type-2, so far there is no direct evidence of it. >You suffer from polydipsia and polyuria. You have a problem with fluid >regulation.

I’m going to continue testing blood sugar for a bit, but I’m going to stop worrying about it so much. And I’m going to start looking into alternate explanations, like a bladder infection, or kidney disease. Thanks to the other poster who suggested a kidney problem. Kidney stones are a potential concern with Topamax, and I’d forgotten all about my kidneys. (How could I do that? They’re right here?) – Hide quoted text — Show quoted text ->>Further, some meds can cause this problem, among them lithium and some >>of the sympathiomemetics. Some are also known to cause >>hypercholesterolemia. Without knowing which meds, it is hard to say more. > I’m taking Topamax, which is an anti-seizure med. I’ve been taking > that for more than a year, and I doubt it’s causing this new symptom. > (But maybe. Or it could be having a weird combined effect.) A month > ago, I started taking Duragesic, which is a different kind of pain med > than I had been taking before. About 5 weeks ago, I started taking > Claritin for sniffles, watery eyes, and overall itching. My doctor > strongly recommends it as an alternative to Sudafed in the morning and > Benadryl at night, though I haven’t been using it every day because it > makes me so drowsy. Those are the only meds I really suspect of > causing trouble, though I also take naproxen sodium, a calcium/magnesium > supplement, and B-vitamins. >The topiramate and fentanyl are strong meds, but not generally known to >cause your problem. The antihistamine and NSAID are not either.

Actually, the fentanyl *can* cause "increased urinary frequency." Though the pamphlet from the pharmacy said that urinary retention was more commom. I had thought that mean the same total daily volume, just coming out in more aliquots…but I suppose it might be this. I’ll ask the dr next week. >One last suggestion. Go see the endo again, and get some blood tests >(like a CBC and CMP) and a UA. The blood tests will tell you if you have >any indication of diabetes mellitus, as well as give you a snapshot of >your electrolytes, the levels of which probably need to be monitored. >The UA specific gravity will help reveal if insipidus is even a possibility.

I seem to have a CBC reasonably often, as chronic pain and/or medication side effects make me feel so awful my dr worries that I might have some non-obvious infection that needs to be treated. But I don’t know what CMP means. Can you explain? Thanks, Adrian

Response:

Adrian Another possibility is something is wrong with your kidneys. When I started Advil (ibuprofen) for my arthritis I started to loose weight from excess water excretion. I only have one kidney and I have to be careful. Anyway my creatine levels went thru the roof and if it had not been caught I may have suffered kidney failure. Get the doc to check your kidney function it may be acting up. Howard

Response:

- Hide quoted text — Show quoted text ->Adrian, >Since you have done all the correct things, like going to an endo, my >comments should just be considered musings. > Thanks for your suggestions, Jim. I’d like to clarify that this > problem with the extreme thirst is a very new thing. It’s been > really bad for the past month, and might have been developing for > a few weeks before that. I certainly did not have it when I saw > the endocrinologist 8 months ago. >It doesn’t appear that you have diabetes mellitus, based on your FPG >readings. But there is another rare type of diabetes called diabetes >insipidus. This is caused by the lack of a hormone called ADH >(anti-diuretic hormone) which is secreted by the hypothalmus in the >brain. The symptoms are pretty spot on to yours. > This would imply there was nothing wrong with my blood sugar > regulation? Rather than that my blood sugar was ok back in > August, and started going bad suddenly at the end of March?

Unless I have missed something here, you have no clinical evidence of a problem with blood sugar regulation. While it is true that elevated TGs, and LDL *can* herald early Type-2, so far there is no direct evidence of it. You suffer from polydipsia and polyuria. You have a problem with fluid regulation. – Hide quoted text — Show quoted text ->Further, some meds can cause this problem, among them lithium and some >of the sympathiomemetics. Some are also known to cause >hypercholesterolemia. Without knowing which meds, it is hard to say more. > I’m taking Topamax, which is an anti-seizure med. I’ve been taking > that for more than a year, and I doubt it’s causing this new symptom. > (But maybe. Or it could be having a weird combined effect.) A month > ago, I started taking Duragesic, which is a different kind of pain med > than I had been taking before. About 5 weeks ago, I started taking > Claritin for sniffles, watery eyes, and overall itching. My doctor > strongly recommends it as an alternative to Sudafed in the morning and > Benadryl at night, though I haven’t been using it every day because it > makes me so drowsy. Those are the only meds I really suspect of > causing trouble, though I also take naproxen sodium, a calcium/magnesium > supplement, and B-vitamins.

The topiramate and fentanyl are strong meds, but not generally known to cause your problem. The antihistamine and NSAID are not either. >The good news is that there is a drug called DDAVP (desmopressin) that >can reduce the symptoms. A couple of squirts from a nasal inhaler can >reduce the excessive urination. > Thanks for the idea.

One last suggestion. Go see the endo again, and get some blood tests (like a CBC and CMP) and a UA. The blood tests will tell you if you have any indication of diabetes mellitus, as well as give you a snapshot of your electrolytes, the levels of which probably need to be monitored. The UA specific gravity will help reveal if insipidus is even a possibility. If you are still concerned about your BG, get yourself a cheap meter (Wal-mart has the cheapest) or cozy up to a diabetic with a meter. I hope you find some answers, Jim — Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

<snip> > About 5 weeks ago, I started taking > Claritin for sniffles, watery eyes, and overall itching. My doctor > strongly recommends it as an alternative to Sudafed in the morning and > Benadryl at night, though I haven’t been using it every day because it > makes me so drowsy.

<snip> My daughter and I both tried Claritin. Didn’t do a thing for either of us. But I think dry mouth can be a side effect.

Response:

> Hello. > I’ve been having problems lately with excessive thirst. (And > the related problem of frequent urination, obviously. Though > the causality might be the other way around – I just live in > this body, I don’t pretend to understand it.) I don’t know if > it could be a side effect of one of the medications I’m taking. > I’ve asked a bunch of people about this concern…the chronic > pain support group, friends, my pharmacist. *Everyone* asked > me, "Are you sure you don’t have diabetes?"

Thirst can be a side effect of medication. I know someone who takes a variety of meds, and among them an anti-seizure med. Her thirst got so bad that the Dr. recommended a special chewing gum to help keep her mouth moist. I should also add that she now has pre-diabetes. Her Dr. suspected diabetes for many years and kept checking her. Only recently did her fasting BG go up. > Well, no, I’m not absolutely positive I don’t have diabetes. My > primary care doctor had me tested for it last summer. He was > worried that I was losing so much weight. (I’m taking an anti- > seizure drug that can cause weight loss. But generally not quite > this much weight loss.) He didn’t check for glucose tolerance, > or sugar in my urine. My fasting blood sugar level was fine, so > he concluded I didn’t have diabetes. And the weight loss kept > happening to me. I’m not getting dangerously thin, it’s just > unsettling that more than a third of my former body weight has > gone away in a little over a year. (Though the weight loss > seems to have slowed down or stopped around the time the extreme > thirst was starting. Recently.)

Checking for sugar in urine isn’t generally done any more. At least not as a testing procedure. You could ask for a GTT though. Some people have good fasting numbers, but go high after eating. > A few months later, he referred me to an endocrinologist, shaking > his head and muttering, "there must me *something* else going on." > The endocrinologist did another fasting blood test, and told me my > sugar level was fine and my thyroid was fine. However, she told me > that the ratio of the different kinds of cholesterol in my blood > indicated that I was at risk of developing insulin resistance in > the future. This wasn’t something she could treat, but I should > exercise more, and maybe it wouldn’t develop.

That doesn’t sound good. Perhaps you should see another Endo. > My primary care doctor started pushing me to try a low-carb diet, > to try to control my seizures and migraines. (Not as restrictive > as the ketogenic diet used for young children.) Neither of us > thought I had a problem with diabetes or anything related to it. > I managed to stick with it for 5 months, though it made me feel > perfectly awful – increased pain, very low energy. After I finally > got permission to go back to a normal way of eating, I find myself > still avoiding pasta and potatoes (which is probably a good change) > and thinking about food much more obsessively than I used to (which > I don’t like at all.)

I know the feeling. That sort of diet wouldn’t work for me at all. > I’m feeling very anxious. I don’t want this new symptom to be a > side effect of my new pain medication. (It took me *years* to > persuade my doctor to prescribe effective pain medication, and > I’m afraid he’ll jump on any excuse to stop it.)

Look up the medication you are taking and see what the side effects are. > At the same > time, I’m afraid of having to go back on that damn low-carb diet > if I turn out to have diabetes, or even if the doctor suspects > I might. I just felt *so* sick and weak all the time, eating that > way. (I know that some people feel better on that kind of diet, > rather than worse. My doctor kept trying to persuade me that I > would miraculously turn into one of those people.)

You do NOT have to go low carb if it turns out you do have diabetes. Yes, some people do. I do not. I eat less carbs than I did before, but certainly not low carb. I am currently munching on popcorn as I type. > After all this background rambling, here are my questions: > 1) Is the excessive thirst a symptom of diabetes itself, or is > it a symptom of uncontrolled diabetes? High or low blood sugar?

It is a symptom of uncontrolled diabetes, or high BG. I drink a lot of liquids now. I am not as thirsty as I once was. Now I can go for an hour or so without a drink. But for a time, going for that long with no liquids was torture for me. > 2) Does it indicate that the disease has progressed pretty far > without anyone noticing, or is it an early symptom? If I have > diabetes now, I’m wondering if it’s new, or if I had it last > August and fasting blood sugar just couldn’t detect it.

Hard to say. > 3) How much water is it safe to drink? I walk 2-4 miles/day > (now that I’m off the low-carb diet, and have energy), but I > don’t do seriously sweaty exercise. I’d really like to drink > more than 2 gallons/day, but I read scare stories about > hyponatremia in the paper.

I don’t know. I’ve heard of something called water poisoning. But I think it’s rare. If you feel the need to drink 2 gallons of water a day though, I’d say something is really wrong! > 4. For people who have diabetes-related thirst, who control > your blood sugar with diet, how long did it take for the > thirst to go away? (Did it?) And how severely did you > restrict carbs?

I’m on meds now. For a time was on diet and exercise. The thirst never goes away. But it lessened some. My carbs are not restricted severely. My usual diet used to be beans and rice or beans and pasta. I gave up the rice. I still eat beans and I still eat pasta. I can eat 1 cup of beans plus one more serving of carbs per meal. Can eat 1 1/2 cups of pasta per meal. Breakast is different. Can eat only 2 servings of carb then. — Type 2 http://users.bestweb.net/~jbove/

Response:

>Adrian, >Since you have done all the correct things, like going to an endo, my >comments should just be considered musings.

Thanks for your suggestions, Jim. I’d like to clarify that this problem with the extreme thirst is a very new thing. It’s been really bad for the past month, and might have been developing for a few weeks before that. I certainly did not have it when I saw the endocrinologist 8 months ago. >It doesn’t appear that you have diabetes mellitus, based on your FPG >readings. But there is another rare type of diabetes called diabetes >insipidus. This is caused by the lack of a hormone called ADH >(anti-diuretic hormone) which is secreted by the hypothalmus in the >brain. The symptoms are pretty spot on to yours.

This would imply there was nothing wrong with my blood sugar regulation? Rather than that my blood sugar was ok back in August, and started going bad suddenly at the end of March? >Further, some meds can cause this problem, among them lithium and some >of the sympathiomemetics. Some are also known to cause >hypercholesterolemia. Without knowing which meds, it is hard to say more.

I’m taking Topamax, which is an anti-seizure med. I’ve been taking that for more than a year, and I doubt it’s causing this new symptom. (But maybe. Or it could be having a weird combined effect.) A month ago, I started taking Duragesic, which is a different kind of pain med than I had been taking before. About 5 weeks ago, I started taking Claritin for sniffles, watery eyes, and overall itching. My doctor strongly recommends it as an alternative to Sudafed in the morning and Benadryl at night, though I haven’t been using it every day because it makes me so drowsy. Those are the only meds I really suspect of causing trouble, though I also take naproxen sodium, a calcium/magnesium supplement, and B-vitamins. >The good news is that there is a drug called DDAVP (desmopressin) that >can reduce the symptoms. A couple of squirts from a nasal inhaler can >reduce the excessive urination.

Thanks for the idea.

Response:

> After all this background rambling, here are my questions: > 1) Is the excessive thirst a symptom of diabetes itself, or is > it a symptom of uncontrolled diabetes? High or low blood sugar?

Thirst is a symptom of uncontrolled diabetes. The worse you are, the thirstier. Symptomatic of high blood sugar. > 2) Does it indicate that the disease has progressed pretty far > without anyone noticing, or is it an early symptom? If I have > diabetes now, I’m wondering if it’s new, or if I had it last > August and fasting blood sugar just couldn’t detect it.

Perhaps moderately far. Thirst is one of the early symptoms. If you’ve lost 1/3rd of your weight from it, then, you’ve had it for a while. Do you have symptoms, such as numb patches on your feet or toes, or perhaps tingling or burning in your feet? How many times a night do you awaken to urinate? Do you find yourself tired and sleepy, often after meals? Did you used to have more energy? Have you noticed that you need new glasses recently? Do you find you’re hungry and eating a lot despite losing weight? > 3) How much water is it safe to drink? I walk 2-4 miles/day > (now that I’m off the low-carb diet, and have energy), but I > don’t do seriously sweaty exercise. I’d really like to drink > more than 2 gallons/day, but I read scare stories about > hyponatremia in the paper.

Drink until you quench your thirst. If you have uncontrolled diabetes, then you’re urinating your bodily fluids away. You need to replace them: that’s why you’re thirsty. Not to replace them is unhealthy. Thirst is not the problem; it’s only a symptom. Walking is good exercise for diabetics. Keep it up. It should lower your blood sugar. Just be sure to keep yourself hydrated. > 4. For people who have diabetes-related thirst, who control > your blood sugar with diet, how long did it take for the > thirst to go away? (Did it?) And how severely did you > restrict carbs?

Fairly quickly, if you’re willing to make the necessary changes. There are three basic tools to control diabetes: diet, exercise, and medication. Some combination of these three will work. You can probably control the thirst within a few days or sooner depending on how aggressive you treat yourself. Diet: all Carbohydrates raise blood sugar. Ignore people who only tell you to watch your "sugars." Try going back to the low carb diet. That should lower your blood sugar levels and make you feel more energetic. If low carb makes you feel tired, then perhaps diabetes is not your problem. If you’re in the U.S., then there are two major approaches to diet. THe Official ADA diet, which is relatively high in carbs. You’re expected to exercise and take medication to bring your blood levels down. The other approach is low-carb. People restrict carbs to the level the need to to obtain control. It varies from person to person. Exercise. walking is very good. keep it up. Medications: There are a number to choose from. Obviously you’ll need to talk to your doctor. You should call your doctor to ask what actual reading your fasting blood glucose test produced. Some doctors are behind the times and are remarkably lacksidasical about what they consider "normal." You need to know the number. Further, It would be useful for you to obtain or borrow a home glucose meter. Test yourself frequently for a few days, first thing in the morning and 1 or 2 hours after meals. web sites such as www.hocks.com frequently offer serious discounts on meters. And come back here for more questions. E

Response:

Adrian, Since you have done all the correct things, like going to an endo, my comments should just be considered musings. It doesn’t appear that you have diabetes mellitus, based on your FPG readings. But there is another rare type of diabetes called diabetes insipidus. This is caused by the lack of a hormone called ADH (anti-diuretic hormone) which is secreted by the hypothalmus in the brain. The symptoms are pretty spot on to yours. Further, some meds can cause this problem, among them lithium and some of the sympathiomemetics. Some are also known to cause hypercholesterolemia. Without knowing which meds, it is hard to say more. The good news is that there is a drug called DDAVP (desmopressin) that can reduce the symptoms. A couple of squirts from a nasal inhaler can reduce the excessive urination. I would assume that your endo would have thought of insipidus, so my musings may only serve to bore you with more than you wanted to know about a rare form of diabetes. But, it might be worth asking her. Jim – Hide quoted text — Show quoted text – > Hello. > I’ve been having problems lately with excessive thirst. (And > the related problem of frequent urination, obviously. Though > the causality might be the other way around – I just live in > this body, I don’t pretend to understand it.) I don’t know if > it could be a side effect of one of the medications I’m taking. > I’ve asked a bunch of people about this concern…the chronic > pain support group, friends, my pharmacist. *Everyone* asked > me, "Are you sure you don’t have diabetes?" > Well, no, I’m not absolutely positive I don’t have diabetes. My > primary care doctor had me tested for it last summer. He was > worried that I was losing so much weight. (I’m taking an anti- > seizure drug that can cause weight loss. But generally not quite > this much weight loss.) He didn’t check for glucose tolerance, > or sugar in my urine. My fasting blood sugar level was fine, so > he concluded I didn’t have diabetes. And the weight loss kept > happening to me. I’m not getting dangerously thin, it’s just > unsettling that more than a third of my former body weight has > gone away in a little over a year. (Though the weight loss > seems to have slowed down or stopped around the time the extreme > thirst was starting. Recently.) > A few months later, he referred me to an endocrinologist, shaking > his head and muttering, "there must me *something* else going on." > The endocrinologist did another fasting blood test, and told me my > sugar level was fine and my thyroid was fine. However, she told me > that the ratio of the different kinds of cholesterol in my blood > indicated that I was at risk of developing insulin resistance in > the future. This wasn’t something she could treat, but I should > exercise more, and maybe it wouldn’t develop. > My primary care doctor started pushing me to try a low-carb diet, > to try to control my seizures and migraines. (Not as restrictive > as the ketogenic diet used for young children.) Neither of us > thought I had a problem with diabetes or anything related to it. > I managed to stick with it for 5 months, though it made me feel > perfectly awful – increased pain, very low energy. After I finally > got permission to go back to a normal way of eating, I find myself > still avoiding pasta and potatoes (which is probably a good change) > and thinking about food much more obsessively than I used to (which > I don’t like at all.) > I’m feeling very anxious. I don’t want this new symptom to be a > side effect of my new pain medication. (It took me *years* to > persuade my doctor to prescribe effective pain medication, and > I’m afraid he’ll jump on any excuse to stop it.) At the same > time, I’m afraid of having to go back on that damn low-carb diet > if I turn out to have diabetes, or even if the doctor suspects > I might. I just felt *so* sick and weak all the time, eating that > way. (I know that some people feel better on that kind of diet, > rather than worse. My doctor kept trying to persuade me that I > would miraculously turn into one of those people.) > After all this background rambling, here are my questions: > 1) Is the excessive thirst a symptom of diabetes itself, or is > it a symptom of uncontrolled diabetes? High or low blood sugar? > 2) Does it indicate that the disease has progressed pretty far > without anyone noticing, or is it an early symptom? If I have > diabetes now, I’m wondering if it’s new, or if I had it last > August and fasting blood sugar just couldn’t detect it. > 3) How much water is it safe to drink? I walk 2-4 miles/day > (now that I’m off the low-carb diet, and have energy), but I > don’t do seriously sweaty exercise. I’d really like to drink > more than 2 gallons/day, but I read scare stories about > hyponatremia in the paper. > 4. For people who have diabetes-related thirst, who control > your blood sugar with diet, how long did it take for the > thirst to go away? (Did it?) And how severely did you > restrict carbs? > Thanks for your help, > Adrian

– Join us in the Diabetic-Talk Chatroom on UnderNet /server irc.undernet.org — /join #Diabetic-Talk More info: http://www.diabetic-talk.org/

Response:

Hello. I’ve been having problems lately with excessive thirst. (And the related problem of frequent urination, obviously. Though the causality might be the other way around – I just live in this body, I don’t pretend to understand it.) I don’t know if it could be a side effect of one of the medications I’m taking. I’ve asked a bunch of people about this concern…the chronic pain support group, friends, my pharmacist. *Everyone* asked me, "Are you sure you don’t have diabetes?" Well, no, I’m not absolutely positive I don’t have diabetes. My primary care doctor had me tested for it last summer. He was worried that I was losing so much weight. (I’m taking an anti- seizure drug that can cause weight loss. But generally not quite this much weight loss.) He didn’t check for glucose tolerance, or sugar in my urine. My fasting blood sugar level was fine, so he concluded I didn’t have diabetes. And the weight loss kept happening to me. I’m not getting dangerously thin, it’s just unsettling that more than a third of my former body weight has gone away in a little over a year. (Though the weight loss seems to have slowed down or stopped around the time the extreme thirst was starting. Recently.) A few months later, he referred me to an endocrinologist, shaking his head and muttering, "there must me *something* else going on." The endocrinologist did another fasting blood test, and told me my sugar level was fine and my thyroid was fine. However, she told me that the ratio of the different kinds of cholesterol in my blood indicated that I was at risk of developing insulin resistance in the future. This wasn’t something she could treat, but I should exercise more, and maybe it wouldn’t develop. My primary care doctor started pushing me to try a low-carb diet, to try to control my seizures and migraines. (Not as restrictive as the ketogenic diet used for young children.) Neither of us thought I had a problem with diabetes or anything related to it. I managed to stick with it for 5 months, though it made me feel perfectly awful – increased pain, very low energy. After I finally got permission to go back to a normal way of eating, I find myself still avoiding pasta and potatoes (which is probably a good change) and thinking about food much more obsessively than I used to (which I don’t like at all.) I’m feeling very anxious. I don’t want this new symptom to be a side effect of my new pain medication. (It took me *years* to persuade my doctor to prescribe effective pain medication, and I’m afraid he’ll jump on any excuse to stop it.) At the same time, I’m afraid of having to go back on that damn low-carb diet if I turn out to have diabetes, or even if the doctor suspects I might. I just felt *so* sick and weak all the time, eating that way. (I know that some people feel better on that kind of diet, rather than worse. My doctor kept trying to persuade me that I would miraculously turn into one of those people.) After all this background rambling, here are my questions: 1) Is the excessive thirst a symptom of diabetes itself, or is it a symptom of uncontrolled diabetes? High or low blood sugar? 2) Does it indicate that the disease has progressed pretty far without anyone noticing, or is it an early symptom? If I have diabetes now, I’m wondering if it’s new, or if I had it last August and fasting blood sugar just couldn’t detect it. 3) How much water is it safe to drink? I walk 2-4 miles/day (now that I’m off the low-carb diet, and have energy), but I don’t do seriously sweaty exercise. I’d really like to drink more than 2 gallons/day, but I read scare stories about hyponatremia in the paper. 4. For people who have diabetes-related thirst, who control your blood sugar with diet, how long did it take for the thirst to go away? (Did it?) And how severely did you restrict carbs? Thanks for your help, Adrian

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