Pre diabetes and heart disease

[peljbl]

Hi - I have just found out that I am insulin resistant - I am obese, hypertensive(on Cardura 1mg and Amiloride 5 mg daily) and only have one kidney due to renal cell ca.  My TC is 216, LDL 112, HDL 68 and Trig. 138, CRP 3.5, Homo 11.8.  I am on folic acid 800 mcg per day.  I am now exercising 1/2 hr on treadmill and starting to add some resistance training and of course watching my diet to lose weight.  My PC dr started me on Lipitor 40 mg and took me off my Vivelle (ERT) patch.  I am miserable - I ache all over and feel terrible.  I am 54 yo, menopausal symptoms are returning - sweats, insomnia, nervousness besides the side effects of the Lipitor.  I have no family history of heart disease or diabetes.  Do you think it is possible to control the glucose - which runs between 100-126 and the lipids by diet and exercise alone?  Are there any other options besides statins that can help?  Is it absolutely necessary to do without the estrogen patch?  I am concerned about my cardiac health but also quality of life.  I did have a normal EKG recently and normal thallium stress test 2 yrs ago.  Do you think a consult with a cardiologist is appropriate?  This is my second question recently so I appreciate your help.

[CCF-M.D.-MJM]

Hi peljbl,

Very appropriate questions given your circumstances.

I just wanted to comment on your statement "besides the side effects of the Lipitor."

You should not be having muscle pains from lipator.  If you are, you need to stop it and talk to your doctor.  The confounder that commonly comes up is that people often start exercising and statins around the same time -- muscle aches are normal if you just getting back into shape.  It is difficult to tease out these differences.  One approach would be to start diet and exercise, and then start the statin a few weeks to a month or two later. It is also possible your symptoms are from stopping the estrogen patch.  Remember the battle against coronary disease is not one of days or months but years.  If it takes 3-4 months to start all your medications and start them one at a time, so be it.  You will not be losing ground and you may feel more secure in the decision to be on medications.

Do you think it is possible to control the glucose - which runs between 100-126 and the lipids by diet and exercise alone?

In some people yes.  The only way to know is to try first.  
Taking medications is not fun, but there are proven benefits to many of the medications or their effects (lower blood sugar).  I would have a VERY LOW thrshold to put someone in your situation on metformin or glucophage.  It does not cause hypoglycemia, decreases blood sugar and helps you lose weight.
Are there any other options besides statins that can help?

Is it absolutely necessary to do without the estrogen patch?

The increased risk of coronary events with estrogen was predominantly in the first 6 weeks after starting the medication.  There is a population that is more like to have clots with estrogen and this shows up very early in the medications use.  There are some doctors that will not start new estrogen prescriptions but will not stop it on someone already on chronic estrogen.  There is no right or wrong answers, just an informed decision about risks and beneftis.

Do you think a consult with a cardiologist is appropriate?

It would never hurt to see a cardiologist.  In your situation, a preventative cardiologist seems particularly appropriate.

Are there any other options besides statins that can help?

statins are well studied to have significant benefits at decreasing future events.  I don't know of replacement.  Medications like zetia also lower cholesterol, but the studies show a survival or event benefit are not complete yet.

I hope this answers most of  your question.  Thanks for posting and good luck.

[bama jane]

I have followed this forum for a while and was wondering if any of you with heart arrhythmias have had an endoscopy.  Unfortunatley I have to have one due to some disturbing information that came back on an upper gi and am concerned about going into arrhythmia while having procedure.  I don't know anyone who has had one at all much less someone with arrhythmia so of course I am looking for some hopefully encouraging information  My arrhythmia is svt plus various aother arrhythmias pvc's pac's etc.
Thanks

[PikaPika88]

Hi,

First gastro dr said I need one to see wheather I have H. Pylori or not.  My A-Fib could be related to.  

She mentioned that about the palpitations, what happen if can't stop?  They didn't have all that heart equipments down at the endoscopy centre.  I told her my pacemaker is working and it'll take all the risks.  What happen if the palpitations over-write the pacemaker?  Ehhh....

She said when the anesthetic go in, the palp will start...  I don't want to do it without the anesthetic.

Now, I quere in the waiting list at the hospital that look after my heart.  I've seen the gastro dr there but still haven't received the waiting list number yet.  Let me know how you go with that.  I've wpw.

[bama jane]

I will let you know, it isn't for a couple of weeks.  My cardio ok'd it and the center here isn't in the hospital where there is a cardiologist, but everyone thinks I should do it because of the result of the upper gi.  My blood test also came back positive for h pylori and the upper gi showed some problem areas in my stomach, but I am more concerned about this than I was for the ep study I had on my heart. Thanks for your answer to my question.

[hbp702]

Not every obese person is insulin resistant, and vice versa.

Fasting glucose of 100-125 is "impaired", 126 is actually diabetes (not pre-diabetes) if it happens more than once.

HDL of 68 is outstanding, TG of 138 is normal/very good - this would argue very strongly against insulin resistance - even if you are taking statins - those numbers are just "too good".

I've got IR, and have had HDL 11-38 and TG 200's-400's, which is more typical for IR patients. Also high blood pressure.

Get a GTT + insulin levels - find out if you have IGT, IFG, type 2 diabetes and/or insulin resistance, or even an very early type 1.

Also get complete blood work, cortisol, hormones, etc - they may be overlooking something.

[mehriels]

hello. have u tried using herbal or alternative medicine to treat herbal disease and diabetes?

i saw this website you might find interesting.

www.thevirgincoconutoil.com

[Dcat]

Referring to your post: I've had Diabetes type 2 since lastyear. I'm a female of 54 yrs of age. Had been off my hormone's for about 1 yr. Had the sweats, bitchiness, and sleep was not good. After learning of my Diabetes, found a great dr. Told him about my situation as far as the hormone's. He suggested to take Black Cohosh. I'm one that will try just about anything once to see if it really does work [well, depending on what it might be of course] : ) Anyway...I've been on Black Cohosh for about 4 months now and it works just fine for my symptoms I had. You only take it once in the morning w/a your meal and once at night w/your meal [capsule]. You can buy this at any health food store. I can get mine at the market. It's not expensive at all. I've read up on this on the web and it does say it can loose it's effectiveness after being on it for 6 months. Spoke to my dr. about that and he also said I could take 1 DHEA 25 mg a day. Have not started on that yet, but will when it's time to. Give it a week to start on the Black Cohosh to see some improvements : )Something I found out about the Hormone Therapy; While I was on the hormone pill, my heart rate was high sometimes 115 a min.[resting] After getting off the hormone's, my rate went to normal. The pharmacist told me the hormone's do increase your heart rate. Also...about your Diabetes. Exercise is excellent to keep your sugar level down to where it should be and of course to get weight down. I take [Metformin] 3 x a day, but Cinnamon I have added to my diet [capsule]. It's good for not only controlling your cholesterol, but for blood sugar also. I take 2 in the morning and 2 at night w/my meal. I also take [once in a while] the Starch Blocker. There are many out there I have read up on. The one that my Dr. recommended was the Carb Cutter Phase 2. It has the White Vanilla Bean Extract in it and that's what helps one out with breaking down your carbs. You can buy that at a health food store. Eating healthy w/exercise is the key. Since I learned of my Diabetes I have lost 76 lbs. I was overweight cause of a back injury. I could not have any surgery due to my side affects and allergic reactions to pain meds [just about ALL pain meds] Spine specialists will not touch me. Went through some pain management classes and that helped also in the long run to use my mind over the pain I have. So, not only doing the exercises, but eating the right way is what helps a greatdeal. I have NO sugar in my diet [even though one can], but I prefer not to...I have NO white flour of any kinds. No pasta anymore unless it's whole wheat. I eat whole grain breads low in carbs, lots of veggies, fruits and vitamins. As far as meat in my diet I have gotten used to not having meat, only fish now. I am between 160-163 right now with my weight w/30 more lbs to go and I'm 5'3. I was at 238 when I learned of my Diabetes last February. Please give the Black Cohosh a try. I have no side affects to this whatsoever. It's sure better than the patch.  
I wish you good luck : ) Dcat