Diabetes, drugs, and alcohol

My husband of 4 yrs. was diagnosed with diabetes last year. Takes pills and insulin, cannot seem to keep it under control.  A few months ago was diagnosed with  Chronic Hep C has had  it for over 20 years. Is at stage 3,4 (liver) right now.
Still drinks and uses crack cocain. Mind you I did not know of this before. End of that. They want to start him on interferon injections but has to bring his sugar levels down to 130 which are now running around 275 & 350. I try to make sure he takes his medicine, tell him not to drink etc. butttttt. Right now all of this is wearing me out and I have'nt left him because he has no one. I've been check for Hep C and have been neg. thank God. What can I do
if anything for him and for me?    

[Trinity4]

He has to WANT to quit drugging and drinking for himself sal15.  If he doesn't want it, no amount of encouragement from you will make a difference.  Research the archives on this forum as well as other websites like janis7hepc.com.  They will provide all the information you need regarding the effects drug and alchohol abuse will have on someone with hepc.  Just don't enable him -  let him know you can't be supportive of him if he continues with his self destructive behavior.  Try attending Alanon meetings or Narcanon suppport groups.  There are also local support groups for those who have hepc or are living with someone who has hepc. He could also benefit by attending AA or Narcanon meeting as well.  The booze significantly raises sugar levels, I live with a diabetic and know this first hand.  He has to take the first steps in maintaining a healthy lifestyle.  It's very hard watching someone abuse themselves on a regular basis and know there is nothing you can do.  Stay strong - get some support - knowledge is power.  Hopefully, between the information you and your doctors can provide, it will be enough motivation for him to change.
Trinity

[Trinity4]

Correction:  I meant to say the alcohol can significantly LOWER blood glucose levels.  This can cause the hypoglycemia. Controlling his diabetes should be done with proper insulin dosage and diet.  Avoiding alcohol with stage 3/4 liver disease is just common sense.
Trin

[FlGuy]

Apparently, the docs doesn't know about the drinking and crack hobbies.  Otherwise, they would think about getting those eliminated before the treatment.  Hep C causes blood sugar abnormalities, so that might have someting to do with the diabetes in the first place.  The hobbies just make that part worse.  Assuming he plays it straight, I don't see why the high glucose levels would keep treatment from starting.  But, if he doesn't take the diabetes stuff reliably he might not have the discipline to take the interferon/ribavirin regularly which is an absolute MUST.  Hubby is in a pickle.  Sorry you have to be a spectator to it all.

[Trinity4]

Insulin resistance decrease chances of SVR.

[jmjm530]

I'm surprised they will treat him if he's still drinking and doing Crack Cocaine. Cure rates aside, do you think he will be able to comply with treatment in his present condition? It's really rough and demands medications to be taken on time. And then his blood sugar levels, no doubt partly because of the drinking. I just don't see a happy ending here whether he starts treatment or not. Do the best you can to get him help for his alcohol and drug problems and then start looking out for yourself.

[FlGuy]

Yes. But as a 3/4 it should not be a reason to avoid treatment in itself. Especially, if tx withhold further liver damage.  Other measures can be taken to enhance svr probabilities in the the face of negative predictors.

[nygirl7]

If he doesn't quit drinking and crack it's all a moot point. End stage liver disease failure it not going to be a pretty picture but to an addict that concept is so far away he can't grasp it really.

He doesn't want to quit (I've been there and get that) so you have to take care of yourself right now, it's all you really CAN do if he won't get sober.  IF he won't the picture is quite bleak and if the doctors find out he's getting high they won't give him treatment as it would be a complete waste of tens of thousands of dollars.

Please - find a local group where you can go and discuss this with other people in a smilar boat.  YOU need support and you deserve some peace of mind in this insanity.

Then ask him which he prefers cremation or a coffin because you will need to know the answer to that one if he won't do something about this NOW.  As a 3/4 he's almost at the point where it won't matter any longer. I know, I was a stage 3 when I was diagnosed and have been an addict all of my life. I'm not trying to sound preachy - just truthful.

Take care of YOURSELF.

[sal15]

He says he does want to quit, but he has'nt, he stopped for about 2months recently, he scared me alot this time because of his demands, just did'nt care,  and now he's trying to recoop.
And no the Dr.s don't know about this problem he has, he does not want to tell them, & yes AA & NA he has been going on and off for years. I tell him he does'nt care about himself like I care, but he is also taking alot out of me for the past 4 years. How are you doing now, and have you had treatment?

[nygirl7]

you need to make sure to take care of YOU - in the end sal it's all you can really do for the situation until he wakes up, I pray.

I treated for 72 weeks. I had two different strains of the disease. I have been 'cured' for over 18 months now.  It was a long road (still is sometimes of course) but I did it.  If I could manage to straighten up and do it he can too.  I really hope that he realizes it before it's too late (I am a single mom so it was easier for me to have incentive).

He's just gotta get treatment - have the doctors explainned in full what will happen if he doesn't? It's a shame and I wish I had some magic words of wisdom but unfortunately - there just aren't any except TAKE CARE OF YOURSELF FIRST.

[sal15]

Thanks alot, everyone tells me to take care of myself and to be strong, but when you are so involve in trying to make a person do the right thing and he does the wrong , it's hard, but I'll start taking care of me, I have to for my family who love me so much.

[CoWriter]

" as a 3/4 it should not be a reason to avoid treatment in itself. Especially, if tx withhold further liver damage.  

Uncontrolled diabetes with blood sugars of 350 is certainly a good reason not to treat since the tx can make it go even higher.  (and if you add the fact that he's using crack cocaine and drinking, I would say he doesn't have much chance of SVR).

A fasting blood sugar of >100 decreases SVR....and Insulin resistance results in HYPERINSULINEMIA.....which can make the interferon ineffective.



World J Gastroenterol. 2006 Nov 28

Insulin resistance and hepatitis C.

Insulin resistance is the major feature of the metabolic syndrome and depends on insulin secretion and insulin sensitivity. In chronic hepatitis C, insulin resistance and type 2 diabetes mellitus are more often seen than in healthy controls or chronic hepatitis B patients. Hepatitis C virus (HCV) infection promotes insulin resistance, mainly by increased TNF production together with enhancement of suppressor of cytokine (SOC-3); both events block PI3K and Akt phosphorylation. Two types of insulin resistance could be found in chronic hepatitis C patients: "viral" and "metabolic" insulin resistance. Insulin resistance in chronic hepatitis C is relevant because it promotes steatosis and fibrosis. The mechanisms by which insulin resistance promotes fibrosis progression include: (1) steatosis, (2) hyperleptinemia, (3) increased TNF production, (4) impaired expression of PPARgamma receptors. Lastly, insulin resistance has been found as a common denominator in patients difficult-to-treat like cirrhotics, overweight, HIV coinfected and Afro-American. Insulin resistance together with fibrosis and genotype has been found to be independently associated with impaired response rate to peginterferon plus ribavirin. Indeed, in genotype 1, the sustained response rate was twice (60%) in patients with HOMA  2. In experiments carried out on Huh-7 cells transfected by full length HCVRNA, interferon alpha blocks HCV replication. However, WHEN INSULIN (at doses of 128 microU/mL, similar that seen in the hyperinsulinemic state) WAS ADDED TO INTERFERON, THE ABILITY TO BLOCK HCV REPLICATION DISAPPEARED, and the PKR synthesis was abolished. In summary, hepatitis C promotes insulin resistance and INSULIN RESISTANCE INDUCES INTERFERON RESISTANCE, steatosis and fibrosis progression.

http://www.ncbi.nlm.nih.gov/pubmed/17131467?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum



"Other measures can be taken to enhance svr probabilities in the the face of negative predictors."

Like what?

[CoWriter]

What can I do if anything for him and for me?    


Besides the fact that uncontrolled diabetes, and drug and alcohol use would lower the chances that the Hep C treatment would work, the medication used to treat can cause severe irritability, depression and in some cases suicidal or homicidal ideation.  That can be very dangerous for somebody using drugs.  And it would put everybody around him at risk of getting hurt....especially you since you would be around him more.

I think you need to let his doctor know about the alcohol and drug use....for your safety and his.  
  

[sal15]

I thought about telling his Dr. in fact I called yesterday and left a message.  I will try again on Monday. So the outcome of not telling the Dr. and Telling the Dr. both have consiquences that are bad, because I don' t think he is going to stop. He just does'nt care and yes it does get a little dangerous and scary to me. One thing I know I need to do is stop fighting about it. He has lost it with me before.  And on top of all this he has been diag. as being Bipolar 7 years ago and does take meds for that on top of everything else. I know what your probably thinking, How did I get involved with this? Well it's a long story, it's not important anymore. The fact is that this situation if big. I need God now to help me thru this.  

[FlGuy]

First, I speak mostly of my own experience as DM2, early cirrhosis and relapser.  DM2 was all over the map pre-tx and poorly controlled (if I could eve use the word control).  Hepatologist, endo doc, pcp and hema doc all pointed to tx in the given conditions. a1c was about 13.1

As for the 'other measusre'.  A team of docs, including a knowledgeable and experienced hepatologist can design and execute a tx regime with the negative predictors in mind and a plan to give a pt a better shot at a satisfactory resolution, as opposed to plain ol SOC.  In my situation it was pre-dosing riba, double peg for a while, early and aggressive use of Aranesp and very frequent monitoring to make any adjustments that may become necessary.

The secondary benefit to successful treatment of those with hcv shaded DM is mentioned in here as well.

http://www.medhelp.org/posts/show/564884

So, it's my experience that pursuit of tx is worthwhile on many levels and in other situation. Curiously, my blood sugar levels normalized on tx, as verified by frequent testing, personal monitoring via meter and a1c. As an added bonus my ldl also increased to over 100 from an average of 65-70  for 15 prior years.  I'm an anomaly which my kids refer to as weird.

[CoWriter]

Were you taking metformin during treatment?  That's one of the insulin sensitizers I believe will help people with insulin resistance inctrease their chances for SVR.  

[FlGuy]

No insulin or metformin on tx. There was no demonstrated need during, tx a1c around 6.3 and other tests about normal.  Docs ascribed it to riba effects.  Post tx raised levels but nowhere near pre-tx levels. Back on metformin but otherwise easy to control now.  Hoping to lose the metformin soon due to better habits and better liver, as Dr. D hints. I think the success of tx was more a result of those other 'measures', doses and duration.

[CoWriter]

Very interesting.  IR is one of my favorite subjects.