High Glucose? What to ask my doctor?

Glucose as of yesterday was "100" (65-99 normal). A month ago was "105". In the 90's a month before that. Any reason for concern? Any questions/further tests for my cardiologist who I'm seeing this afternoon?

TC 212(H)  HDL 33(L)  LDL 141(H) TRI's 189(H) Looks like I'll be getting the Statin talk this afternoon no doubt. I've been doing between 60-120 minutes of cardio for the past two weeks. I shudder to think what my Tri's would look like if I was sedentary. That amount of exercise should have burned them off but apparently didn't enough.

[jmjm530]

Serum Insulin was "9". Normal is <17.
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Unrelated: Platelets: "161" which is similar to pre-treatment. I would have thought platelets would rise post treatment due to a healing liver. Anyone notice any changes in platelets one way or the other from pre to post treatment?

[niceguy2007]

hi jim,

my platelets went down on treatment, from 348 to 200.

i know they'll take at least six mnoths to get back to normal.

In your case, we know it took more than 20 YEARS for your platelets to get from near 300 to 160s.  So, common sense says that it will take YEARS for them to get anywhere near that level.  (when damage takes that long, reversal must take at least half as long, right?)

[niceguy2007]

also, i think u may habve missed an earlier post for u.

i recommended aloe vera gel for post treaters who have confirmed SVR.  

aloe vera is an excellent natural anti inflammatory herb: its great for skin inflammation, arthritis, and autoimmune disorders.  it really does make a difference.

it also contains amino acids and is a storehouse of virtually ALL nutrients known to man.

however, i have a feeling it may compromise SVR during or right after treatment.  Therefore, only people with 6 months post UND should take aloe vera gel.

-- I also have a question for you...do you think diclofenac sodium(voltaren) can compromise SVR? i'[ve been taking a 25mg pill before every shot.

[jmjm530]

Thanks for responding. Supposedly, fibrosis reversal can take place quite quickly, even during treatment, however the tx drugs themselves will suppress the platelets. I'm one year post treatment now so expected my platelets to rise based on what I think might be some fibrotic reversal. I'll mention to my liver specialist next month but his answer to most of these questions is "that's normal, don't worry" sort of what I tell you most of the time :)

-- Jim

[niceguy2007]

but jim are you aware of diclofenac sodium? its a common anti pyretic drug...however, the internet says its not as safe as tylenol.  

whats your take on it?

[niceguy2007]

also i think you should take aloe vera gel really seriously... i think its the answer to 50-70 percent of the post tx symptoms YOU in particular are experiencing :)

[jmjm530]

It's an NSAID which some doctors prescribe on tx but many, like my doctor, prefer Tylenol instead. However, this has nothing to do with SVR, I think it might have to do with bleeding. Volatern will not compromise your SVR in any way. Not to worry. As to Aloe Vera gel, never heard it could compromise SVR. I've tried it for my stomach inflammation but haven't noticed anything positive or negative. How long does it take to work. I've been using the liquid, not the gel per say. Health food store guy said they're similar.

[nygirl7]

I noticed on my blood work that my Glucose was at 89 which was pretty surprising to me personally yesterday.

But then...during treatment I did eat BADLY LOL

[niceguy2007]

Jim,

I suggest you use the most expensive, highest quality gel available in your area.  If you can, get a Aloe Barbadensis Miller plant and grow it in your backyard.  Studies have shown that aloe vera potency is reduced within 24 hours of cutting and extracting the gel.  so yo need a very high quality manufacturer, OR, as is even better, get your OWN PLANTS.

my family uses the raw plant, fresh gel cut out of the leaf.  It has a very rapid, and extremely strong effect.  it works, and is VERY STRONG.

Thats why I recommend you to never take it on an empty stomach...the rapidly absorbed, high concentration nutrient rush can cause you to feel very dizzy indeed.  it can also give you diarrhea.

The dose of the plant gel is 1 tablespoon of freshly cut gel a day, preferably 2 hours after lunch.

[niceguy2007]

i was so crazy i used to drink like 5 tablespoons of the fresh gel mixed in orange juice after workouts.  but tahts just me i am crazy :)

[mikesimon]

My experience has been that my platelet count never got very far above low normal with the exception of right after my motorcycle accident. I was on drugs that cautioned about platelet drop yet mine went from 140 - 150,000 into the 240,000 range. My PCP said that can occur after severe trauma and that mine would get back to my "normal" in a month or 2. That's exactly what happened. You're normal so I wouldn't worry about it. I think as we age a high platelet count might not be all that good - I'm thinking stroke possibility. If my clotting time is good that's all I care about.
I would watch my carb intake with a glucose reading like yours. You know everything I could say about exercise and carbohydrates. They say wine can decrease blood sugar and I think I may have seen that in my situation. But, I am diabetic so hypoglycemia can and does rear it's head from time to time. I also wonder about reefer's affect on blood sugar - does it lower it?  I tend to believe that it may. Am I getting into real trouble here Jim? I really don't care if I am. These are things that have occurred to me and there isn't a lot of information about either of these agents and their impact on blood sugar -in particular reefer and glucose. I wonder why that is. I'd be careful if I were you Jim and I'd be happy that I treated successfully before these negative predictors surfaced - if, in fact, they are. I think that is one factor that isn't stressed enough when deciding whether to treat - the negative predictors associated with aging. Mike

[niceguy2007]

and more:

aloe vera isn't effective for GERD or reflux.  

its efficacy lies in stomach ULCERS, ARTHRITIS, PSORIASIS, BACK PAIN, MUSCLE PAIN, and autoimmune diseases. its also great for BLOATING and FLATULENCE.

[FlGuy]

The glucose level of 100, what were the conditions?  Was this a blood draw or glucose meter? Reading, after fasting, upon waking?.  My doc suggests that that I should take readings each day (handheld gluscose meters) alternating between morning (before eating) and next day in the PM (around 2 pm) after eating and into my day.  The targets should be about 100 (am) and 120 (pm).  Control through diet and exerceise limiting sugar, carbs, fats while enhancing veggies, protein, water, exercise, sleep and good sense.  Most of your stuff sounds pretty good to me and it seems like your healty lifesytle is paying off for you.  Also, you might cut down on other syrupy things like Dancing with Stars and AI.

[Bill1954]

Hiya Jim,

The BG values you mentioned above, while not textbook ideal, do not seem to be something in themselves to worry about. I have read some of your recent posts lately about metabolic syndrome, etc, so I understand your concern about possible pre-diabetes being a factor.

You might ask your doctor for the following labs to R/O diabetes-related issues:

1) Hg A1c test; this test

[jmjm530]

Readings from blood draw. Fasting. Usually between 10AM and 1PM. Does the serum insulin mean anything?

Mike,

I'll get back to you after I see the doc. Thanks.

[GrandOak]

Given the Glucose was not that much over norm on a fasting test, I would not think that it would be an area of great concern, particularily with insulin showing in normal range.

Sounds like this might be a good question to take to the Diabetes forum though as the folks there would probably be much more knowledgeable on it than many of us.

[mikesimon]

I don't know much about serum insulin. I assume that if your serum insulin is normal or high and your glucose is also high that means you are insulin resistant. You are producing enough insulin but it is ineffective or less effective than it should be. Since your BG is not really elevated much I wouldn't think that you have an insulin resistance issue. But, that's just off the top and I could be way off. I don't think that your BG is anything to lose sleep over - I'd just watch it and my diet and exercise. Mike

[mremeet]

I ain't no gluco-ologist, but I really don't think your numbers are that out of line at all. Slight, occasional variations outside of defined norms usually aren't terribly meaningful in of themselves from my learnins'. Type II diabetics can have numbers soaring way, way above a mere 100 or 104. And what about that A1C blood sugar history test (or whatever they call it), did you get that done?  And like Flguy says, the fasting time is important. You say you fasted between 10AM and 1PM? That's not a long fast, usually when I'm told to fast prior to a blood draw they tell me at least 8 hours is required. This is usually orchestrated by having the last meal before going to bed, and then get up and go straight to the hospital in the morning without breakfast (with a growling stomach). Do you recall what you typically ate prior to getting your blood draws? Starchy and sugary foods prior to the draws could also elevate the glucose a bit above normal. Also, I think it's normal for most people to lose at least a little of their insulin sensitivity as they get older (as you probably know insulin is how your body internally regulates sugar levels). Especially in those that have experienced a long history of liver disease (even if it's now resolved). I pretty much expect to eventually develop some type of insulin insensitivity, or outright type II diantes later in life due to my infection with HCV (even if I SVR soon). My dad developed type II diabetes in his mid-50's (he completely manages it with diet and exercise today though), so there is a genetic component too. Anyone in your direct family have any form of blood sugar problems or diabetes?

[jmjm530]

Thanks for the great response! I'll print out and reply later, including a brief rundown of my doctor's visit.

-- Jim

[Tallahassee]

I just thought of something

[GrandOak]

WHAT, you mean eating all that ice cream is bad for you?

Get out of town!  I looked at it that if it made me feel better than the fatigue of the anemia, it must be a good thing !!!!

[Forseegood]

funny you should mention this, was talking with a much revered member of this board just the other day and she said her glucose was a little high (like yours, very little) and that it stablized the longer she was away from treating, over a year now...maybe a lot of things begin to stablize the longer you are away from treating...just a thought...

[Forseegood]

aloe vera gel compromises SVR at any time? that's a stretch, with all due respect...where did you get this stat? some significant gallons of Jim Beam? now you might be on to something, but aloe vera gel? it's just a plant...hope youre well...

[Forseegood]

I tend to think you might be on to something about reefer and the lowering of blood sugar, hence the munchies...and I'm a hypoglycemic (not the diabetic kind) and a few puffs would definitely lower mine...and all the panic that comes with that, (for me anyway) so that's why I left that off years and years ago now...did go nice with Jimi Hendrix though, boy am I aging myself!

[pigeonca]

The great advice from Bill and others is, I believe, insufficiently aggressive.  I've been pre-diabetic for about 3 years now and, after doing LOTS of research, have chosen to take about 15 units of Lantus insulin each night around 10:30pm.  It has enabled me to wake up in the AM with meter readings of 80 to 90, which is ideal.  I also try to exercise and watch my carbs (except for now on tx, when only icecream seems to go down easily, and I can't move my butt around the block).  Here are the kinds of numbers I get without insulin or drugs:

Wake up anywhere from 105 to 115.  These are definite pre-diabetic numbers; anything over 100 fasting should be followed up.  (Diabetes, full-blown, is defined by a fasting over 126.)

After meals, I've been known to get as high as 235 if I ate something like pancakes with syrup, or chocolate cake.  Normal meals usually send me to around 145 to 165, occasionally 180.

A1c, without using Lantus, was slightly over 6.  

As you can see, none of my numbers are quite high enough to be considered worrisome, but my concern has been to keep damage to the islets of Langerhans to a minimum.  Even though I've not received a diagnosis of diabetes, and probably couldn't, my PCP is allowing me to use the Lantus, "off-label."  It's made a major difference in my meter readings.  

The medical establishment has set very low standards for diabetic care.  I think they expect substandard compliance from patients and factor that in.  Your A1c should really remain within the reference range, 4 to 6, to avoid killing off pancreas cells that produce natural insulin.  Ideally you should be around 80 to 90 when you wake up, and one hour after meals 140 (never over 180), two hours after meals 120 or less.  Before meals your blood sugar should be close to what it was when fasting.  

I highly recommend looking at alt.support.diabetes in google groups.  It's very much like our group, with some very smart people providing references to journals and studies and offering some excellent advice.

Lest you think I'm being a bit nutty for using insulin as a preventative, I've met too many people who followed the rules and waited for an A1c of 7 or 8 before taking measures.  Many, many of them had already suffered diabetic damage, including one guy I heard about who, just diagnosed, had to have a toe amputated.  Don't want that.

Best of luck.  I know that, being Jim, you'll do what it takes.

[Forseegood]

really interesting, thanks for this....

[mikesimon]

I've seen Hendrix live that's how old I am. Of course I was young back then - like 19 or maybe 18. I saw a lot of bands - Airplane, Doors, Janis, Stones, Led Zeppelin etc and it was funny the way the crowd would rush the stage with every act back then trying to ratchet up the excitement - but never with Jimi Hendrix. He was enough - invariably the crowd was transfixed. He was the man....and I think he still is. A true genius. Mike

[returntosender]

Interesting that your glucose is rising.  There is something happening post treatment that affects a variety of bodily systems.  My blood pressure shot up at about 8 months post tx.  Never had high blood pressure before.  My glucose was up over 100.  Never had that pretx.  I have very high insulin levels and very low testosterone - again something new to post tx.   Seems to me that these are all a product of an overstimulated immune system but the scary part is that it doesnt seem to get better over time but actually gets worse!   I am now on three! medicines for my blood pressure - Altace, Norvasc and imipramine.  With all that I am barely in normal range.  

The endocrinologist wants to continue the tesosterone but that stuff causes more symptoms than it cures.  He also wants to treat the metabolic disorder with something that lowers the insulin.   I felt so bad this morning that I actually had the thought that maybe a small dose of Riba would help.  I need something for my immune system to attack other than my own body.  I cant even catch a cold these days.  I feel for you brother, this stuff is not easy to figure out - hopefully someone on this board will piece it all together with some good science - where is HR when you need him!  LOL At any rate, any of those blood tests include a Heptimax?   Its about that time for you since my 1 year anniversary is coming up in a couple of months.  If you solve this mystery I know you will let us know - by the way, pop a Riba and let me know if that helps.  LOL

[returntosender]

This is interesting -  testosterone as a factor in metabolic syndrome.  Is the interferon damage to the sex hormones the causal connection to all of the other problems?

"Fifteen patients who had had a myocardial infarction before the age of 43 were compared with thirteen age-matched normal subjects. Twelve of the patients and three of the controls had a delayed glucose and insulin peak in the glucose and insulin areas than normal curves. When the measurements of the four patients with the largest areas under the glucose tolerance curve were separated, significant correlations were observed in the remaining patients and controls. The ratio in serum of the concentrations of estradiol-17beta to testosterone (E/T) correlated with serum glucose area (r equals + 0.69, P is less than 0.001), insulin area (r equals + 0.80, P is less than 0.001), and the ratio of insulin area to glucose area (I/G) (r equals + 0.64, P is less than 0.005) in the glucose tolerance test. Serum cholesterol concentration correlated with E/T, insulin area, and I/G, and serum triglyceride concentration correlated with glucose area, I/G, and serum cholesterol concentration. The hypothesis is presented (i) that in men who have had a myocardial infarction, an abnormality in glucose tolerance and insulin response and elevation in serum cholesterol and triglyceride concentrations are all part of the same defect (glucose-insulin-lipid defect), (ii) that this glucose-insulin-lipid defect when glucose intolerance is present is the "mild diabetes" commonly associated with myocardial infarction but is based on a mechanism different from that of classical diabetes, (iii) that this glucose-insulin-lipid defect is secondary to an elevation in E/T, and (iv) that an alteration in the sex hormone milieu is the major predisposing factor for myocardial infarction."

Phillips GB. Relationship between serum sex hormones and glucose, insulin, and lipid abnormalities in men with myocardial infarction. Proc Natl Acad Sci U S A 1977;74:1729-1733. PMID 193114

In 1977 and 1978, Dr. Gerald B. Phillips developed the concept that risk factors for myocardial infarction concur to form a "constellation of abnormalities" (i.e., glucose intolerance, hyperinsulinemia, hyperlipidemia [hypercholesterolemia and hypertriglyceridemia] and hypertension) that is associated not only with heart disease, but also with aging, obesity and other clinical states. He suggested there must be an underlying linking factor, the identification of which could lead to the prevention of cardiovascular disease; he hypothesized that this factor was sex hormones

Also here: http://www.agingmale2004.com/transcript-Arver.htm

I know you were looking at Relacore in a recent post but these results indicate that testosterone therapy may be needed as well.  Google testosterone and metabolic disorder and throw in interferon as well.  Stir well and feed to DD.  

[jmjm530]

Thanks for the great response! I'll print out and reply later, including a brief rundown of my doctor's visit.

-- Jim

[jmjm530]

Thanks and now off to the cardio. I doubt he will be concerned with BG but wanted to get your feedback. As to diet and exercise, making a lot of efforts here including over an hour of cardio a day plus signficant diet modifications. Been fighting off the Statin thing for some time now but time may be running out.

-- Jim

[mikesimon]

I think you're smart. I like insulin so much better than the oral meds that everyone who thinks that their diabetes isn't that bad take. You've probably seen charts showing pluses and negatives of all treatment drugs. If injections weren't involved everyone with a brain would chose insulin. Mike

[jmjm530]

My normally unhurried and on-time cardiologist was a bit hurried yesterday and not on time. So much for things that seem to good to be true :)

Basically the same as last visit. He looked at recent bloodwork and said that sooner or later I'll be on statins and/or blood pressure meds and let's check back again in 3-4 months. I know there won't be any difference in the blood results because I know my history but went along because wasn't in the mood to start any new meds anyway. His three big questions were: (1) any pains when exercising; (2) Any shortness of breath while exercisisng; (3) Any irregular beats. Answers all 'no'. Basic thrust I guess was to make sure I didn't fall dead in his office :) But kidding aside, this is how medicine is practiced. They basically wait until you are at the very serious or more than serious (heart attack) stage an then they know what to do. Before that, not so much.

Did try and discuss metabolic syndrome and HCV treatment but it was soon apparent, like so many non liver specialists, that he had no knowledge of HCV treatment or the effects of interferon on lipid values. He also acknowledged that this very narrow area -- post tx hep c patients with lipid problems -- is not a priority area of concern for cardiologists so don't look for too many studies soon. LOL.
Tried to discuss my fat redistribution since tx ended, but the problem is the doctors I see are 10-20 years younger than me but I'm in twice as good shape, so to them I look fine. He ends by saying that I'm in better shape that 99 out of 100 of his patients and I remember -- no kidding here -- a patient being wheeled out of his office ten minutes before my appointment -- around 80, in a wheel chair being wheeled, on oxygen, and from the blank stare, apparently a stroke victim. So I'm thinking being at the top of his population base isn't necessarily that great :)

Oh, the glucose. There's a reason you're supposed to write your questions down in advance because between the delay in the office and discussions on lipids, metabolic syndrome and interferon, guess what I forgot to ask. LOL. I'm sure he has no problem with the glucose since he did see the labs but I'm calling him back with a Red Yeast Rice Extract study later this week and I'll ask specifically regarding the glucose.

Cont..

[jmjm530]

Thanks everyone again for your thoughtful answers.

Nice, Could you clarify what time you suggest taking the Aloe Gel. You said not on empty stomach but two hours after lunch. Two hours after lunch to me means an empty stomach or are you saying just don't take it first thing in the morning? Also, is it bad for GERD or just neutral?
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Mike, You got the wrong fellow if you think I care about being politically correct about alcohol.LOL. Actually had a glass of wine my hepatologist not that long ago and he actually recommended red wine to help with my cardiac profile. That said, I stopped drinking my 3-4 glasses of wine a week recently, not because of the liver but because I'm trying to get my triglicerides (triglycerides) down at the moment and lose some belly weight, so it's interesting you say that wine can decrease blood sugar and come to think of it, my blood sugar was slightly lower when I did have some wine but could have been coincidental. But again, I thought red wine is mainly carbs and sugars, so how can that help glucose and triglicerides (triglycerides)? Or is glucose different from tri's in how they are affected by alcohol? As to pot, never agreed with me, so that's off the table.
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FL, I mentioned earlier it was a fasting glucose from a test tube blood draw with at least 12 hours fasting beforehand. My brother mentioned the blood meter thing as well and it's on my list somewhere if I can ever find that list!
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Bill, Thanks for the suggestions. I have been ordering HgA1c tests and I'll have to re-check the results and perhaps get a more current one. My test was fasting. I've heard pro's and con's on the glucose tolerance test but it's also on my list.
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GO, I'll check the Diabetes forum out. Thanks.
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Mre, And all this while I thought you WERE a "gluco-ologist". LOL. The age thing, of course is a factor but just too many things a bit different right after treatment to peg it on age. And then there are the folks, like DD, reporting similar right after treatment who are in their 40's when these things shouldn't happen.
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Tallahassee, Never heard of Zetia. Will look into it. Thanks.
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Forsee, Thanks for the info. Maybe a little Uni will help?
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Pigeonca, You say "anything over 100 should be followed up", but so far, none of my doctors seem overly concerned although I will mention it again to my cardio and maybe call my GP although I believe he didn't say anything when it was around 100 earlier in treatment. That said, I'm going to print out this thread and may present some of the ideas including Lantus to my doctor, but probably a good idea first to try the glucose meter thing and see how I react to different foods, etc.  
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Return, What is your serum insulin? Sorry the testoerone isn't working. I re-tested in the morning and it was in normal range so I didn't decide to pursue it further, at least for now.

[niceguy2007]

jim,

two hours after lunch wouldn't be an empty stomach, because the food would still be in your intestines, which would interfere with the rapid absorption of aloe vera. ( wwe dont want rapid absorption, we want to slow it down a bit)

you have to take aloe vera at an optimum time for its proper absorption.   taking it earlier than 1-2 hours, or earlier than 1 hour, would mean its mixing with your food, thereby causin gyou to feel too heavy (nutrient overload) possibly nauseated.

on the other hand, if you eat it on a totally emptoy stomach, it would be rapidly absorbed, within 5 minutes or so.  this coupled with the enormous amounts of iron, vitamins,and amino acids, would cause you to feel really crappy, with possible diarrhea.

theres no hard and fast rules though.  eating it 1-2 hours after lunch seems logical to me.

this is my experience with the fresh plant; the processed one could have different dynamics.

keep in mind that aloe vera is an EXTREMELY powerful analgesic and anti inflammatory.  \

1. it practically CURES ARTHRITIS in almost 90% of the people who use it daily.  it is also very powerful against psoriasis and other skin conditions.

2. it fixes bloating within 15 minutes of takin it.

[jmjm530]

Thanks, I'll look into the carb thing and red wine some more. Don't want to get started here with all the positive studies regarding red wine, but like I said,  my big-shot hepatologist has encouraged me to drink red wine post treatment and we actually had drinks together,  which for me says it all. Just don't see it as  a black and white issue like some make it out although I must admit after reading some posts, it's evident that there are some that can never be what I would term a 'social" or in my case -- since I'm not very social these days -- a 'healthful" drinker :) Anyone who ever had alcohol issues in the past, probably should err on the side of caution which is not to touch alcohol.

-- Jim

[mikesimon]

I believe alcohol lowers blood sugar and keep in mind that red wine has very few carbs - like .5 grams per 4 oz glass. Since I have a 6 or 7oz glass it's probably .8 grams. Stay away from Port which is a whole lot higher - maybe 14 grams or more - or those sweet whites or reds like Mogan David. Things change so quickly that it's risky to get too invested in anything these days but it seems like every day there is another new positive attribute associated with red wine. Honestly I don't enjoy any alcohol like I did before I was diagnosed. I didn't drink a drop from 1995 to 2006 but after my bike wreck Karen and I were out having dinner one night. I was still in a wheelchair and I felt so fortunate to be alive and sitting with my Woman that I wanted to celebrate. Now, occasionally I will have a glass with dinner when we're out and I have to be careful not to get hypoglycemic. I think it has to do with the insulin I inject so the lowering may be due more to the exogenous insulin and the effect of alcohol more than the lowering effect of the alcohol alone. Mike

[Eisbein]

Just want you to know my platelets never returned to pre tx levels either.  I posted that many times, but maybe you didn't see it.
Pre tx between 220-230, during tx 150-180, post tx 180, and does not budge from there.
I don't worry about it, it's not my liver, but  my bone marrow. I think over the years it may move up, if not, fine with me too.

Ina