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diabetes and hep c
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diabetes and hep c

I just wanted to continue to post and diatbetes and hep c into sunday. I have read here more then once of someone who had diabetes treated for hep c and then there diabetes cleared. sounds to good to be true although I hope it is.

Does anyone have any links to share about studies in regards to diabetes and hep c. I asked by by diabetes docotor and my hep c doctor about a link between the two diseases and both said there wasn't one. Since I am not over weight and there is no diabetes in my family I am inclined to think there is a link.

Also have read here more then once about those of us who crave sugar while on tx, a side effect I have been going through and giving into recently, not good for my diabetes.

love to hear others on this subject
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Avatar_m_tn
Here is one paper on it I had handy. I am sure there are many more others might have.
http://www.natap.org/2002/easl/day5.htm
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Avatar_n_tn
thanks.
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149675_tn?1257636570
So if blood sugar abnormalities and/or Diabetes is more prevalent amongst heppers does anyone here follow a particular diet regimen? Maybe one that pays strict attention to the hypoglycemic index of foods. My brother who I said in an earlier thread is a type 2 Diabetic follows a strict regimen. He takes lots of meds and checks his blood sugar about 6 times a day. He keeps a notepad with him at all times and records everything. Hopefully after his weight gets back into a "normal range" (his about 75-100 lbs. overweight) he hopes to be eventually be med free and just control it with his diet.

He is the one who said to me that maybe I should get my sugar checked. He said what I am describing tired after eating is a symptom and we have a family history. I have had my sugar checked in the past and it came back fine. I know one of the functions the liver performs is metabolizing sugars. Since HCV attacks the livr it only make sense that blood sugar could be an issue with some of us.

I guess my main question is does anyone follow a particular diet?
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149675_tn?1257636570
Dog,

One thing I have found is that doctors do not seem to like to  reconize links easily with Hep C and other problems.

Around the time I found out I had HCV I had to be rushed to the hospital and have my gall bladder removed(2002). I had a pretty bad attack where I felt like the movie "Aliens" and an alien was going to burst out of my abdomen. It was really painfull and I had no idea what was happening to me. Anyway I have asked several doctors if there is any relationship between gallbladder and hep C. I was told no by every doctor. Yet when I talk to many heppers they also have had their gall bladders removed. Obviously there is no scientific link in that but it sure does seem like a heck of a coincidence that so many of us have had it removed.
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Avatar_m_tn
See http://www.medscape.com/viewarticle/530759

Diabetes Mellitus in Chronic Hepatitis B and C: Prevalence and Potential Association With the Extent of Liver Fibrosis
Posted 05/11/2006

Mike
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Avatar_m_tn
Your best bet if you have hep and diabetes is to control it as much as you can with diet and exercise. The drugs they use to control blood sugar are really hard on your liver. The less you use the better.

                                                      Ron
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149675_tn?1257636570
Thanks for the link. It was interesting. I also did a google on diabetes and couln't help but notice that some of the symptoms are the same as Hep C.
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Avatar_m_tn
One thing I notice are all the media articles about the increase in Diabetes 2 and it's relation to being overweight but nary a word about the Hep C connection. You know millions of those people have Hep C as an underlying illness.
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149675_tn?1257636570
Mike,
Thanks for the link it wa a good article.

upbeat,
I agree with you about trying to control it with diet.

Kalio,
you make great points
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Avatar_m_tn
It is so frustrating that many doctors don't even know what's up at times! It's their profession for petes sake! A lot of them are so defensive and can't see around their overblown egos to remain openminded and learn something. This is a relatively "new" disease, you'd think they'd be open minded and willing to look at new onnetions and associations and ideas. Here is just one paper I have about it, but there are more. Those doctors are behind the curve on learning about this disease but you are right on in making the association. Your liver ilness is directly linked to your gallbladder problems. Atually it is pretty common knowledge that liver disease is linked to gallbladder disorders why they don't see the Hep C connection puzzles me.
here's the link to the paper:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15770666&dopt=Citation
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Avatar_m_tn
I too have diabetes. I believe I got it either from transplant or from rejection treatments post transplant. But, it is pretty well established that it is associated with HCV. While I agree that if you can control your blood sugar with diest and exercise that is best, I also believe that the number one goal with this disease is control. I've heard many people say "my diabetes isn't that bad -I don't need insulin". My view is that diabetes isn't good or bad - it's either controlled or uncontrolled. I read an article a couple of years back that stated that as blood sugar increases so too does the incidence of cadiac event, and this is true in non-diabetics as well as diabetics - that was what was surprising. Blood sugar and cardiac event run parallel even below the threshold for diabetes. The point is: sugar in the blood is not healthy. I use insulin because I agree that the oral drugs effect the pancreas and/or the liver and I didn't think that was wise after transplant. Recently I've read of some negative effects of insulin too so I guess there is no perfect solution to this serious disease. But, I do think glucose control is the primary objective regardless of how it is achieved. Mike
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Avatar_f_tn

I also have had my gall bladder removed, which is when i found out i was hep c positive, otherwise i would not have known.

Here is some information on diabetes and hep c.  The link at the end will take you to it.

The relationship between hepatitis C virus (HCV), steatosis, and insulin resistance is genotype specific, and steatosis and insulin resistance are closely linked to the progression of liver disease in HCV infected patients.

Since the identification of hepatitis C virus (HCV) in the late 1980s, chronic HCV infection has emerged as a complex multifaceted disease with manifestations extending beyond the liver. As such, hepatic steatosis, insulin resistance (IR), and type II diabetes have been observed to occur more frequently in association with HCV infection than other chronic inflammatory liver disease.1 A proportion of HCV infected patients with steatosis also exhibit several of the clinical features seen in non-alcoholic steatohepatitis (NASH), questioning the significance of these metabolic disorders in the pathogenesis of HCV related liver disease. Hence, considerable HCV research has recently been directed towards understanding the mechanisms underlying the development of these metabolic manifestations in HCV infected patients and their implications in the progression of liver disease. Several important questions have been examined: are these metabolic disorders in HCV infected patients a result of viral or host factors and, if viral, how do viral proteins interfere with lipid and insulin metabolism? What is the primary event in these patients (steatosis or IR) and what are the implications of steatosis and IR in the pathogenesis of liver disease? Finally, how can we exploit our current knowledge for developing effective therapeutic strategies for HCV infected patients?

Check out this site to view the whole thing.

http://gut.bmjjournals.com/cgi/content/full/54/7/903

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Avatar_m_tn
my FASTING glucose has not been higher then 110 (65-99 normal)for the last 6 months, 3 different tests. my pcp ordered the Alc test and that came back normal 5.5 (4.5-5.7 normal). my question is does this mean i'm PRE-diabetic? and should i try and get the glucose & cholestrol(total cholestrol normal, high tri's, and low HDL) under control before treating? can i take cholestrol drugs while treating? i read that cholestrol drugs are bad for liver? it is possible that when i start tx or better yet svr that these could go back to normal WITHOUT rx? sorry for all the questions. thanks
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Avatar_f_tn
Mike,
It sounds like you're doing what I'm doing, using the insulin.  I've researched this out, and had loads of help from my diabetic family, and concluded that sulfynureas (spelling??) wring out your pancreas and in the end worsen the diabetes.  So I was using metformin until this hcv diagnosis (hopefully can resume it soon), plus I take 15 units of lantus at night.  Every now and then, when I want to eat loads of carbs even though I shouldnt, I might also shoot some Novalog if I've got it handy.

I'm not quite an official diabetic, never had a fasting, without insulin, over 110, but have occasionally hit 235 postprandially (mainly after Chinese food).  When I described my intentions to use insulin to my internist, he said, "I can't approve of it, but I won't tell you not to."

I've never met anyone else with early or "mild" diabetes who's doing this.  But it sure makes sense.  What have you heard bad about insulin, if I may ask?

pigeon
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Avatar_n_tn
I had a liver transplant in January 2001 and took insulin until three months later.  I think the need for insulin diminished as I was weaned off Prednisone.  
Was off all insulin until June 2002, when diabetes returned with a vengeance.  My viral load the first year and one half after transplant ranged between 60k and 250k; in June 2002, it jumped to 1.75 million, and I have been back on insulin ever since.
I have been taking 33 units of Lantus for the last few years.  Started treatment eight weeks ago and I am now taking 60 units of Lantus each day to get fasting sugars at about 120, which is not optimal but okay with me for now.  
Since my alt went from 70 pre-treatment to 150 five weeks after beginning treatment, I am guessing that the initial treatment has made the Hep C flair up and this has increased need for insulin.  So for me, I think there is a connection between viral load trends and the need for insulin.  
By the way, this is by far the most informative forum that I can imagine possible about Hep C treatment.  I am amazed at the good advice you can pick up here!
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96938_tn?1189803458
I was one of those who had resolved blood sugar problems on tx.  When primary doc discoverd questionable liver tests he also dx'd diabetes.  A1C level were north of 13, meaning average dlood sugar was north of 350. Started on insulin. Have never been over weight and am farily active. Alcohol intake over the past 15-20 years 'bout a six-pack a year. Fairly ok diet.  When 12 week pcr showed und, blood sugar returned to normal (A1c at 6.3). Discontinued insulin.  Relapsed after 24 weeks.  Blood sugar going up again, though not to previous levels yet (much better diet habits than pre tx).  For me, definite connection to hcv (early cirrhosis) and BS levels. Off to endocrine guy in two weeks and back to tx in 6. Blood sugar abnormalities a known possible sidecar to hcv.
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Avatar_m_tn
From: http://www.hivandhepatitis.com/hep_c/news/2006/072806_a.html
A study reported in the April 2006 Journal of Hepatology showed that alanine aminotransferase (ALT) levels -- and whether ALT decreased with successful treatment with pegylated interferon/ribavirin -- were associated with markers of the metabolic syndrome, including high body mass index and elevated blood pressure, blood glucose, and blood fat levels. The authors concluded that ALT elevation (a marker for liver inflammation) "partially depends on the degree of derangement of fat and carbohydrate metabolism."

It's nice to see another transplant patient. There aren't too many of us here. I have not noticed a correlation between viral load and blood sugar in my experience. Certainly perdisone does elevate blood sugar in the majority of patients and the trend in liver transplantation is to either not administer prednisone initially or to ween a patient off as soon as possible.
I would be a little concerned about you ALT elevation. While I have seen this occasionally I would want to exclude any possible co-factors. Have you been tested to exclude the possibility of autoimmune hepatitis? I certainly don't want to alarm you but since you have experienced an elevation in ALT at 5 weeks do you think it would be advisable to increase the frequency of your labs - like every week or every two weeks? I'm probably compulsive about labs but I like to know what's going on. I wish you good luck. Mike
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Avatar_m_tn
I just saw your last question about insulin side effects and I looked for the article but I can't locate it. I know it was recent and I seem to think it mentioned a slightly greater risk of stroke...but I can't remember if that is even right and if it is I don't recall what the risk with insulin use was compared to - normal people or diabetics using different therapy - I just can't recall. But, I'll look again later and if I find it I'll post it. I will say that it wasn't too scary or I'd remember it well. Mike
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Avatar_n_tn
I was started out at 450 mg a day for three days, was still on 100 mg a day at day ten.  I don't think many transplant centers use prednisone anymore.

I just got my eight weeks labs.  Here are some results compared to week five:
week 5/8;    ast 64/71;    alt 129/119;    bil 2.3/2.7
platelets 168/169;    neutro# 3.6/2.1;    hgb 13.9/13;  ggt 514/604

My NP says that that treatment sometimes makes the hep c "angry" and liver numbers go up early.  I don't doubt that this has happened in my case.  Any kind of chemical stress (accidental exposure to paint or gasoline fumes, for example) can make me sick for months and my liver numbers, expecially bilirubin alt, and ggt go way up in these periods.  It looks like the riba is  kicking in too.

I see my doctor next week and will ask him about the possibility of  autoimmune liver disease.  The results of my eight week pcr (my first one during treatment; I am geno 1a, viral load >3.5 million) should be back by then.  I'll ask about more frequent labs.  I don't want to keep doing this for much longer without getting a little positive feedback in my liver numbers, especially the viral load.
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149675_tn?1257636570
Thanks for the link

I always believed there was a link between my gall bladder and the hep C. This is why I always like to do my homework. Now a days people follow doctors advice blindly. One of my pet peeves is that if you or especially one of you children goes to the doctor you are almost guaranteed to walk out with a prescription for something. I am not downplaying the knowledge and education of doctors but let's face it they are double booked for appointments and you are herded through like cattle. I see some people who are on so many meds for so many problems I can't wonder if some of their problems aren't actually from the meds. Just my thoughts
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Avatar_m_tn
I agree that it's a whole lot easier to deal with this stuff when you have some encouraging results in front of you. What drugs and what doses - HCV treatment that is - are you on? Good luck. Mike
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Avatar_n_tn
I'm doing the peg-intron, 150 ug once a week and 1200 mg daily of Rebetol (5' 11", 200 lbs, age 51).  Taking 75 mg neoral twice a day.  

Mike, what kind of immunosupression did you take during treatment?  Did you have to increase dosage during treatment?  I've never had a problem with rejection.  I am probably not rejecting, but I don't like what the liver numbers have been doing since starting treatment.
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Avatar_m_tn
I was taking 2 mg Prograf and 250 mg Cellcept daily. I didn't increase while on treatment. I would think that if your numbers are being closely monitored someone probably would have seen evidence that rejection was a possibility and ordered additional testing. I can well understand your worry because I too get worked up easily over lab values. It probably goes with the territory. I like frequent PCRs at least until it is evident whether of not you're responding to treatment. Treating HCV in transplants can be rather tricky. I know fisthand about that but it's probably better if I leave that for a later time. Again, I wish you good luck. Mike
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