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92903 tn?1309908311

Cirrhosis - LFTs - Glucose

I'm diagnosed with 'early cirrhosis'. Six mos post treatment and virus free, my ALT/AST is 31/26. Here's what my docs says in response to my inquiry:

<i>I'm happy with the current enzyme levels.  Teens would be ideal but 20's is fine as well. I think you have a good chance of reversal of damage as I don't think your liver has passed "the point of no return".  Time, of course, will tell.</i>

I'm posting this because we have a few of us with similar damage levels and it might be of interest to the others. "The point of no return". It has an ominous ring, don't it?

Also, a question for the gang about glucose. Mine is right on the cusp of out of range to the high side. When does it become an issue? Should I be concerned now? Should I be working on eliminating all refined sugar from the diet? What else?

50 Responses
Avatar universal
Regarding glucose, buy a blood sugar meter and test yourself one hour after meals and again two hours after meals for several days to see how high you go.  This will tell you far more than a fasting blood sugar test, which only indicates problems when you're pretty diabetic.  Basically, you should not go over 140 at one hour, 120 at two.  Eliminating refined sugar won't do the job.  First of all, white bread, believe it or not, is way worse than any sugar.  Fruit juice is a no-no, as are most refined carbs.  You will need to play around with this to see what sends your blood sugar up.  There is a wonderful support group, alt.support.diabetes, which you should check out.  And a good book is Gretchen Becker's "Prediabetes."  Metformin is an excellent med for early diabetes/prediabetes. Best of luck.  This is not terribly difficult to conquer if you want to.
pigeon
Avatar universal
i have not tx'd yet and my lipids & glucose are out of normal range. there is a direct corralation with the liver and glucuse. my glucose level went as high as 120 with 126 being diabetic so i cut out sugar, carbs, etc and got it down to 103(up to 99 normal). i'm hoping to avoid becoming a diabetic. high frutose sryup is one of the worst things and is in so many foods & drinks, especially soda. they say this is one of the reasons americans are so FAT. kids are even overweight more then ever with drinking soda all the time.  i have read that one of the extra hepatic things that could come with hcv is diabetes so please be careful and get it under control now.
86075 tn?1238118691
Copy that, Copy Man! sorry...anyway, yeah, couldn't agree with you more, high fructose corn syrup, to me, is a scourge on our land... to be a drama queen about it...it's in so many things it ain't funny, and nothing gets your glucose up like that stuff...
96938 tn?1189803458
Those are some attractive numbers.  The envy of many, I'm sure.  As long as you have arrested the damage, you have begun the return.  And it's a question we've had all along - what is it that we recover and to what extent.  I think it was Mike a while back who said something to the effect that it depends on the extent to the area of the portal vein.  Maybe he can give his learned view.  The doc ('the one who should know') echoed what yours said, upon eradication should gain back a stage or two.  The question that I've never heard succintly answered is if there are some dead spots, what happens to those.  Is dead, dead?  In another year that will be a fish to fry for me. I'm grateful that you will have that information for me later on, you trail blazer.
As I said the other day, the endo gave me the 'thumbs up' (and thanks for the remarks). But, there was a 'but'.  Blood sugar has gone awhack again, although not as whacked as previously.
  I have an rx for insulin again which I'm not at all crazy about. But, tx will take care of that pretty soon. If you have not had an HGB A1C, you should. It will give you your average blood sugar over the past 90 days which is a more significant assessment than poking and metereing yourself.
This is where I get lost a little bit.  HCV does affect blood sugar, but I don't know if the effect is from the virus or the damage done to the liver.  If the former, your probably looking at diet modifications (sugar, carbs out, proteins veggies in) and smaller more frequent meals.  If the latter, and you liver is still in self-repair mode, maybe the gooder eating and gradual organic system improvement will right the ship.
But keep in mind, that when we speak of all things like eyes, blood pressure, aches and pains and such these are things that come with graying hair, diminishing hair, fuzzy memory which is God's gift to the over 50 crowd (you just joined the club didn't you).
Goofy, you sound like you're in pretty good shape, for the shape you're in.  And although we believe that having young ones keeps us young, the march of time has it's own pace.
I'm sure that this answers none of your questions, but that's my role here and I intend to meet expectations.  If you haven't seek out an endo and get that perspective.  The whole deal about glucose clinging to RBC's sort of makes my head spin and there may be some bearing on your continued recovery in the hgb department.
Avatar universal
I really agree with cutting out any processed foods, ESPECIALLY white flour and any kind of sugar or fake sugar stuff (Brian still hangs out with me). I started that about 35 yrs. ago (depending on my particular life environment at the time). I can feel my body gunk up when I get broke, cheap or lazy and eat that stuff (no, I'll never be as good as Rocker but I did try at one point).

My sister is a nurse an told me that there can be a part of your liver that can die but not stop general functioning just occasionally interrupt it. Like when I "hit the tree". (It is now a EVENT with my family). Does make sense as long as the portal veins are still functioning, but I am the mentored one around here.
92903 tn?1309908311
Thanks for all the intelligent comments. What did I ever do to deserve those? I'll definitely follow up on the sugar.

On cirrhosis regression, I'll have to pull out my informative bx reading. It talks specifically about intact portal veins an how that does not support a diagnosis of 'true cirrhosis'. Sould like maybe that's the distinction that leaves the door open for regression.

FLguy asks: you just joined the [over 50] club didn't you.
The he<x>ll</x> you say you dogone cotton picker. 48 pal, and that ain't for a couple weeks yet anyway! BTW: I'm gonna be in JAX next week (I think they have a Hooters on every corner there) - typing this reminds me I forgot to get a hotel - oooops.
Avatar universal
Jim and I just finished a discussion on glucose, as mine rose post tx into the abnormal range, and he was concerned about his.
Lots of skin talk of course, but glucose and lipids are discussed in detail.
Started 8/22 worried about HIV/AIDS, and continues 8/15 symptoms of Hepc, no, the other way around.
Skip the skin stuff if you can. I disagree with the idea of bying a meter and testing after a meal. Glucose readings depend on the type of meal, and the glucose challenge, which would be the next best thing to test post prandial, is hardly being used anymore. Just asked my endocrinologist about it. Those posts are at the bottom, and go to archive any moment.

Ina
Avatar universal
If one is on TX or has stopped TX recently an HbA1c may not be reliable. It is likely to be on the low side due to hemolytic anemia that many experience while on TX.
From:http://www.journals.uchicago.edu/CID/journal/issues/v37n4/30812/30812.text.html
"Because HbA1c measurements represent an average of serum glucose
concentrations measured over the course of &#8764;120 days, the patients could have had both very high and very low glucose levels within that period of time and still have had an estimated average glucose level, as measured by the HbA1c value, within normal limits. However, other measurements of glycemic control, all of which were abnormally high, argue against this possibility.
During hemolysis, a state of shortened survival for circulating erythrocytes, the number of glycosylated hemoglobin molecules in circulation is reduced. In addition, the number of immature and less-glycosylated erythrocytes increases to relative abundance. Medications that cause even subtle hemolysis without anemia may interfere with the accuracy of HbA1C measurements [6]. All 4 of the patients in this series were taking a medication reported to cause varying degrees of hemolysis. Two of the 4 patients were receiving dapsone [7], 1 patient was receiving ribavirin [8], and the last patient was an African American man receiving TMP-SMX [9]."
I have found glucose monitoring devices to be extremely accurate nothwithstanding Eisbein's endocrinologist's opinion to the contrary and I compare my fasting glucose with the lab's on a  weekly basis and they are practically identical. Of course, isolated readings here and there won't tell the story and post prandial readings are critical but if you are willing to poke yourself 4 to 6 times a day you'll really know what's going on. I had an HbA1c of 2.8 once during TX back in 2001 and no one could figure it out. After a lot of research I deduced it was the ribavirin caused hemolytic anemia. I'd wait at least 3 months and 4 would be better after stopping TX to get an HbA1c that will be reliable.
I'll try to dig up cirrhosis material if I get some time.
Mike
Avatar universal
You are correct, measuring the fasting glucose with those little home meters would be one way of doing it.
I was referring to the post above, were pigeonca suggested to buy a meter, and measure after a meal.
Sorry if I was not clear.

Ina
Avatar universal
I advocate metering blood sugar after meals for several reasons. First of all, people who don't have problems tolerating glucose don't have high blood sugar, EVER.  From there, the development of diabetes is gradual, and the American Diabetes Association has established limits beyond which diabetes can be diagnosed. And, most importantly, blood sugar levels above 140 - at any time - cause damage.  (With a little hunting, I can find references for all these statements).  

When my brother became diabetic (defined by the ADA at that time as having a fasting blood sugar of 140 or more; nowadays it's 126), he was sent to diabetes class.  A number of his fellow students, also newly diagnosed, already had retinal damage, amputations, neuropathies, etc.  These were not people who had neglected medical care.  They were simply diagnosed too late.  But the medical profession has to establish protocols and follow priorities.  The economics of medicine can be deplored but they can't be thrown out the window - costs truly do need to be monitored in some manner.  

We, who are proactive patients, have the know-how (otherwise we wouldn't be in this forum) to step out of the statistics and demand proper medical care.  If your blood sugar indicates ANY intolerance to glucose you need to know the specifics. Tell your doctor you need that meter. I've found that when I present him with a list of journal references, my doctor usually caves to my requests. I wish I could get Kaiser to pay for a facelift.

pigeon
92903 tn?1309908311
Thanks for the discussion guys. I'll kick things around when I see my PCP in a week. If I'm getting this, generally, it seems that the same protocols apply to me as would apply had I a healthy liver.




Mike says: if you are willing to poke yourself 4 to 6 times a day you'll really know what's going on.

No wonder that forsee is so danged smart.....Friendly too.
96938 tn?1189803458
Enjoy Jax.  I almost ended up there.  If not for the kindness and patronage of one of the big dogs in the company, I'd be living and working there now.  I go there a couple of times a year but our office there is on the south edge of the city.  Never been to the real downtown area but hear that it's pretty nice.  Good luck on finding the Hooters you seek.  If you have some free time scoot over to St. Augustine.
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