Cirrhosis - LFTs - Glucose

[GoofyDad]

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?

[pigeonca]

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

[copyman]

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.

[Forseegood]

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...

[FlGuy]

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.

[Morgaina]

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.

[GoofyDad]

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.

[Eisbein]

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

[mikesimon]

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

[Eisbein]

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

[pigeonca]

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

[GoofyDad]

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.

[FlGuy]

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.

[Kalio1]

I wonder how many of us Geno 3's are cirrhotic?

[mikesimon]

I test myself with a "little home meter" before meals and after meals. I got my doctor to write a script for additional test strips(covered by copay) which gives me 40 test strips a week and I use that many and more. My HbA1c is 4.5 but I am compulsive about glucose control. I became diabetic either as a result of liver transplantation (which isn't uncommon) or as a result of steroid intravenous treatments for rejection (this shocks the pancreas). The point is, after transplantion there is a detailed regimen of drugs and monitoring for the liver alone so it was quite easy to stick glucose monitoring in there with the rest of that elaborate routine. For people that are not as compulsive as I am home monitoring may not be adequate or appropriate. But, for those nuts who don't mind pricking the side of their fingers 5 or 6 times a day they should accurately know their glucose situation. Mike















home monitoring may not be adequate or appropriate.

[Eisbein]

Obsessive compulsive in regards to glucose monitoring LOL...but that is your only flaw, right?, I'll overlook this one :)

Listen, I would like to come back to the post prandial testing, but radiology saw something on my mammo, and they scheduled me for an 8AM MRI, so I have to go to bed early.
It is very difficult for me to put my thoughts together and write, so leave me a note that you be back. My husband is diabetic, and endo doesn't want us to test after meals, only fasting.
I like to give you his explanation tomorrow, but late in the evening.

Ina

[mikesimon]

I'm not going anywhere. Where else do I have unless I do some work?
Mike

[Eisbein]

Hi Mike, I am trying to sum up what my endocrinologist said.
I told him, I wanted to use my husbands glucose meter, and check my fasting, as well as the post prandial, reason being, that on the monthly CMP's, my glucose kept fluctuating between 102-104. That had started right after finishing tx, and I became concerned.

He discouraged post prandial testing, saying that there are no charts that correlate the carbohydrate intake with a 1 or 2 hour post prandial rise in glucose. That for example one slice of bread should not bring on a rise to 139, which would still be considered normal, but would be too high for a single slice of bread.
That people tend to underestimate the amount of carbohydrates they take in with any given meal...not counting the carbs in sauces, dressings, ketchup etc...
Another words, there is no chart that would correlate for example 352 carbs should = a 2 hour post prandial rise to 131.

He thinks that a 2 hour post prandial rise to 140, and a 1 hour post prandial to 120 are general numbers.
That if a patient has a rise of above 140 after eating a couple of french fries obviously has a problem, and that in such a case the fasting glucose would also show elevated numbers.

Like I said to Jim, the questionable period arises when a fasting glucose is consistently between 100-126. In that case, in order to establish insulin resistance, he measures also the triglycerides, and if they are also elevated, he starts handing out diet and exercise leaflets. He wouldn't dream of waiting for a patient to get a reading of 126, he considers consistend readings of 100-126 pre-diabetic, and calls for the war lords.

After watching my glucose (102-404) and elevated triglycerides (225) for about 7 month post tx, he insisted on a radical reduction in carbs (below 60 grams a day), and at least 6 hours a week of exercise. I followed instructions for 2 month, with dramatic results...glucose 97, triglycerides 112.

He thinks that charting the fasting glucose over approx 6 month will give him the answer, and apparently he is correct, because all my 2006 medical books confirm this approach.
Using the glucose meter or lab results makes no difference.
But free glucose meters and testing strips are only given for free to established diabetics. That stuff can get quite exspensive if one has to pay out of pocket.

Well, I am not sure I made myself very clear, but this is the best I can do with pencil and paper.

Give me your take please.
And how are you keeping your glucose in such a good range?

Ina

[mikesimon]

Last question first: I use insulin - N and Lispro.
I agree that one slice of bread (say 12 carb grams) should not result in 139 post prandial reading. Though that might be considered to be within "normal" post prandial range I would think that anyone testing PP would know that their carbohydrate intake was too little for that result and bright red flags would be waving wildly. If, however, the carb intake was 75 grams the PP would not be as troubling. You stated "Another words, there is no chart that would correlate for example 352 carbs should = a 2 hour post prandial rise to 131" I know you are very bright so I am puzzled by that example as 352 carbs reflects what I would consider to be binge eating and is way too many carbs for anyone, be they nondiabetic or diabetic.
I can't argue with your doctor's approach - it's working and with your profile and 60 grams of carbs per day in addition to exercise I would expect that it would. I saw a study, maybe 1 or 2 years ago, that showed that blood sugar correlates with the incidence of cardiac event in a parallel relationship and this was true even below the threshold for diabetes. In short, sugar in the blood is bad for everyone and as blood sugar increases so too does cardiac event in a parallel relationship. It was expected that as blood sugar declined to the nondiabetic number the parallel lines would merge together but they did not- they remained parallel. Am I making this clear? Probabaly not so I'll leave is at: sugar in the blood is bad.
Karen, my better half, can eat ANYTHING & EVERYTHING and her blood sugar might get to 115 - it might, but it will likely be lower. Her insulin response in abundant and efficient - she has no problem. You said "He thinks that charting the fasting glucose over approx 6 month will give him the answer, and apparently he is correct, because all my 2006 medical books confirm this approach." What is the answer he's looking for? I would guess that you're insulin challenged, at least, and that with the diet and exercise plan he suggested he hopes you can achieve and maintain adequate glucose control. I would also think that he would be able to tell you what he wants your PP to be, given that carb intake. Yes, strips are expensive and especially so when one tests as frequently as I do. Since I am diabetic my goal is tight control. I have heard diabetics say that their blood sugar isn't that bad because they don't need insulin. I don't really care what one uses as long as they are controlled - control is crucial. My situation is not typical. The highest my cholesterol has ever been is 120. My triglycerides are low and I am not overweight. While doing my first  TX I had trouble eating anything due to nausea. I asked if I could eat a donut in the AM and cover with insulin. I was told it was okay so now I eat what I want and cover - that explains my frquent testing. I think that for a person concerned about their glucose, if they educate themselves about carb intake and test with a meter before and after meals they'll know whether they have a problem. That's really what I was saying. I don't think we disagree on that or anything that I can see. It seems as though the threshold for the diagnosis of "diabetes" lowers as time passes and knowledge increases - so too has the recommended HbA1c for diabetics. I don't care what they call you so much as what is your average blood sugar - the lower the better. I doubt I've said much, if anything, after all this writing so I apologize if I've merely rambled. I wish you good luck and good control.
Mike

[Eisbein]

Mike, I am a dead duck tonight, please come back tomorrow late, I like to add a few more words to the glucose ramblings, and clarify a few things. I wish Jim would read this, because this was a concern of his. I think I save this thread for him.

You are calling me Eisben, that means nothing...I am Eisbein, which is the name for a German dish, sauerkraut and pig foot, or pork foot...really delicious stuff...hey, I just gave my enemies ammunition !!! :)

Ina

[mikesimon]

I noticed that I misspelled your name the last few times. I used to get it right but I seemed to have lapsed. I'll check back and see what new stuff you have for me. Mike

[Eisbein]

Mike, I am screaming mad. I just wrote this long post to you, and when I clicked the post button, it disappeared, as well as med help site.
I am so pissed, because it is 2AM, and it took me half an hour to write. Did that ever happen to you?
I have a full plate for the next 5 days, so I wont't be able to write.
I apologize, I really wanted to beat the post prandial glucose issue a little more to death.
Now how can I click "post", and the whole thing goes away.
Good grief, if you could hear me cursing...mf, cs, f..st!!!
Catch you some other time.

Ina

[mikesimon]

I've had that happen to me and I was so mad I could spit. I bet you haven't heard that expression in a while - if ever. There's no rush about this. I'll check here and, if and when you post, I'll see it and get back to you. All is well. Mike

[Eisbein]

Hey Mike, are you still reading here. I can't believe this thread has not gone to the archives.
I lost my train of thought in regards to the post-prandial testing.
Pre diabetes has moved to the back burner.
They saw something on my breast MRI, and it was recommended I see a surgeon for further evaluation.
Of course I see myself already at Sloan Kettering...so difficult to remain positive, while trying to overcome post tx depression ( mild though).
Besides, I am battleing with the same sides as DD. He has yet to mention something that I can't relate to.

Well no, that is not correct...he didn't chime in on the cannibalism, LOL...oh what the heck, I am just running my mouth saying nothing.

I wonder how long they plan to keep you on low dose, now that you are negative again. Hope you will ask what they are trying to accomplish.

Anyway, just wanted to say hi.
Ina

[jmjm530]

I have a weeks pass to a local gym pool but held off using it until I saw my last derm. I wanted him to see me 'before' in case it changed things. I have one more derm to see so may wait or may not. My skin appears to be A LOTS less sensitive these days so I don't think I'll have a problem and the plus may be that the cholrine will repress any fungal or bacterial issues. We'll see.

As to V-Beam or IPL, I read it both ways but as mentioned, yesterday's derm acknowledged he didn't know all that much about it and referred me to a laser specialist. Sort of pissed off that I spent $250 consulting the wrong doctor especially since his web site and office staff suggested that's what he does. Turns out he mostly does cosmestic surgery and mostly nose jobs. LOL. Anyway, he seemed honest, did make some helpful comments suggesting that my head "fullness" may indeed be more related to tightened neck muscles than rosacea or sinusitis, gave me a good consult and his office manager was kind of hot and she was either being professionally very friendly or interested. We'll see on that. LOL.