Aa
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?
<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?
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
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
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 ∼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
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 ∼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
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
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
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
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
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.
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.
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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