New bloodwork issue-glucose.

[Lady Lauri]

Well, the thyriod question answered , and thank you very much! AlI I've really 'learned' is the reds/whites, etc.  Got a call from Shands today about my glucose being 30....very low. (reds lower too) Oddly, I am eating a lot of suger so can't figure that one out. She did say it's adding to the feeling so bad.
  I have 3 more shots,  Riba stopped and wondering if anyone's had this or if it's more the Riba or Peg that induce's this? If so, how long to get back to normal.
Last shot is 27th. I have a BIG event to do on March 4th, really want to do it feeling okay.....
any ways I can correct this?

LL

[mikesimon]

Thanks Bill. I do recall reading about that procedure. I was interested in whether I might be a candidate but decided to forget about it since I'm doing pretty well with things as they are.  Mike

[Bill1954]

Here is an interesting article from Mayo that describes the islet-cell to liver TP via infusion to the portal vein:

http://www.mayoclinic.com/health/islet-cell-transplant/DA00046

From the article:

“…During the transplant, the surgeon directs a tube through an opening made in your abdomen to the portal vein, a blood vessel leading into your liver. He or she then infuses the islet cells through this tube to your liver, where they take up residence in the organ's small blood vessels. The liver is a good site for the islet cell transplant because it's more accessible than your pancreas, and the cells appear to produce insulin well in that environment…”

Bill

[Bill1954]

LL-

DM = Diabetes Mellitus (DM type II for instance).

Pancreatic Beta cells are responsible for the production of glucose. I vaguely recall reading somewhere that healthy beta cells from a donor were directly implanted into the liver of a DM patient, where they started functioning in that environment, rather than the original pancreas. I’ll try to remember the source; it’s been several years though.

Mike: “…There are two reasons for this: 1) I love the stuff and can never use it unless I am very low and…”. Too funny! A person would almost *have* to have diabetes to appreciate that; LMAO!!

[mikesimon]

Yes I have heard of pancreatic islet transplantation either alone or along with a liver transplant. It seems to work out pretty well. I am not knowledgeable about islet cell transplantation but I would think that it would be necessary to obtain the islet cells from the same donor as the liver - if not necessary then certainly easier - for immunosuppression and rejection issues. I could be wrong but it appears that way to me. Mike

[mikesimon]

No Bill, I have never heard of resolution of diabetes post liver transplant. New onset diabetes is rather common after liver transplant, however. The relationship between liver   transplant and diabetes seem to be a one way street and it seems to always go the wrong way.
Lady Laurie, I have found that soft drinks, like regular Coke, give me a fast response but, whenever I am seriously concerned I drink real maple syrup - maybe a quarter of a  cup. There are two reasons for this: 1) I love the stuff and can never use it unless I am very low and 2) that stuff is richer in sugar that anything else I have found and it seems to be readily bioavailable because it works very quickly. If you can get your hands on maple syrup and if you like it, I recommend it highly as an immediate treatment for a hypoglycemic state.
Mike

[Lady Lauri]

........Have you ever heard of inserting pancreatic beta cells into the liver at time of TP? I’ve heard this can be an alternative to full pancreatic TP- the islet cells adapt to the liver environment somehow?.............

Now you lost me!?

What is DM ?

LL

[Bill1954]

Oops, one more thing. Have you ever heard of inserting pancreatic beta cells into the liver at time of TP? I’ve heard this can be an alternative to full pancreatic TP- the islet cells adapt to the liver environment somehow? I seem to remember reading about this, but can’t remember where it came up.

Take care—

Bill

[Bill1954]

Mike; thanks for the article; I’ll take a look in a few. As you know, the liver converts glucogon, and other hormones that are responsible for BG allocation; so I suppose as it remodels, it could play havoc on blood sugar. I wonder, have you ever heard of DM resolving/self correcting after TP? Some forms of DM, such as gestational diabetes self-correct, Just wondering…

LL- glad to hear you’re addressing this promptly. If you have some table sugar in the little restaurant packs, throw a handful in your purse just in case…

Bill

[Lady Lauri]

Just saw all those post! Sheeeet!

She just called, I go in at 8:00 am and get fasting lab, sending out and in so they'll have the reading by after lunch!

We stopped the Riba as (2b for one) week 21, and I'm just going down! I need to look at the symptoms of this, but know I have been more 'ill' than usual lately, plus glands in neck swelling, stomach pain, bunch of wierd stuff haven't had on tx.

Drinking juice, going to get the glucose tabs, can't hurt even if it was inaccurate as was in the 50's last labs. Normal range is 65-99.

Bill don't know?..... mg/dL for units. I'll ask next call, doesn't say on my lab sheets.

Thanks!

LL

[Lady Lauri]

  I understand what your saying, think I better check into this more also.
The labs that day were not fasting and I had a shake before.
I just called her, their bringing me back up for a fasting lab and referring me for follow up on this if it wasn't a lab error. She said he felt it probably was a lab error as I would be on the floor -out-not just feeling bad, tho when it's been in the 50's a lot, could add to that, etc.

Thanks again, LL

[mikesimon]

I have had a glucose of 27 once or twice and it was barely tolerable. I do use insulin and very occasionally I don't compensate with enough carbs and I get too low. I do recognize BG of around 65 or 60. I have a friend who is type1 and he can't recognize it when he's 20. As you know, this presents a host of dangerous possibilities -  stroke and coma to name just two.

Though this isn't really on point, I wonder if you've seen this article:

High Incidence of Type 1 Diabetes Mellitus During or Shortly After Treatment With Pegylated Interferon A for Chronic Hepatitis C Virus Infection
Posted 01/28/2008
See: http://www.medscape.com/viewarticle/568466?src=mp

"In conclusion, this is the first prospective study on the development of DM in chronic HCV patients during treatment with Peg-IFN-α/Riba. We have shown that the incidence of DM, especially type 1, during treatment with Peg-IFN-α/Riba for chronic HCV infection is markedly higher than reported previously. DM-related complaints are frequently absent or mistaken for Peg-IFN-α/Riba-related side effects. Routine assessment of random blood glucose is an easy method to identify patients who develop DM during Peg-IFN-α/Riba treatment. These results support routine assessment of blood glucose levels at all outpatient visits before, during and in the first month after Peg-IFN-α/Riba treatment to detect DM without delay."

Mike

[Bill1954]

Take a look at the labs; are they they using mg/dL for units?

[Bill1954]

Cr@p! that is seriously low BG- not garden variety hypo stuff. I've felt as if I've melted through a knothole in the floor at 42 mg/dL, and I tolerate low BG fairly well. Thanks for jumping in here,

Bill

[Bill1954]

I’m with Mike on this; I think finger-stick or serum glucose as measured by lab should be the real thing. My diabetes educator researched the technical stats on my meter, and while they didn’t list Hgb, they did claim accuracy during hemolysis as measured by hematocrit to 27% (might low).

Bottom line; get some glucose tabs at the pharmacy, and try to learn the symptoms of low BG. The tabs are inexpensive and get the sugar up within a few minutes, and come in purse-sized dispensers so they’re convenient. You really want to deal with this sooner rather than later… even though you may be asymptomatic to hypoglycemia doesn’t mean it isn’t occurring. For me, a blood sugar reading of 30 would be the equivalent of trying to drive with a half-gallon of hooch in my system, assuming I was conscious at all.

This can have profound consequences on your systemic health, so it needs to be addressed, like, yesterday!

Take care,

Bill

[mikesimon]

No, that's not what I was saying. I was saying that ribavirin doesn't severely impact the  blood glucose levels that you'd get with a finger stick testing or when you get fasting glucose levels at the lab. I think finger stick testing when done with an accurate meter are sufficiently accurate and reliable. Hemolytic anemia does, however, impact HbA1c levels so those readings can be, and often are, inaccurately low. People on treatment should not rely on HbA1c levels and especially when, for instance, a diabetic tests and the A1C level looks significantly lower than test results preformed previously when not on treatment. I haven't seen glucose readings from finger sticks or fasting blood glucose tests be affected by treatment so I was saying that I don't believe that your glucose level of 30 is the result of ribavirin, at least insofar as hemolytic anemia is concerned. I am diabetic and I treated for over 3 years and I never saw anything like a glucose reading of 30 from a finger stick test or a lab fasting test but I did see incredibly low HbA1C readings - like 2.3 for instance. It sounds to me as though there is some other reason for your reading of 30 and that hemolytic anemia caused by ribavirin is not the sole answer to your hypoglycemia. I would explore this further Lady Laurie because this isn't normally seen with hemolytic anemia.
Mike

[Lady Lauri]

Just saw this. I have been very ill, in bed 24/7 @ 10 days now straight (not the norm up and down tx way)
  I don't think it's inaccurate as levels have been dropping to 53, up to 63, back down, etc. As said above, I was up over 24 hrs., staggering around trying to do things, throwing up, etc. the day before labs, perhaps I 'used' up energy, suger in that hard day? That we normally could supply not on tx.
  So your saying the 'stick finger' tester won't read accurate? Going to research a bit, look at link you gave me. And buy glucose pill's?

Thanks much, LL

[Lady Lauri]

First...she said it was 32 ! To eat natural sugers, etc. (I have 3 OJ tree's, juice every day,etc??) My nurse friend is freakin'!

Charm....Do you feel weak and shaky before a meal????? ..................
Uhhh, thru most of the last 21 weeks,lol!

Bill, I have been in the floor :{ Part of why we stopped the Riba. Ironic thing is...on that lab day I had done shot day before, helped birth NINE pups with my dog till 6:00 AM
(Brat HAD to do this ON shot day!), than made coffee and had to drive myself to Shands (40 miles) and back! Not sure HOW I did all that and it is a blur!
  I don't think it's an error tho as my gluc. has dropped continually on tx, was 53 last labs. I AM living on Breyers, cr*p food right now, so don't undertsand it?? (NOT my norm, diet at all!) Going to get a tester and glucose pill's today!

Flguy....., this was the story the doc told me, but keep in mind I was on tx and he thought I was an idiot. ....................

LOL! Little did he know!!!!!!!!!!!!!  
Thanks! It does make sense (to me , an on tx idiot :} and I feel better about stopping the Riba a bit early now.
Also now don't feel like such a woosy being  'bedridden' so much!


Every move, reduction he has decided to do in my tx, was proven to be the 'right' approach for me...lowering Peg./Riba just talking to me, knowing I wouldn't make it on full does's long, than labs showed Hgb near 'cut off' level for trial, (no rescue drugs) and other changes. Than Fri. he said stop the Riba, try to do the 3 more shots, and labs came back reds low again, glucose really bad, etc.
  The man is good!

Thanks all, time to eat some carbs :}

LL

[mikesimon]

FLGuy, I don't believe that glucose readings (finger stick readings or lab fasting glucose levels) are affected by hemolytic anemia. What is affected is your HbA1c level and that is due to the reasons you set forth. The RBCs do not live for the normal 90 to 120 days and therefore the readings can be lower than they would be otherwise. This is because there is less glycosylated hemoglobin accumulation than would be the case if the RBCs were more mature. Since they are younger - say 30 to 60 days old - they have less glycosylated hemoglobin.

"HbA1c is a test that measures the amount of glycosylated hemoglobin in your blood. Glycosylated hemoglobin is a molecule in red blood cells that attaches to glucose (blood sugar). You have more glycosylated hemoglobin if you have more glucose in your blood."
From: http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm

LadyLaurie, I don't think hemolytic anemia explains your glucose reading of 30. As stated, this is hypoglycemia, assuming the result is accurate. I suspect that reading  may be inaccurate if, in fact, you did not feel any symptoms. A blood glucose of 30 would be extremely uncomfortable for the average person. The only exception that I know about is type 1 diabetics on insulin therapy who, after a long history of treating the disease, no longer recognize when they are in a hypoglycemic state. The failure to be able to recognize hypoglycemia can be very dangerous so, if this is an accurate glucose reading, you should consult with your physician very soon and figure out what is causing this condition. Good luck, Mike

[FlGuy]

Here's how the effects of tx on blood sugar were explained to me.  Not very scientific, but the doc brought it down to my level of understanding.  Blood cells have normal life span of 90-120 days.  During that life span the cells pick up glucose and then die their normal death.  During that lifetime they can gather a lot of glucose and that's when a person tests high for blood sugar using a glucose meter (finger stick reader things) and by the test  hbac1 which gives sort of a 90 day average.  When riba is introduced into you diet, via tx, riba does it's thing as a red blood cell killer.  That's why a lot of people get anemic.  It kills the blood cells at a younger age, before they've accumulated a lot of glucose in their travels.  Thus, lower blood sugar/glucose reading.  If that's the case, the absence of riba in your diet will likely stop the killing madness and might get you back to more lofty levels.  Again, this was the story the doc told me, but keep in mind I was on tx and he thought I was an idiot.

[Bill1954]

Congratulations as you wind down treatment. A blood glucose level of 30 should have you on the floor; *definitely* follow up on this. I’ve been testing blood sugar for years now (4x day) and have never experienced anything below 42. Most people start to feel faint, develop sweats, shakes, and begin to lose feeling in their lips and tongue about 50; if you experience any of these symptoms, take 2-3 tablespoons sugar (or buy glucose tabs at the pharmacy). DO address this with your PCP doctor though… I imagine it is lab error, but check into it.

Hopefully others will check in with their thoughts. Take good care-

Bill

[charm27]

All I can tell you is  believe low blood sugar is hypoglycemia.
If your numbers are under 50.
Hopefully this too will straighten out once off tx.
Do you feel weak and shaky before a meal?????