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Thursday, December 31, 2009

[Type-2-Diabetes] Digest Number 3847

Messages In This Digest (9 Messages)

Messages

1a.

Re: glucose reading ups and down Q. Insulin?

Posted by: "Holly Shaltz" holly@shaltzfarm.com   hollyshaltz

Wed Dec 30, 2009 4:14 pm (PST)



Barb writes:

<<For example, 2 hours after I had breakfast, my
reading was 164. I was watching what I ate, and I
took my Metformin -- so, I wasn't expecting that
high of a reading.>>

I have found that, while my fastings are usually
fine (provided I didn't fall off the wagon the day
before :), being generally 75-85, my breakfast
shoots up my BG quite substantially - 20-30 points
a lot of the time, with just 3 g of carbohydrate
(1 ounce of breakfast sausage and 2 ounces of
mozzarella cheese). I don't know why this is, and
it's frustrating, but I can live with the
breakfast I'm eating these days - I like to have a
breakfast rut, and this one is both reasonably
palatable and does hold me til lunch about 4 hours
later, so I really can't complain.

Many T2 diabetics have less insulin response in
the morning than during the rest of the day. Dr
Bernstein recommends breakfast consist of no more
than 6 grams of carbohydrate - wish *I* could eat
that much without a BG spike :) - because of the
tendency for the BG to spike with breakfast carbs.

I don't know if your spike was due to the problem
of less insulin production in the AM, but it might
help to track your carb - BG relationship very
closely on a few days when all else is pretty even
- normal amount of exercise, normal health, etc -
and see what, if any, patterns emerge.

FWIW, my high fastings totally disappeared when I
got down to a level of carbs I could eat without
BG spikes.

Holly in MI

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2a.

Re: seeing an endo

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Wed Dec 30, 2009 4:30 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, Tiamat <tiamat99@...> wrote:
<snip> Have seen her 2x at her office since and she rxed new insulin to replace the "old" insulin regime I had been on. I have been going up 2u/day and now fasting bg is good. Will see her again in Feb. when she will rx short term insu to cover late meal>>

I'm glad to hear you're doing better. I know you were very worried when your glucose levels went way up at first. See? It just took time. If your glucose is going too high after dinner, you might ask your doc about dividing your Lantus dose in half, take half in the AM and half in the PM, roughly 12 hours apart. When I did that, my evening and bedtime high problems went away. Just an idea.

<<She also rx Vit D which a test showed as very very low. [IMO it has made a huge difference] >>

How much do you take? And is it a prescription Vit. D formula of some kind, or an OTC supplement?

> Docs don't want to chat: they are working, they don't have time and some people like to tell long stories with all the details...ramble around as if it's a personal 'visit'. Docs don't really want 'relationships', this is their *work*, they have 'patients' and you are both there for a specific purpose. Keep it in that place>>

My allergy doctor wants silence from me. I chafe under that, but it's the way he works. If I ask questions or make observations or try to insert a little humor into our deadly serious (on his part) twice yearly visits, HE chafes under THAT and gets... well, he's not sarcastic, and he's not rude, and he's not impolite, and he's not angry per se, but... I just don't like him. I stay under his care because honest to god, this is the *first* time in my 60 years that my asthma has been under control-- I can't wheeze, even when I try! The man knows his stuff, even though he's a major pain in the a**. I don't know how his office staff works with him-- he's yelled at them in front of me, many times, and I want to spit at him when he does that. *rolls eyes*

My point is, every doc has their own modus operandi. Tia is right; we patients are an intellectual, ethical and legal bizniz to doctors, and we're endlessly fascinating, since medicine is their "thing" and many specialists are diagnosis gurus. I *never* expect any level of personal relationship with any of my docs-- in fact, I'm amazed that any of them even remember me when they see me again (except perhaps for my PCP, whom I see more often).

<snip> I write a list of points on a Post-It note and stick it to my blouse or sweater so I don't forget and don't ramble>

A written list is a great idea. Always. Even my a**hole asthma doc will pause and listen and try to answer me, if I get organized and keep it brief.

<< You write about a goal of 'normalizing bgs'. IMO this may be a bit too tight...you don't know what 'normal bgs' are for everyone at every time of day and every condition, so this is not a fact-based realistic goal>>

I think it can be, for those who can achieve it through only diet and exercise especially. We DO know what normal is, Tia-- a fasting and pre-meal level of 65-99, with no more than about a 20-30 point rise after meals. I do agree this can be hard, maybe even dangerous, to use as a goal for those who have to get there with insulin (too many lows!) but especially for someone early in the game, who's willing to do what it takes with weight loss, diet and exercise, I think it's a noble goal, at least,and quite possibly achievable.

<<snip> it's more a question of balancing out the dangers [severe] of too low and too tight control against the safer 'good enough'...low enough to avoid complications but not constantly in danger of death>>

No one who's not taking insulin or a hypoglycemic oral med is going to die from a low. Not possible, not unless they're a known severe hypoglycemic with an occasional hyperglycemic roller coaster problem, which I don't think most type 2s are. And even if they are, six small, regular meals a day will usually bring even them into a nice normal range, especially combined with exercise and weight loss, if needed.

Judy D.

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Messages in this topic (14)
2b.

Re: seeing an endo

Posted by: "Holly Shaltz" holly@shaltzfarm.com   hollyshaltz

Wed Dec 30, 2009 7:23 pm (PST)



Tiamat writes:

<<You write about a goal of 'normalizing bgs'. IMO
this may be a bit too tight...you don't know what
'normal bgs' are for everyone at every time of day
and every condition, so this is not a fact-based
realistic goal. >>

I'm achieving it, so I think it's realistic for
those who want to do it. I certainly understand
not everyone *wants* to do what's needed, which is
perfectly OK. That doesn't mean it *can't* be done.

I adhere to what Dr Bernstein considers
non-diabetic BGs and A1Cs: aiming for a BG of 83,
not changing more than 10 points from that, under
100 at all times, and the A1C in the range 4.2 -
4.6. I'm very nearly there.

<<It's not that they are stupid or ignorant..it's
more a question of balancing out the dangers
[severe] of too low and too tight control against
the safer 'good enough'...low enough to avoid
complications but not constantly in danger of
death. >>

It seems to be quite a strong myth that tight BG
control, with low BG goals, results in dangers of
hypoglycemia and death. I've stated over and over
that I haven't had a significant low since I got
off micronase (a sulfonylurea drug), but no one
hears me, including my PA :) The only lows I've
had have been so minor I wouldn't call them lows
except that my ever-helpful liver dumps glucose
into my system in response to even minor drops of
BG. I don't think I've been lower than 65 since
February. And now that I'm learning how to use
glucose tablets effectively, I haven't been lower
than 70 for a couple months.

Above all, I'm certainly NOT in constant danger of
death! If I were on a hypoglycemic drug maybe I
would be - I sure had some nasty lows on micronase
down to 50 more than once a day for a time, back
when I was eating the ADA diet. Dr B doesn't
recommend using such drugs, and now that I know
more about them, I won't ever take one again :)

<<I'll be very interested in hearing a report of
yur visit: please share!! >>

You can be sure I'll report back :)

Holly in MI

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Messages in this topic (14)
2c.

The "myth" of dangerous tight control

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Wed Dec 30, 2009 10:59 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, Holly Shaltz <holly@...> wrote: <snip> It seems to be quite a strong myth that tight BG control, with low BG goals, results in dangers of hypoglycemia and death>>

This is not a myth for those who take insulin; it's a fact of life. For those who use insulin for control, testing vigilance and adherence to a strict food plan and exercise routine is a must if they seek tight control, and they WILL experience lows.

IMO, a sustainable A1c down into the mid-4s, while not impossible to attain with insulin, might be (well, I hate to use the word "dangerous", but what word do I want here?) ill-advised? for most type 2s. Perhaps a pumper who is also connected to one of the new continuous glucose monitoring systems, someone who is very vigilant, would do okay, but for the ordinary, garden-variety type 2, a 4.5 A1c, sustained over months and years with insulin injections, well... that person *is* going to have to treat lows, maybe even daily, and there's no proof that that kind of tight control is necessarily a good thing, achieved at the expense of constantly dealing with lows and recovering (yuck!) from them.

Someone like yourself, Holly, who is achieving a mid-4s A1c with diet and exercise, there's no danger, AFAIK.

<<I don't think I've been lower than 65 since February>>

Yes, this is normal for you. In the absence of insulin therapy and hypoglycemic meds, this is what happens for most type 2s, with weight loss, strict low-carbing, and exercise.

Judy D.

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Messages in this topic (14)
3a.

Can low blood sugar cause a person to have a seizure/black out?

Posted by: "RebeccaM" pikachu1978rsm@yahoo.com   pikachu1978rsm

Wed Dec 30, 2009 6:39 pm (PST)



Hi my name is Rebecca Murphy and I don't post that often but I do read the messages to keep updated. Anyways as my subject says "Can low blood sugar cause a person to have a seizure or black out?" I'm asking for myself because last night I had proper portion size for dinner with peas and pork chop (small one) and only to find myself seizing 2 hours later and the EMS said my BS was 78. On the way to the hospital I blacked out again and this leads me to my next question if anyone's BS goes too low or too high is a seizure a symptom of diabetes complication? The problem is I am also epileptic so I don't know if what I experienced was related to diabetes or epilepsy or a combination of both?? Any advice on what to ask the neurologist as I will see her Jan 7th. Do you think its time I saw a specialist for diabetes?? I've been seeing my family doctor for my diabetes but currently am on 2 medications as my BS is not stable because it swings up high and down low every time I test myself. I appreciate any feedback you all can give me on this thanks!
Rebecca Murphy

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3b.

Re: Can low blood sugar cause a person to have a seizure/black out?

Posted by: "AnaLog Services, Inc." analog@logwell.com   sydlevine

Wed Dec 30, 2009 10:11 pm (PST)



78 should not be low enough to cause real problems. A few of us feel that as a low, but only because we have been high so long. I suppose if you have a high "set point", it is conceivable that a low capable of inducing the shakes could trigger epileptic problems; don't know if there is any research on that or not. In fact, most doctors do not even understand this set point phenomena, but those of us with it figure out what is going on.

----- Original Message -----
From: RebeccaM
To: Type-2-Diabetes@yahoogroups.com
Sent: Wednesday, December 30, 2009 7:40 PM
Subject: [Type-2-Diabetes] Can low blood sugar cause a person to have a seizure/black out?

Hi my name is Rebecca Murphy and I don't post that often but I do read the messages to keep updated. Anyways as my subject says "Can low blood sugar cause a person to have a seizure or black out?" I'm asking for myself because last night I had proper portion size for dinner with peas and pork chop (small one) and only to find myself seizing 2 hours later and the EMS said my BS was 78. On the way to the hospital I blacked out again and this leads me to my next question if anyone's BS goes too low or too high is a seizure a symptom of diabetes complication? The problem is I am also epileptic so I don't know if what I experienced was related to diabetes or epilepsy or a combination of both?? Any advice on what to ask the neurologist as I will see her Jan 7th. Do you think its time I saw a specialist for diabetes?? I've been seeing my family doctor for my diabetes but currently am on 2 medications as my BS is not stable because it swings up high and down low every time I test myself. I appreciate any feedback you all can give me on this thanks!
Rebecca Murphy

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Messages in this topic (4)
3c.

Re: Can low blood sugar cause a person to have a seizure/black out?

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Wed Dec 30, 2009 10:48 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, "RebeccaM" <pikachu1978rsm@...> wrote:Hi my name is Rebecca Murphy and I don't post that often but I do read the messages to keep updated. Anyways as my subject says "Can low blood sugar cause a person to have a seizure or black out?" I'm asking for myself because last night I had proper portion size for dinner with peas and pork chop (small one) and only to find myself seizing 2 hours later and the EMS said my BS was 78. On the way to the hospital I blacked out again and this leads me to my next question if anyone's BS goes too low or too high is a seizure a symptom of diabetes complication? The problem is I am also epileptic>>>

I'm sorry to hear about your seizure and the ambulance ride, etc, Rebecca. That all sounds wicked scary. Are you doing okay now?

78 is not technically even low. I'm no doc, but IMO your seizure was not caused by that.

Yes, of course it's possible to pass out of the picture with low blood glucose-- as the brain is deprived of the fuel it needs to keep thinking and regulating, its functions just fade away, and the person loses consciousness and can die if no intervention happens. But at 78? No. Losing consciousness would more typically happen at 28 (and it'd be hard to get that low without insulin), not 78.

So if I were you, I'd be real suspicious of the epilepsy, especially since you know you have that disorder.

<<<currently am on 2 medications as my BS is not stable because it swings up high and down low every time I test myself>>>

Is your glucose swinging high and low for no discernible reason(s)? And what exactly do you call high and low. If it's moving between 75 and 125, for instance, that might just be what's normal for you. Usually you can eliminate big swings with a strict adherence to testing, meal times, portion sizes, med-taking schedule, and exercise. If you do and eat in virtually the same way every day, it should pretty much take care of that swinging thing.

Please let us know how you're doing.

Judy D.

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Messages in this topic (4)
3d.

Re: Can low blood sugar cause a person to have a seizure/black out?

Posted by: "jm04161955" jm04161955@yahoo.com   jm04161955

Wed Dec 30, 2009 11:06 pm (PST)





--- In Type-2-Diabetes@yahoogroups.com, "RebeccaM" <pikachu1978rsm@...> wrote:
>
> I appreciate any feedback you all can give me on this thanks!

Hi Rebecca,

I can't speak from direct experience relative to epileptic seizures but I do have a very good friend who is both a long time Type 1 (he was diagnosed at age 21 and is in his mid-60s now) and an epileptic, and in his case, yes, he has had instances when he's seized due to a combination of low BG and a resultant epileptic seizure. I don't know if his seizures occur *because* he is epileptic, or if they would occur on their own as a natural result of low BG independent of the epilepsy. He is normally able to treat his lows fairly well and fairly quickly but he does have instances when there is a definite seizure result, and because of his epilepsy, it's not always easy to really narrow down what's happening with him.

That said, I have seized from low BG, and I'm NOT epileptic. One of my best friends is a hypersensitive T1, since her early 20s, and I KNOW she has seized -- and she's also experienced lows lower than 10 mg/dl and been semi-conscious at the time, albeit extremely compromised. One of the worst lows she ever experienced resulted in a seizure -- the first time that anyone can rememmber her seizing in the midst of a low -- and she has fallen unconscious from lows more times than she could EVER accurately count. Since she is SO sensitive, and such tiny amounts of insulin can have significant impact on her, I have been urging her for a LONG time to go through a short period where she's running a bit higher than normal for her, so t hat she might be able to regain some degree of her hypo awareness, but she is so terrified of highs (and has them plenty as a result of rebounding) that I believe she'll never really be able to sustain those temporarily elevated readings for a long enough time to decrease the danger that she is in every day of her life. I spoke to her last evening and she told me that over the last four weeks she has been consistently testing in the 40s, 50s and 60s -- an occasinal "over 100," but they're the exception. She's now 45 and has been living this way for almost 25 years. It terrifies me.

I witnessed the end of her seizure -- the first that she had; a friend who lives close found her in the midst of it and called me becuase he knows that I live with this reality as well and that I not only know her patterns, I know how her lows need to be treated, and how immediate the need is when she does drop dangerously low. We ALL know this, and we ALL know how to talk her through these lows, but when she was in the midst of that first seizure, there was nothing any of us could do but to call 911. She lives alone and doesn't keep glucagon on hand ("If I'm alone, what good is it going to do me? If I need glucagon, I'm not going to be in a position to give it to myself..."). Bottom line -- she is a mess right now. As for the rest of your subject line, yes, it is more than possible to "black out" from lows -- this has hapened to her countless times and has happened to me on occasion as well, though I'm not nearly as insulin-sensitive as she is and don't experience the same extremes tha she does on any regular sort of basis. I know why she's in the place she's in right now and unfortunately, she's not able to resolve it in the way that she needs to.

I hope I haven't scared you to death, Rebecca. Just writing this down and reading it back, seeing it typed out in front of me, is enough to scare the hell out of me. She's stubborn and tells me all the time that she wants to live a normal life and not be a slave to these lows, but right now, she just can't get there.

Holly, I do hope you're reading this and understand and respect that for some who want to keep their BGs as low as you seem to, it can be extremely dangerous. She works SO hard -- she tests countless times per day, and she knows and recognizes her own pattrerns and where she's going to be heading in an hour if she's at a certain place when she tests - but she can't fix it now. Her hands are tied, and the limitations she has had placed upon her insurance-wise are, I'm convinced, going to kill her.

JoAnne

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Messages in this topic (4)
4a.

Re: foot drop

Posted by: "Tricia" psimmons1219@gmail.com   psimmons1219

Wed Dec 30, 2009 7:15 pm (PST)



Judy
My last Hgb A1c was 5.3. I just sent another one off since I decreased my meds a few months ago and I am fixing to decrease again.

While I was a Medical Technologist I was always letting students practice drawing blood on me so I had my lab work drawn all the time. My glucose was always around 85 until the beginning of this year. I had not had a glucose run for about 4 months so I do not know when I went from prediabetic to diabetic. My GTT was always great. at 2 hours I was never over 92 but at 4 hours my glucose would bottom out into the 50 or 60 range sometimes.

I have some neuropathy in my feet but it comes from my back problem. The spondylolisthesis caused severe nerve problems. I had never really felt my feet before the surgery. I could have ingrown toenails bleeding and never know it. The feeling came back after my surgery but I have lost the feeling again in parts of my feet.

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