Re: Actos

[Guest guest]

Beverly Trice wrote:

<< Now I have the weird feeling in my head like sometimes I'm going to fade

out. It's very hard to explain. Feels like pressure in my head, and

sometimes in the top of my chest >>

Beverly, if you don't already have a good b.p. meter, please get one

immediately and begin testing yourself. Get one that shows not only your

blood pressure, but your pulse. And you should also maybe keep a written

record for awhile. From your description, I don't know whether it's

hypoglycemia, ultra-slow pulse, electrolytes depletion, or what. This is not

something to fool around with. You can buy a decent b.p. monitor for

$30-$40. Get one of the automatic kind that you can slap on and hit a button

.... and not monkey with the stethoscope. Please do so ASAP and keep

reporting back. Your doctor is not concerned ... but we are!

Susie

[Guest guest]

Dear Bev,

This is me again - freaking out big-time, because I'm very concerned about

your posts - and the apparent lack of concern on your doctor's part. You

wrote:

<< Doctor did prescribe my regular bp med with a diuretic added, but I

haven't received it yet from the

pharmacy. I'm very concerned that the leg cramps will return. >>

Leg cramps ... could be dehydration, low potassium, or intermittent

claudication. How much fluid a day do you drink? Are you on an ACE

inhibitor? When was the last time you had bloodwork that included an

evaluation of your electrolytes? You need a sustainable approach to diabetes

.... food intake, supplements, regular physical activity, emotional support,

and relaxation techniques. But first, we need for you to get info on what is

going on with you.

First of all, if your " falling off the wagon " lasted for weeks, very likely

your 15-20 lb. weight gain is weight gain, plus fluid from increased insulin

levels, from a higher carb intake. If it was only a few days " falling off

the wagon, " we need to look at (a) kidneys, ( heart, © insulin levels as

the culprit. Any time a patient gaines or loses 15-20 pounds suddenly, a

doctor should go on Red Alert. That is NOT normal!!

Susie

[Guest guest]

> Dear Bev,

>

> I may get criticized for " practicing medicine without a license "

here, but

> your health is more important to me than someone else's opinion.

>

> Here are my guesses ... You goofed by doing the carb pigout when

you went on

> Actos. You already know that. A change in meds does not mean, " Oh,

I get to

> be not diabetic anymore! " It's an acceptance thing, sweetheart.

We're always

> going to be diabetic ... no vacations. Work on your head - your

body will be

> grateful. The carb excursion caused a huge weight gain and edema in

your

> lower extremities. The solutions for that include cutting carb

intake,

> " water pills, " and getting your electrolytes straightened out. I

have a

> hunch the weird feelings you are experiencing include not only

> hyperglycemia, but possibly a need to adjust your supplements.

>

> Let's go over the supplements you are taking. The lower extremity

swelling

> is not just umcomfortable - it indicates that your body is in an

extremely

> unhealthy state. Your doctor is incorrect in writing off a 15-20

pound

> weight gain as " just fluid. " If it were just water, the fluid pills

would

> handle it; and if it is " just fluid, " it means something serious is

going

> wrong here and needs to be addressed. Fluid buildup can indicate

heart

> trouble and kidney problems.

>

> It sounds as if Actos is not the best drug for you. Let me ask

you ... did

> your doctor tell you to start with one 500 mg glucophage a day for

the first

> few weeks, then add another? Or did he start you on huge doses,

right from

> the get-go? If he started you on 3 pills a day, then he is too lazy

to even

> have read the patient inserts, and you need a doctor who is not so

lazy and

> ill-informed. Many of us have an " adjustment problem " with

glucophage

> (Metformin), but if we're well-informed and have decent doctors, in

most

> cases we can clear the hurdle. Go to http://www.rxlist.com and

read up on

> glucophage as well as Actos.

>

> And meanwhile, let's work on ways to address your needs! The eating

style

> you adapt *must be sustainable*! If you feel terribly deprived, you

won't

> stick with it. We can work on that. I would like you to look at what

> supplements you are taking. They can be just as powerful as

prescription

> meds. I want you to feel empowered to take charge of your disease,

girl!

> Your doctor is sort of waving his hand and dismissing your

symptoms, but YOU

> KNOW there's something wrong. Let's discuss this, please ... I

wanted to

> respond to your last note, but things have been nuts around here.

(By the

> way, our lives are finally getting back on track ... we really

knocked

> ourselves out again this weekend.)

>

> Susie

Hey Susie,

This is my THIRD try to respond to your post and I keep getting

booted or my screens keep bleeding together. (Gotta have my computer

worked on

'

To make it short, I only rode the carb train for a couple of days

before I figured out what was happening. I cut my carbs back, and

that cut out the trigger for the cravings, as best I can figure...

From that time I have eaten no differently than I did for all the

years I was on Glucophage (from the time it came out in the US) I

always had diarrhea on the Glucophage, but it was tolerable for the

most part. However, right before I was taken off, I started

experiencing extreme problems with it and it wouldn't go away. I was

very ill for a couple of weeks, and as soon as I went off the

Glucphage, I was just fine. I don't know what happened, but I cannot

live like that, it isn't worth it.

I read a post on MHD where someone posted the Glitazone Petition

where info from studies on Actos, Avandia, and Rezulin were cited.

Safety issues include liver toxicity, effects on heart function,

weight gain, edema, anemia, low blood pressure, elevated lipid

levels, and possible changes in progesterone levels.

Of these issues, I have identified with 4. I have gained 16 lbs

(after my weight being stable for over 7 years), Edema is a MAJOR

problem, and I complained of irregular heartbeat and strange pressure

in my upper chest at my last doctors visit a couple of weeks ago.

Another thing.....since beginning Actos, I have had these weird

feelings in my head, kind of fuzzy like I might pass out. When the

nurse checked my blood pressure at the last visit, she was so taken

aback by my blood pressure that she exclaimed, " Man, your blood

pressure has REALLY come down!! " I assumed it was a mistake, and

told my doctor that it felt like my head was going to explode from

HIGH blood pressure. I have noticed that at times my pulse is

extremely low, like 48, and considering that I am taking medication

for tachycardia, that's rather interesting.

I also understand that the low blood pressure factor stems from the

fact that Actos acts like a calcium channel blocker. Since I am

already on Norvasc, a CCB, I theorize that I may be getting

overmedicated in this area, causing low blood pressure and a double

whammy on the edema. I haven't had any Norvasc since yesterday at

lunch and I feel fine, and my blood pressure is below normal, MUCH

below what I have come to expect.

I agree that the 16lb weight gain cannot be all water.... the doctor

theorizes that I had been accustomed to losing a great deal of fluid

from the constant diarrhea that I no longer have. That, combined

with the swelling is why I have gained so much weight, in his opinion.

Actos may NOT be the right drug for me, however I am running out of

options here. I appear to be extremely insulin resistant, to the

point that more insulin than I am taking now wouldn't keep me under

400 without some help. Any imput on other options would be greatly

appreciated.

As for supplements, I don't take any. Several times I have tried to

take multivitamins, but they make me have nightmares (no, I am NOT

kidding

Glad to have finally gotten this done! I understand what you mean

about things going nuts! Life here has taken a few turns just

recently.....lol. Hopefully things will calm down soon....Thanks,

everyone for all the responses.

Bev

[Guest guest]

> Bev,

>

> What are the names of the drugs your are taking.

>

> Jan

I take Lopressor HCT, Norvasc (until today;), Actos, Colestid (for

diarrhea), and Humulin 70/30 (37am/30pm).

the HCT was just added a couple of days ago, the Norvasc I've been on

for several years. Actos for a couple of months. Insulin for a year.

Bev

[Guest guest]

>

> Bev, was your doctor checking your liver function?

haven't had it checked in years, that I know of.....

I just

> posted some studies that calcium channel blockers are not the first

choice

> for diabetics. For us, it's still ACE inhibitors, diuretics, and

beta

> blockers, apparently The thing that caused my slow pulse

> was too much beta blocker, whereas it was the ACE inhibitor that

caused my

> b.p. to drop too low.

Ace Inhibitors apparently have no effect on my blood pressure. Tried

them a couple of times...Dioxan HCT is the last one.

>

To me, edema is

> your body saying, " Something is wrong here. " It could be your heart

or your

> kidneys - or insulin resistance.

>

I KNOW I am insulin resistant. That much is obvious after my many

tries at switching meds and the attempt at insulin alone...

>

> I really do feel that you can adjust your insulin and find

happiness. Have

> you read " Dr. Bernstein's Diabetes Solution " ? That book could be

invaluable

> to you. I really hope we can find a way to lower your insulin

resistance. It

> will be tricky, because if you are already insulin-resistant,

injecting more

> insulin seems to be " adding fuel to the fire. " But we gotta get

your numbers

> down into safe territory. That's going to take a combo of injected

insulin,

> I think, and exercise (as much as possible) and diet.

When I was on insulin alone (for several weeks) I had to cut my

carbs to almost ZILCH just to stay under 400. I was losing weight,

but my blood sugar was going into the stratosphere.

>

> << As for supplements, I don't take any. Several times I have

tried to

> take multivitamins, but they make me have nightmares (no, I am NOT

> kidding >>

>

> I consider supplements a necessity for us diabetics. Each of us

probably has

> our own regimen, but some things I think are *essential* for

diabetics

> include a good multi without iron (I take Centrum Silver),

CitriCal, extra

> B-complex, extra E. In addition to those, I take alpha lipoic acid,

Coenzyme

> Q-10, magnesium malate, potassium, and a few others that slip my

mind.

>

> Are you taking a diuretic? They really do help dump extra fluid.

Just changed my Lopressor to Lopressor HCT to try and take care of

the fluid. It helped, but no real change till I cut out the

Norvasc. So far, so good with that.

Bev, I'm

> sorry to be such a pest ... trying to keep my head above water

lately ...

Thanks for your concern< Susie.....I need all the help I can get

> Could you tell us your insulin regimen, please? I hope we can find a

> solution by looking at that. And you've probably given it to me

already ...

> Things have been wacky here lately.

I take Humulin 70/30, 35u in the AM (down from 40 since beginning

Actos) and 30 u pm.

>

> Hang in there, gal ... I'll bet in a few months you'll be on top of

your

> game once again!

Hangin' in there like a loose tooth

>

> Hugs,

> Susie

[Guest guest]

>

> I think others in the group will chime in and suggest a different

insulin

> regimen, Bev. The problem with 70/30 is the insulin is the boss.

It's

> premixed, and so what you have to do is take a hard look at how it

impacts

> your glucose levels, and then eat accordingly. What many diabetics

have

> recently found is Humalog at mealtimes, the units injected

according to how

> many carbs you plan to eat and your level of insulin resistance,

along with

> a " background insulin " such as UL or L or N, either once or twice a

day. I

> really do feel you can achieve excellent control and feel much

better

> physically by carefully fine-tuning your insulin regimen. Dr.

Bernstein can

> help you greatly with that, as can others in this group with much

experience

> in this area.

I have suggested a change in insulin a couple of times. He just

ignores my suggestion. Until I change doctors (and it would be

sticky, as he is also hubby's doc) it appears I'm stuck.....

>

> Susie

[Guest guest]

It looks like my pulse has returned to normal (64 at rest) just with

dropping the Norvasc. I'm pleased with that......

Bev

[Guest guest]

>I have suggested a change in insulin a couple of times. He just

>ignores my suggestion. Until I change doctors (and it would be

>sticky, as he is also hubby's doc) it appears I'm stuck.....

****Beverly, I think docs are concerned about switching insulin because they

don't know how motivated their patient is, and they worry about dangerous

hypos with mismanaged insulin. If your control still isn't what you want,

you can insist. It wouldn't hurt to try. And if he remains stubborn, go

see an endocrinologist who specializes in diabetes. You may wind up with

one down the road anyway. Then you can use " specialist " as an excuse. Tell

your doc you're just not happy with your control. I can't imagine that he

wouldn't respect that. Most docs are sadly uninformed about the nuances of

good diabetes control.

Barb

--------

Rainbow Farm Unltd.

Premium Oldenburg sport horses

and fancy sport ponies for sale.

http://www.RainbowFarm.com

[Guest guest]

Bev Trice wrote:

<< Ace Inhibitors apparently have no effect on my blood pressure. Tried

them a couple of times...Dioxan HCT is the last one. >>

We don't take ACE inhibitors only for hypertension. You need to be on an ACE

to lower the pressure in your kidneys. Even if you didn't have hypertension,

you should be on it. And your doctor's ignorance regarding this basic fact

of diabetes makes me think you need a new doc. If for some reason you can't

find one, you will have to become your own " diabetes expert. "

<< I KNOW I am insulin resistant. That much is obvious after my many

tries at switching meds and the attempt at insulin alone... >>

But you *don't know* that the edema is *not* caused by heart or kidney or

liver trouble.

<< When I was on insulin alone (for several weeks) I had to cut my

carbs to almost ZILCH just to stay under 400. I was losing weight,

but my blood sugar was going into the stratosphere. >>

How much insulin were you on? What type? What was your testing method?

Before meals? In the a.m.? Postprandial? Bev, I think you feel pretty

hopeless now, but there is a way out of this quandary. We just need to keep

exploring what is going on here.

<< Just changed my Lopressor to Lopressor HCT to try and take care of the

fluid. It helped, but no real change till I cut out the Norvasc. So far,

so good with that. >>

<< I take Humulin 70/30, 35u in the AM (down from 40 since beginning Actos)

and 30 u pm. >>

That probably seems like a tremendous amount to you, but I have heard of

insulin-resistant type 2's taking *hundreds* of units daily! This web site

from Eli Lilly can help you, I believe.

http://www.humulinpen.com/02-products/tap.html

It's graphs of the actions of various insulins. Some doctors just don't

realize how *smart* their patients can be. They prescribe 70/30 (or some

other " one size fits all " fixed combo) because they think we can't manage

anything more complicated. You'll see that there's a pretty big peak at the

2-5 hour mark after injecting, and then a second, smaller one at the 10-11

hour mark. It has a long tail, and is out of your system in about 22 hours.

Maybe a review of those insulin graphs can help you decide which insulins

would best serve your needs.

Susie

[Guest guest]

Bev Trice wrote:

<< I have suggested a change in insulin a couple of times. He just

ignores my suggestion. Until I change doctors (and it would be

sticky, as he is also hubby's doc) it appears I'm stuck..... >>

Each State seems to have different laws, but i think in most instances,

Humalog is the only insulin that requires a prescription. If you want to

change your insulin regimen, I believe you are free to do so. The caveat is,

of course, to go slowly ... just gradual changes, then wait and see how you

react. The most important thing is not to hypo.

Your numbers are so high, on so few carbs, I can't help but wonder if you

are, for some reason, moving to type 1 status? Do you think that's possible,

Bev?

Susie