Re: type 1 complications

[Guest guest]

Cass wrote:

<snip>

> bring his blood pressure down. So he eats mostly bread, rice and pasta. I'm

***uh-0h!*** I can hear Susie warming up now!

--

Dave -- Friday, April 28, 2000

t2 8/98 Glucophage & Aspartame

ICQ 10312009

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[Guest guest]

Cass wrote:

<< The standard regimen is 8 units R and 16 N morning and evening, 2 units

extra for every 50 points his glucose reading is over 150. To his

knowledge, he's never had an HbA1c. His readings are generally low in the

morning, 60 to 90. In the 180-200 range, often higher, in the evening

before dinner and the evening injection. >>

Cass, it sounds like he has not been getting good medical care. I hope

that's about to improve. You can also see from the trend of his readings

that he's eating too many carbohydrates for the amount of insulin he's using

daily, because he starts off good - or actually in hypo territory, and then

he climbs during the day.

<< He has retinopathy (laser surgery saved the vision in one eye), and some

neuropathy. High blood pressure. Anemia. >>

Is the anemia from internal bleeding from taking any meds, like painkillers?

<< ... he's restricted on protein, isn't supposed to have more than

two fruits and four veggies a day, and is supposed to lose weight to help

bring his blood pressure down. So he eats mostly bread, rice and pasta. I'm

a little concerned that the diet intended to protect his kidneys is helping

keep his glucose levels up, which in the long run isn't good for the

kidneys. >>

The increased weight and hypertension are often indicators of too much

circulating insulin. He might want to have a C-peptide test, to see if he

has any remaining pancreas function. And you are right about that diet ...

You face a dilemma. You might want to do a lot of internet research to see

if a type 1 with bad kidneys does better on a high-carb diet (with the

decline in control), or if in the long run that person might do better on a

alow-carb diet. Damaged kidneys leak protein, but it doesn't necessarily

follow that *eating* protein causes protein leakage. Dr. K.

Bernstein, author of " Dr. Bernstein's Diabetes Solution, " says high glucose

levels and excess insulin levels are what damage diabetic kidneys.

At a minimum, you should consider switching him to Humalog for meals, with a

background insulin such as UL. I'm glad you are switching doctors, because I

don't think the old one could walk you through that process correctly.

<< Will the blood tests show a normal range or will I need to find out what

a

normal range is? >>

The blood tests will show your SO's numbers, compared side-by-side with the

range of normal readings ... lowest to highest, for his age/sex.

Susie

[Guest guest]

Thank you, Susie. That's very helpful information. I, too, think that Mike

has not been getting good care, and hope that the endocrinologist will

change that. If the endo doesn't suggest a C-peptide test, I will ask why not.

>Is the anemia from internal bleeding from taking any meds, like painkillers?

He doesn't take any painkillers. I don't know what the anemia stems from.

To treat it, he injects 4,000 units of Procrit (epoetin alfa) once a week.

His other medications are: Norvasc 10 mg daily, chlorthalidone 25 mg daily,

furosemide 80 mg daily, florinef 0.1 mg daily, Vasotec 5 mg daily, and

Cardura 4 mg twice daily. (He was taking Vasotec twice daily, 5 and 10 mg,

and Cardura once, but the nephrologist switched that after the last blood

test). He also takes Kayexalate every other day, 8 tsp in water.

The dr's immediate concern is excess potassium. I've been restricting

dietary K to less than 2g daily, which unfortunately means very few fruits

and veggies, and white bread and rice instead of whole-grain. Refining gets

rid of the potassium in the bran and germ, but the refined carbs seem to

make his glucose levels spike, and then it takes forever to get them down

again. To me, the diet is counter-intuitive. His nephrologist seems to be

treating his kidneys in isolation, without taking his diabetes into account.

My Internet research hasn't been terribly productive, but I've ordered Dr.

Bernstein's book and will see how he addresses the problem.

Thanks again for your help.

Cass

[Guest guest]

Cass wrote:

<< ... We'll take all this up with the new doctor. I don't feel comfortable

telling Mike not to take the drugs his current doctor prescribed, and I

think the Florinef has to be discontinued gradually anyway. I did add a

calcium supplement (1200 units), Vitamin E (400 units) and a low-potassium,

low-phosphorous multi-vitamin with iron to his daily regimen. Is there any

reason not to do that?

We're making progress on the BGs (160 yesterday evening, 92 this morning).

He's still eating the dietitian's high-carb, low-protein diet, but I

increased the fat content a little in the hopes of slowing the effect of

the carbs. >>

Cass, I'm really relieved that Mike has you. You are making sound judgments,

and your grasp of all this medical mumbo-jumbo is excellent. I thought a lot

about the two of you last night. I'm worried about Mike, but also hopeful

that - like a miracle - you have come into his life to get him focused and

help him find better medical care. I agree ... the old doctor has been

layering on pill after pill, to counteract the effects of the pills he has

already prescribed. It becomes a nightmare, trying to sort out what is

causing what. And yes - Mike needs to be weaned from the cortisone ASAP.

Mike's broken arm could be a consequence of it, for one thing. Cortisone

makes the bones brittle. To my mind, cortisone is an " emergency pill, " to be

taken only when nothing else will work, and for as short of a time as

possible. I said out loud last night, " That doctor was killing Mike! "

I wish the very best for the two of you. Please do keep us posted as to his

progress and his blood test results.

Susie