HCV & Diabetes

[Johnare]

I've been on treatment for 42 wks. out of 48. 1a stage 1. Und. since week 12. I've had a really miserable tx due to huge drops in my rbc, wbc, Hgb platelets etc. I was hospitalized Monday night for bronchitis due to small amts. of blood in my lungs and sudden temperature spikes. I thought everything was on track and was looking forward to finally ending this Odyssey.

I had lots of blood draws while I was there b/c my blood sugar level kept spiking. Going from 128 to 210 then back to 132 then back to 216 then down to 106. I also noticed my AST is at 35, when I started tx it was 42. But, my concern is my ALT is still at 73. I spoke to my Gastro. after I was released yesterday. He mentioned that my liver was "fatty" , that I may be in the early stages of diabetes and suggested I lose some weight. I'm male, 5'11 and 184lbs. 55 Yrs. He  is also including a blood sugar test with by weekly CBC and another ANA test.

I can't quite figure out how concerned I should be about this at this point (still having moments of  I.Q. drops too). Any opinions would be appreciated. I have decided to lose some weight. Will this help lower my ALT?

[HARRYBEADS]

I agree with these guys. When I was treating 8 months ago I had a bad spell that ended in EMERG, tuff time breathing - fainted twice , freezing cold when it was in the eighties the next minute sweeting like a fool , white as a ghost and shaking. We took my copies of blood work that did include blood sugar levels but their tests were all over the board for everything.They looked confused about the treatment, they heard of it but thats it. They gave me ten under the tongue adivans and sent me home. THATS JUST WHAT A GUY THATS FAINTING FROM LOW BLOOD PRESSURE AND ANEMIA NEEDS.

Anyway I'm 5' 11"  50 and was 175 - 180 not in peak shape but good shape for my age, and one Doctor at the beginning called me obese!!!!  When I lost weight on treatment my FD said I look like ****, yesterday at 200, heavy I think, he said I look great and full of energy. Most peoples ALT spike real high during treatment at some point , check trackers on this site.

  As for loosing weight, RIBAVARIN IS WEIGHT BASED and you like me are on the edge of 1000 miligrams or 1200 if you loose weight they'll drop you by one pill a day, this will help your anemia but depending how far along you are and your response to the treatment this may not be desired. I took the dosage reduction because of my good response. Don't sweat the ADULT ONSET it's not a big deal wait till you finish and recover from the treatment. Both my parents got it around our age and they go for a walk once a day to keep their sugar under control and they are in their eighties now, healthier than me.

Good luck
Harry

[CoWriter]

"I haven't had past issues with sugar levels before tx, that I am aware of. I did have a test done last March by my pcp that indicated a high level but when the test was repeated several days later, everything was normal."

According to the Diabetes Association, diabetes is diagnosed when you have TWO consecutive tests showing a fasting blood sugar >126.


"I'm concerned about having Tx for diabetes recommended when it's not necessary. I'm going to wait until after Tx before I have any testing for diabetes."

I agree with Jim that at this point, the important thing is getting through treatment since you only have a few weeks left.  Since your highest readings while you were in the hospital were in the low 200's, once the bronchitis resolves, the blood sugar will probably be lower than that and not interfere with the rest of your treatment (that's why I didn't recommend getting a glucometer and checking your blood sugar daily).  

HOWEVER.....

There is a small chance that the Peg could cause your blood sugar to go sky high and you would end up in the hospital for it (and tx would be stopped).  Granted, the risk is small but it's there.

I recommend following your doctor's instructions to have your blood sugar checked weekly.  If the results are slightly elevated, you can choose to wait until you finish tx to see if you'll need meds for it.....but if the results are very high, then it's best to know now so you can do something about it before the problem becomes serious.  

Best of luck to you.

[Johnare]

I am scheduled to see my pcp next week for the bronchitis but he's just as clueless about ribavirin and HCV treatment as the E.R. I appreciate the advice because I'm concerned about having Tx for diabetes recommended when it's not necessary. I'm going to wait until after Tx before I have any testing for diabetes.

[Johnare]

First of all, thank you for taking the time to provide such a detailed answer. I very much appreciate it!!

They took chest x-rays and did a Cat-Scan while I was in the emergency room. I did have blood mixed in with the mucus and that's why I decided not to wait until the next day to go to my pcp.

I haven't had past issues with sugar levels before tx, that I am aware of. I did have a test done last March by my pcp that indicated a high level but when the test was repeated several days later, everything was normal.

One thing I learned is if you end up in the E.R. don't expect them to be very knowledgable about HCV or the drugs used for tx. If you need to go to the E.R. take your ribavirin with you and don't tell them you have it if you need to take it while there or they will try and stop you due to hospital policy.

[FlGuy]

It's why I suggested 'When tx is over, and beyond that a month or so, you should make a pit stop at an endocrinologist to have a full ....

[jmjm530]

Many here have had slightly elevated ALT's like yours during tx with good outcomes. The interferon itself can do that in many cases and the ALT normalizes after treatment is over.

"Co" gave you some good eating tips, however I also concur with "FlGuy" that paramount now is getting through treatment. You only have six weeks left and the weight and dieteary issues could probably wait. I assume they are treating the bronchitis.

Meanwhile, for after treatment, you might want to take a look at a few books to help regulate your blood sugar -- "The South Beach Diet", "Sugarbusters", and "The Zone" all deal with this. As "Co" said, don't have fruit alone and in fact don't have too much fruit to begin with and certainly try and eliminate fruit juice. Protein with fruit will help, but so will fat. For that reason, if you do want ice cream, ironically it's better to have premium high-fat ice cream than non-fat ice cream. The fat in the premium will slow the sugar absorption.

-- Jim

[CoWriter]

"If docs think you have a blood sugar issue, you should consider more tests (like a hemoglobin a1c)"

What for?  If he's anemic, the HgA1C test will be low (because the test looks at hemoglobin) but that won't mean that his blood sugar is okay.

"any blood sugar readings done while on treatment can be thrown out of whack by the ribavirin you're taking."

The Ribavirin can impact the results of the results of the HgA1c terst, but NOT "all blood sugar readings".  For example, it doesn't impact pre and post meal readings.

[FlGuy]

The blood draws while you were in the hospital can be a little decieving as it relates to blood sugar levels, depending on when you most recent meal was eaten.  If the blood was taken about 2 hours after a meal it was likely higher.  If the blood was taken upon waking, and before a meal, it was likely lower.  If docs think you have a blood sugar issue, you should consider more tests (like a hemoglobin a1c) and possible getting a glucometer - test yourself over time, once or twice a day.  

But, any blood sugar readings done while on treatment can be thrown out of whack by the ribavirin you're taking.  Riba, as you know from your hgb issues, is a red blood cell assassin. It kills off red blood cells early in their life before thy've had a chance to get a lot of glucose attached to them.  When tx is over, and beyond that a month or so, you should make a pit stop at an endocrinologist to have a full blood sugar shakedown.

Many people on treatment go for foods, given their lack of appetitie, that are the worst for blood sugar; fruits, carbs, energy drinks, ice cream which even further clouds the issue.  If it was me (and it was at one point), I'd focus on getting through treatment as sensibly as possible and then take up that issue.  Seems like you need to take care of the virus and the lungs just to keep standing.  Good luck.

[CoWriter]

"I was hospitalized Monday night for bronchitis due to small amts. of blood in my lungs"

What do you mean?  Were you coughing up blood?  While you were in the hospital....did they do a chest Xray?


"I had lots of blood draws while I was there b/c my blood sugar level kept spiking"

Interferon treatment can cause high blood sugar....and it may or may not go away after you finish treatment.  I have seen people who were not diabetic get blood sugars >800 while on treatment and they had to be put on insulin.  Then when the treatment finished, their blood sugar went back down.....and because they were still taking the insulin, the blood sugar went dangerously low.  

I have also seen people who developed diabetes while on treatment and it didn't go away after they finished treating.

When you have diabetes, any illness (like the bronchitis) will cause your blood sugar to go out of control.  That's why many people get diagnosed with diabetes when they get sick.  They may have been diabetic before but the blood sugar wasn't so high and they may not have had symptoms.  

I believe that during treatment, people may be unaware that they have high blood sugar....because blood sugar is not something routinely checked during tx.....or if it is, it's not done fasting.

(so it's very important that when you have your blood tests done you're fasting.  Otherwise the results will reflect what you ate the previous meal instead of how bad the diabetes is)

Your doctor will probably want to see what your blood sugar results show once the bronchitis goes away before he decides if you need medication to lower it.  

For now, you can follow some simple guidelines that will help you keep the blood sugar under better control:

1.  Don't ever skip breakfast.  Doing so will make your fasting blood sugar higher.  Breakfast doesn't have to be big but you need to eat something.
2.  Eat breakfast as early as you can.  
3.  Have 5 small meals a day instead of 3 large ones. (breakfast, lunch, snack, dinner, bedtime snack).
4.  Try to space your meals so that they're not too close together or too far apart.
5.  Increase your protein intake. Protein lasts longer and it doesn't raise blood sugar as much as carbs do.
6.  Fruit raises blood sugar sky high and it does so quickly.....then it drops quickly.  To prevent that from happening, don't ever eat fruit by itself.  So if you eat let's say a small apple, have some nuts or a piece of cheese with it (or something else).
7.  It is VERY IMPORTANT that you have a bedtime snack half hour before you go to bed and it MUST contain PROTEIN.  

During the day, you eat meals....and the food turns into sugar...so you always have sugar in your blood.  But during the night, you don't eat for many hours....so your blood sugar goes down....and that causes the liver to release a bunch of sugar into your bloodstream.....which causes the fasting blood sugar to be HIGH.

So to prevent the liver from giving you sugar during the night, you have to eat something that will last you all night.  Since protein lasts alot longer than  carbs, your bedtime snack MUST contain protein.  If you eat let's say....cereal, it will last you only for a couple of hours.  

Bedtime snack examples:

Cheese and a few crackes.
Half a quesadilla.
Half meat or peanut butter sandwich.
Nuts
Tuna and crackers

(Remember that this is supposed to be a snack, not a big meal).


"But, my concern is my ALT is still at 73."

Both fatty liver and diabetes can cause elevated enzymes.


"I have decided to lose some weight. Will this help lower my ALT? "

It will help you control the blood sugar.  But I wouldn't try to loose weight until you've recovered from the bronchitis.

BTW....sometimes steroids are prescribed for bronchitis....and steroids cause blood sugar to go up.