Re: Re: HCTZ - proceed with caution

[Guest guest]

, I took it years ago and did not know that it could cause your sugars to go up, and I was diabetic. One would wonder why a dr. would prescribe it when they know you're diabetic. Had I not read the side effects, I'd not known...

bevAnnieRomans 8:28 And we know that all things work together for good to them that love God, to them who are the called according to his purpose.check out my website:

http://www.angelfire.com/tn/shepherdsrest/MorningGlory.html

http://www.angelfire.com/tn/shepherdsrest/porch.html---

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Thursday, September 1, 2011, 2:28 PM

Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

[Guest guest]

or at least try not using it for a while to make sure it wasn't driving sugar up

the doc I mean

>, I took it years ago and did not know that it could cause your sugars to

go up, and I was diabetic. One would wonder why a dr. would prescribe it when

they know you're diabetic. Had I not read the side effects, I'd not known...

>

>

>bevAnnie

>

>Romans 8:28 And we know that all things work together for good to them that

love God, to them who are the called according to his purpose.

>check out my website:

> 

>http://www.angelfire.com/tn/shepherdsrest/MorningGlory.html

>http://www.angelfire.com/tn/shepherdsrest/porch.html

>

>

>

>

>

>Subject: Re: HCTZ - proceed with caution

>To: hyperaldosteronism

>Date: Thursday, September 1, 2011, 2:28 PM

>

>

> 

>

>

>

>

>

>Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!  

>

>

>

>

[Guest guest]

that's good. 112 fasting is ok

>Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

>

>

[Guest guest]

And aggravating DM in some. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I took HCTZ for several years. During those years, my fasting glucose went from the low 80s to the low 100s, bordering on pre-diabetic. It made me retain water, rather than working as a diuretic, and I was constantly bloated. It did nothing for my HTN. When I stopped taking it, I dropped 10 pounds of water weight and within weeks, my fasting blood glucose was back in the low 80s. Also, HCTZ is notorious for lowering K.

>

> I just spoke to my doc and voiced my concerns over the glucose issue and

> Metoprolol being ineffective in patients with PA. He suggested weaning me

> off the Metoprolol and then starting HCTZ and keeping the Amlodipine and

> Spiro. He feels the likelihood that the Metoprolol is affecting glucose is

> minimal but I just have a gut feeling this may be what's causing the spike,

> and I don't want it to get out of control then end up with another issue

> that could have been avoided. I looked up HCTZ and I'm reading that this can

> cause the same glucose problem. I think it was or who mentioned

> Coreg. Would this be better that HCTZ?

>

[Guest guest]

Even tho it can cause DM THOSE who were on it did better on a thiazides than a BB OVER 5 + years. Read the SHEP study for details. Do a pub med and look at DM in SHEP and ALLHAT. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

, I took it years ago and did not know that it could cause your sugars to go up, and I was diabetic. One would wonder why a dr. would prescribe it when they know you're diabetic. Had I not read the side effects, I'd not known...

bevAnnieRomans 8:28 And we know that all things work together for good to them that love God, to them who are the called according to his purpose.check out my website:

http://www.angelfire.com/tn/shepherdsrest/MorningGlory.html

http://www.angelfire.com/tn/shepherdsrest/porch.html---

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Thursday, September 1, 2011, 2:28 PM

Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

[Guest guest]

Diabetes increases as we age. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I went back to when I stopped furosemide because I remembered I saw a large drop in Glucose when I stopped it. Didn't find it right off but glucose went from 244 & 153 to 97 & 96 (and I was on Metformin 1000mg bid!) DASH gave it a bump with the extra sugar in fruit I assume but I've learned to keep that under control most of the time! (We practice low salt and sugar to the point of eliminating salt shakers and sugar bowls!)

I did a google search of "diuretics and glucose" and found this which might help you:

Diuretics are drugs that are used to lower blood pressure. This is mainly done by getting the body to rid itself of excess fluids and sodium through urination. They may be combined with other medications if diuretics alone are unable to bring the desired effects. It has been seen that in diabetics, diuretic drugs may cause blood sugar levels to rise. Generally a few changes in drug, diet, insulin or oral anti-diabetic dosage can help correct this in most cases. When prescribing the medication the doctor can change your treatment after considering the relationship between diuretics and blood glucose levels if you inform him of your diabetic status.

Diuretics and blood glucose levels

A clinical trial conducted in 2002, known as ALLHAT showed that an old, inexpensive diuretic (chlorthalidone) was good at lowering blood pressure and reducing the risk for heart attack and heart-related deaths. Other effective but expensive drugs included a calcium-channel blocker (amlodipine) and an ACE inhibitor (lisinopril). The diuretic was found better at preventing heart failure. The recommendations based on the ALLHAT results included having thiazide diuretic as the first drug or at least as a part of combination therapy for a person trying to control blood pressure.

A new study of the ALLHAT data also shows another interesting result. An increase in blood sugar levels over the course of the trial in people taking any of the three drugs. The study of data on glucose levels over six years showed that increase was largest among those taking the diuretic. It was almost 13mg/L among those taking the diuretic and lowest at 9.3mg/dL among those taking the ACE inhibitor. Moreover diabetes developed in 14% of those taking the diuretic, 11% of those taking the calcium-channel blocker, and 9.5% of those taking the ACE inhibitor.

If you want to see the whole article it is at: http://diabetesadviceweb.com/diabetes/blood-sugar/diuretics-cause-increase-in-blood-glucose-levels-but-are-safer-than-other-high-blood-pressure-medications/

WERE'T YOU ON A CCB ALSO? See if your doctor is familiar with "ALLHAT"! Let see, HCTZ = 14% and Amlodepine = 11% gets you up to 25%, Not good odds in my book! (Before you come completely unglued, please do read the entire article because there is some speculation as to the severity of this type of "induced DM".)

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

>

> Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

>

[Guest guest]

Need both HbA1c and gtt to Dx DM. WE TREAT the HBA1C so if that is not up no DM MOSTLY. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Impared glucose tolerance and prediabetes are the same and tou are considered there when fasting glucose is between 100 and 125. I had to chuckle when they said loosing 10% of your body weight would often correct the problem - What's that 11 or 12 lbs in your case!

A good place to get educated: http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> > >

> > >

> >

>

[Guest guest]

Need both HbA1c and gtt to Dx DM. WE TREAT the HBA1C so if that is not up no DM MOSTLY. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Impared glucose tolerance and prediabetes are the same and tou are considered there when fasting glucose is between 100 and 125. I had to chuckle when they said loosing 10% of your body weight would often correct the problem - What's that 11 or 12 lbs in your case!

A good place to get educated: http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> >

> > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> > >

> > >

> >

>

[Guest guest]

DM in most is caused by choosing wrong grand parents and feeding your roots wrong. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

, are you certain? I know the guidelines changed several years ago. NIH says under 100 is normal, and 100-125 is impaired glucose tolerance: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm

When mine hit 108 while on HCTZ, I freaked, given the history of T2 diabetes in my family. My doctor believes anything over 100 should be watched carefully.

>

> >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> >

> >

>

[Guest guest]

DM in most is caused by choosing wrong grand parents and feeding your roots wrong. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

, are you certain? I know the guidelines changed several years ago. NIH says under 100 is normal, and 100-125 is impaired glucose tolerance: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm

When mine hit 108 while on HCTZ, I freaked, given the history of T2 diabetes in my family. My doctor believes anything over 100 should be watched carefully.

>

> >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> >

> >

>

[Guest guest]

Those assume a food CHO DIET FOR several days before the glucose test. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

, are you certain? I know the guidelines changed several years ago. NIH says under 100 is normal, and 100-125 is impaired glucose tolerance: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm

When mine hit 108 while on HCTZ, I freaked, given the history of T2 diabetes in my family. My doctor believes anything over 100 should be watched carefully.

>

> >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> >

> >

>

[Guest guest]

This is the same group that used to tell us to tell patients to get their A1c as low as possible...until we found out that an A1c below 5.0 actually INCREASES mortality. A blood sugar of 80 is "prediabetes" if one gets diabetes anyway....technically. Still in adult a 112 is a good blood sugar fasting. I wonder how many people they scared into a panic so they essentially starved themselves, got their A1c to 4.8, and are no longer with us. And then we see diabetics flipping out because they have a blood sugar of 128 after a large meal and no one bothered to tell them that it is PERFECTLY NORMAL to have a NORMAL rise in blood sugar after a meal.

Weight loss, and 10lbs is usually the initial benchmark that has been proven time and time again to both decrease blood sugar and decrease blood pressure. In some people very significantly. But of course for many its also much easier and convenient to just take a pill.

Heres some good recent studies:

Treatment with medications is typically recommended when the A1c rises above 7%. When the Hemoglobin A1c blood test ranges higher than 7.0% it correlates with an average glucose level greater than 154 mg/dl.

http://www.knowyoursugar.com/did-i-pass-or-fail-decoding-the-a1c-blood-test/

From www.endocrineweb.com:

Fasting Blood Glucose (Blood Sugar) LevelThe gold standard for diagnosing diabetes is an elevated blood sugar level after an overnight fast (not eating anything after midnight). A value above 140 mg/dl on at least 2 occasions typically means a person has diabetes. Normal people have fasting sugar levels that generally run between 70 to 110 mg/dL.

Articles on the A1c issue;

http://www.sciencedirect.com/science?_ob=MImg & _imagekey=B6T18-4WTS1W0-8-1 & _cdi=4884 & _user=10 & _pii=S0735109709016921 & _origin= & _coverDate=07%2F28%2F2009 & _sk=999459994 & view=c & wchp=dGLzVlb-zSkzV & md5=d7509fc795b967abc15375f7f8dc582e & ie=/sdarticle.pdf

Conclusions The association between mortality and HbA1C in diabetic patients with HF appears U-shaped, with the lowest

risk of death in those patients with modest glucose control (7.1% HbA1C 7.8%). Future prospective studies

are necessary to define optimal treatment goals in these patients. (J Am Coll Cardiol 2009;54:422–8) © 2009

by the American College of Cardiology Foundation

From http://www.sciencedirect.com/science?_ob=MImg & _imagekey=B6T18-4WTS1W0-8-1 & _cdi=4884 & _user=10 & _pii=S0735109709016921 & _origin= & _coverDate=07%2F28%2F2009 & _sk=999459994 & view=c & wchp=dGLzVlb-zSkzV & md5=d7509fc795b967abc15375f7f8dc582e & ie=/sdarticle.pdf

Diabetes mellitus and heart failure (HF) are major health

problems. There are nearly 5 million individuals who have

HF and over 500,000 new cases are diagnosed each year in

the U.S. (1). It has been well-established that diabetes, a

disease that is increasing in prevalence (2), is a significant

risk factor for the development of cardiovascular disease (3)

and amplifies the risk for the development of HF (4–6). In

addition, HF itself is considered an insulin-resistant state

and is associated with significant risk for the future development

of diabetes

Heres one - higher or "normal high" A1c IN CHFers actually improves survival

Conclusions

Paradoxically, elevated HbA1c levels were associated with improved survival in this cohort of patients with diabetes and advanced HF. Further investigation is necessary to determine the nature of this relationship and http://www.sciencedirect.com/science/article/pii/S0002870305009427optimal HbA1c in patients with diabetes and HF.

CONCLUSIONS Insulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.

http://care.diabetesjournals.org/content/32/9/1583.short

Conclusions  Both impaired fasting glucose and the metabolic syndrome predict the risk of new-onset diabetes; however, the metabolic syndrome is a better predictor than impaired fasting glucose in assigning the risk of new-onset diabetes in hypertensive patients, and among those with normoglycaemia

http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2011.03330.x/full

So weight loss is best of all!

RESULTS The magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight.

CONCLUSIONS Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.

http://care.diabetesjournals.org/content/34/7/1481.short

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Thursday, September 1, 2011, 7:34 PM

Impared glucose tolerance and prediabetes are the same and tou are considered there when fasting glucose is between 100 and 125. I had to chuckle when they said loosing 10% of your body weight would often correct the problem - What's that 11 or 12 lbs in your case!A good place to get educated: http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/ - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> > >> > >> >>

[Guest guest]

Those "prediabetes" levels should serve as a "I need to monitor and reassess my lifestyle" but instead they get people so anxious and extreme about it when it is concern, but not life threatening.

Of course some people are going to panic. I know that taking off a mole and saying, "these have a possiblity of turning into cancer so lets get rid of it" turns into the patient ears as "blah HAVE blah blah blah CANCER blah blah blah" and the 70 year old grandmother and husband are now calling me 10 minutes after the patient gets home asking me "how long do they have" and "I am gonna sue that other clinic because my wife had that mole before when we went there and now she HAS cancer!"

Never mentioned in any guidelines regarding BP and blood sugar though is that there seems to be a subset that just don't do well at those levels wherein their norm for some reason is not what the guidelines have set. If they feel worse when we get them to the lower levels, but they were panicked by the provider, they get too extreme and cause themselves some issues. We keep lowering both little by little and I wonder if we end up finding even with BP that real low is not always so good. Like the A1c

Also, I suspect, you probably have seen, that people don't always fast like they say they did and have false highs. They do this in the clinic where they maybe are afraid to admit they ate a little something because they dont want to be lectured or have to come back in.

, are you certain? I know the guidelines changed several years ago. NIH says under 100 is normal, and 100-125 is impaired glucose tolerance: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htmWhen mine hit 108 while on HCTZ, I freaked, given the history of T2 diabetes in my family. My doctor believes anything over 100 should be watched carefully.> > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> >> >>

[Guest guest]

My wife has gestational DM right now, but type 2 runs in her family and she's a little lady (well before she got pregant anyway). Both sets of g-parents were/are French Canadian and in her grandparents and mother they woke up and were planning their meals the second they had their coffee. Dinner was HUGE and breakfast light. And they all get it. My family as the eldest of 8 children we ate alot of oatmeal, cream of wheat, and much lighter. You ate when you could.

There was no planning in our family as we never knew when we'd be home all together. And no one, even my grandparents, have had type II. We DO have HTN in all the men, but as far as I can gather talking to my grandmother who's 84 and plays the piano in church every Sunday still, is that I am the only one who has the hypokalemia issue. But I wonder about the others still.

, are you certain? I know the guidelines changed several years ago. NIH says under 100 is normal, and 100-125 is impaired glucose tolerance: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htmWhen mine hit 108 while on HCTZ, I freaked, given the history of T2 diabetes in my family. My doctor believes anything over 100 should be watched carefully.> > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> >> >>

[Guest guest]

Indeed almost diagnostic in PA by lowering KTiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

I took HCTZ for several years. During those years, my fasting glucose went from the low 80s to the low 100s, bordering on pre-diabetic. It made me retain water, rather than working as a diuretic, and I was constantly bloated. It did nothing for my HTN. When I stopped taking it, I dropped 10 pounds of water weight and within weeks, my fasting blood glucose was back in the low 80s. Also, HCTZ is notorious for lowering K.

>

> I just spoke to my doc and voiced my concerns over the glucose issue and

> Metoprolol being ineffective in patients with PA. He suggested weaning me

> off the Metoprolol and then starting HCTZ and keeping the Amlodipine and

> Spiro. He feels the likelihood that the Metoprolol is affecting glucose is

> minimal but I just have a gut feeling this may be what's causing the spike,

> and I don't want it to get out of control then end up with another issue

> that could have been avoided. I looked up HCTZ and I'm reading that this can

> cause the same glucose problem. I think it was or who mentioned

> Coreg. Would this be better that HCTZ?

>

[Guest guest]

No the gold standard should be what you treat and that is the HBA1c. Glucose is too variable. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

This is the same group that used to tell us to tell patients to get their A1c as low as possible...until we found out that an A1c below 5.0 actually INCREASES mortality. A blood sugar of 80 is "prediabetes" if one gets diabetes anyway....technically. Still in adult a 112 is a good blood sugar fasting. I wonder how many people they scared into a panic so they essentially starved themselves, got their A1c to 4.8, and are no longer with us. And then we see diabetics flipping out because they have a blood sugar of 128 after a large meal and no one bothered to tell them that it is PERFECTLY NORMAL to have a NORMAL rise in blood sugar after a meal.

Weight loss, and 10lbs is usually the initial benchmark that has been proven time and time again to both decrease blood sugar and decrease blood pressure. In some people very significantly. But of course for many its also much easier and convenient to just take a pill.

Heres some good recent studies:

Treatment with medications is typically recommended when the A1c rises above 7%. When the Hemoglobin A1c blood test ranges higher than 7.0% it correlates with an average glucose level greater than 154 mg/dl.

http://www.knowyoursugar.com/did-i-pass-or-fail-decoding-the-a1c-blood-test/

From www.endocrineweb.com:

Fasting Blood Glucose (Blood Sugar) LevelThe gold standard for diagnosing diabetes is an elevated blood sugar level after an overnight fast (not eating anything after midnight). A value above 140 mg/dl on at least 2 occasions typically means a person has diabetes. Normal people have fasting sugar levels that generally run between 70 to 110 mg/dL.

Articles on the A1c issue;

http://www.sciencedirect.com/science?_ob=MImg & _imagekey=B6T18-4WTS1W0-8-1 & _cdi=4884 & _user=10 & _pii=S0735109709016921 & _origin= & _coverDate=07%2F28%2F2009 & _sk=999459994 & view=c & wchp=dGLzVlb-zSkzV & md5=d7509fc795b967abc15375f7f8dc582e & ie=/sdarticle.pdf

Conclusions The association between mortality and HbA1C in diabetic patients with HF appears U-shaped, with the lowest

risk of death in those patients with modest glucose control (7.1% HbA1C 7.8%). Future prospective studies

are necessary to define optimal treatment goals in these patients. (J Am Coll Cardiol 2009;54:422–8) © 2009

by the American College of Cardiology Foundation

From http://www.sciencedirect.com/science?_ob=MImg & _imagekey=B6T18-4WTS1W0-8-1 & _cdi=4884 & _user=10 & _pii=S0735109709016921 & _origin= & _coverDate=07%2F28%2F2009 & _sk=999459994 & view=c & wchp=dGLzVlb-zSkzV & md5=d7509fc795b967abc15375f7f8dc582e & ie=/sdarticle.pdf

Diabetes mellitus and heart failure (HF) are major health

problems. There are nearly 5 million individuals who have

HF and over 500,000 new cases are diagnosed each year in

the U.S. (1). It has been well-established that diabetes, a

disease that is increasing in prevalence (2), is a significant

risk factor for the development of cardiovascular disease (3)

and amplifies the risk for the development of HF (4–6). In

addition, HF itself is considered an insulin-resistant state

and is associated with significant risk for the future development

of diabetes

Heres one - higher or "normal high" A1c IN CHFers actually improves survival

Conclusions

Paradoxically, elevated HbA1c levels were associated with improved survival in this cohort of patients with diabetes and advanced HF. Further investigation is necessary to determine the nature of this relationship and http://www.sciencedirect.com/science/article/pii/S0002870305009427optimal HbA1c in patients with diabetes and HF.

CONCLUSIONS Insulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.

http://care.diabetesjournals.org/content/32/9/1583.short

Conclusions  Both impaired fasting glucose and the metabolic syndrome predict the risk of new-onset diabetes; however, the metabolic syndrome is a better predictor than impaired fasting glucose in assigning the risk of new-onset diabetes in hypertensive patients, and among those with normoglycaemia

http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2011.03330.x/full

So weight loss is best of all!

RESULTS The magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight.

CONCLUSIONS Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.

http://care.diabetesjournals.org/content/34/7/1481.short

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Thursday, September 1, 2011, 7:34 PM

Impared glucose tolerance and prediabetes are the same and tou are considered there when fasting glucose is between 100 and 125. I had to chuckle when they said loosing 10% of your body weight would often correct the problem - What's that 11 or 12 lbs in your case!A good place to get educated: http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/ - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> > >> > >> >>

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[Guest guest]

Depends on age with geriatric guidelines as I recall. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Iteresting, sounds like someone has been lying to me! I was told A1C needed to be <7.0 which correlated to < 140 on the daily stick-pin. Now I have to figure out what the low cutoff is! Thanks for the info.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG.

> > >

> > > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!

> > > >

> > > >

> > >

> >

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[Guest guest]

Exercise and diet still help control weight regardless and it is non-debatable that it is healthy. I am advocating NOT just throwing people on medication immediately or scaring them to death because a blood sugar is 112. If we all had a perfect knowledge if it all how simple it could be then maybe we wouldn't panic. Still....The evidence for healthy weight and weight loss is so non-debatable and so well studied that it's not even a vague argument. That one will be heard over and over. Similar to smoking. It may have been the metformin in your case causing weight gain and spiked your sugar. Maybe naturally might have worked better as pills aren't 100% effective

.. Maybe?

Anyway, I was referring to blood sugar not PA....not sure what you mean. She already has PA so it's not being missed like your case. Either way I would never suggest to anyone stay obese and non-active.

And a misdiagnosis is always a misdiagnosis - that really doesn't apply here. And I have an uncle who didn't wear his seatbelt in the car crash and they told him if he had it on he would have been killed. There's always an exception to everything, I still tell my kids to wear their seatbelts as do I.

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Thursday, September 1, 2011, 10:52 PM

, You raise a very good point, as usual! However, I have to caution you to make damn sure you look for underlying reasons that the PTN may have that may be preventing them from heeding your warning! (I'm sure you know I'm talking PA.)I heard that warning for years re. DM and weight. My BS got bad enough that I was put on Metformin 1000mg bid and my weight went from 276 to 322 1/2! (At one point I told my PCP if one more young resident mentioned weight I was afraid my PTSD might kick in! At 300+ lbs I didn't see it but maybe they saw S-T-U-P-I-D written across my forehead!)When PA got under control weight dropped 25 lbs in 6-weeks and BS ave= 120ish! I imagine they will all send me a note and appologize for missing the DX of PA as far back as early 2007 and if they had any smarts they would have found it in 2005! (And don't start with that hindsight crap - the lab told them to look for it, the SOP from the DOD told them to look

for it and if they just got out of school it must have been mentioned once or twice! - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> > >> > >> >>

[Guest guest]

I got ya. PA compounded everything for you. Me too, though weight isn't my issue (I am definitely not at my best weight for my body type though). PA has truly been a life altering disease and I still see one website that says it's over-rated and others that say maybe up to 10-20% of HTN may be PA. Either way we have to help find those who have PA BEFORE their life is altered and miserable. Educating doctors, pa's, and NP's will be the best thing. We all kind of know about it, but it isn't much on the radar so it's thrown aside and lumped in with rarer things like cushings etc.

You know I bet a good study would be to find out how many PA patients actually were the first to mention PA with their provider, instead of the provider being the first to suspect it.

Subject: Re: HCTZ - proceed with cautionTo: hyperaldosteronism Date: Friday, September 2, 2011, 2:06 PM

I mentioned PA because I believe it has been shown to effect glucose in somewhere around 25% of the PTNs if I recall correctly. (Dr. Grim referred me to some of the work that Dr. Conn did when we were discussing.)I may have been unfair when I characterized that weight loss was impossible. Yes, there were extenuating circumstances, like oxygen and PA was unknown but do you think 7 BP meds and K supplements may have had any impact? Just looking at one that we have been talking about, Met. Tartrate. Both you and Dr. G. indicated that 100mg bid could be causing me to feel "sluggish" - what is your observation when I say I was on 200mg bid (400 mg/day)?I feel like I just "shot the messenger" and that is not my intention because I rally appreciate your answers. I also am quite sure you would have assumed there was something else going on and if you couldn't DX it yourself would have called in a HTN specialist. (And the sad part of it all

is that I have full health insurance so the VA wouldn't have even had to foot the bill!) Maybe that's the answer, the VA collected over $12,000 reimbursement from my insurance last year! - 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP(last week ave): 123/69Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2. and PTSD.Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, 81mg asprin, Metformin 2000MG and Spironolactone 50 MG. > > > > > > >Oh boy! Mine has been at 112 fasting. Thank you for the insight on the HCTZ!> > > >> > > >> > >> >>

[Guest guest]

   This reminds me of one time about 8 years ago I went to the ER

with a BP of 225/120 even while taking 5 BP pills.

The intern mentioned to me that it was not normal to be on 5 bp meds

with a BP like that- duh! I now clearly remember him saying

something about a

phytomas@@@@ some kind of tumor on the adrenal. He said he would

check my blood.  I was then admitted and the doc on the floor didnt

follow through.

I wonder if this could have been caught 8 years ago.

   I didn't know it was PA but I knew something was wrong. My

cardiologist only wanted to add pills. I was in the hospital 4 times

last year

with side effects of medicine. It seemed like whenever they added a

med, my bp would go higher. Of course no one believed me

   The ER ppl started looking at me funny and treating me rude cause

at one time I was there 6 times in 30 days with muscle pain, chest

pain, short of breath,

severe fatigue, leg pain. Finally I just stopped going.  They just

kept writing essential hypertension. I did ask my doc if I could

have secondary hypertension. He said he doubt it.

 

I got ya. PA compounded everything

for you. Me too, though weight isn't

my issue (I am definitely not at my

best weight for my body type though).

PA has truly been a life altering

disease and I still see one website

that says it's over-rated and others

that say maybe up to 10-20% of HTN may

be PA. Either way we have to help find

those who have PA BEFORE their life is

altered and miserable. Educating

doctors, pa's, and NP's will be the

best thing. We all kind of know about

it, but it isn't much on the radar so

it's thrown aside and lumped in with

rarer things like cushings etc.

 

You know I bet a good study would

be to find out how many PA patients

actually were the first to mention PA

with their provider, instead of the

provider being the first to suspect

it. 

From:

Subject: Re: HCTZ

- proceed with caution

To: hyperaldosteronism

Date: Friday, September 2, 2011, 2:06

PM