Re: Another diabetes complication

[Guest guest]

In a message dated 12/03/2000 3:46:17 PM Eastern Standard Time,

lists@... writes:

<< I am also left wondering - has anybody on this list:

- observed the appearance of boils or other skin infections? >>

Yes, me, unfortunately.

On my abdomen, the skin around my stoma, (ileostomy from crohns disease) is

deeply ulcerated, started as red and irritated, but now open ulcer sores.

I went to my DR, endo, ostomy clinic, ET, an ostomy nurse to no avail.

I finally, I think have come on a way to heal,,,,,,, I'm using diluted

hydrogen peroxide in water to clean, and normal saline to irrigate, then

aquacel (a dry thin material that promotes healing in a moist environment)

then duoderm (like a foam padding) over that, then my wafer and pouch over

all this. I do see signs of new skin and appears to be healing.

but I am keeping my bg low.

carol

[Guest guest]

Dave O. wrote:

<< In fact, cuts that took forever to heal and redness around the wound were

one of the things that pointed me towards having diabetes in the first

place. Having better control has helped things to heal better. >>

Yep - I think it's the same the world over. It's the sores on the lower legs

and feet and even arms that just won't heal. (I have little white scars all

over my legs and arms from poison ivy sores from before I was diagnosed that

would last for months.) I would get a blister from a new pair of sandals and

it would still be there, weeks later. And we get bladder infections and

kidney infections and yeast infections and thrush. Oh, there's a long long

list of maladies associated with unhealthy high glucose readings.

, it sounds like your wife is having glucose readings that are too

high, too often. I think she was right to keep her carbohydrate intake low,

to improve control. Maybe she should return to that, to save her eyes and

get her in better shape.

Susie

[Guest guest]

I BEG anyone who has these sores that aren't healing to get prompt medical

attention. My father didn't, and he ultimately paid the price with his life at

the age of 59. He developed a systemic infection that weakened his entire

system. After three months in ICU, his heart gave up. PLEASE don't ignore these

problems.

Teri

Re: Another diabetes complication

Dave O. wrote:

<< In fact, cuts that took forever to heal and redness around the wound were

one of the things that pointed me towards having diabetes in the first

place. Having better control has helped things to heal better. >>

Yep - I think it's the same the world over. It's the sores on the lower legs

and feet and even arms that just won't heal. (I have little white scars all

over my legs and arms from poison ivy sores from before I was diagnosed that

would last for months.) I would get a blister from a new pair of sandals and

it would still be there, weeks later. And we get bladder infections and

kidney infections and yeast infections and thrush. Oh, there's a long long

list of maladies associated with unhealthy high glucose readings.

, it sounds like your wife is having glucose readings that are too

high, too often. I think she was right to keep her carbohydrate intake low,

to improve control. Maybe she should return to that, to save her eyes and

get her in better shape.

Susie

eGroups Sponsor

Public website for Diabetes International:

http://www.msteri.com/diabetes-info/diabetes_int

[Guest guest]

Thornton wrote:

>

> All:

>

> I am also left wondering - has anybody on this list:

> - observed the appearance of boils or other skin infections?

>

> I have a feeling that this is another potential diabetes complication

> that should be monitored and I am fairly sure that for me and my wife

> it is not yet being done. Our present method is to measure body

> temperature whenever the blood glucose response to food intake

> departs from the usual pattern - but then the infection has already

> taken a hold.

So far all my infections have been external, and I didn't get one during

a recent operation. In fact, cuts that took forever to heal and redness

around the wound were one of the things that pointed me towards having

diabetes in the first place.

Having better control has helped things to heal better.

--

Dave - 3:45:57 PM

T2 - 8/98 Glucophage, Precose

-

Davors Daily Aphorism:

* Lottery: A tax on people who are bad at math.

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[Guest guest]

Sure, . When I presented with chronic yeast infections, the first

thing the OB/GYN did was run a blood glucose test. He said it was fine,

about 5 years before diagnosis. Since dx, I've gotten my glucose under

control, and the infections have subsided. Now I'm down to about 1-2 a

year.

Robin G.

>

>Reply-To: diabetes_integroups

>To: diabetes_integroups

>Subject: Another diabetes complication

>Date: Sun, 03 Dec 2000 20:40:01 -0000

>

>All:

>

>During my wife's recent hospital treatment, I asked the chief of

>the diabetes clinic to recommend a good strategy for dealing with

>the incidental infections that can compel a Type 2 diabetic to

>discontinue taking Glucophage until the infection has cleared.

>

>He answered that I was making a big mistake if I really thought that

>the infections were only incidental.

>

>In fact, he said, an increased infection susceptibility was another

>diabetes complication, just like the others. Apparently, cells that,

>as a result of insulin resistance, do not get enough glucose, shrink

>due to extracellular hyperosmolarity. When this happens to the

>lymphocytes (just another type of white corpuscle), their function is

>restricted, in particular the formation of the superoxides which are

>so important for the immune system.

>

>He claimed that most diabetes patients show signs of this increased

>infection susceptibility. Apparently, the primary consequences

>are infections of the skin (boils) and the kidneys (pyelonephritis).

>The infections, in turn, increase the body's requirement for

>insulin which leads to an increased production of insulin-

>antagonistic hormones.

>

>So I assume that anything which tends to reduce insulin resistance

>(e.g. exercise) will also serve as a prophylactic measure against

>this particular diabetes complication.

>

>I am also left wondering - has anybody on this list:

>- observed the appearance of boils or other skin infections?

>- ever been diagnosed with pyelonephritis? (what are the symptoms?,

>what is the treatment?)

>- found out how to measure insulin resistance?

>- heard how immune system deficiency (particularly lymphocyte

>dysfunction) is detected ahead of time?

>

>I have a feeling that this is another potential diabetes complication

>that should be monitored and I am fairly sure that for me and my wife

>it is not yet being done. Our present method is to measure body

>temperature whenever the blood glucose response to food intake

>departs from the usual pattern - but then the infection has already

>taken a hold.

>

>

>

>

________________________________________________________________________________\

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[Guest guest]

> , it sounds like your wife is having

> glucose readings that are too high, too often.

> I think she was right to keep her carbohydrate

> intake low, to improve control. Maybe she

> should return to that, to save her eyes and

> get her in better shape.

No, Susie, it was nothing to do with carbohydrates, it was the

cortisone. I tried to point out that, at the time I wrote that, she

was not eating anything at all but getting diabetes-matched IV

feeding only. That was during the 12 days that she was getting the

tapered-off cortisone shots every day. Over here they don't have low-

carb feeding for diabetics anyway and they sure as hell don't have

low-carb IV feeding!

Now that she is back home again and back onto a " balanced " 55%

carbohydrate food plan, her BGs stabilized at the old level almost

immediately, which " proves " to me that the 55%-15%-30% food plan is

the right way to go. I know that I am never going to convince you so

I have not responded to your recent " provocations " (don't take that

seriously, I am only kidding)!

I am still searching for a proven strategy for Type 2 NDD Glucophage-

treated patients during periods of serious infection, especially

during IV feeding in hospital, and I will let you know what I find

out.

[Guest guest]

> One year before I was dxed (1/99), I developed

> a resistant staph skin infection that appeared

> as boils on my arms and hands. My dermatologist

> was the one who suggested that Insulin Res. was

> probably involved and she is responsible for my

> early dx. This was the only DM symptom I can

> identify. Since my bgs stay in the normal range

> now, I have not had any more breakouts.

Thanks, Carol. This certainly sounds like one of the diabetes

comnplications that shows up early on and can be held in check by

lowered mean blood glucose concentration. I don't understand why

though, because that would seem to suggest that high blood sugar

concentration causes insulin resistance whereas I thought it was the

other way around! I sure wish I could find a way to measure insulin

resistance.

[Guest guest]

Thornton wrote:

<< No, Susie, it was nothing to do with carbohydrates, it was the cortisone.

>>

I wasn't referring to her cortisone treatments at the hospital, but your

recent realiation that sores that don't heal, etc., are diabetes

complications. She is accumulating diabetes complications, which indicates

that her diabetes control is not optimal.

<< Over here they don't have low-carb feeding for diabetics anyway and they

sure as hell don't have

low-carb IV feeding! >>

They don't have it over here either. If you're hospitalized and you can't do

your own testing and insulin shots, or feel too overwhelmed by the system,

they'll let you run 200 and above. They will bring you meals with rolls,

full-sugar Jello, cereal, jelly, fruit juice, potatoes, etc. I believe the

thinking is if a patient hypos and dies, they can get sued. But if the

patient runs 200-400, any damage done by those high readings can't be

specifically traced to them.

<< Now that she is back home again and back onto a " balanced " 55%

carbohydrate food plan >>

You recommend a diet that is 55% carbs, 15% fats, 30% protein. That is not

" balanced " but quite lopsided. You are eating a diet that contains almost

four times as many carbohydrate grams as fat grams. It would be accurate to

say, " I'm eating a *lopsided* 55% carbohydrate food plan. "

<< I am still searching for a proven strategy for Type 2 NDD

Glucophage-treated patients during periods of serious infection, especially

during IV feeding in hospital >>

I would think that increasing her Glucophage to the max. - 2,550 mg a day -

during times of medication- or stress- or infection-induced hyperglycemic

episodes would be helpful. We have been told in the U.S. that the " minimum

effective dosage " of Glucophage is 1500 mg. Do you suppose that would be

because our diet is higher in carbohydrates than yours?

Susie

[Guest guest]

Thornton wrote:

<< I don't understand why though, because that would seem to suggest that

high blood sugar

concentration causes insulin resistance whereas I thought it was the other

way around! I sure wish I could find a way to measure insulin resistance. >>

Someone - and I believe it was the husband-and-wife Eades medical team

(authors of " Protein Power " and more recently " The Protein Power LifePlan " )

said to liken insulin resistance to repeatedly hearing loud noises or

smelling something really unpleasant, for example in a work environment.

Eventually you no longer are bothered by the noise or the odor. We have

learned from archaeological research that our prehistoric ancestors were

skilled hunters of big game and preferred to eat meat. We also learned that

85% of us are born with a " gene variant " that causes unnatural glucose

elevations after eating carbohydrates. We also learned that three-fourths of

" healthy young adults, " when tested, were already demonstrating

less-than-optimal glucose reactions.

My sense is that type 2 is a lifelong process, with chronic glucose

elevations gradually worsening our insulin resistance. If that is not the

case, how to explain the present " epidemic " of what was for years called

" adult onset diabetes " among teens and even children all over the world?

Following diagnosis, and upon learning more details of the disease process

in this group and others, many of us look back and recognize early signs of

diabetes in our own childhoods or early adulthood.

Susie

[Guest guest]

Dave O. wrote:

<< As has indicated (along with the patient insert), taking

Glucophage during periods of infection are contraindicated. >>

My understanding of it was 's concern for type 2's who don't inject

insulin, and type 1's and 2's who do inject insulin but aren't well enough

to manage it during times of illness. If they must discontinue Glucophage

when ill or hospitalized, what are they to do for a substitute to maintain

good control? According to RxList.com, contraindications include: kidney

problems, creatinine clearance problems, being in shock, acute heart attacks

or heart failure, septicemia, those undergoing radiologic studies, or

acidosis.

There is a specific warning regarding lactic acidosis. (A rare occurrence -

..03 cases per 100 patient-years - but fatal in half those cases.) I think

the advice to discontinue Glucophage has to do with the subtleness of

symptoms of lactic acidosis: " The onset of lactic acidosis often is subtle,

and accompanied only by nonspecific symptoms such as malaise, myalgias,

respiratory distress, increasing somnolence and nonspecific abdominal

distress. " It could be easy to confuse it with a general state of disease in

a patient.

RxList.com has this to say regarding surgical procedures: " Metformin HCl

therapy should be temporarily suspended for any surgical procedure (except

minor procedures not associated with restricted intake of food and fluids)

and should be not restarted until the patient's oral intake has resumed and

renal function has been evaluated as normal. "

It would seem their concern is for hypos, if the patient is not eating

regularly, as well as a warning that kidney function should be checked

before resuming taking it.

Susie

[Guest guest]

In a message dated 12/04/2000 2:39:23 PM Eastern Standard Time,

lists@... writes:

<< What I didn't realize before

was that an increased susceptibility to acquiring infections due to

impaired lymphocyte function was a diabetes complication. >>

This is true, my ulcer sores were being treated a GI problem, now that its

being treated as a DM problem, its healing. I'm told it takes a few months to

heal completely from other people with diabetes and crohns that have

ostomies, but that really doesn't matter, I had sores on my lower legs too,

now I keep bg really low all the time, that disappeared.

carol

[Guest guest]

In a message dated 12/04/2000 4:10:39 PM Eastern Standard Time, nws@...

writes:

<< I have also started taking my temperature every time

that I take my blood sugar readings and I record it right along with the

BG's. >>

does everybody feel this? when my bg is starting to rise, I feel really hot,

like hot flashes.

carol

[Guest guest]

Graaaackkk ... I wrote:

<< There is a specific warning regarding lactic acidosis. (A rare

occurrence -

..03 cases per 100 patient-years - but fatal in half those cases.) >>

It was supposed to read " .03 cases per *1000* patient-years " .

Susie

[Guest guest]

Dave O. wrote:

<< " s wife was on insulin during her clinic treatment when the

glucophage was discontinued. >>

I hope I'm not putting words in his mouth, but was wondering about

diabetics who don't wind up in a hospital setting. Are all of us who use

Glucophage supposed to keep insulin and needles around, and learn how to

inject ourselves, in the event we become ill and heed the warning to

discontinue Glucophage? Or do just discontinue it and let our readings soar

temporarily?

Susie

[Guest guest]

For several years, pre diabetic dx,I did have that same sensation whenever I had

double mochas, huge bagels or muffins for breakfast. I mentioned them to my old

dr and she told me I was fine because my fasting bgs were normal. She figured

that since I was over 40, they were good old fashioned hot flashes.

Funny...they went away when my postprandial bgs normalized.

Carol T

In a message dated Mon, 4 Dec 2000 4:19:50 PM Eastern Standard Time,

astrocarly@... writes:

<< I have also started taking my temperature every time

that I take my blood sugar readings and I record it right along with the

BG's. >>

does everybody feel this? when my bg is starting to rise, I feel really hot,

like hot flashes.

carol

Public website for Diabetes International:

http://www.msteri.com/diabetes-info/diabetes_int

>>

[Guest guest]

For several years, pre diabetic dx,I did have that same sensation whenever I had

double mochas, huge bagels or muffins for breakfast. I mentioned them to my old

dr and she told me I was fine because my fasting bgs were normal. She figured

that since I was over 40, they were good old fashioned hot flashes.

Funny...they went away when my postprandial bgs normalized.

Carol T

In a message dated Mon, 4 Dec 2000 4:19:50 PM Eastern Standard Time,

astrocarly@... writes:

<< I have also started taking my temperature every time

that I take my blood sugar readings and I record it right along with the

BG's. >>

does everybody feel this? when my bg is starting to rise, I feel really hot,

like hot flashes.

carol

Public website for Diabetes International:

http://www.msteri.com/diabetes-info/diabetes_int

>>

[Guest guest]

" Susie M. " wrote:

> I would think that increasing her Glucophage to the max. - 2,550 mg a day -

> during times of medication- or stress- or infection-induced hyperglycemic

> episodes would be helpful. We have been told in the U.S. that the " minimum

> effective dosage " of Glucophage is 1500 mg. Do you suppose that would be

> because our diet is higher in carbohydrates than yours?

As has indicated (along with the patient insert), taking

Glucophage during periods of infection are contraindicated.

--

Dave - 9:42:52 AM

T2 - 8/98 Glucophage, Precose

-

Davors Daily Aphorism:

All things are green unless they are not.

--

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[Guest guest]

I'm working without a mouse right now so I can't move around as well.

RxList also says that Glucophage should be discontinued during times of

infection. I know that they specifically mention the word infection in

the patient guideline area, but I can't even type in " glucophage "

because I can't click on the damn window!!!

" s wife was on insulin during her clinic treatment when the

glucophage was discontinued.

" Susie M. " wrote:

>

> Dave O. wrote:

>

> << As has indicated (along with the patient insert), taking

> Glucophage during periods of infection are contraindicated. >>

>

> My understanding of it was 's concern for type 2's who don't inject

> insulin, and type 1's and 2's who do inject insulin but aren't well enough

> to manage it during times of illness. If they must discontinue Glucophage

> when ill or hospitalized, what are they to do for a substitute to maintain

> good control? According to RxList.com, contraindications include: kidney

> problems, creatinine clearance problems, being in shock, acute heart attacks

> or heart failure, septicemia, those undergoing radiologic studies, or

> acidosis.

>

> There is a specific warning regarding lactic acidosis. (A rare occurrence -

> .03 cases per 100 patient-years - but fatal in half those cases.) I think

> the advice to discontinue Glucophage has to do with the subtleness of

> symptoms of lactic acidosis: " The onset of lactic acidosis often is subtle,

> and accompanied only by nonspecific symptoms such as malaise, myalgias,

> respiratory distress, increasing somnolence and nonspecific abdominal

> distress. " It could be easy to confuse it with a general state of disease in

> a patient.

>

> RxList.com has this to say regarding surgical procedures: " Metformin HCl

> therapy should be temporarily suspended for any surgical procedure (except

> minor procedures not associated with restricted intake of food and fluids)

> and should be not restarted until the patient's oral intake has resumed and

> renal function has been evaluated as normal. "

>

> It would seem their concern is for hypos, if the patient is not eating

> regularly, as well as a warning that kidney function should be checked

> before resuming taking it.

>

> Susie

>

>

> Public website for Diabetes International:

> http://www.msteri.com/diabetes-info/diabetes_int

--

Dave - 10:37:53 AM

T2 - 8/98 Glucophage, Precose

-

Davors Daily Aphorism:

Fight Crime: Shoot Back!

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[Guest guest]

> We have learned from archaeological research

> that our prehistoric ancestors were skilled

> hunters of big game and preferred to eat meat.

Sorry, Susie, but I don't believe a word of it. Some of our

prehistoric ancestors might well have been " skilled hunters " but I

bet most of them preferred to creep out when everything was quiet and

pick a few berries and roots and some grass.

You only have to take the Bible as a guide. In Genesis it is

explained quite clearly that, starting with the Garden of Eden, God

provided us with seeds, berries, plants and the fruit of the trees

for our nourishment. Throughout most of the Bible, animals are not

mentioned as a source of food. You can see what goes wrong when we

try to live off animal protein just by looking at what has happened

with BSE (mad-cow disease) when animals that are naturally ruminants

are given animal protein to eat.

> We also learned that 85% of us are born with a

> " gene variant " that causes unnatural glucose

> elevations after eating carbohydrates.

Where on earth did you get that one from, Susie? Who is the genius

that is pretending to be able to decide what is natural and what is

unnatural? The whole of evolution depends on mutations - that's the

way it works. If 85% of us are born in that condition, whose genes

are serving as a reference in order to be able to call it a " variant " ?

[Guest guest]

In a message dated 00-12-04 14:39:17 EST, you write:

<<

That is quite obviously a mistake. Since they recommend starting

dosage at 500 mg/day and working up from there, they must expect that

500 mg/day could, under some circumstances, be an " effective dose " -

and it is. >>

No, , I think they suggest 500 a day to start because of the possibility

of gastric symptoms which can occur with Glucophage. By starting low and

working up this can possibly be avoided. At least that's what my doc told me

when I started it. Vicki

[Guest guest]

In a message dated 00-12-04 16:20:04 EST, you write:

<<

does everybody feel this? when my bg is starting to rise, I feel really hot,

like hot flashes. >>

No, that's what happens to me when I get hyPOglycemic - like when I hit about

40 I get hot and sweaty. (Haven't done that for a long time tho, thank

goodness!)

[Guest guest]

In a message dated 12/04/2000 8:19:10 PM Eastern Standard Time,

whimsy2@... writes:

<< does everybody feel this? when my bg is starting to rise, I feel really

hot,

like hot flashes. >>

No, that's what happens to me when I get hyPOglycemic - like when I hit

about

40 I get hot and sweaty. (Haven't done that for a long time tho, thank

goodness!) >>

for hypo I get freezing cold

carol

[Guest guest]

In a message dated 12/04/2000 8:19:10 PM Eastern Standard Time,

whimsy2@... writes:

<< does everybody feel this? when my bg is starting to rise, I feel really

hot,

like hot flashes. >>

No, that's what happens to me when I get hyPOglycemic - like when I hit

about

40 I get hot and sweaty. (Haven't done that for a long time tho, thank

goodness!) >>

for hypo I get freezing cold

carol

[Guest guest]

I have a feeling that this is another potential diabetes complication

that should be monitored and I am fairly sure that for me and my wife

it is not yet being done. Our present method is to measure body

temperature whenever the blood glucose response to food intake

departs from the usual pattern - but then the infection has already

taken a hold.

My dear friend ,

I'm so very sorry about all of the problems you and your sweet wife have

been going through. I have also started taking my temperature every time

that I take my blood sugar readings and I record it right along with the

BG's. You're right though. By then there is already an infection working.

Hang in there. I'm still praying for all of our people every day. I'm

still praying for a medical break-through on this old 800 pound gorilla that

Susie refers to.

Love,

Tootie

eGroups Sponsor

Public website for Diabetes International:

http://www.msteri.com/diabetes-info/diabetes_int

[Guest guest]

Ahhh.. here it is (with a mouse):

Loss of Control of Blood Glucose: When a patient stabilized on any

diabetic regimen is

exposed to stress such as fever, trauma, infection, or surgery, a

temporary loss of glycemic

control may occur. At such times, it may be necessary to withhold

metformin HCl and

temporarily administer insulin. Metformin HCl may be reinstituted after

the acute episode is

resolved.

DaveO wrote:

>

> I'm working without a mouse right now so I can't move around as well.

> RxList also says that Glucophage should be discontinued during times of

> infection. I know that they specifically mention the word infection in

> the patient guideline area, but I can't even type in " glucophage "

> because I can't click on the damn window!!!

>

> " s wife was on insulin during her clinic treatment when the

> glucophage was discontinued.

>

> " Susie M. " wrote:

> >

> > Dave O. wrote:

> >

> > << As has indicated (along with the patient insert), taking

> > Glucophage during periods of infection are contraindicated. >>

> >

> > My understanding of it was 's concern for type 2's who don't inject

> > insulin, and type 1's and 2's who do inject insulin but aren't well enough

> > to manage it during times of illness. If they must discontinue Glucophage

> > when ill or hospitalized, what are they to do for a substitute to maintain

> > good control? According to RxList.com, contraindications include: kidney

> > problems, creatinine clearance problems, being in shock, acute heart attacks

> > or heart failure, septicemia, those undergoing radiologic studies, or

> > acidosis.

> >

> > There is a specific warning regarding lactic acidosis. (A rare occurrence -

> > .03 cases per 100 patient-years - but fatal in half those cases.) I think

> > the advice to discontinue Glucophage has to do with the subtleness of

> > symptoms of lactic acidosis: " The onset of lactic acidosis often is subtle,

> > and accompanied only by nonspecific symptoms such as malaise, myalgias,

> > respiratory distress, increasing somnolence and nonspecific abdominal

> > distress. " It could be easy to confuse it with a general state of disease in

> > a patient.

> >

> > RxList.com has this to say regarding surgical procedures: " Metformin HCl

> > therapy should be temporarily suspended for any surgical procedure (except

> > minor procedures not associated with restricted intake of food and fluids)

> > and should be not restarted until the patient's oral intake has resumed and

> > renal function has been evaluated as normal. "

> >

> > It would seem their concern is for hypos, if the patient is not eating

> > regularly, as well as a warning that kidney function should be checked

> > before resuming taking it.

> >

> > Susie

> >

> >

> > Public website for Diabetes International:

> > http://www.msteri.com/diabetes-info/diabetes_int

>

> --

> Dave - 10:37:53 AM

> T2 - 8/98 Glucophage, Precose

> -

> Davors Daily Aphorism:

> Fight Crime: Shoot Back!

Dave - 1:33:41 PM

T2 - 8/98 Glucophage, Precose

-

Davors Daily Aphorism:

I'm the person your mother warned you about.

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