Blood Glucose
 

I've changed my diet over the last two weeks to address the high blood glucose issue. I work night, so my scheduled is opposite to most people.

There is a pattern to my readings. After fasting 8 or more hours my reading is in the 150s. At the end of the day, after eating during the evening, my readings are in the 90s. There are fluctuation, but the patter is there.

Why are my numbers higher after fasting?

-Mark-

Blood glucose is raised by steroids.

Fasting high levels, are provided by the liver in response to the fast. People developing type II diabetes often have slowly increasing fasting levels, with fairly normal daily ones in the beginning.

your A1C level is a better predictor.

There used to be a saying..."you have to eat to keep your glucose under control"...

If you have a monitor, check 1hr after eating and 2 hrs after and see what you get. People with blood sugar problems don't usually do well with fasting.

Also working nights is hard on your body, and messes up your circadian rhythms.

I usually am awakened every two or three hours to urinate during my sleeping periods, due to the Prednisone. I often take a sip of water before returning to sleep, but I could just as easily drink a bit of smoothie during these waking periods. This might eliminate the long fast.

I just sent both my neurologist and my new PCP Email about my blood glucose. I will follow up with a phone all in the afternoon, when I awake.

I am scheduled for two days of IVIG on December 1st and 2nd. My new neurologist wants to infuse every three months going forward.

I read somewhere that only 20 percent of MG patients will have a MG crises. I wonder if that statistic is a correct . I have had two MG crises events. My first MG crises was weathered home alone before I was diagnosed. Since my doctors did not see me in the MG crises state, it was not was not documented. My old PCP and my old neurologists did not hear what I was telling them when I described that first MG crises. It was like it went in one ear and out the other.

The second MG crises was well documented while I was in the hospital, and my new doctors are taking my condition more seriously. The Bible talks about the "lust of the eye," meaning that something is more real when seen. It is one thing to tell a doctor about a MG crises, but it is quite another when he or she see it firsthand. Now they know what can happen.

I've been on 1500 mg of Cellcept since mid-July. I am at the 35 mg of Predsione level for this week and the next, followed by two weeks of 30 mg, etc.

Would you expect my blood glucose levels to go down with the smaller doses of Prednisone?

-Mark-

They may eventually. You will also lose potassium and magnesium on the pred.

The frequent urination may be from the elevated glucose too...both factors.

There is a theory around that all people over 40 develop a degree of insulin resistance too. That means the receptors on the cells don't respond to insulin signals normally and the sugar remains in the serum and eventually spills out into the urine.

Make sure you are drinking enough water, and avoid dehydration too.

My diet has improved since leaving the hospital. I got a wood pellet grill that allows me to make many soft foods that I can manage with limited dental equipment and impaired jaw muscles.

I am well hydrated. I started drinking green tea. I drink 16 ounces of green or herbal tea three times a day. I also have 2 to 4 fluid cups of a chicken broth soup I make from stock from the leftover roasted chicken. I also drink water too.

With the grill I can make smoked fish and other dishes that melts in one's mouth.

http://www.losgatosphoto.com/mg/salmon_mg.jpg
Smoked Wild Coho Salmon

http://www.losgatosphoto.com/mg/ahi_mg.jpg
Smoked Wild Ahi Tuna

http://www.losgatosphoto.com/mg/chick_mg.jpg
Roasted Chicken

http://www.losgatosphoto.com/mg/meatloaf_mg.jpg
Smoked Meatloaf

I made a mistake on the recipe and put the bread crumbs into the egg and spice mixture, and then mixed it into the meat. The recipe called for mixing the bread crumbs directly into the meat. The result of this mistake was a very soft meatloaf, very much like a pureed meal. The meatloaf cook at 225 degrees until the internal temperature reached 165 degrees.

I also take advantage of the convention heat on the grill and make vegetable dishes with a Dutch oven. I put a layer of large carrots at the bottom, and then add 10 sweet yellow onions cut in half. I season with garlic and herbs, and place 4 strips of bacon on top. It cooks at 450 degrees for 2 1/2 hours. The result is spectacular. I make cabbage and other vegetable combinations with the Dutch oven.

I eliminated the sweets and sugar that I started to consume after leaving the hospital. My staple is a smoothie with The Ultimate Meal, white grapes, freshly ground golden flax seeds, imported raw almonds (real raw), ginger root, blue berries (or raspberries, or black berries), few ounces of fruit juice (usually soak almond in juice overnight), kale, broccoli, cabbage, spinach, and water. I blend it in a VitaMix emulsifier, yielding 50 to 60 ounces.

I can reserve 16 ounces of this to consume during my fasting hours.

I have one third of the smoothie with breakfast, including ½ cup of oats (cinnamon and 1 tbls of brown sugar), and a cup of kefir. I have another third at mid-day, and the final third as a nightcap after work.

I also take supplements to mitigate the side effects of the Prednisone and other medications:

• Vitamin C 1000 mg
• Vitimin D3 2000 IU (I work nights and get little sun)
• Fish Oil 2400 MG
• Calcium 1200 MG
• Cinnamon 4000 MG
• Potassium Gluconate 1200 MG
• Turmeric Extract 600 MG
• Ground Flax Seeds
• Ginger Root

-Mark-

Update
 

I tested my blood glucose several times in the last 24 hours:

• 2:00 p.m. 149 -- after a ten-hour fast.
• 8:22 p.m. 100 -- before eating (I was out of strips, so no reading after breakfast).
• 9:40 p.m. 103 -- 1.4 hours after eating.
• 11:00 p.m. 129 -- 1 hours after eating.
• 3:35 a.m. 104 -- after work at home -- no food for 2 or 3 hours.
• 5:00 a.m. 111 -- after night time meds, including Prednisone. I did eat during this period.
• 3:00 p.m. 147 -- had 18 oz of a smooth in three portions at 7:00 a.m., 10:00 a.m., and 11:30 a.m. -- 3 hour fast.

I take the a 35 mg dose of Prednisone with my nighttime medications, an hour before going to bed. I wonder if it is the Prednisone that increases my blood glucose? I could test this by switching the Prednisone to my daytime medications.

-Mark-

Before you do anything else try reducing
The number of smoothie snacks.
Try just one 6oz serving instead of 3.
Your daily numbers are good. One high reading
A day is not going to be damaging.
Keep track of your portions too.
A large portion of protein will be converted
To glucose too but more slowly.

Your food looks really yummy! ;)

I got a 122 reading at 5:00 p.m. before breakfast. I will check an hour after I eat.

One hour after eating: 176

I had a 1/2 cup oats with a tbls of brown sugar and cinnamon , a cup of kefir, and 20 oz of smoothie.

The smoothies are made with 2/3 cup of the Ultimate Meal, raw almonds, ground golden flax seeds, ginger root, broccoli, white grapes, berries, spinach, and kale. I add 2 or 3 ounces of a pineapple juice, and the rest is water.

-Mark-

Mark, There is no way you can tell if you have Pred-induced diabetes or Type I or II without consulting with an endocrinologist.

I disagree that your numbers are not harmful. Yes, it is normal to have somewhat higher blood glucose up to 2 hours after eating. But your body is still having harm done to it. And there remains the possibility of a hypoglycemic drop while you are sleeping, which is dangerous!

I agree about the protein shakes. That is not sufficient protein and they have way too much unopposed sugar in them.

I am quite frustrated with this situation and implore you to consult with an endo without delay.

Annie

Dear Mark,

I agree with Annie. Your numbers are not falling within a normal range. Normal is between 70 and 100 by some guidelines, a little higher by others. Post prandial readings above 140 are not normal either.

You need to see an endocrinologist soon and determine the cause of your levels and treat them appropriately. Even if your levels are being caused by the steroids, you need to address this to prevent damage to your body systems. You may need to take a medication WITH the steroids to prevent the higher glucose levels.

I suggest you get your A1C result and keep track of that.

Here is a link with a chart, showing the relationship to A1C value to average daily blood glucose:

http://healthy-ojas.com/diabetes/a1c-glucose-chart.html

A level of 7.0 and above is typically used to start medications or insulin. But some some doctors use a cut off of 6.5.
There are new studies out, showing that with age, some patients normally show higher A1Cs...and this is racially happening too. With Caucasians having slightly higher normal A1Cs than Hispanics and Blacks. The suggestion therefore is to be more aggressive with the latter, and not to overmedicate the Caucasians. But don't expect all doctors to know this yet.

In drug induced elevations, like from steroids, metformin is typically tried first. This is because it helps block glucose stimulation of the liver by the drug. There are some newer ones too in this category, but they bring more serious potential side effects. Metformin can cause diarrhea, and this is because of its stimulation of serotonin release in the GI tract.

Your doctor may order a glucose tolerance test, and if that happens ask for the 4 or 5 hr one (the two hour is not very useful). The values of acceptability are based on pure glucose consumption, and not food. So the levels --cut off are not really comparable to food.

A 1 hr postprandial when high at every meal, will raise the A1C. As will an all day high in the ranges shown on the chart. High one hour readings after eating are 140-200 typically after a non sugar meal. Fructose from fruit is slower in raising glucose than sucrose. But it will raise, only much slower.

So you should check with your doctor about your readings on fasting in the 140 range, get that A1C value, and start reading up on the topic. It is very complicated however, and doctors do vary in how they manage patients taking prednisone in high doses.

And remember eating huge portions of protein, will have the same effect on blood sugar as carbs--only the timing is slower to measure. So watch your portion sizes. Eating whole fruit and veggies, slows the absorption of their carb content because of the fiber present. Juicing, removes the fiber, and the carbs then get absorbed faster. Also having some good fats present slows the stomach emptying and then evens out the carb factor in raising blood sugar. But this does not have a bearing on steroid users where the excess glucose is coming from the liver and not food.

Here are the test my new PCP ordered. I will see him on December 16th. I will see my neurologist on December 9th. My IVIG was moved to December 2nd and 3rd.

Here are the test my PCP ordered:

• TSH - measures the amount of thyroid stimulating hormone
• PSA - measures the blood level of PSA, a protein that is produced by the prostate gland
• B12 Hemoglobin A1C - diagnose type 1 and type 2 diabetes
• Complete Metabolic Panel (CMP) - overall picture of the body's chemical balance and metabolism
• Lipid Panel - check cholesterol levels
• Vitamin D

I could do the test now, instead of waiting. At this point, would another two weeks make a big difference? I had planned to have the blood test a week before my December 9th appointment with my neurologist.

-Mark-

I had the two hour test earlier in the year. I had to stay at the testing area for the two hours. If you do the longer test, do they make you stay there the whole time?

-Mark-

Yes. You stay the whole time. Moving around physically skews the insulin and glucose readings. Activity tends to raise glucose levels, especially in those with pre-diabetic or diabetic syndromes. The longer test shows more, also.

This link shows examples of various responses to the long test.
There used to be university sponsored sites, but they tend to change their addresses or disappear. This person copied some of that to his own site.
http://www.rajeun.net/gtt.html

These graphs and tables show only response to pure glucose after a long fast. The numbers are not really applicable to food.(which takes more time to break down and enter the blood).

Also, home monitors are not 100% reliable. Then tend to report + and -10% .. so they cannot be compared to actual blood drawn in larger quantities like in the GTT.

Dear Mark,

The blood tests ordered are pretty standard and will give your physician a good overall picture and will be useful in deciding if and what other testing might be needed.

Hi Mark,

I have only read this thread so I may be missing a lot of other pertinent info but I think having a lengthy glucose tolerance test at this point in time is premature. Personally, I would wait and see the results from the basic testing you are to have done and then maybe consider some additional testing if the results indicate the need.

Your blood sugar levels are not normal but they are certainly not outrageous either. BUT, the sooner you get the abnormal variations under control, the better off you will be. Waiting until they are BAD is not in your best interest. Damage can be done to body systems even at levels that are not terrifically above normal.

It has already been mentioned that steroids raise blood sugar levels. This may be the entire cause of your abnormal levels OR it may be more complicated. It is not uncommon for people needing steroids to take a medicine to control the effects on the blood sugar levels.

I started to suspect the accuracy of my inexpensive CVS glucose tester. Last night I had a 159 reading when I would have expected a lower figure. I did another test and got 132, and then 136, one and two minutes later. I did notice that the sample did not fully fill the window on the high figure, but not enough to produce an error message.

Are the more expensive testers more reliable?

Here is my typical daily intake of food and drink:

4:00 to 5:00 p.m -- First meal around -- 16 ounces of smoothie, 1/2 cup oats with tbsp brown sugar and cinnamon, and a cup of kefir (your suggesting from earlier this year).

I take five thermos bottles with me to work, one large one with 4 cups of home made chicken soup, one with 16 ounces of smoothie, and three with green and herbal tea.

I also take 1 1/2 cup of meat (roasted chicken, smoked salmon or tuna, or smoked meatloaf). I also have 2 cups of vegetables from the Dutch oven, carrots, onions, cabbage, or broccoli (the heavy stocks).

I have a 3/4 cup garnish with salsa, avocado, and Philadelphia cheese. I sometime I have a 1/2 cup of baked beans, potatoes, or hummus.

I usually have the above in to or more settings through the night. If I eat late I may have it in one setting, but this does not happen very often. I often graze on my working days.

After work I will have the reaming smoothie, and sometimes similar food mentioned above. My appetite is very strong right now.

I also have canned fish and other snacks on hand, sardines, boneless herring fillets, Vienna sausages, and Bumble Bee Snacks (tuna and chicken). I only have a few of these a week.

-Mark-

All home monitors may have drawbacks:

This link I give some information on the two major chemical systems used in common monitors:

http://neurotalk.psychcentral.com/post754069-38.html

The One Touch system is chemically the most accurate, unless something new has come along. I believe they have new strips out today, which I am not yet familiar with.

The link on the post I am quoting is very helpful, so do check it out.

I edited the broken link out of that link above and added another.
You can Google for more-- keyword : "Most accurate blood glucose meters"

This field continues to change and more and more meter types appear yearly.

Also do not consume high dose Vit C before glucose testing. It affects certain chemical systems some of the hospitals use and some home meters.

I wonder if the longer test can be done at the same time that I am being infused. I will be there for 7 hours each day.

-Mark-

You should ask... I have no idea about the parameters of IVIG infusions, and the food allowances during them, etc.

Dear Mark,

The accuracy of home meter devices is not just dependent upon the meter but many other factors will give erroneous results. Just to list a few things that can alter results:
where you test (finger sticks are more accurate than other body parts)
Too much blood on strip
Too little blood on strip
Cleanliness of site of stick
If you stick right after washing hands or using alcohol wipe
Site must be dry and clean
Age of strip (be sure they are not expired)
Age of the batteries in your meter

I am sure there are other things not in my list that can affect a test result.

I, too, have tested and received an "unexpected" result, immediately re-tested twice again and gotten a different result on the subsequent tests. This does happen on some rare occasions. My experience was probably due to some soap residue remaining after washing my hands before testing. Even if I have just washed my hands, I still use a alcohol wipe and allow time for it to dry completely before testing and that seems to provide accurate results each time.

How I calibrate and verify the accuracy of my meter........... I have blood work every 90 days so either right before or immediately following having my blood drawn at a lab, I do my test with my meter. The last blood draw two weeks ago showed the lab reading as 119 and my meter had given me a result of 118. That was close enough for me to judge the accuracy of my meter. I do this every time I have my blood drawn and each time it is never more than one point different.

You certainly did the right thing by re-testing when you get a result that is not in the realm of your expectations.

It is not uncommon, however, for several tests just moments apart to be a little different from each other but a large difference indicates that something is wrong with the test result. Example: You test and get a 158. You test again one minute later and get a 122. You test a third time, again just a minute later and get a 124. You can believe the second and third test and eliminate the 158 as erroneous. Blood sugar varies from moment to moment throughout the day with everyone, not just people having trouble with blood sugar levels. Just like with blood pressure, it changes from moment to moment but with minor variations. Any large variation in close time proximity is suspect.

Hope some of this helps and is not just a repetition of things you already know.

I may get a One Touch after I see my doctor. The meter is relatively inexpensive, but the test strips are $85 for 50 strips, compared to CVS house brand that sell for $12 for 50 strips. My pharmacist said that one can get a prescription for the strips. You can find the strips on eBay for 50 percent less than the pharmacy prices.

-Mark-

The cost
 

Hi Mark,

You are so correct. The cost of a meter is not the big expense, it is the cost of the test strips. A lot of manufacturers will give you the meter for FREE because you will then be using their strips.

Be sure to get a prescription for your supplies, especially the test strips. No one told me initially that a prescription would reduce my cost. When I was told by my doctor that I needed to get a meter and test daily, he did not tell me anything else nor did he mention or give me a prescription. I went and bought a meter and strips paying FULL price for the supplies. This went on for about a year and then while standing in line, a customer behind me heard the astronomical price I was paying as I checked out. She told me that if I had a prescription the price would be greatly reduced.

Once I obtained a script for my test strips, my out of pocket expense each time I purchased strips was reduced about $100. My cost was then $25 per box of 100 strips. With the new insurance I have as of this past year, the exact same strips now cost me $4.99 each box of 100 strips.

I went from paying over $120 per box to now basically $5 per box of 100.

I am using a basic Contour meter and strips. Not the newer fancy kind with the frills, just a basic meter and I love it. It has been extremely accurate.

To get beyond my long winded tale, my point is get a prescription when you see the doctor.

I am so thankful for the woman in the check-out line that gave me that advice.

I also changed doctors for several reasons but one of them was the fact that he did not inform me nor give me a prescription. He just said TEST daily. He knew I was new to all this but couldn't take one moment to write a prescription for me??? That was nearly 8 years ago.

There are a lot of other places that you can get discounts on the strips. Check out the manufacturer online and other diabetic supply places online. I save a lot on my insulin needles by purchasing them online from a diabetes supply company.

Best wishes to you in getting your levels under control no matter what the cause of the variations.

PS My first meter was an AccuCheck with the spool or cartridge test strips. They eliminated the need to touch test strips. Each drop in cartridge had 17 strips if I remember correctly. The pro was nothing to contaminate the strip by handling it. The con was if something went wrong with the cartridge near the beginning of use, it would not advance properly for you to use the remaining strips in the spool. They were very pricey and if you had to discard and waste 15 of 17 strips, it was a real financial hardship.

Selecting a meter is a personal choice. Check out the advantages and disadvantages of the various types on the market and then make your decision. Price is just one factor in making a choice but it is a BIG factor since you have to consider not the meter cost but the cost of the strips.

There are places online that will list and compare almost all of the ones on the market for your comparison and help you decide what one will work best for you.

After looking, I like one of the Accu-Chek systems.

https://www.accu-chek.com/us/

I will get one as soon as I get a prescription.

I believe it is the Prednisone that is causing the elevated reading during my sleeping hours (fasting). I took my nighttime medications, including Prednisone, at 5:00 a.m. I did not go to sleep as usual, but had to stay up until 9:00 a.m. to run some errands.

Here are my readings:

6:00 a.m. - 153 -- 1 hour after Prednisone
9:30 a.m. - 225 -- 3 1/2 hours after Prednisone
9:32 a.m. - 232
5:30 p.m. - 93 -- after awaking - 10 hour fast
5:32 p.m. - 90

Usually, I awake around 2:00 p.m., at which time my reading has been consistently around 150.

I typically get a reading in the low 100s or 90s three hours after eating during my waking hours. One hour after eating, it is usually 130.


-Mark-