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Main Forums => Living With HIV => Topic started by: Valmont on May 09, 2013, 03:43:38 pm

Title: Sugar matters
Post by: Valmont on May 09, 2013, 03:43:38 pm
Ok, so yesterday, I´ve been to my appointment with the doc and I´m a little bit worried about what he told me in regard to my sugar, basically he said that from now I will have to avoid any sugar sources, it is not so hight but at the limit...  I also have osteopenia (- 1,2 in the forearm) and had problems with bones these 3 last years (some low gravity fractures, last was a rib at the beginning of the year), I´m surprised because I´ve always practiced a lot of sport...

I´m only around 8 months on meds (Tenofovir / Entricitabina / Efavirenz, what is the same as ATRIPLA), meds can generate these problems so soon?

My last results sugar were (in mg/dL):
March ´13: 94,5  / post prandial 2 h (75 g glucosa): 68,6
Dic ´12: 108 (Alcaline phophatase was 121)
May ´12: 95 (before starting HAART)
Dic ´11: 83  (before starting HAART)

My CD4 and VL are actualized above.

Everything else is normal...  Despite meds are working well, I´ve been gradually loosing weight last months (70 kg for 1,85 m, before my diagnostic, I was always above 75 kg, with a peak at 82 kg in 2009), no diarrheas to report.


Are these problem with sugar frequents with ATRIPLA?  What do you think of my doc decision in regard to stop consumming sugar, he says I´m exposed to develop diabet in the future, what do you think of it?  I have great problem actually with stress, could this afect significally my results?

I´m going to make some more extra exams by my own, do you sugest anything?

Thank you for your feedback...
Title: Re: Sugar matters
Post by: bocker3 on May 09, 2013, 08:38:10 pm
If I am reading your post properly (it's a little tough to follow) - I don't see anything abnormal in your glucose levels.  At least not from any reference ranges that I can find.  Now, technically, your lab should create their ranges based on their normal population -- in practice, they rarely do that for most tests.

Glucose less than 100-110 is not really concerning.

2hr Post Prandial / Glucose challenge -- I am finding less 145 mg/Dl is OK

of course, I am NOT your doctor -- but you might want to ask him what reference ranges are being used and why 1 test would cause such a dramatic reaction from him/her.

Mike
Title: Re: Sugar matters
Post by: friskyguy on May 09, 2013, 11:42:14 pm
Hi there

A better sugar test is the HBA1c which tells you what your average blood sugar levels have been over the previous 3 months....much better than a one sugar test at one particular point in time. Diabetics use this standard blood test (quarterly-every 3 months) as a guide of their longer term blood sugar control over time. Never heard that Atripla affects sugar levels.

Re the osteopenia, go and have your VitD3 checked. If you live in the Northern hemisphere and from a high lattitude you may be low for this particularly having experienced a long and cold winter. Also check your calcium levels and continue to do weight bearing exercise. Bone is living and needs continuous attention.

And stress can do crazy things to one's body......try good sex or other exercise to release the endorphins  :)
Title: Re: Sugar matters
Post by: LiveWithIt on May 10, 2013, 02:24:03 am
Were you fasting the for 8 hours before your test?
Title: Re: Sugar matters
Post by: Theyer on May 10, 2013, 05:59:27 am
Hello Val , good to see your Posting. I will leave the medical comments to those able to make them, however Type 2 diabetes which is what I think your Doc is concerned about is a bit more than just avoiding the sugar , plenty off info on the net.

Are you still playing Rugby ? being in a sport mad family I am used to the complications arising out off being super healthy. My bro has just had Knee surgery, niece nursing ankle injury and still completed Paris marathon and surprise surprise still has a problem with her ankle.  Nephew who does extreme mountain bike racing surprisingly is OK.

Are you taking anything to strengthen the bones?
Hope the rest off life is good
michael
Title: Re: Sugar matters
Post by: BT65 on May 10, 2013, 07:44:35 am
Hi there

A better sugar test is the HBA1c which tells you what your average blood sugar levels have been over the previous 3 months....much better than a one sugar test at one particular point in time. Diabetics use this standard blood test (quarterly-every 3 months) as a guide of their longer term blood sugar control over time. Never heard that Atripla affects sugar levels.

It's actually the A1C, I'm diabetic and have mine checked only every 6 months.  My doctor stated it will tell him the levels for the past 6 months.

As far as leaving all sugar alone, well, I don't even do that and I"m on Insulin.  I do watch how much I take in and try to keep something else out of the meal, namely carbs, if I'm going to eat dessert (and a small portion of dessert).  I do agree with Mike, your glucose doesn't look terrible.  I would explore this more, your doctor telling you your sugar is abnormal.
Title: Re: Sugar matters
Post by: bocker3 on May 10, 2013, 07:54:27 am
HbA1C and A1C are the same test -- it's actually Glycated Hemoglobin that is being tested.  Basically what amount of your hemoglobin is coated with glucose.

Prior to worrying about diabetes - I still think the OP needs to talk to the doctor about why there is such concerns over these results.  Unless reference ranges are very different where he lives, I'm reading his results as well within expected range.  Perhaps I'm missing something -- maybe the units aren't right or something -- but I am not understanding why these results are causing any concern.  Of course, the fact that a Post Prandial was ordered, suggests to me that something was seen previously as well -- post-prandial are rarely ordered without some "concerned" glucose results.

Mike
Title: Re: Sugar matters
Post by: Valmont on May 12, 2013, 11:38:32 am
Thank a lot everybody and sorry to answer so late...

Glucemy has been tested after fasting 8 hours...  Maximum normal range is to 100-110 mg/dL, depending of the lab.

Like you, I was thinking that my sugar results were not so bad, but I asked a second HIV doc opinion here and both told me to stop sugar, personnally and in regard to what I read, I`m also surprised but what my docs told me.  They told me they want to protect myself in regard to diabete (incidence is quite high here in general population and particularly in HIV infected people, they talked to me about a proportion of 30% of people with that kind of problem here after 5 years of diagnostic, this seemed very high, but in another way, many people here have problem with their lifestyle/alimentation I don`t have), maybe the national guideline they have and they have to follow is very conservative, I don`t know...  By the way, this has generated me a lot of anxiety because I did not felt concerned (yet) with that kind of matter and because of the way docs talked to me...

My girlfriend is also a doc and she desagrees but she doesn`t know a lot in regard to HIV and our matters, she recommanded me to do the Post-Prandial test for tranquility.  These days, she also recommanded me to do HBA1c test and I will do it next week, definitively I think this is a good advise...

If you have some extra info based on fact, it will help me, particularlly talking with docs, here, they are quite orthodox and you have to be really ready to start a discussion with them, the doctor IS the doctor !!!...

In regard to vit D, here these tests are expensive, I started taking 200 UI a day (with Cacium citrat, 1.500 mg).  I live in Ecuador, so I should have problem with the sun, however, I lived a very long time in Europe.  I know that here people don`t have a lot of problem with they bones density and people from northen countries could have normally a lighter bone density because of latitude, I don`t know if the range are local, my doc told me that it was too early to see this problems with meds and I could have a problem with my alimentation and life style, I`m also surprised, I`ve always eat well and never smoked, used drugs, avoided excess of alcohol, but yes, I`m exposed to high stress for years (and I know this generate problem to me to gain weight) and good sex, mmmm what to say, I don`t have bad sex, but it is difficult to have good sex, but reading this forum, I think I`m in the lucky people here, many of us just don`t have sexual life...



Hi Mickael, nice to read you, thanks for your words, I hope you are also ok...  Well, I was playing rugby till april but I`m actually injured with a rib, I`m thinking of stopping, but this time not for HIV but more for age concern, the level has increased a lot and I`m affraid of severe injuries, it would be a good moment to think in a quieter activity, the decision will be mine, rugby has given me a lot and helped me so much particularlly these two years from my diagnostic... And mmmmm, my life is quite chaotic right now, but I expect it will be better next months...
Title: Re: Sugar matters
Post by: bocker3 on May 12, 2013, 02:49:54 pm
I would tell (not ask) your doctors that, given all the evidence you are finding, your glucose is in the normal range, both the fasting and the post-prandial.  Frankly, I don't see any reason to "stop sugar" -- while it is probably a good idea for anyone to ensure moderation, this "stop" order seems excessive and unnecessary.  I suppose if you are overweight, or have a family history of diabetes it might make sense to be extra vigilant, but honestly, these docs need to give you a more detailed understanding on why they are (IMO) over-reacting to some hypothetical situation.  Lab tests are done to see where you are -- you are exactly where your should be, in regards to glucose levels.  This says, to me, that your body is doing what it is supposed to do in this area.  The HBA1C seems wholly unnecessary -- but if that comes back normal, as I would suspect it will -- you really seem to have nothing going on to be concerned about.  Unless (here's my legal fine print) your doctor has some additional information that is not being shared.

Mike
Title: Re: Sugar matters
Post by: Theyer on May 12, 2013, 05:42:17 pm
Hi Val

In poorer counties the Dr is next to God , you can tell um stuff and they can kick you out and not see you again. Simple .

Val , bear with me slight temp at the moment.

From family discussions , there is growing body off off thought ----how much evidence don,t know,------- that the line between extreme fitness and illness is very thin. Contact sports and osteo is an issue also.

Brother is on various older guys get drunk after discussing younger guys sport needs committees , well at least one with the UK armed forces , so I will ask him.


stop bragging about sex its differcult for us born again virgins.

Same lady Dr from final breakup days with wife?

Keep on keeping on Val
Michael

added-----Came back to add how fantastic that you might be stopping the rugby on YOUR terms , given the history off it all. Well done you and team mates.
Title: Re: Sugar matters
Post by: Valmont on May 13, 2013, 03:03:21 pm
Hi Mike,

Well, 70-72 kg for 1,85 m., I´m not overweighted I think, I would be better with some more weight more...  Also, I also don´t have any antecedents in my familly in regard to sugar matters...

Despite I think it can be unnecessary, I´ve done some extra tests in regard to my sugar metabolism this morning, we will see what is coming back... 

In regard to my doc, here, we do labs outside, so it is impossible for my doc having some information in regard to my health I don´t have because I just give it to him each time I see him...  and Michael is right, Docs here seems surprised when you make many questions to them, it is like you don´t trust when you just want to undestand some more about your own health...  I´m looking for the actual HIV guideline, but don´t find it...  In regard to my health, I feel really, really well, and much more better in years, without sport excesses ; I´m not interested in exagereting fittness...
Title: Re: Sugar matters
Post by: Valmont on May 14, 2013, 11:13:24 am
So here are my last glycemy results and the ranges:

I´ve done a 2 hours glycemy courbe (taking 200 g. of glucosa):
Glucosa (after fasting 8 hours): 93.7 mg% (normal range 65 - 100)
Glucosa 30´: 164.6
Glucosa 60´: 98.8
Glucosa 120´: 38.6

Hemoglobina Glicosilada: 5,9% (diabetic stable: 4,5 - 7,0 / diabetic with bad control: more than 8,5%)

For me, everything seems ok, I know you´re not my doctor (and I´not too), but just want your feedback in regard to your experience. 

Title: Re: Sugar matters
Post by: bocker3 on May 14, 2013, 05:34:26 pm
Well, the only feedback, based on experience, that I can give is the following:

I worked in clinical labs for many years, based on your results, I would be reporting out all your tests as normal.  I only gave 100 g of glucose for the test -- your results with 200 g. still fall in to the normal range.

I personally had a HBA1C a few years back -- received a 5.7%, with a reference range of <6.6%.  Doc was happy that all was OK.

I think your doc is having much ado about nothing.

Personally, unless your doc has something else in his/her mind, I think you are good to go -- no need to "stop sugar" (which is a little bit odd to me anyway, as sugar isn't the only thing converted to glucose in the body -- as Betty pointed out -- carbs are important in the management of diabetes.).

Mike
Title: Re: Sugar matters
Post by: Valmont on May 14, 2013, 05:41:58 pm
Thank you Mike, I appreciate.
Title: Re: Sugar matters
Post by: Valmont on May 30, 2013, 09:13:49 pm
So I´ve done another sugar test, 8 hours without food and it come back at 85.  Hemoglobina Glicosilada: 5,5%

I´m about to get a second opinión with another HIV specialist, but I don´t think I have any problema with sugar...  Moreother, before my diagnostic, my glycemy numbers were around 90... Mmmmm, I think I freaked out a lot just because of my doc`s attitude, but well I reduced -not cut at all- food sugar apports...

I`m also really really happy because my CD 4 went back at 945, VL is UN ; wow, I never could have dreamed they could increase so much in a so short time on meds, this makes me feel very confortable...
Title: Re: Sugar matters
Post by: bocker3 on May 30, 2013, 10:16:01 pm
If you go for a second opinion, please bring all your lab results.  You do not need to do any more glucose related testing, aside from whatever the normal cadence is for testing where you live.
To continue with this excessive testing seems beyond wasteful.  Whether you are paying or insurance or the government, there is a lot of waste happening simply because some doctor appears to be concerned over what might happen down the road due to your being HIV+ and/or on HAART.  Please do no let this doctor continue to cause you concern -- get that second opinion.  Hopefully, this doctor will look at what actually is and not what might be -- if the stars align just so......

Congrats on the CD4 result!

Mike
Title: Re: Sugar matters
Post by: Valmont on May 31, 2013, 12:18:04 am
Thank you Mike, I agree, this last test was part of my normal blood routine, each 4 months, so sugar has been tested, I always bring all my lab historial with me when I go to a doc... 

In regard to the second doc opinion, it is not just in regard with sugar but also other matter I have and the doc I have from the public system doc manage directly because it is not on the guideline such as light problems with density bone and prescription of vit D, weight ; I think my health is an invertion and I don`t care about putting some extra USD in it with something so serious like HIV or these kind of problems...
Title: Re: Sugar matters
Post by: mpositive on May 31, 2013, 11:42:46 am
Coming from a doctor, to "stop sugar"and leave it at that seems to me to be a very poorly communicated suggestion.  Especially what we know today.
Processed sugar, would always be best to avoid as much as possible.  In fact, never having processed sugar will only do you good.  There is no need for it in that form.
For diabetes concerns, for sure you should "try" to cut out all forms of white flour, in fact, no bread, pasta, white potatoes and obviously cakes and such. 
Many would argue and say "eat whole wheat products instead".  If you are determined to have it, then sure, it is a better option.  But if possible to avoid, you will be better off for it.
What you should understand is that carbs are best eaten when they come from a fibrous food.  This is why vegetable carbs are superior to all others. 
This is really the crux of it all.  However, we are human and staying completely away from a food or ingredient is never easy, do the best you can.  If everyone ate like a diabetic should, we would all be healthier...for the most part.
Here is a fun fact - did you know that Sweet Potato is not from the potato family at all?  In fact, it is a very healthy food for all to enjoy.
:)
Stay healthy folks and ALWAYS smile!  :) :) :)
Title: Re: Sugar matters
Post by: Valmont on June 02, 2013, 04:57:54 pm
Thank you "m"...

Well for now and in regard to my result, I don´t have diabet problems, but you´re right, I also think my doc management of these matters have been very poor and not only sugar should have to be concerned...  I don´t have access to a nutricional specialist that would be much better in my case (despite my good numbers, I´m still loosing weight and I know I have problem with food), anyway, I think I have a really good and healthy physical condition and I´m interested in keeping it the more I can ; also, I like to understand what is happening to me...

What I´m not completely clear about is the evolution in future with my med regime in regard to sugar matters.  It is clear that cutting sugar won´t help me earning more weight and I will have to think again about my calories/joules apports, but I what to be sure if it worth it...  I also don´t really understand if diabete apparition can be prevented by cutting or decreasing sugar and other carbohydrate that use insulin ways.

Title: Re: Sugar matters
Post by: Valmont on June 06, 2013, 07:47:48 pm
So I´ve been right to go to the other doc, she has much more experience than the doctor I usually see and made me feel good in regard with these "sugar matter", for her, there are no reasons to cut it completelly in regard to my numbers she considers normal, she recommanded me to have an hyperproteic diet and to exercitate (I do both for a long time).  In her opinión, she does not see the need for me to see a doc for the next 6 months with my numbers, mmm, I feel greater now !!!
Title: Re: Sugar matters
Post by: bocker3 on June 06, 2013, 09:09:50 pm
Great news Valmont --- now just go on and enjoy life!!

Mike