CPAP Induced Aerophagia Causes Elevated Blood Glucose Levels

[roster]

........
I read Dr. Bernsteins Diabetes Solutuion book (recommended reading) which discusses what Den is talking about "dawn phenomenon".

Have you tried eliminating carbs ... a ketogenic diet (< 50 g carbs per day) ... just to see what happens?

DS,

I am changing some things and will see if the BG level responds. I started low carb this week. Not counting precisely, but I estimate 100 to 150 carbs per day. Typical meal is a chunk of lean protein (lean beef, grilled salmon fillet, canned tuna, smoked turkey or ham, egg, chicken breast filet) plus fat (olive oil, nuts, cheese), then a palm size serving of vegetables or occassionally fruit. Between some meals I might have a snack of a few nuts or a tiny amount of fruit. This is a huge reduction for me as I have always eaten large meals and large snacks. Like for just one meal, a full rack of ribs with a sugarey sauce, thick cut fries, cole slaw with sugar in the recipe, hush puppies, dessert! It was fun while it lasted but the abuse is showing up in my lipid profile and BG levels.

Even though I am slim (BMI 23) and very active, I know there is too much stomach fat which is the most dangerous kind.

The first few days of low carb were rough but now I am getting confidence. There is a long-held psychological problem for me: I fear if I don't eat a lot, I won't have enough energy to make it to the next meal. So the first few days I had to prove to myself that survival on fewer carbs/calories is not only possible but also better. It is surprising that I am feeling quite well and able with so much less food. This afternoon is a heavy day for free-weight lifting. That always gives me a ravenous appetite for 36 hours so this may be a challenge to stick to the carb reduction.

I borrowed the Bernstein book on your recommendation and will check what he says about dawn phenomenon. Den had previously given me the reference on the ADA site.

I am staying away from an A1C test at the moment because I don't want to get a diabetes diagnosis. I need to firm up my future health insurance plans before I take that on.

If BG doesn't improve I will try the ketogenic route. How many days should it take to show results?

Thanks to everyone who responded,

[Nexus]

I've made an interesting discovery myself over the weekend! I use an apaps by resmed and that seems to be doing well, but I've had attacks of gas that have occurred that have grown in intensity since apaps use. This weekend I ate some raisins and had an alarming gas attack as soon as I walked outside into the cold, it was like air was being generated in my stomach to low to go up and to high to go down. Felt like a ballon filling up on the inside. 2 weeks ago, I had a similar attack after some grapes.....commonality grapes and raisins and cold temperature. Both attacks would make you think there is something wrong with your heart..... The first time went to the hospital, I thought it was a fluid build up..(CHF sufferer from not using CPAPs a long time ago) this time I took ginger and a little ginger ale and relief.. along with passing of gas. Now I'm realizing that smaller meals, avoidance of gas inducing foods (grape like acids) and probably an apaps adjustment of the range of pressure are what is needed, and to eat slower..ie no rushed digestion. I found this place based on a google search indirectly of gas caused by grapes.

Nex

[gasparama]

Rooster, I read a lot of information about low carb eating. A book that I'm reading presently is by Dr. James Carlson and it titled "Genocide". In it, he explains how our bodies must have sugar to make cholesterol. The more sugar that you have floating around in your system, the easier it is to have elevated blood lipids. This book is a great read. It addresses a lot more than just diabetes. I think that even though you may not have to fight the battle of the bulge, you are wise to start watching your carb intake.

[Captain_Midnight]

Rooster, I'm quite impressed with the association of the info you heard about regarding gastric banding and BG levels, and its potential application that to aerophagia.

It's altogether possible that it could be one of the many reasons for elevated BG. Needed are in vitro and in vivo studies, involving lots of replicates.

I'll echo what D.S. says about carbs. My BG has declined modestly w xPAP, but I keep my carbos mostly in check. Not ketogenically in my case, but at or lower than 40 percetnt of my total caloric intake. (It inches up during the Christmas holidays, but then I get it back down.)

I used to work next to a diabetic who, by observing her bg levels and noting what she ate, steadily lowerd carbs to the point at which her bg levels normalized, with no meds. She's still diabetic, but her bg levels remain good (and she weighs about half of what she d formerly.)

Good work, keep on keeping on!


I

[Jason S.]

Here's my $ 0.02. It may not be worth that much.

1. I don't believe aerophagia increases the size of the stomach. It increases the amount of air in the stomach. In any case, the increase is temporary. the body naturally expels all the gas.

2. You tied your increase in blood glucose to aerophagia, as a negative side effect of CPAP, but disregarded it might just be a side affect of using CPAP.

[roster]

Here's my $ 0.02. It may not be worth that much.

1. I don't believe aerophagia increases the size of the stomach. It increases the amount of air in the stomach. In any case, the increase is temporary. the body naturally expels all the gas.
...........

Jason, I can show you that. If I set the machine at the prescribed 19 cm, my stomach will actually blow up like a balloon to the point the enlargement of the belly is visible. The distension can also be felt with the hand. Now if you are talking about the actual mass of the stomach itself, I think you are right.

........ You tied your increase in blood glucose to aerophagia, as a negative side effect of CPAP, but disregarded it might just be a side affect of using CPAP.

I did not disregard that it might be a side effect of using CPAP, however, this is contrary to studies that show using CPAP lowers BG levels. For example, http://www.medpagetoday.com/searchPlus. ... Fiqiwkh1b6
It is also contrary to anecdotal evidence in this thread and elsewhere in the forum about people seeing a decline in BG levels after starting CPAP.

But even if I am completely wrong, the point that started this discussion is still amazing me:

.......... He talked about patients with hypertension and/or type 2 diabetes and reports that the surgery is curing both of these conditions.

Now here is the amazing part! The surgeon claims that after the surgery the patients do not have to wait for the weight loss to cure hypertension and type 2 diabetes. Both blood pressure and blood glucose levels are normal the night the patients go home from the surgery. He says it is not known why the sudden cure, but they suspect it has something to do with an immediate change in hormone secretion.

..........

I wonder if this is true? Remember, I trust doctors but always feel the need to verify what they are saying. Scratch that. I can't be nice; hell no I don't trust them and will question everything they say.

[DreamStalker]

The digestive system is often considered the second brain because of the density of nerve cells that make up the enteric nervous system. It controls many of the most powerful hormones of the body … including the ones that regulate blood glucose. I believe I read somewhere that a large meal causing the stomach to expand will cause the release of additional levels of insulin into the blood system (even before BG levels rise) in an effort to preemptively mitigate the expected WMDs of the meal. Our metabolic systems are extremely efficient and able to make use of every bit of nutrient energy that we consume (hence our obesity epidemic). Not sure how aerophagia would increase BG levels and I would think maybe it would help reduce BG levels rather than increase BG levels by preemptively releasing insulin into the blood system.

As for the bariatric surgery patients, depending on the type of bariatric surgery, if they bypass the duodenum (upper part of the small intestine) … then I could see how that would lead to lower BG levels since the duodenum is the most efficient part of the digestive system for extracting carbohydrates which are “quickly” and easily converted into blood glucose within the duodenum. Removing excess BG would then in turn help reduce hypertension.

I still think Mr. Rooster’s high post prandial BG levels are due to glucose intolerance and could more easily be regulated by permanently changing over to a low to very low carb diet. While working out does indeed raise the need for greater amounts of carbs, timing is very important (again due to efficiency of the duodenum). Make sure that any carb consumption is followed by intense resistance training (like weight lifting) within an hour of ingesting the carbs and only consume enough carbs to get you through the workout and post workout drops in BG levels (which causes your ravenous appetite). This approach is called a targeted ketogenic diet which is basically a carb-free diet except for very short periods targeted at getting you through high intensity physical activities.

I sure do miss my french fries and potato chips more than any other type of carb.

[jessicasteven]

Not sure if this question belongs here in these forums or not, but here it goes.

For the past few months I've been using an Easy Pro Plus meter, which is pretty cheap at Target (<$10) and the strips are equally as inexpensive (<$20 for 50!). My doctor/nurse has always said they'd give me a meter and see if my insurance will cover the costs of the lancets/strips, so I decided to give it a go. The wife picked up a meter for me and its the Bayer Contour.

Now the issues I'm having are this (and I'm totally frustrated). I decided to do a check on both meters and with the same drop of blood I got 2 decidedly different readings. Before dinner I checked and with the Easy Pro Plus my reading was 151. With the Bayer it was 96!! Can it really be that far off? So I decided to check the expiration of the strips and they don't expire for another year. I did a Solution Control test on the Bayer and it registered within normal parameters (I did a test on the Easy Pro Plus, but it went crazy with a 554 reading, but the solution I used was a Bayer solution...does it matter).

Does anyone else have this type of varying degree of readings? Any suggestions on which one to believe and/or solutions? Any similar experiences with either the Bayer Contour or the Easy Pro Plus? Thanks for listening.

[john_dozer]

I'm familiar with that from my mom. Two machines should be a lot closer together. Maybe off 10 pts or less. Now handling the blood can matter. My mother was swabbing her fingertip with alcohol and not letting it dry completely. One of her meters gave her inconsistent readings when she did that. Blood that too old can give bad readings too.

And I think the control solution may need to be from the same manufacturer because I think some meters need to be told they are being used on control fluid.

Also some meters need to be told a number that corresponds to a particular batch of strips so it can calibrate itself properly while others auto detect or use a chip you insert.

[JoyD.]

Re. high protein diets . . . no need to limit non-starchy veggies which are so healthy.

This probably goes without saying . . . but I'll add my "nutritionist" 2 cents anyway . . . just in case. What we should aim for is avoiding the BAD carbs and the BAD fats. What we want to consume are the GOOD carbs & fats. Remember, spinach, cauliflower, green beans, etc are ALL carbs . . . and they contain valuable antioxidants. It's the starchy carbs (potatoes, pasta, rice, breads), white flour, & simple sugars that we want to reduce. Likewise, olive oil & other monosaturated fats are valuable fats.

An excellent & healthy diet is the South Beach Diet . . . which "starts out" (first 2 weeks) with high protein & NO starchy carbs or sweets (not even fruits which contain the simple sugar fructose). This breaks the "craving" for sugar & bad carbs). Besides breaking "carb cravings", one early result of the diet is reducing stomach fat (it's the starchy carbs & simple sugars that contribute most to stomach fat). I'm always amazed each time I restart the SBD, how well this works! By week three you are permitted to begin adding fruits and other healthy foods. The South Beach Diet is a "long term" way of eating that you can live with. . . whenever you blow it for a few days you can always resume the first two weeks to get back on track.

[DreamStalker]

Re. high protein diets . . . no need to limit non-starchy veggies which are so healthy.

This probably goes without saying . . . but I'll add my "nutritionist" 2 cents anyway . . . just in case. What we should aim for is avoiding the BAD carbs and the BAD fats. What we want to consume are the GOOD carbs & fats. Remember, spinach, cauliflower, green beans, etc are ALL carbs . . . and they contain valuable antioxidants. It's the starchy carbs (potatoes, pasta, rice, breads), white flour, & simple sugars that we want to reduce. Likewise, olive oil & other monosaturated fats are valuable fats.

An excellent & healthy diet is the South Beach Diet . . . which "starts out" (first 2 weeks) with high protein & NO starchy carbs or sweets (not even fruits which contain the simple sugar fructose). This breaks the "craving" for sugar & bad carbs). Besides breaking "carb cravings", one early result of the diet is reducing stomach fat (it's the starchy carbs & simple sugars that contribute most to stomach fat). I'm always amazed each time I restart the SBD, how well this works! By week three you are permitted to begin adding fruits and other healthy foods. The South Beach Diet is a "long term" way of eating that you can live with. . . whenever you blow it for a few days you can always resume the first two weeks to get back on track.

Great advice Joy. Non-starchy veggies are indeed very healthy "low" carb "energy" nutrients (a lb of spinach is about 64 calories) and should be the staple of any diet. I would add the following:

I think everyone is a bit different and some could perhaps use the inital 2 weeks of SBD for an extended period (some as long as 6 to 10 contiguous weeks at a time) depending upon their level of body fat and genetic tolerances. Basically, the greater the body fat, the longer one can stay in the 2-week phase and thus "safely" increase the rate of fat loss. In addition, good quality Omega-3 supplements (5 to 10 grams per day of "extra good fat") and generous consumption of water can help folks with significant adipose (belly) fat to more quickly enhance their sensitivity to insulin/glucagon blood level ratios and thus lose that belly fat more quickly. Finally, the closer one gets to their ideal BMI (w/in 10 to 15 lbs) or bodyfat levels, the more appropriate that the long-term phase (addition of fruits and low glycemic load carbs) of SBD should become a lifestyle and also the more important carbohydrate-titrated daily exercise should become part of that lifestyle.

[travismcgee]

Fascinating discussion. I have a couple of questions and I don't know if these were addressed during the seminar. First, the surgeon speculated that the surgery itself was responsible for "an immediate change in hormone secretion", were hormone levels measured in gastric bypass patients before and after surgery? My second question is aimed at the surgeon's first observation, how does reducing stomach size lower blood pressure? Anyone want to take a stab at that one?

[roster]

........... First, the surgeon speculated that the surgery itself was responsible for "an immediate change in hormone secretion", were hormone levels measured in gastric bypass patients before and after surgery? ...........

No. That is why the doc is only speculating. Sounds like a good research project.

BTW, do you believe him about the blood-glucose and blood-pressure levels dropping to normal almost immediately?

I haven't done the research to see if other surgeons are reporting this. Anybody want to research this and post some links here?

[Emmy1]

... Easy Pro Plus meter, ...The wife picked up a meter for me and its the Bayer Contour....I decided to do a check on both meters and with the same drop of blood I got 2 decidedly different readings. Easy Pro Plus ...was 151. ...Bayer was 96!! ...(I did a test on the Easy Pro Plus, but it went crazy with a 554 reading, but the solution I used was a Bayer solution...

Hi Jessica,

Yes, it does matter. The test solution needs to be the one made for the meter you are testing. Ask the pharmacist if they can get it for you.

One rule of thumb for glucometers is that the cheaper the test strips are, the less reliable you will probably find them to be. Since the Bayer test showed that the Bayer test strips are accurate, I would rely on the Bayer meter and stop using the other one.

Another issue that could have been a problem is coding. Most meters require a code from the test strip vial to be input into the meter so they match up. If you don't input the proper code, the readings will be off because the meter is basing its results on the improper code.

Some variation is normal, even with tests done with the same meter, on the same drop of blood or using the control solution. These meters are not as exact as lab tests and there is a 20% margin for error allowed by law. The important thing is to use whichever meter is showing more accurate results and stick with that meter. You can find out for sure by having your doctor write on your next labwork requisition "calibrate patients home glucometers". The lab will draw your blood and have you test at the same time, and write it down. Then when your labwork comes back, your doctor can tell you what their results were, and how it compared to the reading you showed them on your meters, at the time. This way you'll know how much your meter varies from true, and in which direction.

By the way, the new Freestyle Lite meters do not need coding so this is one less error that can occur. I use Freestyle meters, and have had mine calibrated by the lab that does my bloodwork. Mine are very very accurate, so I'm sticking with Freestyle. You can get a free Freestyle Lite meter when you purchase 100 test strips if you send for a coupon. They usually offer them on their website at
http://www.abbottdiabetescare.com/index.htm

[Woody]

Roster, it sure seems like what you are describing is the Dawn effect. There is a good description of it
at mendosa.com . In a type 2 diabetic not only is the blood glucose elevated in the morning but they
are more insulin resistant in the morning. The later in the day the lower there insulin resistance is.
I have type 2 diabetes when I get up at 6AM my BG is ~110 over the next 2 hours it will rise to about
130. If I eat 20g of carbs at 7AM my bg will rise another 30mg. However the same 20g of carbs will
not effect me nearly as much if I eat them at 7PM. Now the opposit is true of a non diabetic. Carbs
eaten later in the day raise there blood sugar more than those eaten in the morning.