CPAPtalk.com

Google Actos--nasty side effects.
It's not as popular as it once was.

2flamingos wrote:
This post has me a bit confused. My understanding is that if your blood glucose is at a certain level, you are considered diabetic. At that point, you are put on medication - such as Metformin (which is the drug insurance companies usually require to be prescribed first). If the initial dosing of Metformin does not control you blood glucose, it is either increase; another medication added; or a change in medication altogether. If oral medications do not control it, then you are put on insulin.

Actually you can very often control it at first simply by diet if you catch it early enough. The problem is that very few people want to be bothered with diet. But once a diabetic, always a diabetic. There is no cure. Only control.

I have just got back from the American Diabetes Association meeting in Philadelphia. There were some very interesting posters there on apnea and diabetes, and also some information on the prevention of progression of diabetes. For apnea, a small Scandinavian study showed that one third of patients with Type 2 diabetes (the old adult-onset category) have sleep apnea - they excluded patients with known severe apnea. I spoke with the investigators, and they are wanting to test whether treatment of the apnea will control the diabetes. I spent a while educating them about the "challenges" of continuing to use the machine and mask, and gave them some tips on how to improve compliance. I suggested that one of the first things they should do is try CPAP themselves at 4 cm and find out just how difficult it is for many people to breathe at that level. Also, to make sure that they don't pull the straps too tight. Finally, the best place to learn about how patients actually get on with the machine and mask, is here - or the ASAA forum.

For prevention of (or delay in) progression of diabetes - you must continue to take the medication that the doc prescribes. Also, do your very best to follow the lifestyle and exercise patterns that work for you. Weight loss will certainly help, but it is not the complete answer. The latest information is that injections of a very long-acting insulin 2-3 times a week may help you stop the worsening of your fasting blood glucose, and keep your HbA1c below the limit for classification as diabetes. Good luck with finding someone to pay for that, though. The exciting thing is that there are lots of new options coming along, although all of them have to be proven safe and effective for long-term (10-20 years) use. The major question for you and your doc to answer is whether you can afford to wait for the new products?

Unfortunately, just as with sleep apnea, there is no cure for diabetes. As painful as the treatment is, we must continue with it for the rest of our lives.

if I am ha1c 6.4 am I forever diabetic? (glucose meter reading of 160 sometimes) I heard this blood test ha1c is one of the best. the other forum was telling me that I am diabetic based on symptoms. terrible to have confusion and nausea and breathing problems!

when I was in the hospital they gave me and insulin injection but didn't seem to do much...
is byetta a good drug and safe?
yeah it's a terrible circle the sleep apnea causes diabetes and low testosterone, low cortisol it seems and then that in turn causes diabetes by crippling you and preventing exercise

With an HbA1c of 6.4, a single injection of insulin is not going to do much. You need to talk with your docs about what options might work for you. Diet and exercise are important parts of the process of slowing the progression of diabetes. Just because you have an A1c of 6.4 doesn't mean you will have that value forever. BUT, and it is a big but, getting it down is not going to be easy. There are a number of options available to your doc now, and could be many more in the future. Every medication is going to have side effects, some of which will not be pleasant. Diet and exercise also have side effects, some of which are not pleasant . If your doc can't talk to you about the help you need, you will need to track down a doc who will. Good luck!

The treatment is not as simplistic as AVI123 states. Each person will have their own drug regimen depending on a lot of factors, including the doctor's biases and preferred treatment methods. I took other drugs for years before the doc put me on metformin in combination with Actos. I also take Januvia. Other drugs are being clinically tested, all with the aim of avoiding having to move to insulin injections. Chromium picolinate reportedly is used in Europe but it has not done me any good. My doc says the ADA review of studies shows it to be of zero value.

The A1C test is the best. It gives about a 2 to 3 month average of blood glucose level and levels out all the daily highs and lows.

Today, insulin is a last resort treatment. The body needs and uses insulin but for a Type II diabetic added insulin increases the insulin level floating in the body, unless the pancreatic cells that make it have already crapped out. Too high a level and insulin starts to be more a bad thing than a good thing, almost like a poison. You seriously want to avoid taking insulin if at all possible.

Diabetes used to be defined as a fasting blood glucose level of 146 or greater. About 1998 or so it was redefined. Pre-diabetes is 110 or higher, and diabetes is 126 or higher. Morning BG tests are not definitive, but are a good indicator. They are not the same as the fasting BG test numbers would be. American Diabetes website indicates that the diagnosis may be, if not already, changed to an HbA1c number of 6.5. I find this interesting because an A1c of 6 corresponds to a BG reading of 126. And ADA says if you can keep your A1c below 7.0 you're doing good. Nothing like contradictory numbers to try to state a definitive position!

Once you cross the threshold, in the absence of special circumstances such as pregnancy or long illness, you will forever be classified as diabetic.

My pancreas quit working in 2004 due to being on large doses of predisone for ulcerative colitis, but it took years for me and the doctor to figure out why no pills or insulin would work after a while, so after some adjusting, and a long wait, I was put on an insulin pump, which has been a blessing. The doctor also has put me on byetta, which has helped my A1C go down from 9, which is horrible to 6 in the last months, which has been wonderful considering I have been trying to work on that for years it seems, but I have to watch it close, or it will go back up! Side effects from byetta is one that isnt very bad for me, as its nausea when first starting it, and I still have it sometimes if I don't overeat. It makes you lose weight which for me is not a bad thing as I have trouble doing so anyway. Im sure there are other side effects, but to me the side effects are not as bad as me not taking it. Im insulin resistant too, and once your a diabetic, you always have it, although you can get it under control to where you dont have to have medications, but have to keep monitoring it. For the first time in 5 years, I actually got blood work from my doctor the other day, and everything is great with my cholestoral, blood sugars, hormones, blood pressure etc. I have to say that I am thanking CPAP for that, and since I was off of it for almost a year after a devistating divorce, I went back on it in January. Just in this small amount of time, being back on it has changed it all, and the tests and blood work prove this, as I did not think it did help that much, in my mind, even though it was very important to get back on it, and use it everytime my eyes are closed, whether it be nap or nightly sleep. I do get fragmented sleep, (*sleep 3 hours, up for a while, back to bed for 3 hours more), have done this for years, and doctor seems to think as long as I get sleep, this is alright to do, even though I feel must better after a full 7 or 8 hours which i would love to have, but it just don't happen. Sorry for being so long, but hoping this will help someone that has diabetes and uses cpap. I was skeptic, but now the proof is proving me different. Hang in there.

My earlier post may have seemed as if I was not aware of diabetes dx and/or treatments.

I was dx last year after several of my quarterly blood work had come back with a fasting blood glucose over 140, followed by a 4 hour glucose tolerance test - which I failed miserably (290 in 30 mintues, 260 at 1 hour, still over 200 at 2 hours, just under 200 at 3 hours, dropped to 130 at 3.5 hours, and 51 at 4 hours). My doc and I discussed options, which included meds, diet, exercise, and weight loss. He initially wanted to put me on some fairly new med (don;t remember what), but then remembered that insurance prefers that they start a patient on the tried and true Metformin - and then adjust after that if it does not work.

Luckily, in 6 months or so I dropped 25 lbs, watched my diet, and began walking daily (had to - got a dog). I have had my A1C checked twice - first time 5.9, second 5.6. I go for blood work, including A1C in about a month. He now has me check my level once a day - morning - and I range from 104 - 130. I can pretty much tell when it's is going to be the higher end of that range based on dinner the night before. White rice seems to be the worst culprit for me. Potatoes and Pasta, not so much.

Just goes to prove we are all different, and we all react differently to meds, to osa treatment, to life.

My question is - how does stress impact the effectiveness of treatment for either and/or both conditions?

Stress will definitely affect blood glucose levels - think about it. We need extra energy to run away or fight whatever is causing us stress, so blood glucose levels will tend to rise. Sleep apnea and stress? Not sure of the mechanism, but it definitely affects me. I think it probably relates to how we cycle through the phases of sleep or how frequently we turn in our sleep, disrupting our masks. It is hard to tell which is worse - stress or allergies. As someone said above, we are all different. Our pressure needs will vary according to different situations, just as our needs for medications for diabetes will change.

Another comment on the use of insulin in diabetes. Traditionally, the docs thought that it was the last resort. However, the latest study that I mentioned in my post above may change that thinking. The idea is that by giving insulin early, you may give the pancreas a rest. The study used a small dose, so it is not in the "poison" category. How it works out for all the people not in the trial, I have no idea. But it gives your doc another option to discuss with you. There are definitely medications that have weight loss as a side effect, and several that do not cause any weight gain. Although diabetes can NOT be cured, there are now some very effective options for keeping it under control. The hard part is for the patients to continue doing what works best for them - whether it be diet and exercise, taking some kind of medication, or injecting insulin.

Hi--I think everything is related!! Diabetes is an evil disease and I hate mine. I was diagnosed with type 2 diabetes and put on Metformin about the same time I got on CPAP. It is hard to lose weight when you are tired all the time. Hang in there-you are not alone,
Carrie

2flamingos wrote:



My question is - how does stress impact the effectiveness of treatment for either and/or both conditions?

Some would argue stress is just as unhealthy as either of these conditions if not kept in check. This is a great book if you haven't heard of it:
http://www.amazon.com/Why-Zebras-Dont-G ... 0716732106