February 28, 2007

A Low!

The Diovan dropped my blood pressure back to normal/near normal. Thanks to everyone who wrote to ask me how I was doing!

Yesterday, though, I started to feel really, really odd. I tested my blood sugar and it tested at 73 mg/dl. Because of how I felt, I immediately took two grams of glucose and then ate a 17 gram piece of whole wheat bread. Half an hour later I tested at only 79 mg/dl.

It's possible there was a little lemon juice on my figure the first time I tested, (I'm using squeezed lemon juice to counter the water retention swelling caused by going off hormones). If so, it's possible that my 73 mg/dl reading was actually lower. I have never felt anything quite like what I felt at that time before before. It was a very scary feeling, and half an hour after a 20 grams carb intake, I should have risen more than 6 mg/dl.

It is possible that this low is due to the Diovan lowering my blood sugar. When I stopped taking the Diovan a few years ago, my blood sugar started to rise and that was when my doctor put me on insulin, thinking my beta cells were tanking. It took me a while to connect going off the Diovan with the rising blood sugars. But I saw clear evidence of that stopping the Diovan might have had this effect when I took a Diovan pill, back when I was taking insulin, and saw blood sugars considerably lower than what I expected all day.

Though no one else I know has this response to Diovan, there's evidence that ARB drugs of the "sartan" class have a mild effect on PPAR-gamma receptors, the same receptors that Avandia and Actos work on, and do have a very mild effect on Insulin Resistance. If you are only slightly insulin resistant as I am, this can make an appreciable difference.

Since the Januvia/Metformin combination has occasionally dropped my normal baseline afternoon blood sugar as low as the high 70s, a drop of 20 mg/dl or so (which is what I saw with Diovan that earlier time) would be enough to push me into the 60s or even 50s.

I've heard from one other person on Januvia who reported having to cut back to a 50 mg dose of Januvia to avoid lows, so I'll be keeping an eye on the lows for a while.

In other news, I am up a couple pounds, and I'm not sure if it is weight gain from Januvia or from going off the hormones. Someone else on Januvia reported to me they've gained a couple pounds, which in their case was good news. In mine, it isn't.

I had read in some pre-release study that though Januvia was "weight neutral" in the group of subjects as a whole, the data actually showed the thinner people gaining a few pounds and the heavier people losing a few pounds.

Let's hope it's only a few pounds. I've maintained my weight for 3 years now, even through a whole year of using insulin at most meals.

February 15, 2007

Something ELSE Entirely Different

We just got cable internet and I've been having fun with MySpace. My Sweetie talked me into putting up a music page featuring some of my old garage tapes.


Next? Videos of the cat doing silly things for You Tube. .

Too much excitement!

Tuesday my blood pressure went from mildly elevated to "Get down here to the doctor's office immediately!" just out of the blue.

I drove the 40 minutes to the doctor, just ahead of the incoming blizzard, got taken TOO seriously--I hate it when doctors agree that something I'm worried about is worrisome--and got a prescription for Diovan. I'd taken one of my two-year-old Diovan pills that morning but learned, the hard way, that when they get that old they didn't work any more.

By afternoon yesterday my blood pressure had dropped from 180/100 to 120/78 though my pulse is still faster than normal. My blood sugars were fine through all of this, though I didn't feel like eating when the BP was that high. In the past Diovan dropped my blood sugars a bit, so it will be interesting to see how it does with the Januvia.

Of course all this happened with the backdrop of 15 inches of heavy snow coming down which was scary, especially when I woke up the day after the Dr. appointment with the BP still very high and no way of getting out of our steep, long drive way. My Valentine went out there and blew 8 inches of snow off it first thing in the morning which was an even nicer gift than the candy, card and flowers he'd gotten for me.

I am almost 99% certain that the blood pressure rise is from going off estrogen. I have a long history of weird and unpleasant responses to hormones and my BP did rise the last time I went off estrogen, though not as dramatically--probably because I was already taking Diovan.

It's ALWAYS something . . .

February 12, 2007

Estrogen and Blood Sugar

As I mentioned in my previous posts, I went off my long-term Estrogen Replacement Therapy about three weeks ago. I did this after reading an excellent book, Hot flashes, hormones, & your health, by Joann E. Manson and Shari Bassuk. Dr. Manson heads the Woman's Health Initiative (WHI) which studied the long term effects of HRT and ERT.

This book made an excellent case for using the kind of estrogen I was taking (Menest) for about five years, and then stopping, because that is the point where the potential to stimulate cancers outweighs the benefit. The author also explained that most of the side effects associated with menopause, like hot flashes, are caused by sputtering hormone levels, and that once these levels flatten out, the side effects stop for most women.

With that in mind, I figured it was time to stop my estrogen, as I've been on it for six years. When I tried to stop it 3 1/2 years ago, I had a miserable time with interrupted sleep, hot flashes, and terrible moods. But so far, I am feeling fine and have not had any hot flashes yet.

I have, however, seen my blood pressure and blood sugar creep up. This is exactly what happened the last time I stopped the estrogen, so I thought it would be worth discussing both these effects here for any of you who might be going through something similar.

Estrogen lowers blood pressure by increasing the elasticity of blood vessels. This is one reason why it was expected to help prevent heart disease, which it turned out not to do.

Over the past weeks my blood pressure which had stabilized over the past year at a high of 120/80, which is normal, even when stressed at the doctors office, to 130/80 at home when not stressed. Unfortunately, while this doesn't seem like a big change, it pushes me back into the range that is not healthy, and I will have to talk to my doctors about going back on Diovan at my next appointment. I had taken Diovan for years until after a year of taking Metformin when, rather surprisingly, my blood pressure dropped dramatically even though I hadn't lost any weight.

My blood sugar started creeping up this past week, around the time that the last of the estrogen probably left my body. My average fasting bgs are about 10 mg/dl higher than they were the previous weeks. This, too, is what I saw when I stopped estrogen in the past.

If I do start the Diovan again, it will probably lower both my blood pressure and my blood sugar, as that was what I found to be the case when I took it in the past. In fact, when I tried Diovan a year ago, when Levemir was raising my blood sugar, I discovered that Diovan was causing me to hypo when taken in combination with the basal insulin! Unfortunately, it also caused my blood pressure to drop too low, even at the smallest dosage, which is why I had stopped taking it.

Note: the blood sugar lowering effect of Diovan only seems to happen in people like myself who are not significantly insulin resistant. The reason for this happening is that Diovan (valsartan) and other ARB drugs of the "sartan" family affect PPAR-gamma, the receptor that is also affected by Avandia and Actos, though more mildly than those drugs do.

One reason I stayed on the estrogen as long as I did was because it seemed to me that these effects on blood sugar and blood pressure had to be good for me, but the discussion of cancer risk in the book cited above was sobering, and I decided that the benefits of the hormones weren't worth continuing, especially if the menopausal symptoms weren't a problem.

The final really annoying "side effect" of going off the estrogen is that I have packed on 3 lbs within three weeks after years of keeping my weight stable except right before the holidays when I'd seriously overdo things. I haven't been overdoing things, dietwise, but I still am gaining weight. I have to assume that some of the gain s water weight (pray! pray!) but some of it is probably from metabolic changes due to ending the estrogen--the same changes that are pushing up my blood sugar. Whatever it is, I hate it and I'm going to have to go on a serious diet after Valentines day to prevent any further weight gain.

February 5, 2007

Must have been the hormones

The munchies went away as fast as they'd come on, so the Januvia seems to be off the hook for causing them. A couple other symptoms suggest that the problem was being caused by hormonal changes caused by ending my estrogen replacement therapy.

So that's good news!

I went to a Super Bowl party yesterday and learned, the hard way, that I can't eat very much food without feeling unpleasantly stuffed. So I suspect that the Januvia might be delaying stomach emptying. I haven't been eating all that much food at one time over the past couple weeks. Eating even a modest amount of more food was not fun.

The Super Bowl wasn't much fun either, which is a whole nother story. Sloppy weather like last night's torrential downpour makes for sloppy football that can only entertain hard core fans of the teams that are playing. Mine wasn't, so I found myself really not caring what happened on the field. For my money, the San Diego/Patriots game was the best game of the entire playoff season and San Diego was the best team in football this year--and I'm saying this as a die-hard Patriots fan!

My continuing fasting blood sugars in the 80s and very low 90s are fun. My Ultra 2 shows an average "Before Meal" reading of 87 mg/dl based on 15 readings over the past 2 weeks and of 91mg/dl over the past 30 days (based on 36 readings). The "After Meal" average reading is 110 based on 61 readings over the past 30 days. Most of those "before meal" readings were fasting. The rest were taken more than 3 hours after eating. The "after meal" readings are those taken 1 and 2 hours after eating.

I continue to test a lot less than before because I'm feeling so much better. The exception was during the three days during the past week when I had the nonstop muncies. My readings during that time did not rise, so whatever it was, the problem was not caused by blood sugar problems.

February 2, 2007


The blood sugars continue to be beautiful with Januvia, BUT I've suddenly started having the munchies.

Not good.

I am not sure if this is from the Januvia stimulating insulin response or because I've stopped taking estrogen. I never felt hunger while I was using supplemental R insulin, but I did feel this kind of hunger when I briefly tried Amaryl, which also stimulates insulin secretion.

I'm hoping it is the changing hormone levels. I'd been on estrogen for 6 years and decided it was time to try stopping it again. The first time I tried to stop it, 3.5 years ago, I quickly became miserable with hot flashes, no sleep, bad temper etc. This time, three weeks in, I feel fine. A few zits, but that is it. I'm sleeping better, not worse, too.

A book I recently read written by the doctor who headed the Woman's Health Initiative study explained that the nasty menopausal symptoms come from wildly fluctuating estrogen levels not low estrogen levels, which is why you don't experience those kinds of symptoms BEFORE puberty when your estrogen is also low. According to her, once the whole menopausal process is over and your estrogen levels flatten out, you have a good chance of feeling great without hormone supplements.

She also says that despite the press about the badness of the Prempro hormone prep there are some benefits to taking estrogen, especially the kind I was taking, which was not made from mare's urine, without progesterone (which I can't take as I have a horrendous response to it). But these benefits are pretty much all done 5 years and after that the cancer risk starts to be significant. So good bye estrogen!

I used to get munchies like I've had the past couple days right before I'd have my period, which was definitely a hormonal thing, because it didn't matter what I ate, I was hungry. That's kind of how I'm feeling now.

I had no hunger at all with Januvia throughout the first month I was taking it, nor did I have hunger issues when injecting insulin, except one or two times when I used Novolog instead of R with too much carb and rollercoastered.

I'm hoping the munchies are from the hormone changes. Especially since I'm still taking Metformin which usually completely eliminates any kind of problem with inappropriate hunger.

If anyone else taking Januvia is getting the munchies, let me know!

The bgs are still great. Woke up at 81 mg/dl. Ate 25 grams of carb for breakfast and was at 91 an hour later. Ate too many hand cut french fries for lunch (not usual and won't do it again) went up to 135 at 1 hour and was back to 91 at 90 minutes. If I stay under 30 grams at a time I'm golden.

But I'm way too hungry all of a sudden. Hope it passes!