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.


Anonymous said...

I wouldn't call a BG of 73 a low. If you treat it like one by taking glucose tablets, however, your body will never get used to what is actually a very nice number. Best to just tolerate those false lows.

Also, even if it had been a low, TWO glucose tablets would have been excessive as each one will generally take you up about 20 points. Have you ever tested to see just how much one raises YOUR BG's? It's a good thing to know.

Jenny said...

I have tested extensively since I spent a year using bolus insulin.

One gram of glucose raises me exactly 5 mg/dl.

However, I didn't use a glucose tab, I used 2 gms worth of Smarties, followed by fast carbs in food when I didn't see my bgs rising.

Diovan can cause my bg to really crash and I didn't know if 73 was the final destination or a stop on the way down. So I felt it was safer to correct.

Since I was still in the 70s an hour after eating almost 20 grams of carbs, it's likely I would have ended up a lot lower. Twenty grams of carbs should have raised me a lot higher.

tina said...

Hi, Jenny. I've just been diagnosed with Type 2 -- one week ago today -- and have been obsessively searching for information online ever since. I found your blog through the ADA website, and want to thank you for putting so much great information out here. I was especially inspired by your article about avoiding complications, and hope to get my BG#s well within the ranges you mentioned, as quickly as possible. Like you, I had been wondering why I was being told an A1C of 7 is considered "good control," since that number indicates average BG levels high enough to cause nerve damage and other complications! Thanks for pointing me toward studies and other more in-depth info. I will be bookmarking this site!