CFRD, what are the early signs?

[stevehof]

So my blood sugar spikes nearly every afternoon a couple hours after lunch. Anywhere between 150 to 175. After another couple of hours I crash to 60-65. I long suspected I had episodes of hypoglycemia but never suspected high blood sugar. I was able to finally figure all this out when I got a Glucose meter along with a 10 day prednisone treatment. My blood sugar seems to be around 80 in the morning before breakfast and doesn't seem to spike up much above 110 after breakfast or dinner. So, do I have pre CFRD or just some sort of reactive hyperglycemia/hypoglycemia?
When I was doing the prednisone my blood sugar got up to 275 in the afternoon. I just took a 20 minute walk and got it down to 120 or so.

 

[Havoc]

I would ask your doc about a glucose tolerance test. Depending on the results, an endocrinologist consult might be helpful. Just make sure it's an endo who is familiar with CFRD.

 

[saveferris2009]

Anything over 140 causes the bacteria in your lungs to grow more.

I was getting anywhere from 150 to the occasional 200 after doing a 2 week diary. I had more frequent exacerbations the past 18 months, 2 new cavities (I had only had 1 cavity my whole life up until that point) and my energy was low. I passed 2 OGTT's with flying colors.

The energy thing I figured was because I'm hypercompliant with all my CF stuff, I work full time, and heck, I've got CF.

Since I have been started on insulin and kept my sugars below 140, I have so much more energy to just live life.

The reason I share all this is that often CFRD isn't straight forward. Some people feel fine with sugars at 180 and their lungs tolerate it just fine as well..... others feel so much better with some insulin even if sugars rarely go above 140.

I think all CFers should do a blood sugar diary at some point because an OGTT simply doesn't do it justice. CFRD can come in fits and starts at the beginning and can show up in mysterious ways.

The one thing other than hemoptysis I used to fear was CFRD. Needles (I need a benzo just to get a PICC put in and I usually pass out at blood tests), counting calories, etc. Turns out, persuing my CF diagnosis has been the best thing ever for me because I feel like my 24 hour days are now 48 hour days.... so much more energy to live life!

 

[stevehof]

Thanks for the info. I'm still a bit vague on the differences between CFRD and type 1 and 2 diabetes. Is there a simple explanation? Does 180 make you diabetic or does it have to go above 200. Some general guidelines would be helpful so I can make sure my GP Doc knows what to look for. I do not have a CF center available in my area with Kaiser Permanente.

 

[saveferris2009]

they say 180 is the guideline, but with 140+ causing bacteria to flourish, I think this is a no-brainer threshold. Treatment goals for tight control of CFRD are 140, or should be (i guess some endo's vary). But why not give your lungs a fighting chance?

Anyway, Type 1 diabetes is your beta cells in the pancreas are destroyed, therefore you produce hardly any, if any at all, insulin.

Type 2 is you produce an adequate amount of insulin, but your body can't use it properly (aka insulin resistance) due to increased body mass. Often with weight loss, insulin resistance can be improved.

CFRD is a combo of both. Often in CFRD there is some beta cell destruction so there is less insulin produced (like Type I diabetes), and due to chronic colonization of bacteria in the lungs, there is chronic inflammation in the body as a whole, leading to insulin resistance (like Type II). With active infection, insulin resistance can increase and many CFRDers can find the need to increase insulin.

Hope this helps. CFRD can have a huge impact on longevity with CF and therefore the tightest control of sugars possible should be achieved. 180 is unacceptable simply from my own experience as well as from the literature I have read regarding bacterial growth.

Hope this helps

 

[Mistyjo]

I'm getting ready to start the process of checking my daughters blood sugars for a few days. They want to make sure she isn't cfrd. We have to test at 3am, first thing before breakfast, 2hrs after a meal. For a few days.

 

[Printer]

There is an article this month in the BOSTON CHILDREN's HOSPITAL CF NEWSWIRE. It reads in part as follows: SYMPTOMS OF CFRD Common symptoms, such as increased thirst and increased urination, are caused by high blood sugar levels (hyperglycemia). Other symptoms of CFRD are excessive fatigue, weight loss and unexplained decline in lung function. I hope that this helps. Bill

 

[stevehof]

Thank you saveferris2009 and everyone else who answered too! I think I now have enough info to deal with my GP doc on this issue! I was wondering about the insulin because when I'm at the worst part of a flare up, I'll hardly feel like 'walking' my BG down.

 

[Havoc]

<div class="FTQUOTE"><begin quote><em>Originally posted by: <strong>saveferris2009</strong></em>with 140+ causing bacteria to flourish</end quote>

Can you point me to where you found this? I've looked at quite a few studies and can't find a hard number at which bacterial growth is accelerated. In fact, the only studies I could find had to do with bone marrow transplant and febrile neutropenia. I did find a mechanism, which was described in a 2011 study of human airway epithelial cells, which uses a form of facilitated diffusion to reduce the amount of glucose in ASL at an equal or faster rate than it can be supplied by blood glucose uptake at the basal membrane.

 

[saveferris2009]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>Mistyjo</b></i> I'm getting ready to start the process of checking my daughters blood sugars for a few days. They want to make sure she isn't cfrd. We have to test at 3am, first thing before breakfast, 2hrs after a meal. For a few days.</end quote>

i would do it after 3 meals, not just one. as you can see, blood sugars can even vary throughout the day. so she may be getting highs at b'fast only, but if you're only checking dinners, then you will be missing it

 

[Mistyjo]

Doctor called back and talked to my husband. They changed it, we are to check first thing in am, two hrs after every meal. We start tomorrow.