Fasting plasma glucose and atypical antipsychotics

Post by Rosemary
Completely off drugs, my reading came back at 4.6mmol/l. I am hoping this
is not a freak reading, and it means that I am not (yet) diabetic. Does
anyone know if it could indeed be the anti-psychotics that caused this
raised blood sugar, or should I be panicking? I am considered to be at
high risk for type two diabetes as I have a BMI over 40 (partly caused by
the excessive weight gain I experienced by taking Zyprexa/olanzapine,
partly caused by depression, and partly caused by laziness), and I also
have a close family member who developed the disorder.
Thank you very much for reading this far. If you have any ideas, I would
be really grateful to hear from you.

Rosemary, I don't know if the specific drug you've been taking is associated
with high blood glucose independently of the weight gain risk, but it's not
uncommon for diabetes to be brought on by a drug challenge. What happens
when a person is obese is that they become insulin resistant, so their body
can't use insulin properly. The pancreas reacts by massively overproducing
insulin; this can cause the insulin-producing cells in the pancreas to burn
out and die. For someone who isn't genetically predisposed to diabetes, this
still isn't a problem; but if you do, it may be enough to tip the balance. A
diabetes diagnosis typically means that more than half the beta cells have
died, and other changes mean that a diabetic isn't able to replace them. To
add insult to injury, insulin is a growth hormone; extra in the bloodstream
is used to store fat, making the obesity problem worse.

Given your family history, I think you're right to be concerned about the
drug - but the tradeoff with your mental health is something you need to
work through with your doctors. Tackling the obesity would be a worthwhile
goal. A low carb diet, low in saturated fats, is often very helpful for
diabetics, because it minimises the challenge from dietary carbohydrate. If
you combine that with exercise (started very gently), you get a virtuous
cycle, because exercised muscles extract glucose from the bloodstream
independently of insulin action; your pancreas can heave a sigh of relief
and stop overreacting, making the insulin flood less. A gentle stroll after
meals for 20-30 minutes would be a great start on this. Lower weight means
lower insulin resistance, increasing the cycle.

Getting the occasional non-fasting blood check - possibly through your local
chemist? - would be useful too. If your glucose levels are higher than 7 or
so an hour after a meal, that's another indicator that diabetes is here.

I'd recommend a book by Gretchen Becker whose title I've forgotten - but
it's about how to prevent the onset of diabetes. I bought the next one in
the series, about how to survive a diagnosis : )

Good luck, keep asking questions....

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-08 18:49:00 UTC

Rosemary, I don't know if the specific drug you've been taking is
associated with high blood glucose independently of the weight gain risk,
but it's not uncommon for diabetes to be brought on by a drug challenge.
What happens when a person is obese is that they become insulin resistant,
so their body can't use insulin properly. The pancreas reacts by massively
overproducing insulin; this can cause the insulin-producing cells in the
pancreas to burn out and die. For someone who isn't genetically
predisposed to diabetes, this still isn't a problem; but if you do, it may
be enough to tip the balance. A diabetes diagnosis typically means that
more than half the beta cells have died, and other changes mean that a
diabetic isn't able to replace them. To add insult to injury, insulin is a
growth hormone; extra in the bloodstream is used to store fat, making the
obesity problem worse.
Given your family history, I think you're right to be concerned about the
drug - but the tradeoff with your mental health is something you need to
work through with your doctors. Tackling the obesity would be a worthwhile
goal. A low carb diet, low in saturated fats, is often very helpful for
diabetics, because it minimises the challenge from dietary carbohydrate.
If you combine that with exercise (started very gently), you get a
virtuous cycle, because exercised muscles extract glucose from the
bloodstream independently of insulin action; your pancreas can heave a
sigh of relief and stop overreacting, making the insulin flood less. A
gentle stroll after meals for 20-30 minutes would be a great start on
this. Lower weight means lower insulin resistance, increasing the cycle.
Getting the occasional non-fasting blood check - possibly through your
local chemist? - would be useful too. If your glucose levels are higher
than 7 or so an hour after a meal, that's another indicator that diabetes
is here.
I'd recommend a book by Gretchen Becker whose title I've forgotten - but
it's about how to prevent the onset of diabetes. I bought the next one in
the series, about how to survive a diagnosis : )
Good luck, keep asking questions....
Nicky.

Thanks very much for your reply. I am currently losing weight on a diet, but
it's low fat rather than low carb, because the dietitian I see thought that
would be the best way for me to lose weight. I've come to the conclusion
that it is not worth facing a higher risk of diabetes, and putting on weight
and being unable to lose it, by taking the anti-psychotic drugs, because the
benefit I get from them is fairly minimal.

If I continue testing at around 4.6mmol/l is there still a good chance I
could be diabetic? My surgery tend not to offer anything else in terms of
tests if you get a fasting plasma glucose that's non-diabetic. I don't know
if this means that it's unlikely there will be any problems if the fasting
bloods are okay, or whether it just means they can't be bothered :-) (lack
of funds, time, or whatever).

One thing I'm worried about is that, if the drugs are indeed pushing up my
blood sugar, would it be a temporary thing that would stop as soon as I
stopped taking the drugs, or would it eventually become a permanent kind of
damage?

Thanks again for your reply, and sorry about the whole new battery of
questions :-)

Rosemary

Trinkwasser

2006-09-08 22:03:50 UTC

On Fri, 08 Sep 2006 18:49:00 GMT, "Rosemary"

It's a fairly well known side effect, I'm surprised your doctors
didn't know this. Off the top of my head I can't remember which drugs
are worse.

Post by Nicky
Rosemary, I don't know if the specific drug you've been taking is
associated with high blood glucose independently of the weight gain risk,
but it's not uncommon for diabetes to be brought on by a drug challenge.
What happens when a person is obese is that they become insulin resistant,
so their body can't use insulin properly. The pancreas reacts by massively
overproducing insulin; this can cause the insulin-producing cells in the
pancreas to burn out and die. For someone who isn't genetically
predisposed to diabetes, this still isn't a problem; but if you do, it may
be enough to tip the balance. A diabetes diagnosis typically means that
more than half the beta cells have died, and other changes mean that a
diabetic isn't able to replace them. To add insult to injury, insulin is a
growth hormone; extra in the bloodstream is used to store fat, making the
obesity problem worse.
Given your family history, I think you're right to be concerned about the
drug - but the tradeoff with your mental health is something you need to
work through with your doctors. Tackling the obesity would be a worthwhile
goal. A low carb diet, low in saturated fats, is often very helpful for
diabetics, because it minimises the challenge from dietary carbohydrate.
If you combine that with exercise (started very gently), you get a
virtuous cycle, because exercised muscles extract glucose from the
bloodstream independently of insulin action; your pancreas can heave a
sigh of relief and stop overreacting, making the insulin flood less. A
gentle stroll after meals for 20-30 minutes would be a great start on
this. Lower weight means lower insulin resistance, increasing the cycle.
Getting the occasional non-fasting blood check - possibly through your
local chemist? - would be useful too. If your glucose levels are higher
than 7 or so an hour after a meal, that's another indicator that diabetes
is here.
I'd recommend a book by Gretchen Becker whose title I've forgotten - but
it's about how to prevent the onset of diabetes. I bought the next one in
the series, about how to survive a diagnosis : )
Good luck, keep asking questions....
Nicky.

Unfortunately dieticians are stuck on the low fat high carb diet
although it seldom seems to work (I actually put on weight and my
lipids got worse, which was the reason I was put on it. By low carbing
instead I lost the weight and my lipids improved. For people with
diabetic type genetics this appears to happen.)

Post by Rosemary
If I continue testing at around 4.6mmol/l is there still a good chance I
could be diabetic? My surgery tend not to offer anything else in terms of
tests if you get a fasting plasma glucose that's non-diabetic. I don't know
if this means that it's unlikely there will be any problems if the fasting
bloods are okay, or whether it just means they can't be bothered :-) (lack
of funds, time, or whatever).

The best thing you can do really is to buy yourself a blood glucose
meter - the meters are cheap but the strips are damn expensive -
that's what I had to do to convince my GP that I had a problem.

http://www.alt-support-diabetes.org/newlydiagnosed.htm

http://www.phlaunt.com/diabetes

two useful sites for the beginner

By testing after your meals you are likely to spot your highest
readings, mine are after around 1 hour and much improved after two
hours, technically I'm not actually diabetic but I'm working on
keeping the numbers down anyway and putting off the actual diagnosis
as long as possible - even without the diabetes diagnosis I have some
symptoms of diabetic damage, and some of them, have improved simply be
keeping my BG in a normal range as much as possible.

Post by Rosemary
One thing I'm worried about is that, if the drugs are indeed pushing up my
blood sugar, would it be a temporary thing that would stop as soon as I
stopped taking the drugs, or would it eventually become a permanent kind of
damage?

probably both. Sorry I'm not helping am I? <G> Put it this way,
esoecially with your weight and the family incidence you may well have
genes predisposing to diabetes. Things which can worsen your condition
include eating too many carbs which will increase your blood glucose,
not exercising enough, and taking certain medications. Whoops!

Things which can improve your condition are basically anything which
tends to normalise your blood glucose. The good thing is, if you can
get your own meter and afford to run it you can find out for yourself
what helps and what hinders.

For example, number one on *my* list was avoiding almost all carbs in
the morning when I'm most sensitive, trying to find alternatives to
that big ol' bowl of "healthy" breakfast cereal. I eat gradually
increasing amounts of carbs (in my case wheat is particularly bad,
even the crunchiest most ethnic wholemeal bread, rice and pasta and
potatoes less so, ryebread OK, oatcakes better still and quinoa acts
as if it has almost no carbs at all) but far less than I used to. Many
vegetables are good, most meat and especially fish excellent, fruit
somewhat variable, fruit juice a definite no-no. Nuts make good
nibbles.

If you have time look here

http://www.mendosa.com/

IMO probably THE best diabetes resource, it's huge but links to most
everywhere relevant. The parts on the Glycemic Index can be helpful in
working out a diet.

I'd have to advise against going off your meds but you could discuss
with your doctor whether there might not be something better for you.

Post by Rosemary
Thanks again for your reply, and sorry about the whole new battery of
questions :-)

You might also want to look at

alt.support.diabetes.uk

alt.support.diabetes

both have more traffic, the latter almost too big to follow

best of luck!

Rosemary

2006-09-09 05:17:45 UTC

It's a fairly well known side effect, I'm surprised your doctors
didn't know this. Off the top of my head I can't remember which drugs
are worse.

If it's that well known, I'm surprised too! It shouldn't really be my job to
try and find this information in the way I've had to - for a start, I should
have been given a patient information leaflet. I see it as my responsibility
to inform the GP what drugs I'm taking, to read the information leaflet and
take notice of what it says, but not everybody has access to the internet.

I've tried to convince the doctor I see that the reason I'm worried is that
I've found information that concerns me, and the doctor should be able to
tell me more about it and exactly what the risks are. I tried asking her but
got nowhere - she said "Well, if it isn't here on my screen, it must be a
very rare side effect and so I wouldn't worry about it". I'm suspicious of
the whole "rare side effect" thing, as the dangerous heart problems I
developed on another of the atypical antipsychotics were also not a listed
side effect in any of the usual reference books doctors have lying around.
It was found eventually from somewhere that this drug did in fact have that
side effect.

<snip>

Post by Rosemary
Thanks very much for your reply. I am currently losing weight on a diet, but
it's low fat rather than low carb, because the dietitian I see thought that
would be the best way for me to lose weight. I've come to the conclusion
that it is not worth facing a higher risk of diabetes, and putting on weight
and being unable to lose it, by taking the anti-psychotic drugs, because the
benefit I get from them is fairly minimal.

I've lost two stone on this diet so far so I know at least that it works in
that sense, so I'm loath to change something that appears to be working.
They haven't told me anything about my lipids, though they check them when
they do my 6-monthly bloods, so I'm hoping that means they're normal. How
are lipid levels related to diabetes?

The best thing you can do really is to buy yourself a blood glucose
meter - the meters are cheap but the strips are damn expensive -
that's what I had to do to convince my GP that I had a problem.

Ah, so I'm not the only one having trouble getting my GP to give a damn :-)
Is there a difference between blood glucose and plasma glucose? The family
member who has diabetes has a meter that tells her blood glucose, but my
GP's blood test was plasma glucose.

Post by Trinkwasser
http://www.alt-support-diabetes.org/newlydiagnosed.htm
http://www.phlaunt.com/diabetes
two useful sites for the beginner

Thanks.

Post by Trinkwasser
By testing after your meals you are likely to spot your highest
readings, mine are after around 1 hour and much improved after two
hours, technically I'm not actually diabetic but I'm working on
keeping the numbers down anyway and putting off the actual diagnosis
as long as possible - even without the diabetes diagnosis I have some
symptoms of diabetic damage, and some of them, have improved simply be
keeping my BG in a normal range as much as possible.

I'm hoping that being off the olanzapine will help mine, too - my fasting
plasma glucose was what they told me was "nearly diabetic" (not sure what
that's supposed to mean!) at 6 point something, and during the 2 years I was
on it I was getting really bad boils and cysts which I've heard can be
associated with high blood sugar.

Heh :-)

<snip>

Post by Trinkwasser
I'd have to advise against going off your meds but you could discuss
with your doctor whether there might not be something better for you.

Yeah, I think I'm going to have to. I'm running through them, though. The
stelazine gave me extra-pyramidal effects, and my doctor and I were worried
about me developing tardive dyskinesia, the risperidone gave me heart
problems, the olanzapine caused massive weight gain and in hind-sight
probably high blood sugar too, and the quetiapine probably caused even
higher blood sugar, plus I couldn't eat while I was taking it! I think I'm
going to stop taking anti-psychotics altogether. They're more trouble than
they're worth.

Thanks for all your suggestions, and for pointing me towards some additional
resources. It's really nice to find a newsgroup with such helpful people in
it :-)

Rosemary

Nicky

2006-09-09 08:25:04 UTC

Post by Rosemary
If it's that well known, I'm surprised too! It shouldn't really be my job
to try and find this information in the way I've had to - for a start, I
should have been given a patient information leaflet.

Dangerous practice, assuming your GP knows the ins and outs of everything
he/she tells you to put in your mouth... You should certainly have had the
leaflet. Thank god for the internet. Here's a drug interaction checker,
too - you may have to sign up, but they don't spam and are a wonderful
medical resource:
http://www.medscape.com/druginfo/druginterchecker?src=rxlad

Post by Rosemary
she said "Well, if it isn't here on my screen, it must be a very rare side
effect and so I wouldn't worry about it".

Ah, a deep concern for the individual. How lovely.

Post by Rosemary
I've lost two stone on this diet so far so I know at least that it works
in that sense, so I'm loath to change something that appears to be
working.

Sure - if it ain't broke, don't fix it - but you should check your glucose
levels an hour after meals occasionally just to be sure you're not swapping
one problem for another. My local Lloyds will do this, if you don't want to
buy a meter, so I assume they all do - just not too often : ) Or you could
ask your family member occasionally? Strips cost about 50p each.

Post by Rosemary
They haven't told me anything about my lipids, though they check them when
they do my 6-monthly bloods, so I'm hoping that means they're normal. How
are lipid levels related to diabetes?

Intimately : ) For a start, the liver is the major organ apart from your
pancreas affected by diabetes, and is also the major source of blood lipids.
That can be a bad synergy. Lipid abnormality is also a big predictor of
heart disease risk, which is worse in diabetics because, among other things,
the low-level inflammation caused by high blood glucose. Big area to read up
on, if you get interested!

You do know that you can (and should) ask your GP for copies of every test
result you've had? That way you can spot trends and abnormalities. If you've
had a full lipid panel, the ratios tell you a lot about levels of insulin
resistance. They may ask for a photocopying fee.

Post by Rosemary
If I continue testing at around 4.6mmol/l is there still a good chance I
could be diabetic?

There's 2 ways for diabetes to show; the usual way is for your fasting
figures to deteriorate, but it's also possible to have perfectly normal
fasting with post-meal peaks that are high enough to cause diabetic
complications. Your quack's only looking at one of these; fortunately,
checking your glucose after meals yourself occasionally is enough to catch
the other. Ask for an A1c test as well as the fasting if you're worried -
it's a rough everage of how high your bgs have been over the last 3 months.

Post by Rosemary
Is there a difference between blood glucose and plasma glucose? The family
member who has diabetes has a meter that tells her blood glucose, but my
GP's blood test was plasma glucose.

Yes, there is - I forget the difference, 10-15% springs to mind but I'm not
sure on that. It's not important so long as you pick one and stick to it -
what's important is the trend.

We've got no problems with questions - keep 'em coming : ) You'd get a
wider audience for them on alt.support.diabetes.uk, though.

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-09 18:06:10 UTC

Dangerous practice, assuming your GP knows the ins and outs of everything
he/she tells you to put in your mouth...

This is why I don't :-) I just consider myself fairly lucky that I have some
access to other sources of information. Plenty of people DO put all of their
trust in the GP, unshakingly. I know - my dad's a GP. I think that they
should really have considered the possibility that the latest readings could
have been caused by the drug. If I hadn't come off the drug myself for the
second test I would now have the diabetic label, whether or not I actually
am, which can't be helpful.

Post by Nicky
You should certainly have had the leaflet. Thank god for the internet.
Here's a drug interaction checker, too - you may have to sign up, but they
http://www.medscape.com/druginfo/druginterchecker?src=rxlad

Thanks.

<snip>

Post by Rosemary
I've lost two stone on this diet so far so I know at least that it works
in that sense, so I'm loath to change something that appears to be
working.

Sure - if it ain't broke, don't fix it - but you should check your glucose
levels an hour after meals occasionally just to be sure you're not
swapping one problem for another. My local Lloyds will do this, if you
don't want to buy a meter, so I assume they all do - just not too often
: ) Or you could ask your family member occasionally? Strips cost about
50p each.

Do you know how much Lloyds charge?

Post by Rosemary
They haven't told me anything about my lipids, though they check them
when they do my 6-monthly bloods, so I'm hoping that means they're
normal. How are lipid levels related to diabetes?

Intimately : ) For a start, the liver is the major organ apart from your
pancreas affected by diabetes, and is also the major source of blood
lipids. That can be a bad synergy. Lipid abnormality is also a big
predictor of heart disease risk, which is worse in diabetics because,
among other things, the low-level inflammation caused by high blood
glucose. Big area to read up on, if you get interested!
You do know that you can (and should) ask your GP for copies of every test
result you've had? That way you can spot trends and abnormalities. If
you've had a full lipid panel, the ratios tell you a lot about levels of
insulin resistance. They may ask for a photocopying fee.

Oh no, they already think I'm a hypochondriac :-) Thanks for that info - I
didn't know you could ask for a copy.

<snip>

Post by Nicky
We've got no problems with questions - keep 'em coming : ) You'd get a
wider audience for them on alt.support.diabetes.uk, though.

Thanks - I was a bit scared of posting on there as the atmosphere seemed a
little different. I guess if it is a higher traffic group, though, there are
going to be more conflicts and stuff.

Rosemary

Nicky

2006-09-09 18:58:16 UTC

Post by Rosemary
Do you know how much Lloyds charge?

Free : ) Many of the high street chemists seem to be doing this kind of
service. If you live somewhere busy, you could use a different one every day
of the week...

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-10 02:07:20 UTC

Post by Rosemary
Do you know how much Lloyds charge?

Free : ) Many of the high street chemists seem to be doing this kind of
service. If you live somewhere busy, you could use a different one every
day of the week...

Heh :-) Thanks, I'll look into that.

Rosemary

Trinkwasser

2006-09-09 17:47:51 UTC

On Sat, 09 Sep 2006 05:17:45 GMT, "Rosemary"

It's a fairly well known side effect, I'm surprised your doctors
didn't know this. Off the top of my head I can't remember which drugs
are worse.

My drugs all come boxed with the leaflet still enclosed.

Post by Rosemary
I've tried to convince the doctor I see that the reason I'm worried is that
I've found information that concerns me, and the doctor should be able to
tell me more about it and exactly what the risks are. I tried asking her but
got nowhere - she said "Well, if it isn't here on my screen, it must be a
very rare side effect and so I wouldn't worry about it". I'm suspicious of
the whole "rare side effect" thing, as the dangerous heart problems I
developed on another of the atypical antipsychotics were also not a listed
side effect in any of the usual reference books doctors have lying around.
It was found eventually from somewhere that this drug did in fact have that
side effect.

Any chance of changing doctors?

In my view a GP can't possibly know everything about everything and
should NOT pretend to. I have a lot more respect for one who says "I
don't know!" and looks stuff up - and strangely that type seem to give
better treament too.

The PDR is the Gold Standard drug information source but it's owned by
Thompson, you have to sign up and pretend to be a Medical Professional
and you're almost certainly going to become a target for spam.

http://www.rxlist.com/

is pretty decent, also for psych meds

http://www.geocities.com/nomdeplume1000/index.html

(the references he has are all pdf files so you may prefer to download
them and read them later, also his front page refers to

http://www.crazymeds.org/

another decent information source)

Post by Rosemary
<snip>
I've lost two stone on this diet so far so I know at least that it works in
that sense, so I'm loath to change something that appears to be working.
They haven't told me anything about my lipids, though they check them when
they do my 6-monthly bloods, so I'm hoping that means they're normal. How
are lipid levels related to diabetes?

See Nicky's post - fairly intimately if you're running excessively
high blood glucose.

If it works stick with it. I *would* ignore the no doubt
well-intentioned advice though and test after meals, before developing
"real" diabetes you can run numbers which are excessive enough to
cause long term damage. I know because I have.

The best thing you can do really is to buy yourself a blood glucose
meter - the meters are cheap but the strips are damn expensive -
that's what I had to do to convince my GP that I had a problem.

My previous doctors would use a fasting BG test or a urine dip and
then assume because the numbers were normal I was making up my
symptoms. Many variants of diabetes start with normal FBG and raised
postprandial numbers, a glucose tolerance test will demonstrate this
but is expensive to administer, though you have to buy your own
lucozade the test runs for three hours and requires three or four
blood draws so is often considered too expensive to bother with. My
current GP did based on the numbers I showed her from my meter.

Post by Trinkwasser
http://www.alt-support-diabetes.org/newlydiagnosed.htm
http://www.phlaunt.com/diabetes
two useful sites for the beginner

Thanks.

I've suffered from skin infections and the like most all my life, so I
sympathise.

Diabetes (Type 2, though I suspect this name covers a whole bunch of
different diseases with some similar symptoms) is a progressive
disease. It's a crapshoot where they draw the line between "diabetes"
and "not diabetes", and below that there's another line between "not
diabetes" and "impaired fasting glucose" or "impaired glucose
tolerance" - the lines are moved from time to time. The point is, if
you are proactive enough early enough you can forestall the
progression, see

http://www.medscape.com/viewprogram/145_pnt

in fact the CME papers on Medscape are an excellent resource, they're
some way behind cutting edge so are relatively authoritative and often
way ahead of current medical practice by overworked doctiors who were
trained years ago, you need to register but DON'T get any spam

Post by Rosemary
<snip>

Post by Trinkwasser
I'd have to advise against going off your meds but you could discuss
with your doctor whether there might not be something better for you.

What are you taking them for, and are there other alternatives?

Rosemary

2006-09-09 18:25:29 UTC

<snip>

I agree. I did take in the information I'd found, but my GP seems to feel
threatened by that, and insists that if she didn't already have the
information then it can't be that important - grrr. I do go to a partnership
practice with several different GPs, so I think I'm going to have to try and
see one of the others.

<snip useful links>

The best thing you can do really is to buy yourself a blood glucose
meter - the meters are cheap but the strips are damn expensive -
that's what I had to do to convince my GP that I had a problem.

So the glucose tolerance test is a little bit like a more tightly controlled
version of testing after meals?

<snip>

Post by Rosemary
I was getting really bad boils and cysts which I've heard can be
associated with high blood sugar.

I've suffered from skin infections and the like most all my life, so I
sympathise.

It's foul - I had an operation to remove two cysts from the back of my neck
which were about an inch in diameter each, but the GP messed up and I had to
go to A & E to get it fixed and take three different types of antibiotics.
I'm getting fed up with that lot! :-D

Post by Trinkwasser
Diabetes (Type 2, though I suspect this name covers a whole bunch of
different diseases with some similar symptoms) is a progressive
disease. It's a crapshoot where they draw the line between "diabetes"
and "not diabetes", and below that there's another line between "not
diabetes" and "impaired fasting glucose" or "impaired glucose
tolerance" - the lines are moved from time to time. The point is, if
you are proactive enough early enough you can forestall the
progression, see
http://www.medscape.com/viewprogram/145_pnt

Thanks - I'll take the time to read that a little later on.

<snip>

Post by Trinkwasser
I'd have to advise against going off your meds but you could discuss
with your doctor whether there might not be something better for you.

What are you taking them for, and are there other alternatives?

I have what is this week being diagnosed as psychotic depression with
generalised anxiety disorder. I take neuroleptics partly to ward off minor
delusions and hallucinations, but mainly as an anxiolytic. Benzodiazepines
also work well, but obviously I can only take those rarely. Sometimes, when
I'm relatively well, a combination of an antidepressant and a
mood-stabiliser can help, but it tends to become less effective after a few
months. I also use a lot of relaxation techniques, but these are very
difficult to do properly when I'm extremely agitated. The best thing seems
to be a combination of all of these, used at appropriate times, and so the
antipsychotic is just one of the methods that I use to help.

I think if I suffered from schizophrenia, the benefits might outweigh the
risks, but as it is I don't think the scales even balance.

Rosemary

Nicky

2006-09-09 19:10:45 UTC

Post by Rosemary
I agree. I did take in the information I'd found, but my GP seems to feel
threatened by that, and insists that if she didn't already have the
information then it can't be that important - grrr. I do go to a
partnership practice with several different GPs, so I think I'm going to
have to try and see one of the others.

Yeah - try asking the nurses which doctor has the healthiest diabetic
patients. I got a very detailed breakdown of characteristics, making it
easier to choose - shame they're bound by practice rules : ( The person in
my surgery who has been most helpful was the nurse who retired last month
<sob>...

Post by Rosemary
So the glucose tolerance test is a little bit like a more tightly
controlled version of testing after meals?

Yes - but there's a possible side effect of that much glucose and the
resulting sugar crash. You can get seriously unpleasant bodily reactions to
a rapid change of bg, in either direction. If you're doing a home-brew GTT,
don't schedule anything for 3-4 hours afterwards, because you may feel like
slime left on the beach. Testing after a meal you're used to is a LOT less
traumatic. Oatmeal or pasta would be a good place to start...

Post by Rosemary
I have what is this week being diagnosed as psychotic depression with
generalised anxiety disorder.

Hmmm... you sound as impressed with that as Trink is about his various
brushes with mental health experts... could be you two are just about to
widen my horizons again : )

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-10 02:14:16 UTC

Yeah - try asking the nurses which doctor has the healthiest diabetic
patients. I got a very detailed breakdown of characteristics, making it
easier to choose - shame they're bound by practice rules : ( The person
in my surgery who has been most helpful was the nurse who retired last
month <sob>...

Oh, I hate that. I managed to find a really fantastic GP, who was
sympathetic but didn't bullshit me or treat me with kid gloves, who did
everything in her power to get me the treatment I needed - I'm the only
person I know who didn't have to wait for cognitive behavioral therapy and
got an immediate home visit from a consultant psychiatrist when I was very
ill (by the way, that almost never happens round here). She moved to
Australia. :-(

Post by Rosemary
So the glucose tolerance test is a little bit like a more tightly
controlled version of testing after meals?

Yes - but there's a possible side effect of that much glucose and the
resulting sugar crash. You can get seriously unpleasant bodily reactions
to a rapid change of bg, in either direction. If you're doing a home-brew
GTT, don't schedule anything for 3-4 hours afterwards, because you may
feel like slime left on the beach. Testing after a meal you're used to is
a LOT less traumatic. Oatmeal or pasta would be a good place to start...

I don't really seem to react that much, luckily.

Post by Rosemary
I have what is this week being diagnosed as psychotic depression with
generalised anxiety disorder.

Hmmm... you sound as impressed with that as Trink is about his various
brushes with mental health experts... could be you two are just about to
widen my horizons again : )

Gawd, there's a lot of incompetents working in MH - I've been in the system
5 years and they still can't decide what's wrong with me, or even what
medications to give me - so they just give me one of everything and hope
something works - my long-term regime has been an antipsychotic (plus
something for the side-effects), an antidepressant, and a mood stabiliser,
plus Valium and beta-blockers and anything else that'll keep me doped up
enough to stop me complaining, basically. A lot of these diagnoses are very
arbitrary, I feel.

Rosemary

Nicky

2006-09-10 07:45:42 UTC

Post by Rosemary
Oh, I hate that. I managed to find a really fantastic GP, who was
sympathetic but didn't bullshit me or treat me with kid gloves, who did
everything in her power to get me the treatment I needed - I'm the only
person I know who didn't have to wait for cognitive behavioral therapy and
got an immediate home visit from a consultant psychiatrist when I was very
ill (by the way, that almost never happens round here). She moved to
Australia. :-(

Aargh! Immigration? : )

Post by Rosemary
Gawd, there's a lot of incompetents working in MH - I've been in the
system 5 years and they still can't decide what's wrong with me, or even
what medications to give me - so they just give me one of everything and
hope something works - my long-term regime has been an antipsychotic (plus
something for the side-effects), an antidepressant, and a mood stabiliser,
plus Valium and beta-blockers and anything else that'll keep me doped up
enough to stop me complaining, basically. A lot of these diagnoses are
very arbitrary, I feel.

Why does that sound like people stirring your brain with a dirty stick and
seeing what happens? Being able to do root cause analysis sounds a long way
away : (

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-11 03:07:00 UTC

<snip>

Post by Rosemary
Gawd, there's a lot of incompetents working in MH - I've been in the
system 5 years and they still can't decide what's wrong with me, or even
what medications to give me - so they just give me one of everything and
hope something works - my long-term regime has been an antipsychotic
(plus something for the side-effects), an antidepressant, and a mood
stabiliser, plus Valium and beta-blockers and anything else that'll keep
me doped up enough to stop me complaining, basically. A lot of these
diagnoses are very arbitrary, I feel.

Why does that sound like people stirring your brain with a dirty stick and
seeing what happens? Being able to do root cause analysis sounds a long
way away : (

A very long way. The other thing is that psychiatry seems particularly prone
to is fashion-following - seems every woman I meet in the MH system has at
some point had a diagnosis of Borderline Personality Disorder. AFAICT I have
the same illness as my mother, her mother, and her mother before that, which
have been diagnosed as "depression and anxiety", "manic depression" and
"nerves(!)" respectively. I suspect a certain amount of this phenomenon is
evident in other medical fields, too, but luckily I haven't had much
experience of them. I think that some of the time this urge to diagnose is
unhelpful, as different people with supposedly the same mental illness have
entirely different symptoms and thrive on entirely different types of
treatment.

Sorry, I'll get off my hobby-horse now :-)

Rosemary

Nicky

2006-09-11 07:48:28 UTC

The other thing is that psychiatry seems particularly prone to is
fashion-following - seems every woman I meet in the MH system has at some
point had a diagnosis of Borderline Personality Disorder.

Isn't it impossible NOT to have a Borderline Personality Disorder at some
point? I was reading an article the other day that explained that according
to the psychiatrists' bible (ADM??), being angry occasionally was
Intermittent Explosion Disorder; being sad was another... it sounded very
much like people with a label looking for people to stick it on.

AFAICT I have the same illness as my mother, her mother, and her mother
before that, which have been diagnosed as "depression and anxiety", "manic
depression" and "nerves(!)" respectively.

And presumably nobody managed to find a pharmaceutical solution for the
previous generations either : ( A study of familial clusters might be very
interesting, if for nothing more than pooling information on coping
mechanisms. Any sign of diabetes in the same line?

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-13 10:32:39 UTC

The other thing is that psychiatry seems particularly prone to is
fashion-following - seems every woman I meet in the MH system has at some
point had a diagnosis of Borderline Personality Disorder.

Isn't it impossible NOT to have a Borderline Personality Disorder at some
point? I was reading an article the other day that explained that
according to the psychiatrists' bible (ADM??), being angry occasionally
was Intermittent Explosion Disorder; being sad was another... it sounded
very much like people with a label looking for people to stick it on.

Very much so - and they don't even follow their own rules. Personality
disorders are supposed to be long-standing problems, and at the time I was
given that label I had been ill for maybe 10 months. The main book they seem
to use is the DSM-IV-TR, but I think they also use the ICD-10
classifications sometimes. I think in order for them to even think about
giving someone such a stigmatising label as "personality disorder", they
should make sure that it is a long-standing problem, is causing sufficient
difficulties in someone's life to warrant some kind of diagnosis, and that
they have categorically ruled out any other possibility, because once you
have the "personality disorder" label, doctors seem to see you as
essentially incurable and a lost cause.

AFAICT I have the same illness as my mother, her mother, and her mother
before that, which have been diagnosed as "depression and anxiety",
"manic depression" and "nerves(!)" respectively.

And presumably nobody managed to find a pharmaceutical solution for the
previous generations either : ( A study of familial clusters might be
very interesting, if for nothing more than pooling information on coping
mechanisms. Any sign of diabetes in the same line?

That grandmother died early of suspected lithium toxicity. My mother
developed breast cancer. She was otherwise at a pretty low risk, but had for
many years taken a tricyclic antidepressant which is now known to triple the
likelihood of getting breast cancer - from a 1 in 9 chance to a 1 in 3
chance. It may have been just bad luck, and we have no proof that the drug
caused the cancer, but these two possibly iatrogenic illnesses in the family
have made me very suspicious of any drug, particularly if the psychiatrist
tells me, as she did with olanzapine, that "this drug doesn't really have
any side-effects worth worrying about". That line of the family, though,
seems blighted. Every female from my great-grandmother downwards, save for
my cousin (I suspect the validity of my uncle's paternity ;-) ) has had
significant trouble with mental health problems, diagnosed variously as mood
disorders, anxiety disorders, various eating disorders, OCD, and sundry
other comorbid diagnoses.

That line seems to have no diabetics at all. Everyone from that side of my
family seems to be a splendid specimen of physical health, save for the
possibly drug-induced problems I mentioned before, with the majority of them
living into their nineties, though they are all long dead now. My dad's side
of the family seems more prone to obesity, diabetes, asthma, migraine,
severe eczema, and also things like hayfever, susceptibility to infection,
etc. etc. .

I don't know how strong the genetic component is for diabetes - I suppose it
probably varies from family to family. I knew a girl whose dad's family all
seemed to be T2s past the age of about thirty. Ach!

Rosemary

Nicky

2006-09-13 15:56:54 UTC

once you have the "personality disorder" label, doctors seem to see you as
essentially incurable and a lost cause.

which view also seems to extend to any other condition you may have...

I don't know how strong the genetic component is for diabetes - I suppose
it probably varies from family to family. I knew a girl whose dad's family
all seemed to be T2s past the age of about thirty. Ach!

The theory is, 15% for mother-daughter (might be any parent to child) for
straight T2. But it is, as you say, very complicated; my mother's people
are/were small round people who die usually relatively young of cancer and
heart attacks. My father's people are tall, lean and very long-lived (100+)
and no-one's ever had anything remotely diabetes related. My full sister is
diabetes-free, but my half-brother (same father) has diabetes too.

In any case, what exactly causes the several strains of T2 we know about
today is going to keep people busy for decades, let alone how they interact
with the rest of the genome. Alzheimer's seems to be a close cousin of
diabetes, and so does Celiac disease - but as with the depression clusters,
who knows whether it's chicken or egg.

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Trinkwasser

2006-09-15 19:40:25 UTC

On Wed, 13 Sep 2006 16:56:54 +0100, "Nicky"

once you have the "personality disorder" label, doctors seem to see you as
essentially incurable and a lost cause.

which view also seems to extend to any other condition you may have...

The theory is, 15% for mother-daughter (might be any parent to child) for
straight T2. But it is, as you say, very complicated; my mother's people
are/were small round people who die usually relatively young of cancer and
heart attacks. My father's people are tall, lean and very long-lived (100+)
and no-one's ever had anything remotely diabetes related. My full sister is
diabetes-free, but my half-brother (same father) has diabetes too.
In any case, what exactly causes the several strains of T2 we know about
today is going to keep people busy for decades, let alone how they interact
with the rest of the genome. Alzheimer's seems to be a close cousin of
diabetes, and so does Celiac disease - but as with the depression clusters,
who knows whether it's chicken or egg.

It gets complicated don't it?

All the results are not yet in but in that part of my family where the
diabetes comes from there seems to be three types of people.

The diabetics are skinny and exclusively male.

Some of the non-diabetics are skinny, long lived, and die of
cardiovascular stuff, after scarfing down increasing handfuls of BP
and other cardio meds.

The others are plumper, overweight in the "lived too well" kind of way
rather than that "glandular" type of obesity. The do exactly the same
but appear (too small a sample to be diagnostic) to have better lipids
and blood pressure than the skinny ones.

Go figure.

Genetics ain't simple.

Trinkwasser

2006-09-15 20:02:23 UTC

On Wed, 13 Sep 2006 10:32:39 GMT, "Rosemary"

The other thing is that psychiatry seems particularly prone to is
fashion-following - seems every woman I meet in the MH system has at some
point had a diagnosis of Borderline Personality Disorder.

Isn't it impossible NOT to have a Borderline Personality Disorder at some
point? I was reading an article the other day that explained that
according to the psychiatrists' bible (ADM??), being angry occasionally
was Intermittent Explosion Disorder; being sad was another... it sounded
very much like people with a label looking for people to stick it on.

That;s the point AFAICS.

When I was rediagnosed as "personality disorder" after about thirty
years of being a mere depressive, I was not as phased as I believe I
was intended to be, mainly because at the same time there were a rash
of people either similarly rediagnosed, or who had their
antidepressants cancelled, or the dose reduced, when they were doing
well.

This was around the time The Thatch decreed that the NHS was spending
"too much money on prozac"

In the States Borderline is the garbage-pail diagnosis, it's
considered to be uintreatable but actually Marsha Linehan's
Dialectical Behavior Therapy shows good results in dealing with the
thoguht processes and various meds can deal with the biochemical
issues.

Here personality disorder per se is regarded as untreatable and
incurable so it's a good diagnosis for any health authority looking to
cut their spend.

The other side of the coin is, some people with exactly the same bunch
of symptoms use them to advance their lives and careers (see Mrs
Thatch, as above) one authority, can't recall who, said there should
be a separate diagnosis of "personality order".

AFAICT I have the same illness as my mother, her mother, and her mother
before that, which have been diagnosed as "depression and anxiety",
"manic depression" and "nerves(!)" respectively.

And presumably nobody managed to find a pharmaceutical solution for the
previous generations either : ( A study of familial clusters might be
very interesting, if for nothing more than pooling information on coping
mechanisms. Any sign of diabetes in the same line?

This is not uncommon. Doesn't necessarily hit every individual but
runs in families. I strongly suspect apart from neurotransmitters
endocrines and other pathways may be involved.

Over the internet I can't see much sign of Borderline in you, though
of course I'm not going to attempt a diagnosis. My ex had pretty
severe symptoms BUT they switched on and off in a most Jekyll and Hyde
way according to time of month, it was like PMS with a turbocharger.

The lines that got to me were the shrink (curiously only one of about
three) claiming that my mother was "very controlling and manipulative"
while *she* was spending her time trying to control and manipulate me
herself.

And obviously my mother was soooo evil that she could turn my father's
great uncle bipolar and several of his other relatives depressive
*before she was even born* yes makes a lot of sense. Not.

I suppose from her point of view it was obvious, since I was then
living (temporarily after my divorce, in theory) with my mother at the
same address as when I last saw a shrink back in the sixties I had
obviously lived with and been dependent on her all my life, and
everything I claimed to have done in the meantime was mere fantasy.

"Tell me about your childhood sexual abuse"

"I was never abused as a child"

<therapist writes> "Patient is in denial about her sexual abuse
issues"

Nicky

2006-09-15 22:04:14 UTC

Post by Trinkwasser
The other side of the coin is, some people with exactly the same bunch
of symptoms use them to advance their lives and careers (see Mrs
Thatch, as above) one authority, can't recall who, said there should
be a separate diagnosis of "personality order".

That is a scary thought. Particularly when linked to almost any politician
: )

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Trinkwasser

2006-09-16 16:22:24 UTC

On Fri, 15 Sep 2006 23:04:14 +0100, "Nicky"

That is a scary thought. Particularly when linked to almost any politician
: )

Exactly. And not a few managerial types. And doctors. And
psychiatrists. Especially psychiatrists . . .

Rosemary Harker

2006-09-17 04:38:35 UTC

<snip>

Post by Rosemary
once you
have the "personality disorder" label, doctors seem to see you as
essentially incurable and a lost cause.

That;s the point AFAICS.

It seems to be a shorthand for "I wouldn't bother with this one if I were
you" which annoys me because a diagnosis of personality disorder IMO
indicates that the doctor giving the diagnosis can't think of a way to cure
it, therefore there mustn't be one.

Post by Trinkwasser
When I was rediagnosed as "personality disorder" after about thirty
years of being a mere depressive, I was not as phased as I believe I
was intended to be, mainly because at the same time there were a rash
of people either similarly rediagnosed, or who had their
antidepressants cancelled, or the dose reduced, when they were doing
well.
This was around the time The Thatch decreed that the NHS was spending
"too much money on prozac"

Prozac's cheap! Even when it way brand shiny new it wasn't expensive
compared with other types of treatment.

<snip>

Post by Rosemary
Every female from my great-grandmother downwards, save for
my cousin (I suspect the validity of my uncle's paternity ;-) ) has had
significant trouble with mental health problems, diagnosed variously as mood
disorders, anxiety disorders, various eating disorders, OCD, and sundry
other comorbid diagnoses.

This is not uncommon. Doesn't necessarily hit every individual but
runs in families. I strongly suspect apart from neurotransmitters
endocrines and other pathways may be involved.

I agree. I think there must be very complex mechanisms at work for virtually
every woman in my family to be affected, but to display symptoms different
enough to receive such differing diagnoses, even when accounting for
psychiatric fashions. the thing that seems to me to be difficult to explain
is why and how all these mental illnesses seem to be related. In my family
it seems to be mostly women who have the mental health problems, but the men
are mostly shy and socially awkward, with some problems akin to those
experienced by aspergics, though not severe enough to warrant such a
diagnosis. It's very odd, and I don't think there's any way that these
problems don't have some kind of biological basis.

<snip>

Post by Trinkwasser
The lines that got to me were the shrink (curiously only one of about
three) claiming that my mother was "very controlling and manipulative"
while *she* was spending her time trying to control and manipulate me
herself.

I'm currently struggling with a psychotherapist who is the most manipulative
person I've ever met. I managed with a great deal of difficulty to persuade
her to allow my partner to come with me into a meeting with her (not part of
my therapy). She toned down her manipulative behaviour a great deal, but
still tried to undermine my partner's contributions by suggesting he was in
need of psychotherapy himself (not in a good way).

But of course your shrink wasn't manipulative - she was merely using
techniques and persuasiveness to help you see and deal with the problems
caused by your mother :-)

<snip>

Post by Trinkwasser
"Tell me about your childhood sexual abuse"
"I was never abused as a child"
<therapist writes> "Patient is in denial about her sexual abuse
issues"

Argh! I have trouble with that kind of thing. I think they decided that it
was possible that I might have Borderline Personality Disorder, and so I had
probably been abused. I remember being an inpatient in an adolescent unit
and being interviewed repeatedly for hours at a time to try and get me to
say I'd been abused; they eventually hit paydirt when I admitted that very
occasionally, when I was little, if I'd been about to do something
dangerous, my dad had smacked me lightly. They jumped on that, refused my
parents and any relatives "access" to me for a few weeks, and my dad was
suspended from work while the "allegations" were considered. I was 15 at the
time, and in an emotionally very fragile state. They then decided that I
must be holding more back, and because I'd been "abused" I probably had BPD.
I am currently (6 years later) the only member of my psychotherapy group who
has not been abused as a child. I'm not saying it's specifically a group for
people who have been abused, but at times it seems a lot like that. Perhaps
it's the case that I share some problems with people who have suffered
sexual abuse, but it annoys me intensely that psychiatrists,
psychotheripists et al make endless assumptions about patients.

The same seems to go for other diseases and problems. You've got lung
cancer? You must have smoked. You've got diabetes? Your diet must have been
bad. You've got spots? You don't wash.

Grrr.

Rosemary

Trinkwasser

2006-09-17 19:15:15 UTC

On Sun, 17 Sep 2006 04:38:35 GMT, "Rosemary Harker"

Post by Rosemary
<snip>

Post by Rosemary
once you
have the "personality disorder" label, doctors seem to see you as
essentially incurable and a lost cause.

That;s the point AFAICS.

It's shorthand for "we can save money here, that'll look good on the
annual report"

Prozac's cheap! Even when it way brand shiny new it wasn't expensive
compared with other types of treatment.

Yes but the point was the cost of the *quantity* being prescribed.
Drugs are a cost per patient, therapy (especially group therapy) is a
cost per therapist. Looks better on the balance sheet even if it
doesn't work.

Post by Rosemary
<snip>

mood

Post by Rosemary
disorders, anxiety disorders, various eating disorders, OCD, and sundry
other comorbid diagnoses.

This is not uncommon. Doesn't necessarily hit every individual but
runs in families. I strongly suspect apart from neurotransmitters
endocrines and other pathways may be involved.

http://www.mhsanctuary.com/borderline/siever.htm

I can see a common factor in "personality disorders" of a kind of
emotional overreactivity: consider normal male behaviour - macho
behaviour - narcissism - psychopathology and in the opposite direction
normal femal behaviour - PMS - bordeline, the effect of the
overreactivity mediated by hormones.

Dame Whatsername claimed that medical treatment for mental disorders
was "like stacking seesaws", well she was correct in a way, it's a
cascade of chemicals, but on the other hand there are millions of
folks who have had their seesaws satisfactority stacked by modern
medication.

I can see a similar pattern from my family background, the depression
seems to stem exclusively from one side, and has a fairly specific
form. The diabetes comes from the other side and is mainly within a
more distant part of the family. Also from that side but from mother's
father rather than her mother's side comes something in between
aspergers and "geek syndrome". I collected the whole bunch. But there
are subsets of symptoms in most everyone.

There's an interesting cluster effect in a friend's family: his
grandfather was depressive and had cardiovascular problems. His father
was not depressive but had cardiovascular problems. His younger son
died of a heart attack in his thirties. He and his older son both have
the depression to some degree and both have developed signs of
metabolic syndrome but so far without more serious cardiovascular
symptoms, or diabetes which looking at all their body shapes they
might be expected to get. He and the deceased son used to be lithe and
muscular people who suddenly became plump and pudgy (think Van
Morrison) the others were always plum and pudgy. So it goes.

Over time you get to see these kinds of patterns emerge, it's always
amazed me that some medically trained people don't look, or disregard
them.

You met her too huh? <G>

Post by Rosemary
But of course your shrink wasn't manipulative - she was merely using
techniques and persuasiveness to help you see and deal with the problems
caused by your mother :-)

Quite. And if I say I see *her* expressing the behaviours she is
projecting onto me, and my mother, and that such projection is common
to some personality disorders, then bingo! I have projected my own
symptoms onto her and confirmed her diagnosis.

I am psychiatrist of Borg, you will be assimilated . . .

Post by Rosemary
<snip>

Post by Trinkwasser
"Tell me about your childhood sexual abuse"
"I was never abused as a child"
<therapist writes> "Patient is in denial about her sexual abuse
issues"

And historically when you look at some of these campaigns against what
turns out to be non-existent child abuse, the main abuse has come from
the psychiatrists pulling the children out of their families, sticking
them in care and harassing them into "admitting" stuff that never
happened.

Post by Rosemary
The same seems to go for other diseases and problems. You've got lung
cancer? You must have smoked. You've got diabetes? Your diet must have been
bad. You've got spots? You don't wash.

BTDT.

Also, you can't have gallstones, you're too young and the wrong sex.

Trinkwasser

2006-09-11 20:21:34 UTC

On Mon, 11 Sep 2006 03:07:00 GMT, "Rosemary"

Post by Nicky
Why does that sound like people stirring your brain with a dirty stick and
seeing what happens? Being able to do root cause analysis sounds a long
way away : (

That tends to heppen when you argue or answer back.

Post by Rosemary
AFAICT I have
the same illness as my mother, her mother, and her mother before that, which
have been diagnosed as "depression and anxiety", "manic depression" and
"nerves(!)" respectively. I suspect a certain amount of this phenomenon is
evident in other medical fields, too, but luckily I haven't had much
experience of them. I think that some of the time this urge to diagnose is
unhelpful, as different people with supposedly the same mental illness have
entirely different symptoms and thrive on entirely different types of
treatment.

Yes. The DSM categories are more for the benefit of American Insurance
Companies and have little bearing on the best treatment options,

Trinkwasser

2006-09-10 20:04:57 UTC

On Sun, 10 Sep 2006 02:14:16 GMT, "Rosemary"

Yeah - try asking the nurses which doctor has the healthiest diabetic
patients. I got a very detailed breakdown of characteristics, making it
easier to choose - shame they're bound by practice rules : ( The person
in my surgery who has been most helpful was the nurse who retired last
month <sob>...

That's taking it a bit far <G>

I've had exactly that problem in the past with dentists, just as you
get a good one they go and retire.

You are extremely lucky to get such quick referrals.

Post by Rosemary
So the glucose tolerance test is a little bit like a more tightly
controlled version of testing after meals?

Yes - but there's a possible side effect of that much glucose and the
resulting sugar crash. You can get seriously unpleasant bodily reactions
to a rapid change of bg, in either direction. If you're doing a home-brew
GTT, don't schedule anything for 3-4 hours afterwards, because you may
feel like slime left on the beach. Testing after a meal you're used to is
a LOT less traumatic. Oatmeal or pasta would be a good place to start...

I don't really seem to react that much, luckily.

It's not something to do without someone around to keep an eye on you,
just in case.

Post by Rosemary
I have what is this week being diagnosed as psychotic depression with
generalised anxiety disorder.

Hmmm... you sound as impressed with that as Trink is about his various
brushes with mental health experts... could be you two are just about to
widen my horizons again : )

Try alt.support.depression.medication, you'll soon spot the trolls and
psychotics off their meds, Pablo, Nom De Plume and Larry Hoover among
others know whereof they speak.

Trouble is some of the meds are not available here, you cannot get
Wellbutrin but the exact same drug is available as Zyban if you want
to stop smoking. Also some of the more off-label uses such as
selegeline for depression are unavailable AFAIK.

I used to have a friend who was a psychiatrist and village GP, but
that was during one of my sane periods <G> I'll swear some of them
have worse personality disorders than many of their patients

http://isnt.autistics.org/

look at the spoof DSM entries

Rosemary

2006-09-11 03:40:24 UTC

<snip>

Post by Trinkwasser
You are extremely lucky to get such quick referrals.

I know. I seem to have a knack for it. When I lived in Lincolnshire, I
presented at casualty and for some reason was immediately admitted to the
psychiatric ward there, even though the overcrowding is such that another
local woman who was pregnant, schizophrenic, and actively psychotic and
suicidal couldn't get into any of the mental hopspitals in a 50 mile radius,
despite doctors saying that she needed to be sectioned. Maybe it's something
in my eyes... . I don't think it's fair, but what could I do?

Post by Rosemary
So the glucose tolerance test is a little bit like a more tightly
controlled version of testing after meals?

Yes - but there's a possible side effect of that much glucose and the
resulting sugar crash. You can get seriously unpleasant bodily reactions
to a rapid change of bg, in either direction. If you're doing a home-brew
GTT, don't schedule anything for 3-4 hours afterwards, because you may
feel like slime left on the beach. Testing after a meal you're used to is
a LOT less traumatic. Oatmeal or pasta would be a good place to start...

I don't really seem to react that much, luckily.

It's not something to do without someone around to keep an eye on you,
just in case.

Righty-ho.

<snip>

Post by Trinkwasser
http://isnt.autistics.org/
look at the spoof DSM entries

Love it :-) Thanks.

Rosemary

Trinkwasser

2006-09-11 20:27:20 UTC

On Sun, 10 Sep 2006 21:04:57 +0100, Trinkwasser

Post by Trinkwasser
On Sun, 10 Sep 2006 02:14:16 GMT, "Rosemary"

Post by Rosemary
Gawd, there's a lot of incompetents working in MH - I've been in the system
5 years and they still can't decide what's wrong with me, or even what
medications to give me - so they just give me one of everything and hope
something works - my long-term regime has been an antipsychotic (plus
something for the side-effects), an antidepressant, and a mood stabiliser,
plus Valium and beta-blockers and anything else that'll keep me doped up
enough to stop me complaining, basically. A lot of these diagnoses are very
arbitrary, I feel.

Thinking about it, in view of the first paragraph above Wellbutrin and
selegeline would probably NOT be a good idea, nor would be anything
else likely to increase your dopamine, such as the basis of my food
pyramid caffeine and nicotine <G>

There's considerable anecdotal (mostly) support for increasing your
intake of Omega 3s, can't hurt anyway. I find fish oil makes me
bloated and gives me fishy halitosis but it works fine when combined
with the rest of the fish.

Also have you tried Evening Primrose Oil?

Trinkwasser

2006-09-10 19:51:54 UTC

On Sat, 09 Sep 2006 18:25:29 GMT, "Rosemary"

Post by Trinkwasser
Any chance of changing doctors?
In my view a GP can't possibly know everything about everything and
should NOT pretend to. I have a lot more respect for one who says "I
don't know!" and looks stuff up - and strangely that type seem to give
better treament too.

Try asking a nurse or even the receptionist (assuming they aren't
alumni of the Hitler Youth Charm School) they might know if one of the
other GPs has a special interest in diabetes, or anything else
relevant.

Post by Rosemary
So the glucose tolerance test is a little bit like a more tightly controlled
version of testing after meals?

Basically, yes, you fast for 12 hours then take equivalent of 75g
glucose AFAICR, then they take bloods every hour for three hours or
so.

Post by Rosemary
<snip>

Post by Rosemary
I was getting really bad boils and cysts which I've heard can be
associated with high blood sugar.

I've suffered from skin infections and the like most all my life, so I
sympathise.

Yeow! :( Mine were mostly just annoying except for a bout of
infectious exzema, and a horrendous abcess under a tooth. do NOT try
that at home.

Thanks - I'll take the time to read that a little later on.

There are more recent papers on Medscape, that was one Old Al was
championing when I first arrived and opened my eyes to a lot of stuff
I never knew before.

Post by Trinkwasser
What are you taking them for, and are there other alternatives?

I have what is this week being diagnosed as psychotic depression with
generalised anxiety disorder. I take neuroleptics partly to ward off minor
delusions and hallucinations, but mainly as an anxiolytic. Benzodiazepines
also work well, but obviously I can only take those rarely. Sometimes, when
I'm relatively well, a combination of an antidepressant and a
mood-stabiliser can help, but it tends to become less effective after a few
months. I also use a lot of relaxation techniques, but these are very
difficult to do properly when I'm extremely agitated. The best thing seems
to be a combination of all of these, used at appropriate times, and so the
antipsychotic is just one of the methods that I use to help.
I think if I suffered from schizophrenia, the benefits might outweigh the
risks, but as it is I don't think the scales even balance.

My sympathies. I also suffer from depression, with side orders of SAD
and ADD, but my particular variant seems to respond well to tricyclics
and more recently venlafaxine (Effexor).

One thing I have noticed is that as I have gotten my BG undr control
the symptoms have lessened, the depression is currently under control
on 1/10 the dose of Effexor I started out on, and the ADD is only
mildly annoying *unless* my BG goes over 8, when I go back to that
state of reading a page, discovering none of it has sunk in, reading
the page again, discovering none of it has sunk in, reading the page
again . . .

Now I don't know if the same might happen to you, but here's hoping!

I had a friend who had the most horrendous bipolar, used to cycle from
suicidal depression to up-all-night saving the world mania and back
over about five days. When she was stable she was a very competent
person, but after time whatever combination of meds she was on the
cycling would start to recur, and she'd have to go back on the test
this, add that, tweak the dose rollercoaster again. Sometimes she'd be
stable for months or even years. You really need a competent
psychopharmacologist or the like.

The only good news is, more and different meds are coming onto the
market all the time, hopefully you'll find the combination that has
your name on it sooner rather than later.

steve

2006-09-09 07:42:10 UTC

On Thu, 07 Sep 2006 04:17:37 GMT, "Rosemary"

Rosemary, don't get worried by readings such as these. When I was
first diagnosed, mine was 31mmol/L ( no, I haven't missed out the
decimal point).

Post by Rosemary
The next time they took my bloods, I had started taking Seroquel/quetiapine.
It came back with a reading of 7mmol/l, which I was told meant I could be
diabetic. I did some quick reading up and noticed that in America there are
cautions attached to the drug for diabetics and those with a strong family
history, and something about blood sugar levels too, but to be honest I
couldn't work it out as I am not well educated in pharmacology or medicine
or in fact anything in that sphere. Because the information British GPs have
in front of them doesn't seem to mention this, my doctors don't believe my
high result and the medications could be linked. They wanted to repeat the
test as they suspected I had not fasted properly (yeah, like I want to give
myself a diabetes scare), so I took myself off the drug a week or so before
the test, to see if that made any difference to the reading.
Completely off drugs, my reading came back at 4.6mmol/l.
<snip>

This is the sort of reading a 'normal' person would expect.

If you have information from the USA on the possible side effects of
the drug that your GP is unaware of, tell him. Print it out, take it
in and show him. Your GP can only make an informed decision using the
information available to him in this country. He doesn't have time to
check every other country in the world.

I told my practice nurse (in most GP practices, she's the one who
looks after diabetic needs) that I would volunteer for UK trials of a
new diabetic drug for type 2 diabetics which has just been licenced
for use in the USA if and/or when it gets trialed here. Neither she,
my GP or the whole diabetic team at the local university hospital knew
what I was talking about. They do now because I printed out the
relevant pages from the web site I got the information from and took
it in to show her. She in turn showed everyone else, now they all know
about this new drug and if the americans have it, it won't be long
before we have it.

A couple of other things you might like to know. Even if you tested
with a reading of 10mmol/L it is doubtful that your diabetic team
would start you on medication straight away. They usually try and
bring down the reading using diet alone as a first resort.

Testing: if you purchased your own meter, DO NOT perform a test until
at least 2 hours after taking food. Testing after only 1 hour will
give you a false reading. Don't get me wrong, testing after 1 hour has
it's place for the diabetic team but is no good at all just for your
own use.

Meters: If you do decide to buy a meter (and in your case I wouldn't
bother) then go to your local chemist (not Boots). Most have them on
special offer for around 5 pounds. These are no frills meters but
accurate all the same. Their saving grace for the occasional tester is
that they come with 5 or 10 test strips. Once you run out of test
strips, throw it away and buy another meter, far cheaper than having
to buy the test strips yourself and I doubt your GP will give you a
prescription for them because you are not diabetic.

If you are diagnosed as diabetic sometime in the future, your practice
nurse will give you a meter to use unless you want to buy a decent one
yourself.

Hope some of this helps.

BTW my fave web site for anything to do with diabetes is
http://www.diabetesuffolk.com/default.asp

Steve

Nicky

2006-09-09 08:00:57 UTC

Post by steve
Rosemary, don't get worried by readings such as these. When I was
first diagnosed, mine was 31mmol/L ( no, I haven't missed out the
decimal point).

Yeah, sure - she's trying to figure out how not to guarantee diabetes...
advice like that is really dumb. What's the relevance of your own evidence
of bad practice?!

Post by steve
Testing: if you purchased your own meter, DO NOT perform a test until
at least 2 hours after taking food. Testing after only 1 hour will
give you a false reading. Don't get me wrong, testing after 1 hour has
it's place for the diabetic team but is no good at all just for your
own use.

WTF? If she has a peak at 1 hour, that's when she needs to test!!

Post by steve
BTW my fave web site for anything to do with diabetes is
http://www.diabetesuffolk.com/default.asp

Ah yes, this advice explains yours: "Have starchy foods at each meal -
preferably rich in fibre. These should be the main part of each meal. "
They're stuck in the ADA rut. Shame.

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

steve

2006-09-09 08:26:36 UTC

On Sat, 9 Sep 2006 09:00:57 +0100, "Nicky"

Post by steve
Rosemary, don't get worried by readings such as these. When I was
first diagnosed, mine was 31mmol/L ( no, I haven't missed out the
decimal point).

Yeah, sure - she's trying to figure out how not to guarantee diabetes...
advice like that is really dumb. What's the relevance of your own evidence
of bad practice?!

WTF? If she has a peak at 1 hour, that's when she needs to test!!

Post by steve
BTW my fave web site for anything to do with diabetes is
http://www.diabetesuffolk.com/default.asp

Ah yes, this advice explains yours: "Have starchy foods at each meal -
preferably rich in fibre. These should be the main part of each meal. "
They're stuck in the ADA rut. Shame.
Nicky.

Whoa there little boy, just trying to help the lady

Nicky

2006-09-09 12:28:40 UTC

Post by steve
Whoa there little boy, just trying to help the lady

Sorry if I barked - but I think all you're doing is propagating the kind of
lowest common denominator advice that the GPs use, and that gives such dire
results. Rosemary has evidenced a bit more intelligence than that.

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Trinkwasser

2006-09-09 17:55:02 UTC

On Sat, 9 Sep 2006 13:28:40 +0100, "Nicky"

Post by steve
Whoa there little boy, just trying to help the lady

Nicky and I are both in Suffolk. She has to fight tooth and nail for
test strips. I was informed that "we don't like people testing their
own bloods" (though she backed down later when I proved I knew what I
was doing) and have been told categorically that even when I am
diagnosed with diabetes I will still not be prescribed test strips.

Someone elsewhere in Suffolk can have all the strips she asks for
prescribed but has been told she can run dangerously high postprandial
numbers and has not had that advice linked to her stroke or her
angina.

So you'll have to forgive us for not being overenthusiastic about that
site.

(also Nicky is not a boy . . .)

Nicky

2006-09-09 19:01:30 UTC

Post by Trinkwasser
(also Nicky is not a boy . . .)

Aw, Trink - you noticed : )

Nicky.

--
A1c 10.5/5.3/<6 T2 DX 05/2004
No Metformin, 100ug Thyroxine
95/72/72Kg

Rosemary

2006-09-10 02:17:53 UTC

Post by steve

Rosemary, don't get worried by readings such as these. When I was
first diagnosed, mine was 31mmol/L ( no, I haven't missed out the
decimal point).

Ouch! You must have been feeling pretty ill.

<snip>

Post by steve

Post by Rosemary
Completely off drugs, my reading came back at 4.6mmol/l.
<snip>

Thanks, I did that.

<snip>

Post by steve
Meters: If you do decide to buy a meter (and in your case I wouldn't
bother) then go to your local chemist (not Boots). Most have them on
special offer for around 5 pounds. These are no frills meters but
accurate all the same. Their saving grace for the occasional tester is
that they come with 5 or 10 test strips. Once you run out of test
strips, throw it away and buy another meter, far cheaper than having
to buy the test strips yourself and I doubt your GP will give you a
prescription for them because you are not diabetic.

I think before I decide whether or not I need a meter I'll look up Lloyds
chemist as Nicky suggested to see if my local branch do the testing.

Post by steve
If you are diagnosed as diabetic sometime in the future, your practice
nurse will give you a meter to use unless you want to buy a decent one
yourself.
Hope some of this helps.

Thanks. I feel a bit silly for being so worried, really as the GP reckons
it's not important, but then it's MY health, not hers :-)

Post by steve
BTW my fave web site for anything to do with diabetes is
http://www.diabetesuffolk.com/default.asp

Thanks.

Rosemary

Bernard Peek

2007-07-18 21:55:00 UTC

Post by steve
On Thu, 07 Sep 2006 04:17:37 GMT, "Rosemary"

Rosemary, don't get worried by readings such as these. When I was
first diagnosed, mine was 31mmol/L ( no, I haven't missed out the
decimal point).

My GP's comment was that although atypical antipsychotics can raise
blood glucose the effect is quite small, and probably not worth worrying
about.

Martin. B

2008-05-03 20:52:39 UTC