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Post Info TOPIC: HepC, diabetes and peripheral neuropathy


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RE: HepC, diabetes and peripheral neuropathy
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Hi Canuck,

Sorry about the timing confusion. Neuro #1 was Nov 2015. Fasting glucose then was 10. As usual, I ignored it and kept on my usual diet of steak/chips/sald or fish/chips/sald etc with nightly chocolate and dessert.

PN symptoms worsened so I saw Neuro #2 last month. Fasting glucose 15, so he wanted me to start treatment for T2D. I started Metformin 2 weeks ago, only 500 mg/day, slow release tablets. My wife has taken over my diet for the last 2 weeks. I have a glucose monitor and my pre-breakfast glucose for the last 3 days has been- 7.2, 7.5 and 6.9. I'm playing golf 3-4 times a week, so the exercise bit should be OK.

I don't expect 'normal' levels for a few more weeks, and may have to increase the Metformin dose to 1000mg/day. We'll see.

The rest of my stuff, Ultrasound lesions and raised LFT's also showed up last month. Separate issue and will be followed up.

Cheers mate.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm



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So, lemme see if I got the timelines right about your longstanding, ongoing (kinda "occult") mostly unaddressed 20 year blood sugar thing. Spurred by seemingly chronic progressive PN type symptoms, you re-hash with neuro #1 (about Nov?). Then to neuro #2, for fresh thinking/assessments (also about Nov?). Your FBS is 15 (Nov?). You start concerted dietary efforts (Nov?), and the 500 mg slow-release metformin (sometime after Nov/or only last few weeks?).

When did dietary measures start? When did metformin start?

I am trying to piece together the timing/consequence of diet and metformin, in relation to your response of your drops in FBS's  of (prior) 15, to now (sometime after Nov., after dietary changes, and after 2 weeks of metformin) to be in the improved 6 -7 range. I am reading that perhaps diet came first, then the metformin, with good response after only 2 weeks of metformin?

So, if your AC1's (subsequent to Nov/diet, or metformin start) are behaving better at 7.9 (hoping for below 6.5), and an AC1 is your peek at the last 120 days or so - then what do you best/first attribute your good response to? Did you have any bloods for diet alone response?

I am very interested in this metformin stuff.

I hope neuro #1 can pat his own head, and that neuro #2 is correct, about controlling sugars/perhaps neuropathy. Hmm, jury remains out on hep doc's "rubbish!"?

Do you have any further thinking on the newly seen U/S lesions?

Great post about Australian lab neg PCR stats!  C.



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HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)



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Thank you for the explanation and information Malcolm!

Here's hoping that it does not progress anymore as you had said. It is always great to hear from you and your wealth of knowledge.

Be well and take care.

SF

 



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65 yo, GT1A, , Cirrhosis, F-Scan F4 33.5, TX Naive Harvoni 12 wks

SOT 2/9/16 / ALT 187 AST 114 VL 2.3M.    POSTS

EOT 5/2/16  ALT 35/ AST/25  platlets 126 C/B VL UND

EOT +12 7/26/16  ALT 25 /AST 22/ ALP 83  platlets 129 C/B VL UND

EOT + 24 10/18/16 ALT 27/ AST 20/ ALP 71 platlets 153 C UND

 * SVR *



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Ragdoll,

Lucky RC.  You've got his back.

My brother has type 2 diabetes and has controlled it for years through diet and steady walking/hiking.  His numbers started rising this year and he knocked out ALL carbs - no bread, no rice, no cereal, no pasta, no sugar, period.  His numbers are better than they've ever been.  He's getting a little skinny but reports that it's so rewarding he doesn't feel deprived at all. I don't know if this works for everybody, but it sure is worth a try to head in that direction.

I love that you two are taking care of each other.  Warming.

Cheddy



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GT2a, VL 681,500, Less than F1, Treatment Naive

12 wks Sovaldi/Ribavirin, SOT 2/25/16, EOT 5/17/16

UND at 2,4,8 and 12 wks during treatment but ribavirin crazy.

ALT/AST normal EOT

SVR12 8/13/2016!!!!!!!!!  I WON!!

EOT 6 Months 11/12/2016  CURED

 



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Thanks Mallani, great information.  I have been looking at the relationship of HCV and T2D as RC has had a lot of trouble controlling Diabetes the last few years.  As the weight goes on the IR kicks in.  When weight down and very controlled low carb high protein diet he did not use insulin for 2 years.   But since 2 failed treatments and foot surgery and HCC stuff ,weight up and IR back.  But now back on his feet, RIBA out of his system and strict diet weight coming down, Insulin use going down, better control.   So many things to work on.  Thankfully no sign of PN !   Don't need another diagnosis !   Thanks for all your valuable research and information you provide the forum.  God Bless and take care.   Chris



-- Edited by RAGDOLL on Thursday 11th of August 2016 10:48:38 AM



-- Edited by RAGDOLL on Thursday 11th of August 2016 10:49:25 AM

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F 63,  1b  1974, no cirrhosis, fibro scan 5.8 F0-F1,fibro test .37 ,V/L 702987, ALT 90, AST 75.  ABBVIE Topaz II on 10-30-14 Viekira Pak no RIBA , EOT 1-22-15 SVR, ALT 37, AST 29, 4-15-15 SVR12 - fibro test .22,  1-21-16 SVR 52 ,  1-21-17 SVR 104! 1-21-18 SVR 3 years ,2020 5 years



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Hi Malcom

Sorry to hear about PN and type 2 diabetes.  

You have an excellent way of explaining science is understandable terms.

My understanding is that diabetic neuropathy takes time to occur and given that you have only recently been diagnosed with T2D, notwithstanding your longstanding raised glucose levels, maybe your hepa is right.  The thought of interferon causing PN is scary.  I hope that isn't in the post for me.  I had a rough ride on it at the time (depression, mainly) but have had - some 8 or so years later - no longterm side effects from interferon, but I have friends who describe all sorts of weird immunological effects.

Pablo

 



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44 y.o. male, HCV G4 since 1996, F-scan score 9, F2, Failed prior I/R, finished sof/vel/vox 8 weeks 5/16, pre-treatment VL 2 million, EOT UND, EOT+4 UND, EOT+12 UND.



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Thank you so much for the detailed explaination about PN. I asked every dr I've been to for years about the intermittent stabbing and numb pain in my foot and never really got a definative answer about what it is, what it could be, what caused it... I finally figured out it was PN from your previous posts on the subject.

we have to be our own advocates and your explanations really help arm us with knowledge.

 

Alison

 



-- Edited by Observer on Wednesday 10th of August 2016 05:07:32 AM

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61 y/o, Infected via transfusion Oct'83, GT-1a, F-4 cirrhotic,
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4 years.... successful dragon slayer 

Tig


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Thanks for the update and explanation, Malcolm. It's interesting to see the different opinions from your doctors. I'm sure the new dietary changes made by Lani will help get that A1C back to an acceptable level. I have no doubt you'll get there.

I enjoyed seeing your post. Keep us informed, good luck!



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Tig

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Hi all,

Tig has a Sticky on Extrahepatic manifestations of HCV, but I'll add to this, using my personal experiences.

Back in 2013, during my 48 weeks of treatment, I started getting some numbness in my feet. No big deal.

This has slowly become worse and extends to just below my knees and has also started in my little fingers. Last November, I consulted a Neurologist who confirmed I had peripheral neuropathy (PN), with fairly marked loss of vibration sense. He patted me on the head and said, bad luck, there's no effective treatment and he doesn't know what caused it. He did check my Vitamin B12, which was normal.

Since November, my balance has been affected. When I started to sway, when I was putting on a golf green, I decided to go to a different Neurologist. He did nerve conduction studies, which showed slowing of the transmission, but with a normal but low amplitude wave form. This indicates axonal damage rather than nerve sheath problems. In view of my history of long term HCV and 4 courses of Interferon, he ordered the usual batch of tests for cryoglobulins. As we know, mixed cryoglobulinaemia is common in HCV. However the peripheral neuropathy from mixed cryoglobulinaemia is due to a vasculitis, and predominantly affects the nerve sheaths. I don't have any cryoglobulins, apart from a slightly raised ANA. Thyroid tests, iron, copper and all else was normal. However my fasting glucose was 15!

He is convinced my PN is due to Type 2 diabetes (T2D). He urged me to get treatment and come back for re-testing in 6 months, after my blood glucose was lower. I have since started Metformin, slow-release, 500mg/day. Lani has started cooking low GI meals, which I find difficult (but will persist). After 2 weeks of Metformin, my fasting glucose is down to 6-7. Metformin takes 4 weeks to get steady state levels.

I have had raised blood glucose for 20 years. Previously I would avoid sweets etc before any blood tests. However, HbA1C measures glucose in red blood cells (glycated haemoblobulin), and as a red cell lives 120 days, it is not possible to cheat any more. My HbA1C is 7.9. It needs to be below 6.5

The association between HCV and diabetes has been documented for at lest 15 years. Initially it was thought that the virus affected the pancreas directly, but viral RNA has never been found in the pancreas beta cells. The association is due to Insulin Resistance (IR). Viral damage to the liver hepatocytes impairs the insulin-signalling pathway by several complex mechanisms. These are now well known and most involve cytokines SOC-3 and 7. Some studies have shown up to 70% of HCV patients have IR. Many of these go on to develop T2D. This is most common in obese patients, Latino and AfroAmerican patients and is most common in Genotypes 1b and 3.

So, armed with all this, I saw my Hepatologist. He said 'rubbish', my PN is due to HCV and/or Interferon. He claims about 50% of his SVR patients over 60yo have PN, and most are not diabetic, He thought my 'mild'(his words) diabetes may play a small part. His view is that axonal PN can be due to HCV and particularly the Interferon damage. In his experience, the PN does not progress beyond the hands and feet and there is no motor component.

Sorry to ramble, but this shows how difficult life can be , even after SVR.

I'll keep you informed. Cheers.



__________________

Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm

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