At my last endocrinologist visit, about two weeks ago, my A1c was a
respectable 6.7. When I watch what I eat my fasting Blood glucose in
the morning varies between 95 and 115. I haven’t checked my
cholesterol number lately but last year the doctor told me it was 150
or so.

I’m going to try to take your advise, Alan, and Hairy Antelope. A
couple of my problems are 1) I love to eat and 2) I prefer sitting to
standing. My leg strength is not good.

Thanks again.

John

On Fri, 20 Aug 2004 12:12:48 +1000, Alan

- Hide quoted text — Show quoted text -

<loralweightandca…@optusnet.com.au> wrote:
>On 20 Aug 2004 00:13:16 GMT, jcdej…@aol.comnojunk (John) wrote:

>>So that’s the story. Intuitively I feel like the primary causes of the swollen
>>ankles and feet are, #1 my weight (325 lbs); #2 the fact that I seat behind the
>>wheel of a car all day every day (and, sadly, the more I sit the more I want to
>>sitting); #3 I drink very little water, probably less than two glasses a day;
>>and #4 I do not exercise.

>Hi John

>And, as you said in your intro, you’re type 2. You sound like a nice
>guy, so excuse me if I sound a bit tough on you.

>You can’t change the type 2 diagnosis, but the other four are all your
>choice. Which do you intend changing before the next set of cardio
>checks?

>I’d put them in priority order of #1, #4, #3 and finally #2. You may not
>be able to change that last one for income, but if you don’t change the
>others, you won’t be doing the job for a lot longer.

>You haven’t mentioned lipids and Hba1c, or FBG and post-prandials.

>Do yourself a favour, check out the a.s.d. web-site "Newly Diagnosed"
>advice at http://www.alt-support-diabetes.org/NewlyDiagnosed.htm . Then
>follow it. If you also reduce your saturated fats input, increase your
>water drinking and start on at least a little exercise (park the car
>further from your destination to start with) you will find the weight
>will start to come off. And just as important, the BGs and lipids will
>improve.

>Your life, your choices.

>Good luck,

>Cheers Alan, T2, Australia.
>Remove weight and carbs to email.

>Thank you, Alan and Hairy Antelope.

>At my last endocrinologist visit, about two weeks ago, my A1c was a
>respectable 6.7. When I watch what I eat my fasting Blood glucose in
>the morning varies between 95 and 115. I haven’t checked my
>cholesterol number lately but last year the doctor told me it was 150
>or so.

>I’m going to try to take your advise, Alan, and Hairy Antelope. A
>couple of my problems are 1) I love to eat and 2) I prefer sitting to
>standing. My leg strength is not good.

>Thanks again.

>John

Good luck John

You will find that we’re a little tougher here; speaking as a NIDDM type
2, 6.7 may be "respectable", but under 6 is good and closer to 5 is
better.  The risk of cardio-vascular problems increases dramatically as
you increase A1c.

I also loved to eat, and still do. However, I made the decision that
instead of eating lots of junk (anything that makes you fat or gives
high BGs is junk:-) I would become more selective and eat less but
better quality.

So I lost weight, saved money, and eat the best I can afford. My steak
is still an inch thick, but it’s only two inches square (if I have the
big serve:-) I used to eat lots of cheap cheddar, now I eat much less
but it’s top aged cheddar, brie, blue, camembert, parmesan. You get the
picture – a little lasts me a long time. I savour my food now, instead
of shovelling it in.

That fasting BG is good, better than many here. But, I am sure you are
in for a surprise when you start following Jennifer’s intensive testing
advice, particularly with the post-prandial results.

As you follow that advice, you will automatically reduce the high GI
carbs; the trick is not to replace them with lots of protein and fat (in
your situation) but to use leafy veg to fill the hunger gap.  Carry
small plastic packs of salads (lettuce, celery, tomato, onion, whatever,
with a little olive oil and vinegar to dress) in the car for those snack
moments.  At meals, use cauli, cabbage, broccoli, spinach, silver-beet,
chard etc instead of potato, rice, corn, pastas. Experiment. And learn
to talk far too much when you eat:-)

Finally, I know what it’s like tied to a car. I drove a cab for 17
years. I also got to the point where I had to move the seat back further
to give stomach clearance. Of course, that’s never happened to you, has
it?

Off now – cyu in a couple of weeks.

Cheers, Alan, T2 d&e, Australia.
Remove weight and carbs to email.
—
Everything in Moderation – Except Laughter.

>So that’s the story. Intuitively I feel like the primary causes of the swollen
>ankles and feet are, #1 my weight (325 lbs); #2 the fact that I seat behind the
>wheel of a car all day every day (and, sadly, the more I sit the more I want to
>sitting); #3 I drink very little water, probably less than two glasses a day;
>and #4 I do not exercise.

Hi John

And, as you said in your intro, you’re type 2. You sound like a nice
guy, so excuse me if I sound a bit tough on you.

You can’t change the type 2 diagnosis, but the other four are all your
choice. Which do you intend changing before the next set of cardio
checks?

I’d put them in priority order of #1, #4, #3 and finally #2. You may not
be able to change that last one for income, but if you don’t change the
others, you won’t be doing the job for a lot longer.

You haven’t mentioned lipids and Hba1c, or FBG and post-prandials.

Do yourself a favour, check out the a.s.d. web-site "Newly Diagnosed"
advice at http://www.alt-support-diabetes.org/NewlyDiagnosed.htm . Then
follow it. If you also reduce your saturated fats input, increase your
water drinking and start on at least a little exercise (park the car
further from your destination to start with) you will find the weight
will start to come off. And just as important, the BGs and lipids will
improve.

Your life, your choices.

Good luck,

Cheers Alan, T2, Australia.
Remove weight and carbs to email.
—
dx May 2002 , A1C 8.2=>5.9, wt 117kg(257)=>95kg(209),
Diet and not enough exercise.
I have no medical qualifications beyond my own experience.
Choose your advisers carefully, because experience can be
an expensive teacher.

Everything in Moderation – Except Laughter.

I was checked out for congestive heart failure last fall when I expressed
concerns to my primary physician about Actos. I had read newspaper accounts of
people on Actos showing up in emergency rooms with heart failure. My doctor
reassured me by saying that thosde people likely already had "weak" hearts and
the edema caused by Actos exacerbated their problem and congestive heart
failure followed.

He said, "You don’t have a weak heart, but it has been three years since yoiu
had an echo cxardiogram and a stress test. Why don’t we just redo them." I
agreed.

No problem with the ech, but the stress test "seemed" to show possible
insufficient blood supply to parts of my heart. He said further testing was
required, so I underwent first a CT Heart Scan (inconclusive), and the the gold
standard, an angiogram.

The angiogram showed no plaque and just a little (maybe 20%) narrowing here and
there. The doctor, who happens to be a cardiologist said, "I don’t know what
you’re doing, but keep on doing it." "You have no heart issues."

So that’s the story. Intuitively I feel like the primary causes of the swollen
ankles and feet are, #1 my weight (325 lbs); #2 the fact that I seat behind the
wheel of a car all day every day (and, sadly, the more I sit the more I want to
sitting); #3 I drink very little water, probably less than two glasses a day;
and #4 I do not exercise.

I will look into that Metformin. Thanks, Old Al. And thank you all once again.

>Anyone have any ideas how to reduce or eliminate the swelling?

>Thanks.

  Actos and Avandia are two very popular and useful meds for Type 2
diabetics.   Unfortunately,  one of their most prominent side effects is
edema which is exactly what is bothering you.

I don’t know how to beat the edema but do know that metformin has many
useful effects similar to those of Actos but does not cause edema.

(It causes gastrointestinal problems in some folks though)

The problem with edema in we older folks is that if you are in congestive
heart failure or are susceptible or prone to congenstive heart failure,  the
edema from a med such as Actos will also promote or amplify any congestive
heart failure.

If the edema becomes too extensive,  or makes you or your doc worry about
congestive heart failure too much,  then metformin is a good med to
substitute for the Actos.

Your doc seems to be watching for congestive heart failure.   You don’t say
enough to let us know exactly why he prescribed the Calan,  but note that
Calan is one of the anti-Congestive Heart Failure meds  (and anti-heart
attack and anti-kidney failure and a few more things).

In any case,  taking any med for a serious problem  (Diabetes is serious!)
often means you risk side effects but the risk is usually worth it so long
as you are watching closely for the possible side effects.  (That’s what the
doc meant by "Trade Off")  That suggests that you should memorize the signs
of congestive heart failure so that you can call your doc if they start
showing up.

Some web sites to look at:

http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm

http://www.americanheart.org/presenter.jhtml?identifier=339

Some symptoms:

Weight gain
Swelling of feet and ankles**
Swelling of the abdomen**
Pronounced neck veins
Loss of appetite, indigestion
Nausea and vomiting
Shortness of breath with activity, or after lying down for a while
Difficulty sleeping
Fatigue, weakness, faintness
Sensation of feeling the heart beat (palpitations)
Irregular or rapid pulse
Decreased alertness or concentration
Cough
Decreased urine production
Need to urinate at night

(**Since you are taking a med which can cause swelling,  I don’t think you
can regard swelling as a symptom of Congestive Heart Failure)

Regards
  Old Al

David

- Hide quoted text — Show quoted text -

Crone wrote:
> David wrote:

>> go to another doctor.

>> David

>> John wrote:

>>> I am a 64 yearold male type 2 diabetic. I take Actos, Zetia, Calan,
>>> Novolog (insulin), Folic Acid, and a baby asperin daily. For about two
>>> years or so I have had swelling of my feet and ankles. My
>>> endocrinologist says its due in part to the Actos. He seems
>>> unconcerned, "A trade-off," he says. I’ve been thoroughly checked out
>>> for heart problems, echo cardiogram, Thalium stress test, even an
>>> angiogram. Clean as a whistle. But the swelling in my feet and ankles
>>> is annoying. Because of my work I sit in a car all day and don’t get
>>> much exercise. In addition, I don’t drink nearly enough water.

>>> Anyone have any ideas how to reduce or eliminate the swelling?

>>> Thanks.

> It is most likely the Actos, Zetia and Insulin.
> The best things to take that seem to work are a good diuretic and leg
> exercise.
> By yourself a stationary bicycle and exercise a few times a day for a
> few moments til you can do it longer.  Walking up and downstairs helps also
> propping your feet up above your heart for 20 minutes on a slant pillow
> will really help.

David wrote:
> go to another doctor.

> David

> John wrote:

>> I am a 64 yearold male type 2 diabetic. I take Actos, Zetia, Calan,
>> Novolog (insulin), Folic Acid, and a baby asperin daily. For about two
>> years or so I have had swelling of my feet and ankles. My
>> endocrinologist says its due in part to the Actos. He seems
>> unconcerned, "A trade-off," he says. I’ve been thoroughly checked out
>> for heart problems, echo cardiogram, Thalium stress test, even an
>> angiogram. Clean as a whistle. But the swelling in my feet and ankles
>> is annoying. Because of my work I sit in a car all day and don’t get
>> much exercise. In addition, I don’t drink nearly enough water.

>> Anyone have any ideas how to reduce or eliminate the swelling?

>> Thanks.

It is most likely the Actos, Zetia and Insulin.
The best things to take that seem to work are a good diuretic and leg
exercise.
By yourself a stationary bicycle and exercise a few times a day for a
few moments til you can do it longer.  Walking up and downstairs helps also
propping your feet up above your heart for 20 minutes on a slant pillow
will really help.

Nev.

"Crone"  wrote …

- Hide quoted text — Show quoted text -

> It is most likely the Actos, Zetia and Insulin.
> The best things to take that seem to work are a good diuretic and leg
> exercise.

David

- Hide quoted text — Show quoted text -

John wrote:
> I am a 64 yearold male type 2 diabetic. I take Actos, Zetia, Calan,
> Novolog (insulin), Folic Acid, and a baby asperin daily. For about two
> years or so I have had swelling of my feet and ankles. My
> endocrinologist says its due in part to the Actos. He seems
> unconcerned, "A trade-off," he says. I’ve been thoroughly checked out
> for heart problems, echo cardiogram, Thalium stress test, even an
> angiogram. Clean as a whistle. But the swelling in my feet and ankles
> is annoying. Because of my work I sit in a car all day and don’t get
> much exercise. In addition, I don’t drink nearly enough water.

> Anyone have any ideas how to reduce or eliminate the swelling?

> Thanks.

news:q485i0dnun51db4ogrb9vcek832emudqo6@4ax.com…

> I am a 64 yearold male type 2 diabetic. I take Actos, Zetia, Calan,
> Novolog (insulin), Folic Acid, and a baby asperin daily. For about two
> years or so I have had swelling of my feet and ankles. My
> endocrinologist says its due in part to the Actos. He seems
> unconcerned, "A trade-off," he says. I’ve been thoroughly checked out
> for heart problems, echo cardiogram, Thalium stress test, even an
> angiogram. Clean as a whistle. But the swelling in my feet and ankles
> is annoying. Because of my work I sit in a car all day and don’t get
> much exercise. In addition, I don’t drink nearly enough water.

> Anyone have any ideas how to reduce or eliminate the swelling?

May I suggest that whenever you take a five minute break, stretch out in the
back seat with your feet up on a pillow and a bit higher than your heart, to
help the fluids dran? Or if you can’t do that, walk around. And check your
shoes and socks for good fit, maybe consider orthopedic socks?

The blood vessels in your legs are kind of odd. The arterial blood is pumped
*down* by the heart, and a series of valves in the veins coming back from
the leg helps make sure the blood gets pumped back up the veins, which is
aided by muscular movement of the legs. Getting your feet up will help
excess fluid be absorbed and drained away by your capillaries and veins in a
way that’s much tougher with them stuck at the bottom of your body, only
flexing once in a while to hit the accelerator or brake.