Diabetic for a Day

Or two. DEX makes us temporarily diabetic by messing with the glucose transport system, which decreases the body's normal ability to move glucose out of the blood and into muscles and other organs.

I have a blood glucose monitor and did a simple study of my own blood glucose, taking a reading every half hour or so all day long, on four different sore-fingered days. Here is the bottom line result, where Day 1 is the next day after taking the DEX the previous evening. The "glucose" value is an average for the whole day, expressed in mg/dL:

Day	Dose mg	Glucose	Comment
1	40	144	Highest was 193
2	40	101
5	40	88	DEX effect must be gone
1	20	116

More information about this little personal "study" is detailed in earlier blog posts HERE and HERE. Graphics included. The graph here shows Days 1, 2, & 5 on 40 mg DEX.

I am NO expert in diabetes, but when Dr. L at Mayo saw the graphics and numbers for Day 1, she reduced my DEX dosage from 40 mg to 20 mg. The glucose spike of 193 mg/dL seemed to be a particularly important factor. Fasting glucose for a non-diabetic should be in the range of 80 to 120, and diabetics are urged to keep their glucose, fasting or not, below 180.

Many diabetics will need insulin shots along with a careful diet, but those of us who are not normally diabetic already have the insulin, except that its effect is inhibited by the DEX. Therefore we need to manage our temporary DEX-induced "diabetes" at least partly through diet. When I asked Dr. L about this, she commented that several of her patients are eating a low-carb diet on DEX day.

Here is a set of dietary principles that I have recently been following, with the help of Sunshine and Sweet Pea (they're the cooks!), on DEX day 1 and, to some extent, on Day 2:

• Most important: Keep the amount of food modest, because all food raises blood sugar. I do this with Weight Watchers "journaling," but calorie counting would work too;
• Reduce carbohydrates in favor of protein, and good fats such as nut oils, olive oil, and fish oils;
• Prefer carbohydrates with a low glycemic index, to reduce the glucose spike;
• Eat some of the protein and fat first at each meal, because this slows the entire digestive process and thereby moderates the glucose spike;
• Good food: Chicken, fish, vegetables, nuts, eggs, certain fruits and berries, legumes, whole-grain foods; and
• Bad food: Sugar (except fructose), soda, potato, candy, white bread or any relative, (the list goes on).

One caution: People whose kidneys are already at risk should be careful about increasing protein, and every myelomiac should take plenty of fluid to help the kidneys. As always CONSULT YOUR DOCTOR! But don't settle for "oh, don't worry about it." This is real, and somewhat outside the experience of many oncologists. Know what you are talking about, be your own advocate, and press a little. If you're interested, a blood glucose monitor costs between $30 and $100 with supplies.

You might notice that the foods that we eat on the DEX diet are foods that are really good for us anyway, and delicious. Those that are bad are ones that we never eat, ever. We just tilt the balance of protein, fat, and carbohydrates. So except for the protein issue for those with kidney disease, there is no downside to eating like a diabetic for a day or two. The food can be wonderful!

I wholeheartedly invite your comments, pro or con, and I especially hope that you will straighten me out if I have made any errors, or share with us if you have something to add.

Examples of DEX day meals that I have recently eaten. Oh, the suffering that we put ourselves through :-)

Today's DEX lunch: Organic chicken breast, Jim's broccoli, dill cheese, organic strawberries. Weight Watchers points = 6.


Today's DEX salad: Organic romaine, cucumber, avocado, organic cashews, organic strawberries, pecans, organic red wine vinegar. Weight Watchers points = 6.


Yesterday's DEX dinner: Wild-caught Alaskan sockeye salmon, organic lime, Jim's organic beet greens, spinach, and onions, with a few organic raisins, plus orange and mango. Weight Watchers points = 8.

Dex and Blood Sugar, Part 3

In early April I did a little experiment, measuring my blood glucose approximately every half hour on three different days: (1) Dex day (after taking dex the night before), (2) the next day, and (3) the fifth day (hopefully no dex). Results are here.

I didn't like that much dex for several reasons, and when I showed the shart to Dr. L she reduced my dex dosage from 40 mg to 20 mg. This week I did the measurements again for "dex day," and found the glucose levels significantly lower, as expected.

Here are averages for each of three different days:

Dex		Glucose mg/dL
40 mg		144.3
20 mg		115.8
None		88.2

Bottom line: 20 mg of dex puts the average glucose approximately midway between 40 mg of dex and no dex. Huh - no surprise.

Here is a TABLE showing actual measurements and times.

Below is a chart. Click to enlarge.

Dex and Blood Sugar, Part 2

Well, this experiment is complete, or as nearly so as it will get. I took blood glucose measurements on three days: (1) Saturday, after taking 40 mg of dexamethasone Friday at bedtime; (2) Sunday, the next day, and (3) Wednesday, the fifth day. Here are average blood glucose measurements for the three days:

Sat:		144.3 mg/dL
Sun:		101.2 mg/dL
Wed:		88.2 mg/dL

Bottom line: Assuming that Wednesday's measurements were "normal," then Sunday's were at least 10 points higher than normal and Saturday's were more than 50 points higher! This is "low-dose" dex - it's no wonder that high-dose dex gives people the symptoms of diabetes and sometimes even gives them the real thing.

Here is a TABLE showing actual measurements and times. It also has links to photos of the meals that were eaten.

Below is a chart of the same thing. Click to enlarge.

Dex and Blood Sugar, Part 1

We myelomiacs are all aware that dexamethasone (dex) can cause type II diabetes, sometimes permanent and sometimes reversible after discontinuing dex. This is most common among people who have taken "high-dose" dex, typically 40 mg per day four days on and four off.

I am taking "low-dose" dex, 40 mg once a week, Friday night before I go to bed. Nevertheless I already have a blood glucose monitor which I bought for another reason (not diabetes) and wanted to see what happens to my own blood sugar when I take dex. I decided to take a measurement about every half hour between waking and bedtime on three days: (1) Saturday, the day after taking dex, also called "buzz" day; (2) Sunday, "recovery" day; and (3) Wednesday, the fifth day, when effects from dex should be minimal.

The graph will be much easier to read if you click on it to enlarge it.


Here is a table with the actual numbers, exact times, and comments.

This experiment is only two thirds complete, but already somewhat instructive. I couldn't wait to post:

• About two years ago I ran a similar experiment for different reasons, and got an average reading of 104 mg/dL over parts of three days.
• Saturday's average reading was 144 mg/dL, much higher.
• None of my readings quite reached 200, which some say can be a signal of diabetes.
• Sunday's (today's) average is 101, even with big meals, much lower than Saturday.
• Glucose pretty much went up after eating carbohydrates, then down again, but with a few surprises:
  • The highest Saturday spike, 193, was measured shortly after finishing a big oatmeal breakfast with fruit and juice.
  • Later, a large serving of homemade chocolate fudge pudding, about 270 calories, seemed to raise glucose by only about 10 points. Are chocolate and milk able to slow absorption of sugars?
  • Still later, a slice of gluten-free bread with honey seemed to raise glucose by about 20 points.
  • All but one of Sunday's readings were lower than the lowest reading of Saturday.

I'll post about this again after Wednesday's test.