Tag: Navy (Page 35 of 45)

Dental Health, Diabetes, and Dialysis: The Three Ds

July 25, 2023 / Henry Feeser / 0 Comments

Normally one would not associate Dental, Diabetes, and Dialysis in the same sentence or thought process. However, it is an uncontested fact that Diabetes and the need for Dialysis are closely associated with over 40% of dialysis patients also diabetic. Up to now, I had never heard or read any association between the latter two Ds and Dental. I know that often diabetic patients have dental challenges, but the study I’m about to present notes a causality going the other direction, Dental Problems -> Diabetes and further -> Dialysis.

Writing in the July 9 2023 issue of SciTechDaily, the University At Buffalo wrote an article titled “The Surprising Connection Between Chewing and Type 2 Diabetes.” The article is linked here:

With the following Prompt, I asked my AI to condense the article for this blog into 400 words or fewer entries in laymen’s terms. The Prompt and result follow. My closing comments are at the end. The lead graphic is from Bing Illustrator.

Summarize the following article into a 400-word or less entry at laymen’s level for a blog that concentrates on peritoneal dialysis:

ChatGPT:

Mehmet A. Eskan, a researcher from the University at Buffalo, suggests medical professionals treating Type 2 diabetes (T2D) patients should pay attention to their patient’s dental health. Eskan’s recent study, published in PLOS ONE, found a significant link between chewing functionality and blood sugar levels in T2D patients. Essentially, those who could chew well had much lower blood sugar levels than those who couldn’t.

Eskan and his team analyzed data from 94 T2D patients at a clinic in Istanbul, Turkey. They divided the patients into two groups based on their ability to chew – those with a good “occlusal function” (the ability to chew food effectively), and those who couldn’t chew well due to missing or improperly placed teeth. The results were striking: the group with good occlusal function had an average blood sugar level of 7.48, while those who couldn’t chew well had an average blood sugar level almost 27% higher, at 9.42.

Chewing, or mastication, kickstarts the digestion process by stimulating saliva production. It also helps our bodies absorb fiber and other essential nutrients from food, which are important for controlling blood sugar levels. Moreover, chewing well can promote feelings of fullness, helping to prevent overeating – a major risk factor for T2D.

Eskan’s research comes amid growing recognition of the role oral health plays in managing diabetes. In one case, a patient’s blood sugar level dropped dramatically after dental implants and restoration improved their ability to chew. However, the study also showed that factors like Body Mass Index (BMI), sex, smoking status, medications, or infections did not significantly affect the participants’ blood sugar levels.

High blood sugar levels can have serious health consequences, with a 1% increase linked to a 40% rise in the risk of heart disease among diabetic patients. Eskan hopes his research will spur further studies to understand the cause-and-effect relationship between dental health and blood sugar levels better.

So, the next time you sit down for a meal, remember: chewing your food well isn’t just good manners – it could be critical for your health, especially if you’re living with Type 2 diabetes.

My wife often laments that she spends hours cooking a nice meal for us, and given my military background where you are taught to inhale food on the run in uncertain circumstances, it is often gone in five minutes. As a couple, we are working on slowing our food intake down in keeping with the findings of this article.

Blood Pressure, Cell Phone Use and Dialysis

July 21, 2023 / Henry Feeser / 0 Comments

The National Kidney Foundation (NKF) reports that about 15% of Americans, or 37 million people, have chronic kidney disease (CKD). NKF further states that hypertension (high blood pressure) is second only to diabetes in the cause of kidney failure. About 20% of those with hypertension may have CKD. Recently (2023), the U.S. Food and Drug Administration (FDA) highlighted the correlation between hypertension and chronic kidney disease on its website, urging Americans to control their blood pressure in order to reduce their chances for CKD.

I recently ran across an article in SciTechDaily by European Society of Cardiology dated 7/17/2023 titled “An Unexpected Pathway to Hypertension: Your Phone Habits Could Be Putting Your Heart at Risk.” I immediately applied this concept to myself, my triple bypass, hypertension, and subsequent Peritoneal Dialysis. Are we as a global population setting ourselves up for hypertensive-driven health challenges as a result of cell phone use?

I turned to my ChatGPT and instructed it to write a 500-word or less summary of the article. The results follow. Talk less, live longer?

New research published in the European Heart Journal – Digital Health suggests that spending over 30 minutes per week talking on mobile phones may lead to a 12% increased risk of high blood pressure (hypertension). The study, conducted by Professor Xianhui Qin of Southern Medical University, Guangzhou, China, utilized data from the UK Biobank and involved over 200,000 adults aged 37 to 73 years.

Nearly three-quarters of people aged 10 and over globally own a mobile phone, and approximately 1.3 billion adults worldwide suffer from hypertension, a major cause of heart attack, stroke, and premature death. Mobile phones emit low-level radiofrequency energy, previously associated with short-term blood pressure increases. This research exclusively focused on the link between phone call duration and hypertension onset, an area that past studies showed mixed results, possibly due to the inclusion of other mobile phone activities.

The study participants’ information regarding phone usage for calls was collected via self-reported questionnaires, and those who used their phones at least once a week for this purpose were categorized as mobile phone users. The researchers then analyzed the relationship between mobile phone usage and new-onset hypertension, adjusting for factors such as age, sex, BMI, race, medical history, lifestyle, and medication.

The median follow-up period was 12 years, during which 13,984 (7%) participants developed hypertension. A 7% higher hypertension risk was observed in mobile phone users compared to non-users. Individuals spending 30 minutes or more per week on phone calls were found to have a 12% higher likelihood of developing hypertension than those who spent less time. The results were consistent across genders.

Further, the study revealed a positive correlation between phone usage time and hypertension risk, irrespective of participants’ genetic susceptibility to hypertension. The risk was notably high (33% higher) in those with high genetic risk who talked on the phone for at least 30 minutes weekly compared to those with low genetic risk spending less time on the phone. Notably, the study found no significant link between hypertension and years of phone use or usage of hands-free devices or speakerphones.

Prof. Qin advised limiting mobile phone calls to under half an hour per week for heart health preservation until more research confirms these findings.

Proprioception, Dialysis, and You

July 19, 2023 / Henry Feeser / 0 Comments

Jen Murphy wrote an article that was in the 7/15/2023 edition of The Wall Street Journal titled “Six Exercises for Better Balance from a Trainer Who Lives on a Paddleboard.” At first blush, you might cast this article out of hand into the trash as not having any application to those of us on dialysis. Nothing could be further from the truth. Dialysis can take the starch out of you, drain your energy, cast you as a shut-in, and all sorts of other degenerating aspects that directly impact something named “Proprioception.” In this blog, I will first define the concept of Proprioception and how it applies to those of us on peritoneal dialysis followed by an excerpt from Murphy’s article on the most simple way for us, regardless of age, or fitness, to improve our proprioception.

First I turned to my AI Assistant with the following prompt and result concerning proprioception:

Prompt: Write a blog entry about how Proprioception applies to those of us who are up in age and on peritoneal dialysis.

ChatGPT

Proprioception refers to the sense of the relative position of one’s own parts of the body and the strength of effort being employed in movement. It is essentially our sense of body awareness and is often described as the “sixth sense”. This is extremely important for all individuals regardless of age, health condition, or treatment modalities.

In the context of aging and peritoneal dialysis, proprioception plays a few significant roles:

Fall Prevention: As we age, our proprioception can decline, increasing the risk of falls. Being on peritoneal dialysis doesn’t directly impact proprioception but can contribute to frailty and general weakness. Falls can be especially harmful to people undergoing dialysis due to weakened immune systems and a greater risk of complications. Thus, maintaining good proprioception can help prevent falls.
Self-Care Tasks: For someone on peritoneal dialysis, maintaining good proprioception can help with the ability to perform self-care tasks, like dialysis exchange, and maintaining independence.
Exercise and Rehabilitation: Proprioceptive exercises, which can include balance training and strength training, can help maintain muscle mass, improve coordination, and improve quality of life. This can be particularly important for people on peritoneal dialysis who may experience muscle wasting.

If you are an older adult on peritoneal dialysis, you might find it beneficial to work with a physical therapist or an occupational therapist. They can provide proprioceptive exercises and balance training, which can improve your safety, independence, and overall well-being. Always remember to consult with your healthcare provider before starting any new exercise regimen.

Murphy notes in her article that “Falls are the leading cause of injury and injury-related death among Americans 65 and older, according to the Centers for Disease Control and Prevention. Research shows our balance begins to decline starting at about age 50. But falling doesn’t have to be an inevitable part of aging.”

In her article, Murphy outlines six exercises to improve balance as a proprioceptive incentive. The first is most applicable to those of us on dialysis and is a doable do. It is named “Single-leg balance” and is illustrated in the lead picture from Bing Illustrator. The following is a quote from this section of the cited WSJ piece:

“

Why:

A 2022 study published in the British Journal of Sports Medicine suggests an inability to balance on one leg for 10 seconds in mid- to later life is linked to a near doubling the risk of death from any cause within the next decade. You can do this simple balance drill while brushing your teeth or watching TV.

How:

Stand with feet hip-width apart. Balance on your right foot as you bring your left foot off the floor. Start with a hover. Eventually, bring the left knee just below hip height. Keep hips square and eyes focused forward on a steady object. If you need assistance, stand near a chair or wall and use your fingertips as a light aid. Hold for 10 to 15 seconds. Complete three reps per leg.

Options:

Increase the challenge by standing on an unstable surface such as a BOSU ball or pillow. Progress to bouncing a tennis ball in front of you and catching it while you remain balanced. Next, try to move the hovering foot in front of you, to the side, and behind you while keeping the hips square. The most advanced progression is performing any of these variations with your eyes closed.”

Summary: We introduced the concept of Proprioception which in laymen’s terms is balance, how and why it declines as we age, how the concept applies to those of us on peritoneal dialysis, and by conducting a simple exercise how we can improve in this area from just about anywhere in our domicile. So get off your butts and stand on one foot for a while. I am.

Chronological Dialysis Activities and eGFR

July 18, 2023 / Henry Feeser / 0 Comments

I sense that one of the many bothersome attributes of being associated with dialysis is the timing and sequencing of events leading up to the actual event. It is much like an avalanche; once set in motion it adapts a will of its own. In this blog, I relate the events that preceded and included my journey from chronic kidney failure to being a card-carrying peritoneal dialysis member.

I am going to start off by relating my eGFR readings by date preceding my decision to request dialysis. In the table below, I present the date and corresponding eGFR calculation. As you can see from the table, roughly two years prior to requesting dialysis my eGFR was in the 14-15 range. Just prior to requesting dialysis, it was 7. So for me, I went two years between an eGFR of 15 to dialysis.

Date	eGFR Calculation
5/20/20	14
8/20/20	15
11/17/20	15
2/24/21	15.7
5/4/21	14
8/4/21	11
11/9/21	11
12/30/21	11
3/1/22	10
7/7/22	7

Table Date versus eGFR Reading

Let’s now turn to the events leading up to my actual dialysis. From the table below, note I started Hemo on Saturday, August 20, 2022, followed by Peritoneal Dialysis at home on 9/30/2022.

Date	Activity
8/16/2022	Felt bad, requested dialysis
8/17/2022	Hemo port installed Ft Worth hospital
8/20/2022	0500 Sat morning started hemo @ Fresenius
9/24/2022	Last hemo dialysis
9/26/2022	Started PD training and manual PD
9/29/2022	Last training and manual PD
9/30/2022	First home PD treatment I’m in charge
10/3/2022	Local doctor removed hemo catheter in office
9/6/2022	PD port in Ft Worth Hospital (out of order)

Chronology PD Journey

A comment on timing based on the above table. Given that my eGFR was slowly decreasing, I took the time to research what PD was all about and watched numerous YouTube videos on the mechanics of using the Liberty Cycler for dialysis. Going into training I was already up to speed on most of the mechanics, techniques, and sanitary requirements. My wife and I purchased the home we currently live in with the foresight that I would be requiring dialysis, and knew from research that vast amounts of dialysis fungibles would be required. We had our master bedroom outfitted and ready for dialysis prior. The home we purchased provides the required storage. Lastly, I successfully completed the training in just four days. This is because of our research prior to dialysis and also because I am a Purdue University-trained engineer used to dealing with “systems.” Dialysis is a system. Fresenius allocates two weeks for training and it is not without precedent to take longer.

I consider myself fortunate to be in the care of nephrologist Dr. T. Turner and the Fresenius Dialysis Team. It is obvious that you really really have to have your ducks in a line to accomplish an aggressive timeline such as I just presented. But I am living proof if you have the opportunity to plan ahead and anticipate it can be done.

Dialysis Labs and Potassium

July 17, 2023 / Henry Feeser / 0 Comments

Recently I blogged about how critical Phosphorus control is to those of us on peritoneal dialysis. In this blog, I’m going to discuss another lab reading that my team keeps a close eye on, that being Potassium. My last lab result July 5, 2023, indicated my Potassium (symbol “K”) to be 4.2 with a goal between 3.5 and 5.5 so I’m within range. In the past, I have been right up against the upper limit with readings of 5.4 and 5.5.

There are many foods that are high in K, but herein let’s just frame those I often eat. Those are tomatoes, bananas, orange juice, avocado, cashews, lentils, and raisins. The most difficult for me to avoid is tomatoes. It is in many sauces, pizza, soup, salads, etc. I like to have 6 oz with breakfast to wash down my meds. But there is more to K than meets the eye and a cursory inspection. The following is quoted from here: https://www.hsph.harvard.edu/nutritionsource/potassium/

Potassium and Health

The functions of sodium and potassium in the body are closely related and often studied together.

The interplay of potassium and sodium

Potassium and sodium are closely interconnected but have opposite effects in the body. Both are essential nutrients that play key roles in maintaining physiological balance, and both have been linked to the risk of chronic diseases, especially cardiovascular disease. High salt intake increases blood pressure, which can lead to heart disease, while high potassium intake can help relax blood vessels and excrete sodium while decreasing blood pressure. Our bodies need far more potassium than sodium each day, but the typical U.S. diet is just the opposite: Americans average about 3,300 milligrams of sodium per day, about 75% of which comes from processed foods, while only getting about 2,900 milligrams of potassium each day. [3,4]

A study in the Archives of Internal Medicine found that:

People who ate high-sodium, low-potassium diets had a higher risk of dying from a heart attack or any cause. In this study, people with the highest sodium intakes had a 20% higher risk of death from any cause than people with the lowest sodium intakes. People with the highest potassium intakes had a 20% lower risk of dying than people with the lowest intakes. But what may be even more important for health is the relationship of sodium to potassium in the diet. People with the highest ratio of sodium to potassium in their diets had double the risk of dying of a heart attack than people with the lowest ratio, and they had a 50% higher risk of death from any cause. [5]
People can make a key dietary change to help lower their risk: Eat more fresh vegetables and fruits, which are naturally high in potassium and low in sodium, but eat less bread, cheese, processed meat, and other processed foods that are high in sodium and low in potassium.

So it looks like we’re walking on a knife’s edge again because of dialysis. Too much K is not good while too little is really not good. Life is made up of balances and it looks like this is another.

Dialysis and Living

July 14, 2023 / Henry Feeser / 0 Comments

Even though some on dialysis are of the viewpoint that life is centered on this life-giving requirement, other life-requirements do also happen. This blog is about a couple of “happenings” that recently took place in our space that were of high(er) priority.

Last Saturday evening our septic alarm went off indicating something amiss in our system. Our system is a bastard concoction. Seems our black water sewage system does not have enough fall for proper “flushing” to the main drains in the street. A small holding tank was placed in our yard with a Liberty Series 41 Lift Pump and a pole with a low float switch (turns the pump on and off) and a high float switch that sounds the alarm if the effluent level gets too high.

The alarm has sounded once previously and the bottom float switch was bad. Tried calling around for professionals to fix the problem and of course the soonest anyone could come was Monday. Try shutting down all showers, washing hands while on dialysis, etc let alone no toilet use – just doesn’t work.

Turns out our son has vast experience installing such systems so we called him and he came first thing Sunday morning with a spare float switch in hand. Didn’t need it. The power cord to the pump insulation had failed, effluent had entered the hot wires and totally corroded them in two a length of about two feet. We cut this power cord off and spliced in a completely new cord back to the junction box and sealed it with heat shrink and we are back in business.

The entire ordeal took about three hours from start to finish. Luckily we were working in the shade (we are having 100+ temps here in N. Texas). To preclude this from happening again, I ordered a replacement pump from eBay and it’s due to arrive tomorrow. The current installation has all the wiring hard-wired via a junction box that’s buried in the ground. When I have to replace a component, I’m going to wire in a standard male and female plug to make installation much more straightforward.

On to yesterday. On the way back from helping our son finish up the electrical wiring in his new chicken coup, the temp was 110F. Was starting to take a shower, and my wife came and got me to listen to the compressor unit of our whole house a/c. It was making a screeching noise indicating a bearing going out in the unit’s fan. My wife called the HVAC company we have a maintenance contract with and believe it or not they arrived in less than an hour.

The condenser fan by now had totally crapped out and was not even attempting to turn on. No fan, no a/c and it’s currently 105F or so. My wife would melt without a/c in this weather.

Luckily the repairman had a replacement fan on the truck and affected repair. Bottom line, some $900 later we can again flush toilets and have a/c in the N. Texas sun. Life in this regard is good.

My whole point is that dialysis takes center stage, but, sometimes you have to go with the flow.

Understanding the Adequacy Test for Peritoneal Dialysis: Essentials, Implications, and Caveats

July 11, 2023 / Henry Feeser / 0 Comments

Every quarter (three months) I have to do a PD Adequacy Test. From my perspective, it involves collecting my urine for 24 hours, and collecting the Cycler drains into separate collection bags rather than draining them to the shower drain. The following morning I take both containers to my Fresenius lab appointment, where my dialysis nurse Cindy also draws blood, and often gives me an injection of this or that. I think I actually am getting more shots than I did in the military. The results of the adequacy test are central to my nephrologist’s input at our next dialysis team meeting, which is always scheduled shortly after this test.

With this as background, I thought readers might be interested in on what underlies the “adequacy test” so I obtained the following from my AI assistant. Read it and you’ll know all you need to know about this dialysis-specific test.

Title: Understanding the Adequacy Test for Peritoneal Dialysis: Essentials, Implications, and Caveats

Peritoneal dialysis (PD) is a life-sustaining treatment for patients suffering from end-stage renal disease (ESRD). PD uses the body’s own peritoneal membrane as a filter to remove waste products and excess fluid from the blood. To ensure the treatment’s effectiveness, an “adequacy” test is routinely performed, a vital assessment tool in managing PD patients. This blog will delve into the details of the PD adequacy test, discussing its significance, interpretation of results, and potential limitations.

What is the Adequacy Test for Peritoneal Dialysis?

Adequacy in the context of peritoneal dialysis refers to how effectively the treatment is cleaning the blood of toxins and maintaining proper fluid balance. The adequacy test measures key parameters like residual kidney function, total urea clearance, and ultrafiltration volume.

The primary focus of the adequacy test is measuring the clearance of a molecule called urea, a waste product produced by the body during protein metabolism. High urea levels indicate the body is not effectively removing waste, signifying suboptimal dialysis.

Why is the Adequacy Test Essential?

The adequacy test is crucial for several reasons:

Monitoring Treatment Effectiveness: The test gives healthcare providers a clear understanding of how effectively PD is functioning. It helps clinicians tweak the PD regimen, optimizing dialysis fluid volumes and dwell times to ensure maximum removal of toxins.
Preventing Overhydration: By measuring ultrafiltration volume, the test can help detect and prevent overhydration, a common complication in PD patients.
Preserving Residual Kidney Function: The adequacy test measures residual kidney function, which plays a critical role in the overall well-being of PD patients. The aim is to preserve this function as long as possible to improve the patient’s quality of life.

Interpreting Adequacy Test Results

The Kt/V is a commonly used index for assessing the adequacy of peritoneal dialysis. It measures the dialytic clearance of urea (K), adjusted for the patient’s total body water (V), and considers the time of dialysis (t).

The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a target weekly Kt/Vurea of ≥1.7 for adults on continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). This signifies that the volume of blood cleaned of urea over a week should be at least 1.7 times the volume of the patient’s total body water.

Results lower than this threshold may necessitate adjustments in the dialysis prescription to improve urea clearance and maintain an optimal balance of electrolytes and fluids.

Caveats and Limitations

While the adequacy test provides crucial insights into the PD’s effectiveness, it also comes with certain limitations:

Urea as a Sole Marker: Urea clearance is an imperfect marker of dialysis adequacy as it doesn’t reflect the removal of larger, potentially more toxic solutes. New research is ongoing to identify additional biomarkers that could be used to assess PD adequacy more comprehensively.
Patient Variability: Factors such as age, gender, body size, and residual renal function can influence the required level of dialysis adequacy. Therefore, individualized patient assessment is crucial.
Quality of Life: Although dialysis adequacy is important for patient survival, it does not necessarily correlate with the quality of life. Factors such as dialysis-related symptoms, physical function, and mental health also need to be addressed.

Conclusion

The adequacy test for peritoneal dialysis is a critical tool for managing patients with ESRD. It helps gauge the effectiveness of the dialysis regimen and informs necessary adjustments to optimize the patient’s health. However, it is essential to remember that it is only one piece of the larger clinical picture.

Given the caveats and limitations of the PD adequacy test, it should not be used in isolation. Complementary assessments, such as those for nutritional status, inflammation, anemia management, bone-mineral disease, fluid status, and patient-reported outcomes, must also be considered to ensure comprehensive patient care.

Furthermore, communication between the healthcare provider and the patient is vital. The patients should understand the importance of the adequacy test, the implications of the results, and the potential adjustments in the dialysis prescription that may ensue based on the results.

Ongoing research might provide us with more precise markers of dialysis adequacy in the future, which can potentially enhance our ability to individualize and optimize PD therapy for each patient. However, until then, the urea clearance test continues to be a cornerstone of assessing and managing dialysis treatment for ESRD patients.

In conclusion, peritoneal dialysis adequacy testing is a significant part of the treatment plan for patients with end-stage renal disease. It is a tool that helps deliver personalized care and treatment, keeping patients’ unique needs and conditions in mind. However, it is just one aspect of a complex and multifaceted treatment landscape, and ongoing research and development promise to refine and enhance these critical treatment parameters.

New Type 2 Diabetic Shot in Trial

July 10, 2023 / Henry Feeser / 0 Comments

Keep in mind that up to 47% of those on dialysis are also diabetics with hypertension coming in second. Thus anything pertaining to diabetes has almost a 50:50 chance of applying to those of us also on dialysis. I am one of this group thus my interest in all things diabetic. I have been treating diabetes for roughly 40 years and have been on dialysis less than one. Thus my sensitivity to advances in the treatment of diabetes.

In a June 24, 2023 article in The New England Journal of Medicine by Julio Rosenstock, MD et al titled “Weekly Codec Versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin,” research sponsored by Nova Nordisk was reported. Some clarification of terms first. “Week Codec” is a new weekly basal injection under development by Nova. This article reports on a phase of human testing under the rules and regulations of the USA’s FDA. Another definition: a basal injection for Type 2 diabetes is a long-lasting injection. An example of such an injection is Glargine U100 sold under the brand name “Lantus” by Lilly which I inject daily.

As is usual in these trials, the null hypothesis of no difference in paired groupings between those receiving the Weekly Codec and those receiving Lantus was made. The following conclusions are copied directly from the report’s end:

“the findings of the current trial highlight the totality of evidence for glycemic control with icodec. Among persons with long-standing diabetes taking noninsulin glucose-lowering agents including GLP-1 receptor agonists and SGLT-2 inhibitors, those who received icodec were more likely to reach a glycated hemoglobin level (That’s A1C) below 7% than those who received glargine U100, and they spent more time in the target glycemic range and were more likely to reach a glycated hemoglobin level below 7% without clinically significant or severe hypoglycemia (low blood sugar). In this phase 3a trial, we found that once-weekly insulin icodec offered better glycemic control than once-daily insulin glargine U100 in persons with type 2 diabetes who had not previously received insulin.”

While this is but one component of the march by Nova to gain full approval of Weekly icodec for treatment of Type 2 diabetics, it looks like its release in the future looks probably and perhaps we can move from daily injections of Lantus to weekly injections of icodec? I would be for that.

Fatty Liver, Diabetes & Dialysis: An Intersection

July 7, 2023 / Henry Feeser / 0 Comments

Elaine Chen, penned an article in the June 25 2023 STATNews.com titled “ADA says all diabetes patients should be screened for nonalcoholic fatty liver disease.” As you might surmise, I have never heard of this malady. The article starts off with “The American Diabetes Association said Sunday that all adults with type 2 diabetes or prediabetes should be screened for nonalcoholic fatty liver disease, an increasingly prevalent condition that can lead to serious liver damage.” If you have been reading this blog, you know that I am a diabetic exacerbated by exposure to Agent Orange in Vietnam.

Fatty liver, also known as hepatic steatosis, is a condition where there is an accumulation of fat in the liver cells. The liver is responsible for processing fats, but when there is an excess of fat, it can build up in the liver, leading to fatty liver disease.

There are two types of fatty liver disease: alcoholic fatty liver disease and non-alcoholic fatty liver disease (NAFLD). As the name suggests, alcoholic fatty liver disease is caused by excessive alcohol consumption, while non-alcoholic fatty liver disease is caused by factors such as obesity, high cholesterol, and type 2 diabetes.

Fatty liver disease often has no symptoms, but it can lead to more serious liver damage, such as cirrhosis if left untreated. Treatment usually involves lifestyle changes such as losing weight, exercising regularly, and avoiding alcohol.

If you suspect you may have fatty liver disease or are a diabetic for certain, it’s important to see a doctor for proper diagnosis and treatment. I’m going to bring this concern up with my GP next visit. The reason this is so important to those of us on dialysis is that on the order of 47% of us are also diabetic. So it figures that we are also the heavy half of people with NAFLD. For the record, my BMI is less than 24 which rules out the obesity factor, and I do not have high cholesterol.

More About Abbott’s CGM and Dialysis: IMPORTANT

July 6, 2023 / Henry Feeser / 1 Comment

I am using the Abbott Libre Freestyle 3 as I have often noted herein, and paying for the same out-of-pocket. Recently I had a bad sensor, called Abbott’s customer service, and they replaced it and requested I send the defunct one back which I immediately did. Today I received a formal letter from Abbott which stated they had not received the return and requested the same. The letter went on to state if it had already been returned to disregard their request. Before the letter went in the bin I read the small print.

On the back of the letter under Warnings/limitations, it states: ” The FreeStyle Libre Pro System does not provide real-time results and patients should adhere to their blood glucose monitoring routine while using the system….Patients with high levels of ascorbic acid (Vitamin C) or salicylic acid (used in Aspirin) or severe dehydration or excessive water loss may experience inaccurate results with this system. The FreeStyle Libre Pro System is not approved for pregnant women, persons on dialysis, or recommended for critically ill population….” All emphasis is mine.

The first sentence, “patients should adhere to their blood glucose monitoring routine while using the system” directly states to keep doing old fashion finger pricks while using the Libre system. Doesn’t this totally beg the issue of why even use it then?

The second group excludes Orange Juice which I am drinking for breakfast since my dialysis dietician took me off tomato juice because of potassium, and I have also been taking glasses of orange juice to stave off low glucose readings. I take a baby aspirin every day to appease my cardiologist. I have noted that I have been receiving lots of low glucose readings from my Libre 3 while at the same time having no physical presence of being low. Having been at this game for about 40 years I know what a low feels like.

The last statement precludes persons on dialysis from using their CGM in no uncertain terms, no ifs ands, or buts.

I turned to my ChatGPT AI with the following prompt and response in an attempt to dig deeper into this subject with the following results:

Prompt: I just received a letter from Abbott concerning the use of the Libre 3 CGM system. It states in Warnings/Limitations that the Freestyle Pro system is not approved for persons on dialysis or with high levels of ascorbic acid (Vitamin C). Why is this?

ChatGPT provided the following response:

The Freestyle Libre 3 Continuous Glucose Monitoring (CGM) system, like many glucose monitors, works by measuring the level of glucose in your interstitial fluid. This is the fluid that surrounds the cells of your tissues, and it generally mirrors the glucose levels in your blood.

For people on dialysis, there could be a few reasons why the device isn’t approved. The body’s fluid levels can fluctuate significantly during dialysis, and this might affect the accuracy of the CGM system. Additionally, dialysis patients often have other health complications that might affect the system’s performance. However, without more specific information from the manufacturer, it’s difficult to say for sure.

As for high levels of ascorbic acid (Vitamin C), this is likely due to the fact that ascorbic acid can interfere with glucose monitoring systems. Many glucose monitors, including the Freestyle Libre, use a method called glucose oxidase to measure glucose levels. However, ascorbic acid can react with glucose oxidase, leading to falsely high glucose readings. This is a known issue with many glucose monitors, and it’s likely the reason why the Freestyle Libre 3 isn’t approved for use in people with high ascorbic acid levels.

At this point, I am flummoxed and speechless. No MD I have interfaced with has brought this up. No RN I have interfaced with has brought this up. No medical professional of ANY ilk has brought this up. I am going to continue underway as before and keep gathering data, such as it is. Stand by for another itshay!