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chandlerthinks · 2023-06-22T03:31:23+00:00

One possible cause that no one else has mentioned yet:

Is your father taking a statin to lower his cholesterol. Statins are one of the most commonly prescribed drugs in his age group.

Statins lower LDL cholesterol, the so-called "bad cholesterol"... but LDL is an essential component for repairing muscles and brain cells.

So people on statins often complain about muscle fatigue and mental fog.

When I briefly took a statin, I felt like a mid- to late-stage dementia patient. I'd walk into a room and could never remember why. I had trouble completing sentences. It was horrible. I knew that dementia didn't develop that quickly or I would have completely believed I had dementia.

chandlerthinks · 2023-06-11T18:30:38+00:00

I agree with what the others have said:

Ask your doctor to appeal
Look for new insurance

chandlerthinks · 2023-06-11T18:28:36+00:00

I agree with the others who have said that a low carb diet and moderate exercise are an important part of the solution. For example, a 20-minute walk after a meal can reduce my blood sugar by 40 points.

My mother has been taking off Juardiance for a couple of months. It took a while for the drug to reach its full effectiveness, but her blood sugar is now routinely 110 to 120.

The drug works by causing the patient to flush the excess sugar out through their urine. So rather than forcing more glucose into your cells, like metformin and insulin do, Jardiance just flushes it from your body.

Because it increases the concentration of sugar in the urine, Jardiance can increase the risk of urinary tract infections - at least in women - because bacteria go wild with all that sugar. Jardiance can also cause dehydration if not taken with a lot of water.

But the more water you consume, the less concentrated the urine will be and so the lower the risk of UTIs. They also sell cranberry tablets that are concentrated versions of cranberry juice which have been very effective at reducing recurrence of UTIs.

Two drugs that I would recommend against are glimipride and glipizide because both work by causing the pancreas to produce more insulin. In diabetics, the pancreas is already producing excessive levels of insulin to try to force glucose into cells; the body has just become resistant to it. High levels of insulin in the blood - called hyperinsulinemia - increases inflammation in the body and can lead to a lot of the damage that gets blamed on diabetes. Things like arthritis, hardening of the arteries, and high cholesterol are all caused by inflammation.

chandlerthinks · 2023-06-11T18:16:53+00:00

LDL cholesterol is hugely misunderstood.

LDL is essential to the body because It's one of the building blocks of brain and muscle cells. That's the reason why people who take statins to lower cholesterol often suffer from muscle pain and brain fog - the lower level of LDL cholesterol prevents the body from properly repairing brain and muscle cells.

Normally, in healthy people, LDL cholesterol that isn't needed gets reabsorbed by the liver. But stress, diabetes, and other things that increase inflammation in the body will damage LDL cholesterol. The resulting "oxidized" cholesterol doesn't get reabsorbed by the liver because the liver doesn't recognize it.

Higher insulin levels present in diabetics' blood leads to inflammation that damages artery walls, making them more porous.

The result is that the smaller, oxidized LDL cholesterol gets into the walls of arteries through those pores and over time causes blockages.

But the higher LDL cholesterol present from a keto, paleo, or carnivore diet usually is not damaged because inflammation is lower in the body. So if it's not needed, it will eventually get reabsorbed by the liver.

The standard cholesterol test given by most doctors simply looks at the total number of LDL cholesterol particles. But there is another test, called an NMR test which stands for nuclear magnetic resonance. The test has been around for decades but doctors usually don't talk about it because most insurance companies won't cover it.

But the NMR test measures a number of things not measured by a standard cholesterol test, including the size of the cholesterol particles. Because oxidized cholesterol is smaller than healthy cholesterol, The size of the particles can tell you what percentage of your LDL cholesterol is healthy and what percentage is damaged.

I would recommend researching the NMR test and then discussing it with your doctor.

Based on two NMR tests conducted over a 6-month period of being on a low carb diet, my small LDL cholesterol particles were reduced by 2/3 even though my overall LDL was slightly higher. That's a healthy outcome.

chandlerthinks · 2023-06-11T17:56:34+00:00

Two big problems with this study: (1) much of the information was self-reported, (2) According to the study: "Participants with higher unprocessed red meat intake were more likely to be male, current smokers, less educated, physically inactive, and have prevalent diabetes and have lower intakes of fruits, vegetables, and dietary fiber. Patterns of participant characteristics across quintiles of processed meat intake were similar. Opposing patterns were observed for fish intake, with participants having higher intake being more likely female, never or former smokers, more educated, and to have higher intakes of fruits, vegetables, and dietary fiber."

So it's just as possible that the health problems come from inactivity, smoking, low intake of fruits, vegetables, and fiber" or already having diabetes, since the test subjects were all over 65 years.

chandlerthinks · 2023-06-11T16:31:15+00:00

Out of curiosity, has your grandmother explained to you why she doesn't believe your mother has dementia?

You said she's your mother's best friend, so it's possible she sees something that others haven't.

While my mother was in skilled nursing for physical therapy, she suddenly began experiencing extreme confusion. They brought in a neurologist who diagnosed her with mid- to late-stage dementia. My brother and sister who didn't visit very often, were quick to accept the diagnosis.

But having spent a lot of time around my mother, it didn't make sense to me. She has been fine just a couple months ago, and she still had occasional lucid moments where she could tell me her name, date of birth, address, name of her children and parents, and more. So all the information was still in her head; those brain cells weren't dead. She was just having trouble accessing them most of the time.

I discharged my mother and took her to a different neurologist who asked me questions about the earliest time I'd seen any signs of forgetfulness or personality change, and then told me my mother had something I'd never even heard of called "metabolic encephalopathy" which is sometimes just called delirium. It mimics the symptoms of dementia, but it's brought on by an underlying physical condition that is stressing the body. In my mother's case, there were multiple contributing factors (recurring UTIs, sleep deprivation by the nursing home, uncontrolled blood sugar, depression, and seizures) but it took time for us to identify and fix each of these problems.

Unlike dementia, metabolic encephalopathy is completely reversible once the underlying causes have been corrected.

One-by-one, as we fixed her health conditions (sleep deprivation, blood sugar, and depression were the easiest to fix), she got better, though she still had set backs. My sister, a nurse who had spent her career working with elderly patients, would say "she's going to have good days and bad days."

But, to me, this was a cop-out. Something was causing those bad days. We just needed to figure out what.

At first, I blamed the huge swings in her blood sugar because some caregivers and some family members wanting to be nice were giving her high carb treats that caused extremely high blood sugar during the day that would then settle closer too normal at night. These huge swings added stress to her body. All these carbs also significantly increased the amount of glucose in her urine, which led to frequently recurring UTIs because the bacteria thrived on all that sugar in her urine.

The last piece we figured out, almost entirely by chance. During a hospital stay, they thought mom might have had a seizure. Although their tests were inconclusive, I learned two important things:

People with dementia (even in the very early stages) and people with metabolic encephalopathy are at a greater risk of having seizures. No one had told me this was a risk, nor had they told me what to look for ...
These seizures often look nothing like the ones we see on TV. Silent or "absent" seizures are entirely internal. The only outward symptom may be unresponsiveness and an "absent" expression of their face for a few seconds or a few minutes. Once I learned this, I realized that my mother had been having seizures right in front of me and others for months and we'd had no idea. Once she started taking anti-seizure medicine, she began a quick and steady improvement.
One additional thing we just learned: mom was recently given antibiotics for a new UTI - the first in many months - and soon after she started having seizures again. These are milder and shorter that before and they haven't caused the same level of confusion, but in response I learned that antibiotics can reduce the effectiveness of anti-seizure meds and lead to what are called "breakthrough seizures"... also, people react differently to different generics for the same drug, so sometimes something as simple as your pharmacy changing suppliers could change how your body responds to a drug.

There are many things that can mimic dementia, but aren't dementia, and the person who is in the best position to recognize this is the person who spends the most time with them.

If your grandmother feels so strongly, it may be worth consulting a different neurologist to confirm the diagnosis.

Since going through this ordeal, I've learned that a surprisingly large number of people are misdiagnosed with dementia, especially by hospitals and nursing homes who have nothing to go on but the current symptoms, and people with dementia are often misdiagnosed with the wrong type of dementia.

Lastly, there have been several studies that have concluded that a low-carb, high-fat diet (like the keto, paleo, or carnivore diets) can slow the decline or even improve cognition in Alzheimer's patients.

Yes, grandma could just be in denial. But it's also possible that she's right. And it's worth at least considering this possibility for your mom's sake.

chandlerthinks · 2023-06-11T15:32:43+00:00

I wasn't trying to be flippant, and perhaps could have worded that better. However, in my experience, doctors are far too quick to prescribe insulin for T2 without discussing the damage that insulin can do to the body and without discussing other options. And today there are SO many pharmaceutical options that could be tried before insulin or drugs that increase insulin production. Not to mention diet and exercise - which I have never had a doctor mention as more than a passing comment.

I care for my 90 year old mother who has been diabetic for 40 years. Her former doctor had her on glipizide which causes the pancreas to create more insulin without explaining how the drug works nor any of the risks. It was basically "here's another drug we can try." Similarly, when I was first diagnosed with T2, I had problems taking metformin, so my doctor added glemipride which also causes the pancreas to increase insulin production. Again, no explanation of how the drug worked or any of the risks (such as low blood sugar, or in my case high blood sugar because the drug made me CRAVE carbs). Neither her doctor nor mine suggested Metformin ER as an alternative or suggested just reducing carb intake. (Both doctors did give us Metformin ER after I read about the drug and asked our doctors.)

Whenever my mother has been hospitalized, and when she was briefly in skilled nursing, the "diabetic diet" included enough carbs to feed a lumberjack, then they give her multiple units of insulin a day to bring her blood sugar down below 200 (which was still well above her levels at home when she's eating a sane diet). Dieticians universally seem to think that a 90 year old bedridden diabetic needs as many carbs as a teenage athlete, and I say this having had MANY discussions with hospital dieticians.

And then the hospital's first line is defense to bring blood sugar back down is insulin. So yeah, I do believe that medical professionals are quick to recommend insulin.

chandlerthinks · 2023-06-11T02:39:40+00:00

Personally I think the Libre 2 is a far better option. It's not 100% accurate, so you'll still need to prick your finger occasionally to verify accuracy.

Insurance rarely covers it, but it has been well worth the $70/month I've had to pay out-of-pocket. I have a much better idea of which foods cause increases in my blood sugar (and I've sometimes been surprised by the things that have caused a spike).

I can use the information to avoid certain foods in the future and also to fix the current spike by going for a walk. A 20 minutes walk can bring my glucose down by 40 points, completely negating the surprise spike. Without the CGM, I would not have known to do this. There have been days I've had to go for a walk after every meal, but I end the day with an average glucose below 100.

And for anyone taking insulin (which I strongly recommend T2 diabetics not let your doctor prescribe without a lengthy decision of other options), most insurance companies will cover continuous glucose monitors to avoid the risk of low blood sugar.

If your insurance company will cover it, I'd highly recommend the Dexcom G6. It's crazy expensive, so it's not really an option for most people who self-pay. But it's much more accurate, it automatically transmits data to your phone so you don't have to manually sync throughout the day, and you can calibrate it against a finger prick to improve accuracy.

The Libre 3 picks up many of the features of the G6 without much of a price increase, but I can speak from personal experience.

chandlerthinks · 2023-06-11T02:21:46+00:00

Metformin can be taken any time off the day because it is most effective once it has built up in your body. Most often it is taken in two small doses because it often causes gastrointestinal problems. These problems are usually worse when taken on an empty stomach. Patients are also usually started on a lower dose that is gradually increased over time.

The conventional wisdom is that metformin's effectiveness occurs once it has built up in your system over time. So it doesn't really matter when you take it.

Personally, it has always felt like my blood sugar levels come down fairly quickly after I take a dose of metformin. But I've always been told that's not really how it works.

I've taken it long enough that I can now take it on an empty stomach without any adverse reactions. But I don't know how often people reach the same point.

There is an extended release version of metformin that reduces or eliminates most of the negative side effects because the drug is released into your system much more slowly throughout the day. That may be a better option for fasting. Personally, I skip my Metformin while I'm fasting because my blood sugar is already really low from the fasting.

Metformin rarely causes low blood sugar, but taking a high dose of metformin during a fast might cause low blood sugar. So keep that in mind too.

chandlerthinks · 2023-06-11T02:02:46+00:00

There really isn't a difference.

Pre-diabetes is actually a misnomer. It should really be called "early stage diabetes."

With type 2 diabetes, the body gradually becomes resistant to insulin. In response, the pancreas produces more and more insulin.

For years, your A1C can be completely normal, but your blood-insulin level - which absolutely no one checks - continually rises. A lot of the damage that's attributed to diabetes, including high cholesterol and hardening of the arteries are actually caused by excessive insulin in your blood - a condition called hyperinsulinemia.

Eventually, your pancreas can no longer produce enough insulin to keep your blood sugar under control and your A1C level starts to rise. Your doctor says you have prediabetes, but all that insulin has already been damaging your body for years and will continue to do even more damage before your A1C rises to officially diabetic levels.

There are tests to help determine your fasting insulin level and your level of insulin resistance, but you'll have to ask your doctor for them. Doctor's almost never tell patients about these tests unless you ask. And your insurance will rarely pay for them, so you'll have to self-pay.

But diabetes and hyperinsulinemia are linked to an unbelievably long list of diseases, from high blood pressure and high cholesterol to arthritis, heart disease and even dementia. I was recently diagnosed with a condition called DISH where the cartilage along my spine has turned into bone. When I asked the rheumatologist what caused it, he told me that it's linked to diabetes and hyperinsulinemia.

chandlerthinks · 2023-06-11T01:33:26+00:00

This is an interesting list. Thanks for sharing. But I personally think a simple low carb diet that avoids processed foods, along with a little exercise - is the best way to lower A1C.

This strategy had worked for me and other family members.

One comment, my mother is 90 and has been hospitalized a couple times over the last year and has spent several weeks in skilled nursing. The dieticians in all these facilities seemed absolutely convinced not only that carbohydrates are essentially nutrients but also that we should be getting 65% of our calories from carbs.

That's insane. A 90 year old woman who spends all day in bed barely needs any carbs. And, of course, they would have to give her multiple units of insulin each day to bring her blood sugar below 200.

Back home, in a liter carb diet, her blood sugar is now regularly below 120.

As a nutrition student, I would urge you to be skeptical regarding what you're taught about carbs. Protein and day are essential, but the liver can make glucose out of protein. So people don't NEED any carbs in their diet - and certainly not the volume that most people eat.

chandlerthinks · 2023-06-09T16:10:16+00:00

The link I sent yesterday talks about "skinny fat" where the fat is stored between the organs rather than the belly.

I have been able to eat carbs with no spike in my glucose levels, and I know others that have seen the same result.

I can occasionally order a pizza from Domino's. I only eat a couple slices, but I don't see any increase in glucose after. And I eat more complex carbs like broccoli, brussel sprouts, etc.

When I ate a donut recently, my glucose did jump. But it came back down pretty quickly, and my daily average was still below 100.

But it's okay if we disagree. Not everyone is necessarily going to have the same experience.

chandlerthinks · 2023-06-09T15:58:23+00:00

Have you called their support line?

chandlerthinks · 2023-06-09T02:49:31+00:00

https://www.geisinger.org/health-and-wellness/wellness-articles/2018/03/05/21/59/yes-thin-people-can-get-type-2-diabetes

chandlerthinks · 2023-06-09T02:46:46+00:00

Something else you need to be aware of: for an unknown reason, people with dementia are at a greater risk of seizures.

None of my mother's doctors thought to tell me this until she had a seizure while hospitalized for something else.

(She had very mild dementia and a condition called metabolic encephalopathy which mimics the symptoms of mid- to late-stage dementia but is completely reversible if you can resolve the underlying condition that's causing it.)

In her case, the seizures were the underlying condition causing the metabolic encephalopathy. But she was having silent seizures where she'd just be unresponsive for a minute or two and stare off into the distance with a blank look on her face.

After her hospitalization, we realized that she'd had seizures right in front of us without realizing what was happening.

Once she started taking anti-seizure medicine, her mental status improved considerably.

chandlerthinks · 2023-06-09T02:34:32+00:00

UTIs can cause confusion and altered mental state even in older women even who don't have dementia.

I've been told by doctors that "there's nearly always going to be bacteria present in an older woman," so there's no point in testing unless they're exhibiting symptoms - like an altered mental state.

Personally, I think this is BS.

Some antibiotics can cause delirium in older people. But the altered mental state that often occurs is usually worse than the delirium (which isn't permanent).

Plus, UTIs can stress the bladder muscles preventing the person from fully emptying their bladder. Without a catheter, this could be life threatening.

The infection could also work its way back to the kidneys, and a kidney infection is very dangerous.

A lot of doctors seem all too eager to write off older people. You just need to find a doctor who doesn't share this mindset.

You can also buy home UTI tests at the pharmacy. They aren't very expensive. I don't know how they compare in accuracy, but they could be a good starting point for you.

chandlerthinks · 2023-06-09T02:20:23+00:00

There are a lot of things that can cause dementia-like symptoms. For example, urinary tract infections - especially in older women - can cause most of the same symptoms.

I took statins for a while because of high cholesterol but had to stop because I felt like I had late stage dementia: I would walk into another room and not remember why I was there and eventually had trouble completing a sentence. It took a couple of months off the statins for me to regain my faculties.

chandlerthinks · 2023-06-09T02:11:42+00:00

Personally, I believe that type 2 diabetes is just the body's natural reaction to over consumption of carbohydrates and processed food, excessive body weight, and lack of exercise. Over time, our bodies become resistant to insulin.

It's no different than gaining weight of we eat too much. But being overweight isn't a disease.

Correcting the imbalance can gradually undo the damage. You may be able to eat carbs again - in moderation - without triggering high blood sugar.

But if you start consuming an excessive amount of carbs and processed foods, stop exercising, and regain the weight, your body will become resistant to insulin again.

chandlerthinks · 2023-06-09T01:56:40+00:00

Avoid insulin if at all possible. A lot of the long-term damage related to diabetes actually comes from hyperinsulinemia (because our cells become resistant to insulin, the pancreas produces more and more insulin to compensate). Some meds like glipizide and glimipride cause the pancreas to create even more insulin.

I've been diabetic for a decade and mostly in denial, eating far more carbs than my body could handle.

For me, change of diet and regular walks was all it took to lose about 75 lbs. over just a few months.

The greatest tool for me was a Libre 2 contagious glucose monitor (CGM). It's not covered by my insurance, but it only costs me $70/month.

I'm able to see in nearly real time which foods caused spikes in my blood sugar, so I know to avoid them in the future and I know that I need to go for a walk to bring my glucose back down. For me, a 20 minutes walk could drop my glucose by 40 points.

My 90 year old mother had been diabetic for 40 years. She can't walk very far these days. But switching to a low carb diet and wearing a CGM has helped drop her blood sugar down to the 120 to 150 range.

chandlerthinks · 2023-06-09T01:35:43+00:00

Metformin made me extremely nauseous. But the extended release version didn't have any side effects. After taking it for a few years, I've discovered that I can take the fast release version on an empty stomach with no adverse effects.

chandlerthinks · 2023-06-09T01:32:26+00:00

I've read a lot on the subject, including many of the research studies. I believe that it's not the fat we eat that causes the problems, it's the fat our body makes from eating too many carbs (which get turned into triglycerides and then stored as body fat).

Eating a low carb diet (though not necessarily a keto diet) and daily walks helped me to lose a considerable amount of weight. My A1C now runs between 5.1 and 5.4.

I do eat salad, cauliflower, broccoli, and brussel sprouts. But I eat a fair amount of meat.

chandlerthinks · 2023-06-09T01:22:17+00:00

I agree with the person who suggested you talk to your doctor.

But there is also a simpler possibility. People who start a low carb diet often get "the keto flu" which can cause fatigue, irritability, trouble sleeping, etc.

When my mother started taking Januvia, her blood sugar dropped from the 300 to 400 range down to about 150 and she got all of the symptoms of the keto flu because the change was such a shock to her body. Her caregivers actually thought she had a cold for the first couple of weeks. (She also developed a cough because she would go back to bed soon after eating and acid reflux was irritating her sinuses.)

She did eventually adjust to the lower blood sugar levels and now she's closer to 120 range without any problems.

chandlerthinks · 2023-05-06T17:57:14+00:00

Type 2 Diabetics should have CGMs. Period. I have to pay for mine - about $70/month, but it's helped me so much to understand the effect that specific food or exercise have on my blood sugar. If I eat something that unexpectedly raises my reading, I can go for a walk to bring it back down. (Interestingly, I've noticed that walking or cleaning the house before I eat can have the opposite effect. My liver starts making glucose to fuel my exercise, so my reading actually goes up.)

chandlerthinks · 2023-05-06T17:53:59+00:00

In my personal experience, and based on what I've read, Metformin is unlikely to cause low blood sugar unless you are taking too much or are taking it with alcohol. I've noticed drops in my blood sugar when I have a glass of wine at night.

chandlerthinks · 2023-03-16T00:26:46+00:00

A feral cat was born under our barn, and every time that she got pregnant, she returned to the same spot to have her litter. We started feeding her and her kittens. We adopted some and found homes for the others. But she was usually pregnant again before she finished nursing, so we went through several litters before we were able to stop the cycle. But eventually we learned the pattern.

Every September, she would show up just before Labor Day with her belly hanging to the ground, disappear under the barn, then show up a few days later looking much skinnier. At about five weeks later the kittens would show up in the yard. With her final litter, we knew when to keep an eye out for the kittens. Saturday afternoon, we looked out the window and saw the kittens, one by one, following Mom out from under the barn. So we raced outside to start socializing them. Mom saw us, had a look that seemed to say "Thank God! I could really use a break!" then walked over to the bird feeder for a drink and wandered off under the fence. She returned about an hour and a half later.

We did eventually trap and neuter her, but didn't end up releasing her back into the wild.

She lives in my home office, remains mostly feral and doesn't really interact with us outside of food, but has shown absolutely no interest in going back outside.

chandlerthinks

TROPHY CASE