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Decisions
You need to take into consideration the degree of fibrosis, age, depression, stress and Insulin Resistance.
- It is best to sort out your personal life and anything around you that may be causing you stress so that you can get through treatment without added pressure. Taking friends or family members to counselling or information sessions with your doctors before treatment is also beneficial.
- Also taking a support person to each appointment while you are on treatment helps, as they will be able to remember details for you.
- If you have fibrosis stage 2/3 or more then treatment may be the best option for you at this time, so that your liver does not become cirrhotic and you can maintain your liver and possibly reverse some of the fibrosis during treatment, even if you dont get a sustained viral response (SVR) at least you have given your liver a break and given yourself more time until a new treatment becomes available.
- If you suffer from depression or have had depression in your past you may not be able to cope with the treatment and would need to take antidepressants (ADs). These take about 4-6 weeks to work, so it is best to start them before treatment.
- The treatment can cause depression and mood changes.
- Your GP or Specialist can refer you to a psychiatrist or psychologist to be assessed before starting treatment.
- The older you get the less chance of SVR, especially people that are over 50.
- If you are healthy, have no stressors in your life, stage 0-2 fibrosis and feel you are ready to give treatment a try, then do it otherwise you have time to wait for a new treatment to become available that has lesser side effects and/or a shorter duration of treatment.
- If you dont want to do the treatment and fibrosis, age or depression is not an issue, then you may want to maintain your liver and symptoms of hepatitis C with vitamins/supplements and eating a healthy diet and exercise.
Psychiatrist & Counselling
- Get a referral to a psychiatrist before starting treatment so that you can be monitored for depression, mood changes, anger, irritability and mental distress.
- During treatment the brain thought process is altered and we can experience different mood changes and be unable to cope with treatment.
- You may need to see the psychiatrist all the way through treatment and for up to 6 months after treatment has finished.
- Dont be afraid to try some antidepressants or anti psychotic drugs during treatment, we must do whatever it takes to get to the end of the journey.
- Ask your partner, family or friends if they notice any changes in your moods or character so that you are aware of how others see you.
Dentist
- Get your teeth checked by a Dentist prior to treatment because if there is any weakness in any tooth or gums then it is a target for getting gingivitis or a tooth infection. Ask your GP about the Dental Program that you may be eligible for as a person with a chronic illness, you will be able to access a private dentist near where you live up to the value of just over $4000. This program is called the GP Health Care Plan for people with a Chronic Illness. You will need to be seeing at least 3 professionals to access this plan, so its best to set this in motion to cover everything that may go wrong during treatment. e.g. the GP, your Liver Specialist and/or a Dietician or Psychologist.
Liver Biopsy
- Try and get a liver biopsy done, so that you know what condition that your liver is in pre treatment (baseline), then have another biopsy when treatment is completed, then you will be able to see if there has been a reversal of fibrosis or cirrhosis. Having a liver biopsy will also help you decide whether treatment is right for you at this time.
Alcohol
- It is recommended that people with HCV DO NOT drink alcohol.
- If you are an alcoholic then make sure you have 2 alcohol free days per week, and limit yourself to 2 glasses of alcohol on the other days.
- Alcohol causes the liver to progress faster towards cirrhosis, and has been known to interfere with the success of treatment.
Hopefully, if you were ever drinking any type of alcohol, you’ve stopped completely. If you are having trouble avoiding alcohol, talk to your healthcare team and get the support you need. If you only drink alcohol in moderation or socially, you may feel that your drinking isn’t a problem and helps you cope with the stress of hepatitis C and treatment.
But if you have hepatitis C there may be no “safe” amount of alcohol you can drink. Alcohol is toxic to your liver. Even moderate amounts of alcohol may be dangerous when you have hepatitis C.
Consider these points:
* Alcohol use during antiviral therapy may negatively affect your response to therapy
* Alcohol weakens your body’s ability to fight the virus, which makes it easier for the virus to attack your liver
viewtopic.php?f=40&t=2461&p=13505#p13505
Insulin Resistance
- Make sure that you get checked for Insulin Resistance (IR) before doing treatment, by having a Fasting Glucose Blood Test & a Fasting Insulin blood test taken at the same time, once you have these results use the HOMA IR FORMULA to work out your score, if it is 2 or higher then you have Insulin Resistance. IR is another reason that the treatment will not work for you.
- HOMA IR FORMULA = fasting serum insulin (uU/ml) × fasting plasma glucose (mmol/l) divided by 22.5
- IR can be controlled with diet, by eating Low GI Foods and cutting out coffee and sugar. Read our information in the Insulin Resistance & Diabetes section of these forums: http://hepcaustralia.com.au/forums/viewforum.php?f=37
- Even if you are slim and exercise, you can still have insulin resistance, so get checked to make sure, you want to give yourself every opportunity to clear the virus.
viewtopic.php?f=40&t=2455
Treatment Schedule & Blood Tests
- When you receive your SCHEDULE for 'blood tests' & 'GP or Specialist' appointments when you start treatment, make sure you check the dates, so that you get all your blood tests at the end of each important week, e.g. week 12 test should be taken on the day of your 13th injection. (before you inject).
- Also check which blood test forms you need before each appointment, so that you can have them written out all at once instead of going back to the GP or Specialist each fortnight, this saves running around and going backward and forward.
- Make sure you get a VIRAL LOAD test done a day or two before starting treatment so that you have a baseline result.
- Injecting the interferon is best done at night time, so that you can sleep during any side effects, this also gives you the daytime to do tasks or simply enjoy the day.
- Ribavirin or Rebetol pills should be taken 12 hours apart, e.g. 10am & 10pm. These are best taken with Yoghurt as the fat content helps to absorb the ribavirin, and it is also smoother to swallow.
By Linda McInnes
Diabetes & Insulin Resistance & Hepatitis C Explained
WHY EVERYBODY SHOULD READ THIS THREAD.......
In cellular metabolism, glucose (sugar) can be converted into fatty acids. Many viruses use these fatty acids to build their viral envelopes, or outer coatings, which help the viruses penetrate and infect human cells.
When the Hepatitis C virus gets into your body, it tries to increase your metabolism so that it can reproduce more quickly by using fatty acids to build protective outer coatings which will help it penetrate and infect your liver cells.
And one of the ways to create more glucose that can be converted into fatty acids, is by making you INSULIN RESISTANT and eventually turning you into a DIABETIC.
And being INSULIN RESISTANT or DIABETIC, lowers your chances of treatment success. And if you know nothing about insulin resistance or diabetes, then you're already at a disadvantage. So keep reading even if you think this thread is not for you because you're not diabetic. Because what you learn here, may help you beat the virus.
A fasting blood sugar higher than 5.5 (>100 in American measurement), means you're insulin resistant and gives you a diagnosis of "PRE-DIABETES".
The first time I heard about "Pre-diabetes" was at a diabetes conference. An endocrinologist giving the lecture started by saying she'd just gotten married and showed us a picture of her wedding. She and her new husband were standing in profile....and his big belly was sticking out of his belt. It looked terrible. I remember thinking that she should have chosen a better picture.
Then she pointed to her husband's belly on the picture and loudly said, "PRE-DIABETES".
You see....a fat belly (waist larger than hips) is a sign of pre-diabetes. And having pre-diabetes means that you're insulin resistant and it gives you a higher risk of becoming a diabetic later on in life.
I was so excited about what I learned that on my way home I stopped by my office and picked up a glucometer...and the next morning I tested every member of my family. Everybody's blood sugar was <5.5 (100 in American measurement). Except for my son's. His was 5.7 (103 in American measurement).... It made sense.....all four of his grandparents were diabetic. So my son was already pre-diabetic (insulin-resistant) and he was just a kid....and he was thin.
What was the one thing I could do to hopefully...maybe... keep him from becoming diabetic in the future????
Teach him how to keep his weight down. Obesity is like an invitation for diabetes. However, thin people can be insulin resistant too. And the Hepatitis C virus causes insulin resistance!!!
And a Glucose >100 mg/dl Reduces Interferon/RBV SVR
http://www.natap.org/2008/HCV/031008_01.htm
We know that the Hepatitis C virus CAUSES INSULIN RESISTANCE....but....
What is Insulin Resistance?????
Insulin Resistance means that the body becomes less sensitive to insulin. Even though the insulin may be there, the body does not recognize it or use it. It's as if some of the insulin keys got RUSTY and your body can't use them to open the cells. The keys are there but your body can't use them.
When you first start getting insulin resistance, the pancreas notices that some of the insulin keys are rusty and you don't have enough insulin to keep your blood sugar under control. So the pancreas starts working faster to produce more insulin. But gradually, the insulin resistance gets worse and worse. Let's say that from 10 rusty keys you went to having 50 rusty keys.....and the pancreas works faster to make more insulin. But since your body is insensitive to some of the insulin, you end up with a bunch of insulin you can't use.....WAY TOO MUCH INSULIN......that's called HYPERINSULINEMIA.
And THAT is what lowers SVR. The high amounts of INSULIN caused by the insulin resistance. You see....too much INSULIN, MAKES INTERFERON INEFFECTIVE!!!!!
(Here's a study that showed that during Hep C treatment, HYPERINSULINEMIA (high levels of insulin).....MAKES INTERFERON INEFFECTIVE!!!)
"interferon alpha blocks HCV replication. However, when insulin (at doses of 128 microU/mL, similar that seen in the hyperinsulinemic state) was added to interferon, the ability to block HCV replication disappeared"
http://www.ncbi.nlm.nih.gov/pubmed/1713 ... d_RVDocSum
And decreasing insulin resistace increases SVR!!!
http://aasld.scientificposters.com/epsAbstract.cfm?id=5
How do you get tested for insulin resistance and to see how bad it is?????
HOMA is a formula that uses the results of 2 blood tests ....a FASTING INSULIN and FASTING GLUCOSE(sugar) to figure out if you're insulin resistant.
A HOMA result of < 2 is considered NORMAL.
In genotype 1, studies have shown that the more insulin resistant you are, the lower the SVR (and Genotype 2 and 3 can also be insulin resistant!!!)...
HOMA < 2 SVR 60.5%
HOMA between 2-4 SVR 40%
HOMA > 4 SVR 20%
http://www.ncbi.nlm.nih.gov/pubmed/1713 ... d_RVDocSum
What DECREASES INSULIN RESISTANCE??????
1. EXERCISE
2. Gradual weight loss if you're obese. (quick weight loss can cause insulin resistance)
3. Getting rid of the Hepatitis C virus.
4. Medications like Metformin, Avandia and Actos
(sometimes exercise and weight loss are not enough to get rid of the insulin resistance because the Hepatitis C virus keeps causing it)
Medications like Metformin (or Avandia) decrease insulin resistance. In other words, they help make the cells in your body more sensitive to insulin. BUT they DO NOT make the pancreas produce more insulin, so they won't make your blood sugar come down 20 points of whatever. They don't do that.
Let me explain to you what Metformin and Avandia do....
When you eat a meal, the food goes from the mouth to the stomach where it turns into liquid sugar. From the stomach and intestines, the sugar is quickly absorbed into the blood.
Metformin helps by making the sugar slow down a little so it's not absorbed into the blood so fast.
When the sugar goes inside the muscle cells....the muscles use the sugar as energy.
Metformin helps the muscles use the sugar a little faster.
During the night, the liver gives you a bunch of sugar (this is a big problem for people who have Hep C because the virus causes the liver to disgorge large amounts of sugar).
Metformin tells the liver not to give you so much.
So Metformin helps....but it doesn't make the pancreas produce more insulin. So it's not going to make the blood sugar come down 50 or 60 points. It doesn't do that.
Think of it this way......
If insulin is like keys....and some of those keys get rusty and don't work.....then Metformin is like oil you put on the key holes so the keys work better.
What is "borderline diabetes"?????
The American Diabetis Association retired the term "borderline diabetic". It is no longer used. You know why? Because normal fasting blood sugar is 4.4 to 6.6......(80-120 in American measurement) and some doctors called 7.7 "borderline" while others called 11 "borderline" so many patients were not being diagnosed as diabetic when they should have been.
So there's no such thing as "borderline diabetic". You're either a diabetic or you're not. It's sort of like being a thief. You're either a thief or you're not. You're not a "little bit" thief...
Insulin Resistance can advance to Diabetes.
For a long time, maybe YEARS, the pancreas is able to keep up the fast pace and is able to make enough insulin to keep your blood sugar under control. But eventually the pancreas gets tired. It can't keep up the fast pace and slows down.....and your blood sugar gets higher and higher.....until you become a DIABETIC. (On the other hand, some people can be insulin resistant and never advance to diabetes).
(A fasting blood sugar >126 on two separate occassions gives you a diagnosis of DIABETES)
So before you become a diabetic, you first become insulin resistant. That means that ALL Type 2 diabetics are insulin resistant.
I'm sure you've heard diabetics say that their diabetes used to be under control with just one diabetes pill a day.....but later they had to take two.....and eventually they had to take insulin even though they were eating the same things. Why did that happen if they were eating the same and exercising the same? Because their Insulin Resistance increased. Their body became less sensitive to the insulin.
WHAT IS DIABETES?????
First we're going to talk about somebody who DOES NOT have diabetes....
Whenever we eat, the food goes from the mouth to the stomach......where it turns into SUGAR.....EVERYTHING we eat turns into a liquid type of sugar. EVERYTHING, doesn't matter what it is. (Some things, like bread and pasta turn into sugar quickly while other foods like meat, take 6-8 hours to turn into sugar, but eventually, everything we eat turns into liquid sugar).
From the stomach and intestines, the liquid sugar is absorbed into the blood. So now you have lots of sugar in your blood....(and some of the sugar is saved by the liver).
As soon as you have lots of sugar in your blood, that automatically sends a message to the pancreas. "Mr Pancreas, Mr Pancreas! Please give me some insulin because I have lots of sugar in my blood!".....and Mr Pancreas says...."Sure....no problem" and it gives you a bunch of insulin.
Imagine that the INSULIN looks like YELLOW KEYS......and let's say the pancreas gives you 100 insulin keys.
The yellow insulin keys go and open all the doors on the MUSCLE CELLS......and once the doors are open, the sugar in the blood can go inside the cells and feed them. And if you over-eat, the yellow insulin keys also open the FAT CELLS......and sugar goes inside them too and you get fat.
And THAT, is how food turns into energy. That's the way it's supposed to work.
Now let's look at a DIABETIC....
Mr Diabetic eats the same food as the other person. Food goes in the mouth and down to the stomach where it turns into SUGAR....liquid sugar.....and from the stomach and intestines, the sugar is absorbed into the bloodstream and some of it is saved in the liver.
As soon as Mr Diabetic has lots of sugar in his blood, it automatically sends a message to the Pancreas.....
"Mr Pancreas, Mr Pancreas! Please give me some insulin because Mr Diabetic has lots of sugar in his blood".
But Mr Pancreas, says, "I'm sorry....I don't have enough"....so let's say that instead of giving him 100 insulin keys like it gave the other person, it only gives Mr Diabetic 50 insulin keys. ( ***People can also be producing enough insulin, but because they are insulin resistant...insensitive to insulin... the body doesn't recognize it and can't use it )
Those 50 insulin keys go and open SOME of the muscle cells .....but since Mr Diabetic didn't get enough insulin keys, some of the muscle cells remain CLOSED. The sugar in the blood goes inside the cells that are open but it can't go inside the cells that are closed. And the sugar has no place to go and STAYS IN THE BLOOD. So when his doctor orders a blood test, it will show that he has high blood sugar....that's DIABETES.
And having diabetes.....lowers treatment success.
Bottom line....being insulin resistant/diabetic, decreases your chances of SVR greatly. Many of you who have failed treatment, probably failed because of insulin resistance.
By Typo - Registered Nurse and Diabetes Educator
Sources:
Insulin resistance and hepatitis C.
http://www.ncbi.nlm.nih.gov/pubmed/1713 ... d_RVDocSum
Insulin-Resistance in Chronic Hepatitis C patients: New Predictor of Sustained Virological Response Independent of HCV Genotype and Liver Fibrosis Stage
http://aasld.scientificposters.com/epsA ... .cfm?id=37
Insulin Resistance and Hyperinsulinemia. Is hyperinsulinemia the cart or the horse?
http://care.diabetesjournals.org/cgi/co ... type=HWCIT
Hepatitis C and insulin resistance: steatosis, fibrosis and non-response.
http://scielo.isciii.es/scielo.php?pid= ... ci_arttext
Incidence of type 2 diabetes mellitus and glucose abnormalities in patients with chronic hepatitis C infection by response to treatment: results of a cohort study.
http://www.ncbi.nlm.nih.gov/pubmed/1870 ... d_RVDocSum
Insulin resistance and response to therapy in patients infected with chronic hepatitis C virus genotypes 2 and 3.
http://www.natap.org/2008/HCV/010708_02.htm
Therapies to Manage Insulin Resistance Improve Response to Interferon-based Therapy in Chronic Hepatitis C Patients.
http://www.hivandhepatitis.com/2008icr/ ... 108_a.html
Is HOMA-IR the best marker of insulin resistance in chronic hepatitis due to HCV infection?
http://aasld.scientificposters.com/epsAbstract.cfm?id=5
Hepatitis C virus infection enhances insulin resistance induced by visceral fat accumulation.
http://aasld.scientificposters.com/epsAbstract.cfm?id=6
Steatosis, Insulin resistance, Iron overload, Fibrosis and Viral load as negative factors affecting Early (EVR) and Sustained (SVR) Virological Response in patients with Chronic Hepatitis C treated with peginterferon and ribavirin.
http://aasld.scientificposters.com/epsA ... .cfm?id=36
Viral Kinetic Response to 12 Week Treatment with Rosiglitazone in Chronic Hepatitis C, Genotype 1 Patients Who Are Previous Relapsers or Nonresponders to Pegylated Interferon and Ribavirin.
http://aasld.scientificposters.com/epsAbstract.cfm?id=3
In Chronic Hepatitis C (HCV), Pretreatment with Thiazolidinediones (TZDs) or Metformin Decreases Insulin Resistance (IR) and HCV Viral Load and Increases Early Virologic Response (EVR).
http://aasld.scientificposters.com/epsAbstract.cfm?id=5
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