Rising Glucose

[SherryKahn]

My husband is on ADT and Orgovyx and Flomax and Cyalis. His glucose which was 90-100 range rose to 130 this month even though he’s lost weight and eats healthy. I know ADT can do that. Any suggestions appreciated to combat rising glucose while on the meds. His Dr told him he will be in it atlwqst for two years.

[mrscruffy]

I struggled with A1c for quite a few years despite losing weight and eating well. Finally lowered my numbers after using Osempic and adding daily cardio to my workouts

[JohnInTheMiddle]

Hi. Couple of comments.

1. Confusing - Orgovyx, the amazing new oral GnRH antagonist, is ADT.

2. PCa therapy generally and ADT specifically are known generally to put one at risk for developing metabolic syndrome or diabetes, over time.

3. Your husband is losing weight, which suggests deconditioning. Has he had one of those standard tests (it's sort of like standing on a scale in the bathroom in your bare feet) for his muscle/fat ratio? His weight loss may be more of a concern than you know if the weight loss has been more muscle than fat.

4. I'm assuming your husband is trying to exercise, which of course is difficult, but so essential. It's common not to have enough protein to avoid eventual sarcopenia, or just mere deconditioning now. Especially if one is trying to exercise, one needs a little more protein. Lack of protein either way makes one tired. None of my doctors ever mentioned getting enough protein. If you don't have enough protein, you will experience deconditioning. In my own case of not being aware of the insufficient protein situation, and during a period of successful exercise, I managed to knock myself out as a result, well figuratively. I recovered and now I'm better at balancing additional protein intake and exercise.

5. Back to question number one, so your husband is on monotherapy only?

6. As for rising glucose, I now have a prescription for metformin which is helpful against the development of diabetes, and there is interesting research as well, although not RCT standard, that metformin may be also helpful against progression. (For the record and some people won't like this, I also take berberine - the lipomicel version. I'm not recommending either of course.) Ending up with a prescription for metformin is not unusual in our circumstances, and the safety profile for decades and decades is the best. By the way, and maybe this is something you and your husband can do, but I do make an effort to keep carbs down, and especially to avoid sugar snacks. And no spaghetti. Higher glucose is scarily associated with cardiovascular disease, which is PCa treatment-driven over and above any such concern that a person of our age might have anyway

7. The whole thing is such a balancing act. It's like walking on a tightrope. And if you wobble and fall off and try and climb back on, it's tough. Things cascade one thing to another. We want homeostasis. Blood sugar stable and not elevated, metastases quiescent, bone density maintained, fatigue tolerable, sleeping well, mental clarity, no progression of atherosclerosis or CVD, maintenance of muscle strength. Etc. Yikes. It's a big job! All these things are interrelated and support each other.

Notice though that these issues are all sort of manageable -- assuming a way for now new metastases or the development of resistance or progression, and/or radiation or surgery or science fiction treatments etc. etc . -- which are all irrelevant if we can just sort of stay like we are. I have the fantasy that maybe I can stay like this way a little longer this month. And then next month. Etc. Etc.

Okay that's a lot of an answer. But because it's such a big question I've spent a lot of time trying to learn more. And while the usual advice and literature gives us the pat on the head and tells us to eat healthy and keep active blah blah blah, it's hard to really figure out what this means on a daily basis. And how strategically important the whole thing is. And how interrelated everything is.

You've got through the first phase! (I won't congratulate you 😃) And you have excellent medical care. Keep up the good work!

[j-o-h-n in reply to JohnInTheMiddle]

The best part of your post is the "blah blah blah" section. Is that copyrighted or can anyone use it?

Good Luck, Good Health and Good Humor.

j-o-h-n

[JohnInTheMiddle in reply to j-o-h-n]

Go for it! 💪🎉

[j-o-h-n in reply to JohnInTheMiddle]

Thanks and blah blah blah....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Lost_Sheep in reply to JohnInTheMiddle]

JohninTheMiddle, regarding the spaghetti and carbohydrates: Cabbage, shredded into thin strips and steamed to an al dente texture texture is a fine low-carb substitute for spaghetti noodles. Very little cabbage flavor and what there is is nicely covered by the spaghetti sauce.

[JohnInTheMiddle in reply to Lost_Sheep]

Sounds absolutely delicious, Lost Sheep! In fact my wife and I enjoy this sort of thing all the time. Although I confess that it's my wife who is the maestro and chef of low carb, or any carb. As for cabbage itself, we're big fans regardless. And also we've become big fans of "cauliflower rice".

[timotur]

I would suggest buying a continuous glucose monitor (CGM), to get a picture of which foods are causing glucose spikes. I've used Stelo and Lingo CGM's and found some interesting results about different foods that affect glucose. E.g., oatmeal, which I've eaten for years, can spike my glucose over 150, even plain steel-cut oatmeal. Others that significantly raise glucose are bread, pancakes, cherries, grapes, pretzels, and an In-and-Out burger with fries and half-a-lemonade, which pushed my glucose over 200.

Two things can be done to lower the effect of carbs on glucose: 1) eat protein with carbs in at least a 1:1 ratio, and 2) do some exercise shortly after eating, such as a short walk, deep knee bends, or burpees to allow muscles to use excess glucose.

[j-o-h-n in reply to timotur]

Hey Giuseppe, "whatsa makes me so fat?"

Tony, It's cose the pasta you eat is like glu.

Good Luck, Good Health and Good Humor.

j-o-h-n

[addicted2cycling]

JohnInTheMiddle wrote -- " .... 6. As for rising glucose, I now have a prescription for metformin .... "

I started taking 1,700mg/day of Metformin in 2015 and stopped it then began taking ENZYMEDICA Berberine Phytosome. Numbers got slightly better and have felt better since switching.

[JohnInTheMiddle in reply to addicted2cycling]

I also do berberine but it's important to do any available "lipomicel" version for absorbability, and possibly stomach tolerance. Not that I'm in any way promoting supplements!

[Professorgary]

research berberin both for effectiveness at controlling glucose and its comparison to metroform. Take with a healthy fat or black perrer for absorbtion.

[SteveTheJ]

I was diabetic before cancer. ADT meds (erleada + Lurpron) caused my A1C to shoot up past 8. Added more synthroid + cytomel, brought A1C back down. YMMV but the point is that it should be treatable.

[RoseDoc]

What was his HbA1c? That is the more reliable indicator. Decrease carbs and increase activity is the usual advice. If the HbA1c becomes elevated, he will need to be treated. Metformin is the more commonly used drug.

Discuss the options with your physician. You may want to ask to see a nutritionist.

[Mgtd]

Diet, exercise and if necessary meds for control. First two offer other benefits.

Exercise and diet only works if you do it. Most go to step 3 — pills.

[kayak212]

I had T2 diabetes for about 5 years before i was Dx with PCa in 2015, I also had a heart attack in 1994 and have high cholesterol, blood pressure and heart disease for many years. All of that mess gave me chronic disease anemia for the past few years and more recently i have now gotten to Stage 3a of Chronic Kidney Disease. Like most of us i take a lot of meds daily but i have been on Metformin 1000mg a day for about 7-8 years and it keeps my A1c down around 7% which averages about 135 daily. My PCa treatment in 2021 did not include ADTbut my PSA which was 19 when i received treatment is down to .38 as of January. I realize i am lucky enough to have avoided metastatic PCa for 10 years ,but my main point in replying to your message is to say that depending on his age, the Blood sugar scores you cite dont sound bad , especially if he hasnt gone on Metformin yet. I have no idea if it is true or not, but i have read that Metformin may even help in delaying PCa progression....maybe a good question for his RO. I have never had any side effects from Metformin but that is just me. I also now take Ezetimibe and Farxiga which my Cardiologist recommended and which, in addition to preventing cardiac events, are supposedly helpful in dealing with PCa and Chronic Kidney Disease although very expensive!

Finally, and most importantly, I have found that the best action i have taken as my pile of serious conditions grow is to exercise often and rigorously to keep that A1c under control and also help with the PCa and other conditions. Without that i doubt i would be here even with all the meds i take. Wish you and your husband the very best.