Diabetes Q&A: Insulin Resistance, Cough Meds, and Alcohol

1) What should I do if my glucose is on the higher end and my liver enzymes are above normal range? My ALT is 74, my AST is 42 and my glucose is 131. Should I be alarmed?

There are several lab tests that are used to ascertain whether there's damage to the liver. These tests are usually called "liver function tests" (abbreviated LFT's) and include measurements of several liver enzymes and other substances such as bilirubin.

The liver enzymes that are commonly measured include ALT (also known as GPT or SGPT) and AST (also known as SGOT or GOT). Elevated levels of these liver enzyme tests indicate liver damage. The elevations may be mild (as they are in your case), and unaccompanied by any other changes in lab tests, or huge -- over 1000 -- in which case it's likely that all the other liver tests would be way out of whack.

It's fairly common for people with uncontrolled diabetes to have mildly elevated liver enzyme test results, while the rest of the liver tests remain normal. Other causes of mildly elevated LFT's include adverse reactions to some medications, or excessive alcohol consumption, or viral hepatitis, or a liver disease called NASH amongst other possibilities.

Should you be alarmed? Well, yes. The rest of the LFTs need to be checked if they weren't. And you'll need to have repeat testing to see if the problem was transient or progressive. If everything else is normal, and repeat testing shows the same level, it might simply be due to uncontrolled diabetes, in which case if you get your diabetes under better control, the liver tests will probably normalize.

2) What can a person with type 2 diabetes take for a cough?

The concern that some folks with diabetes have about using over-the-counter cough remedies is that they may contain sugar, and hence would contribute to elevating blood glucose levels needlessly. This is more of a worry simply because PWD who are ill frequently have elevated blood glucose levels as a result of the illness. Of course, there are lots of sugar-free cough medications available, so it's probably best to keep some around the house so that when a flu or other illness strikes, you've got the sugar-free versions. Get them at your local pharmacy or supermarket -- one website for a national pharmacy chain lists 32 such products!

3) What is Trialmin and what is it used for?

Trialmin is a brand name used in some countries for a cholesterol-lowering drug which has the generic name of gemfibrozil; the brand name in the US is Lopid. It's an older drug, and in a different class (called the fibrates) than the widely-used statin drugs, and is frequently used in combination with a statin to help control high cholesterol levels.

4) What are the dietary causes of insulin resistance?

"Insulin resistance" is a technical term used to describe the situation when insulin just doesn't work as well as it should. There are several causes; the most frequently mentioned is obesity. (Other causes include certain medications including "steroids", polycystic ovary syndrome, and Hepatitis C virus infection.)

You asked about the "dietary causes." There's a long discussion of the role of diet at Wikipedia's discussion of insulin resistance. But, in my opinion, it's simply eating too many foods with too many calories.

5) I have type 2 diabetes and I’m not sure when the best time is to take my insulin. Do I take my Lantus before or after food?

Lantus (the brand name for insulin glargine) is a very long-lasting variety of insulin. It really doesn't make any difference what time of day (or night!) that you take it, as it is slowly released from the subcutaneous tissues into the bloodstream. So choose a time that works for you, and use your Lantus at that time routinely. Two additional thoughts: if you are also injecting a rapid-acting insulin (such as Humalog, Novolog, or Apidra), you may want to give both types of insulin at the same time -- but Lantus should be given in a separate syringe, not mixed with the other insulin. And if you goof and forget to give your Lantus at the usual time, and then suddenly remember that you forgot it a short while later, go ahead and give the Lantus late. If you remember very much later, check your BG and call your doctor or diabetes nurse educator if the BG is really screwy.

6) Is there heightened harm for a diabetic person who drinks beer?

Too much of anything is probably harmful for everyone, and there's definitely a slight additional risk to people with diabetes from drinking alcoholic beverages, whether it's beer or wine or other drinks. For example, alcohol may result in hypoglycemia. But that doesn't mean alcoholic drinks are forbidden for people with diabetes -- only that they should be used in moderation. Sipping your drink slowly and pairing your drinks with food are just some tips to safely consume alcohol while living with diabetes.