PD: Question about dextrose absorption

[kickingandscreaming]

I have recently been switched to a shorter dwell schedule of 3 hrs/dwell.  Reason is I'm a high average transporter and was getting very low UFs (very good solute clearance).  I was getting bad leg swelling every day.  Now the swelling has stopped, and my UFs have nearly doubled.  What I'm wondering, is it I'm also reabsorbing less of the dextrose in the solution.  I'm diabetic, so I really care about getting extra sugar in my system (especially in a form that I don't enjoy). Seems to me with the new regime I'm pulling out more and there probably absorbing less.  But I'm guessing here.  Any thoughts?

[Charlie B53]

You are correct in thinking that your exposure to the sugar in the PD solution an amount will be absorbed into your system.  Shorter dwell times reduce that exposure and thus will reduce that blood sugar gain somewhat.

It is that difference in sugar between your blood sugar and the PD solution that draws water into the higher sugar side in attempt to equalize the sugar concentrations.   Reducing the dwell time, draining off and refilling with fresh solution helps to keep that difference higher, thus drawing off even more water.


Keep tight control of your blood sugar.

Once I managed to keep my sugars well controlled, I lost another 20 pounds of weight, most all water.  My legs still look pert near 'normal' once again!

[kickingandscreaming]

Thank you,Charlie.  But the more fluid I take off hasn't had any effect on my weight.  It seems stuck in one place. I don't know how you have lost weight on PD.  I have gained since my brief stint on HD and start on PD.

[Charlie B53]

Give it time.  When I started I had ballooned up from 272 to 310.  That was all water gain in a short ime.  My previously swollen legs felt like they were going to burst.  The 'leaks' I had already became steady streams of water down my calves.

I lost that 40 pounds of water in the first week.  After that I steadily dropped  one to two pounds a week.  I was gaining a couple of pounds every day from eating and drinking, but over each week I had small total loses.

Over the next two years because I always carried Ico and was never dry, the PD fluid added a bit of pressure to my stomach.  If I ate slow I would get full much faster and ended up eating far less than I did before starting PD.  This also contributed to my weight loss.  In two years I went from 272 down to 202.  Prednisone has made me eat, the last few months I have regained some weight.  Now averaging right around 223, give or take a couple, depending on how much fluids I drink.

Do not expect magic losses.  Take your time, plan to eat more responsibly and slowly.  It takes time for the brain to realize you have had enough.  Eating faster we tend to over eat.  That makes it very difficult to lose.

[kickingandscreaming]

I don't overeat at all.  But I'm having to force feed protein food to keep my albumin up.  I used to be a vegetarian (for 35 years) and I only started to eat animal protein again about 8 years ago when I cut out most carbohydrate to control blood sugar.  Now I eat in one day the amount of meat I ate in one week.  And my albumin is still low.  There's nothing I can cut out.  All I eat it protein and low-starch veggies.  And I don't carry a lot of fluid.  So this is my weight--as long as the dextrose solution doesn't add to it. I'll be interested to see where my HgA1c is in my next set of labs and whether my blood glucose improves since shortening my dwells.

[Charlie B53]

Are you taking Insulin?  Or are you able to control your blood sugars through diet and exercise?

I take the slower Lantus late evenings.  I took my sugars 4 times daily and adjusted my fast acting Novalog to keep tight control within 100 to 115.  In the first three months my A1C fell from 10 to 6.

I have been getting lax and not testing near that often.  My numbers ahve been within an acceptable range so I just skipped.  Wondering what tomorrows A1C will be.  If higher than 7 I will start testing again.

[kickingandscreaming]

No insulin. I would do practically anything to avoid taking insulin. No diabetes meds at all for the last 8 or 9 years since going low carb.  I don't test as there's nothing more I can cut out--exept to quit eating altogether.  My last A1c was 6.   It used to a 9 at my worst before I radically changed my diet, dropped vegetarianism (which clearly didn't agree with my body although it fits my ethics and spirituality) and most carbs except for low-starch veggies and and the occasional fruit. I'm 74 and have been diabetic for 20 years.

[Charlie B53]

WOW!  NO tic meds, and NO insulin.  You have done great.   I cannot imagine having that much self-control to eat that clean.   I have to admit that I used to be so physically active that I could eat anything, and pretty much gorge myself as I would burn it all off the very next day.  Until I got hurt and really slowed down.  I didn't know then the damage I was doing to my kidneys.  Or if my diet had anything to do with that at all.  Mostly it was my constantly taking NSAI's and dehydrating every day at work.  I would sweat so much I couldn't drink enough to stay fully hydrated.  I couldn't eat until home for a few hours drinking almost a gallon of sweet tea, without sweating or P'ing during those hours.

You have done remarkedly well.  It would be hard to say you are diabetic being that well controlled.

[kickingandscreaming]

I am definitely diabetic.  An A1c of 6 is still not a normal reading even tho it's a good reading for a diabetic.  And I'm sure I won't be able to hold my own indefinitely given the amount of dextrose swimming around in my system these days from PD.  I am so needle phobic that I would rather die than have to shoot up with insulin.

The low carb lifestyle is actually quite easy to maintain once you get over a small hump.  It never made sense to me to have diabetics eat lots of carbs and then "cover" them with insulin or something else.  Why not just remove the element that diabetics can't handle.  And that element is high glycemic carbs.  There are tons of very good creative websites where people specialize in remaking foods the low carb way so there is really very little hardship.  Having to control for phosphorus at the same time does make it harder as the whole world of nuts is practically off limits. But there are still ways. After a while I didn't miss carbs at all.  I do eat a fair amount of good fats, so I'm getting calories that way.  And, of course, the ton of protein that I now have to eat.

[Charlie B53]

Needlephobic?  Welcome to the Club!    I used to be sooo bad that I would take naps, often just at the smell of the alcohol wipe.   I somehow manage to learn that labs are a necessary evil, but my veins still haven't learned that yet as they shrink and hide, when a needle does touch one it rolls away.  I am a pretty hard 'stick'.  And even worse when they are wanting to put an IV in.  It often take a tag-team, each making two attempts before a third person gets it done.  By then I am very thankful it is over!

Wife has been diabetic on the needle for years.  @ and a half years ago Dr told me I needed insulin.  Here again, it's one of those necessary evil things.  I manage to stick and test 4 times daily, followed by my insulin.   Thankfully these are 30 gauge needles and short enough, so ahrp you almost can't even feel them until you don't change the needle for a couple of days and it starts getting dull.

Ther are even smaller needles.  I know of 31 gauge, which is surprisingly thin.  I don't know if they get much smaller than that.  But I can assure you, when or if it comes down to making a very large difference in your life whether to inject necessary medication, you can do it.  You are a lot stronger than you think.

If you tried telling me 30 years ago that I would be injecting regularly by myself, I would have laughed in your face, and used language more fitting an old sailor.

But I am doing it now.

Take Care,

Charlie B53