I am a 73 y.o. lean Caucasian female in "well-controlled" health with
a very active lifestyle - I am 5' 4" on a medium, evenly-proportioned
frame and weigh 128 undressed.  For over 10 years I have fast-walked 3
miles 6X per week, weight-trained 30 min 3X per week, swam laps 30 min
3X per week, and have rather strictly followed a low-fat,
sodium-restricted, largely vegetarian/low-glycemic load diet.

My health conditions include well-controlled Stage 1 hypertension
(last 2 yrs daily avg 124/74) treated with Felodipine 10 mg daily and
Triamterene + HCTZ 37.5/25 daily; mild osteoporosis of the left hip
treated with Fosomax 70 mg once weekly; elevated but controlled LDL
cholesterol treated with Zetia 10 mg daily, Niacin (inositol
hexanicotinate) 1000 mg daily, and Red-Yeast rice with Co-Q 10 1200 mg
daily (can't take statins due to major CPK/enzyme elevations in
muscles.)  Lipids have been very stable on this regimen for the past
four years with less than 7% variation between quarterly profiles with
TC 216, LDL 116, HDL 79, Trig 120.  I also have a non-progressive
aortic stenosis that is regularly monitored by my cardiologist.  All
other blood chemistries are completely normal.

My question:  Over the past 3 years my fasting glucose has risen from
an avg of about 93 to an avg about 107.  In the summer of '05 it was
as high as 109 on a fast commencing at 7 PM the night before.  Both my
primary care physician and cardiologist tell me that the elevation is
not something I should be concerned with because it is probably
indicative of an "individual difference" in glucose metabolism as I
have aged, and will likely NOT progress to Type 2 diabetes because I
do not appear to have a true Syndrome X with the standard metabolic
risk factors present, and those factors that are present have been
well-controlled for years.  Therefore, neither physician believes this
is a case of "pre-diabetes" and consequently decline to give me a
referral for additional glucose/insulin profiling, such as a
glucose-tolerance or insulin test.  I feel the slow but steady rise in
the glucose numbers may be cause for concern and warrants further
testing and possibly treatment with meds such as Metformin as a Type 2
preventative measure.  When I asked my physicians about the recent
change in the diagnostic criteria of pre-diabetes from >110 mg/dl to
>99 mg/dl, they stated this was still a rather "grey-area" in medicine
due to metabolic differences among certain populations, and they told
me to stop worrying until my glucose somewhat exceeds the higher bound
(110-115).  I am concerned because I witnessed my husband suffer the
last 8 years of his life with severe microvascular complications of DM
and I do not wish to suffer that same horrific pain and disability,
not to mention a rise in the risk of CVD due to pre-diabetes alone.

So, does the consensus of current medical research/opinion dictate
that I should take any other action now or continue with the ?watchful
waiting?? From my reading, I also thought that the Niacin 1000 mg may
be slightly adversely affecting glucose metabolism, but don?t I need
this as an adjunct to the Zetia as I can?t tolerate the statins? 
Please provide an informed opinion on my dilemma citing the evidence
used to substantiate your position, preferably submitted by an
endocrinologist or qualified medical researcher.  (As this question is
rather complex and may necessitate advanced research and follow-up, I
have attempted to price it appropriately.)

---

Clarification of Question by neurowiz954-ga on 03 Feb 2006 16:35 PST

In addition, I should add I also take a supplement of 1000 mg of
cinnanmon (in 500 mg capsule form) twice daily - hence my cause for
concern for the glucose level as the cinnamon should be having a
substantial overall hypoglycemic effect, somewhere on the order of
10-15%, according to Mahpara (2004), Pakastani Journal of Nutrition 3
(5): 268-272.

Hello Neurowiz954,

     Blood glucose can indeed rise slightly as one ages. 

?Research shows that some increase in blood glucose levels often comes
with age. This may be caused by weight gain, especially when fat
builds up around the waist.?
http://www.niapublications.org/agepages/diabetes.asp


?Another 20 percent of people over the age of 65 have impaired glucose
tolerance. That adds up to a full 40 percent of our senior citizens
with some degree of glucose intolerance!?
http://www.northcoastmed.com/newsletter/news004.htm


?Drugs that can increase glucose measurements include the following:
?	Tricyclic antidepressants 
?	Corticosteroids 
?	Diazoxide 
?	Intravenous dextrose 
?	Diuretics 
?	Epinephrine 
?	Estrogens 
?	Glucagon 
?	Isoniazid 
?	Lithium 
?	Phenothiazines 
?	Phenytoin 
?	Salicylates (acute toxicity -- see aspirin overdose) 
?	Triamterene
You did not mention if you may be taking any medications beyond what you mentioned.
http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm





How long have you been taking Triamterene?
?Triamterene may raise blood glucose levels?
http://www.rxlist.com/cgi/generic/triamterine_ad.htm



Felodipine
?Hyperglycemia may occur as calcium channel blockade inhibits insulin release.?
http://www.emedicine.com/emerg/topic75.htm



Glucose Values:
===============

     A couple of things to consider about your lab values:

Glucose results and normal ranges vary from lab to lab. Are your blood
samples being sent to the same lab?  Are they using the same testing
method? Was your blood sample easily drawn? When the phlebotomist has
a difficult time drawing blood, it may become hemolyzed  - causing
lots of ruptured red blood cells to empty their  contents into the
plasma ? raising a glucose value, along with several other parameters.


If the tourniquet is applied to tightly and for too long, your sample
can become a bit concentrated. Once your blood is flowing into the
vacuutainer tubes, the tourniquet should be removed.

Fasting blood samples are more concentrated than random samples. It?s
possible that you were dehydrated more than usual on the day of your
last blood test. Most labs require you to fast after midnight for a
morning draw, and you said you fasted from 7pm!

Notice the values at the lab whose site is posted here- your result is
in line with their normal ranges.
?Other conditions that can cause high blood glucose levels include
severe stress, heart attack, stroke, Cushing's syndrome, medications
such as corticosteroids, rare cancers, or excess production of growth
hormone (acromegaly).?
http://www.bchealthguide.org/kbase/topic/medtest/hw8252/results.htm




HbA1C
===============
You can discuss the HbA1C and the serum C-Peptide tests with your
doctor. The results may make you feel better about a glucose of 110.
?The hemoglobin A1c (HbA1c) test is a simple blood test that indicates
how well your diabetes has been controlled over the past three months.
Unlike daily blood glucose testing, which measures your blood glucose
level at the moment you test, the HbA1c test provides a broader
picture of your overall glucose control.?
http://www.pennhealth.com/health_info/tips/diabetes/hba1c_test.html


?Red cells live for 8 -12 weeks before they are replaced. By measuring
the HbA1C it can tell you how high your blood glucose has been on
average over the last 8-12 weeks. A normal non-diabetic HbA1C is
3.5-5.5% (this varies between hospitals). In diabetes 4-6% is
acceptable.

The HbA1C test is currently one of the best ways to check diabetes is
under control; it is the blood test that gets sent to the laboratory,
and it is done on the spot in some hospital clinics. Remember, the
HbA1C is not the same as the glucose level.

Coincidentally the glucose/HbA1C numbers for good control are rather
similar though: glucose levels 5.5-6.5 mmols/l half an hour before
meals versus 7% HbA1C?
http://medweb.bham.ac.uk/easdec/prevention/what_is_the_hba1c.htm



Serum C-Peptide Testing
========================
Serum C-Peptide (Fasting)
?C-peptide is a protein produced by the beta cells of the pancreas
whenever insulin is made. The level of C-peptide in the blood is a
crude index of the amount of insulin you?re producing. The level is
usually zero in type 1 diabetics, and within or above the ?normal
range? in mild type 2 obese (insulin-resistant) diabetics.

If your blood serum C-peptide is elevated, this would suggest to your
physician that your blood sugar may be controllable merely by diet,
weight loss, and exercise. If, at the other extreme, your C-peptide is
below the limits of measurability, you probably require injected
insulin for blood sugar normalization. C-peptide measurements, to be
most significant, should be checked after a 12-hour fast when blood
sugars are normal. The test can be best interpreted if blood sugar is
measured at the same time.?
http://www.diabetesincontrol.com/issue188/bernstein.shtml






Metabolic Syndrome
==================

It does not sound like you meet the criteria for metabolic syndrome!
?The metabolic syndrome is characterized by a group of metabolic risk
factors in one person.  They include:
?	Central obesity (excessive fat tissue in and around the abdomen)
?	Atherogenic dyslipidemia (blood fat disorders ? mainly high
triglycerides and low HDL cholesterol ? that foster plaque buildups in
artery walls)
?	Insulin resistance or glucose intolerance (the body can?t properly
use insulin or blood sugar)
?	Prothrombotic state (e.g., high fibrinogen or plasminogen activator
inhibitor [?1] in the blood)
?	Raised blood pressure (130/85 mmHg or higher)
?	Proinflammatory state (e.g., elevated high-sensitivity C-reactive
protein in the blood)?
?According to the ATP III criteria, the metabolic syndrome is
identified by the presence of three or more of these components:
?	Central obesity as measured by waist circumference:
Men ? Greater than 40 inches
Women ? Greater than 35 inches
?	Fasting blood triglycerides greater than or equal to 150 mg/dL
?	Blood HDL cholesterol:
Men ? Less than 40 mg/dL
Women ? Less than 50 mg/dL
?	Blood pressure greater than or equal to 130/85 mmHg
?	Fasting glucose greater than or equal to 110 mg/dL

http://www.americanheart.org/presenter.jhtml?identifier=534





Niacin
===============

?Niacin (nicotinic acid) has been used for many years to reduce
elevated cholesterol and triglycerides. It is a B-vitamin (B-3), but
when used in the doses necessary for blood cholesterol control, it is
a drug and not a vitamin. It has side effects and should be treated
with the same caution as other medications.?

?Niacin has been shown to decrease cardiovascular events and
mortality. Some degree of angiographic regression has also being shown
with niacin when used with other cholesterol medications.?

?Remember that the use of niacin in high doses can cause serious side
effects. Please only take niacin under the direct supervision of a
physician. The most common side effect from niacin is flushing of the
skin. This reaction is well documented and is mediated by a substance
called prostaglandin.?

?Other important side effects:
?	Elevation in liver function test.
?	Elevation in uric acid. 
?	Possible exacerbation of atrial arrhythmias. 
?	Rare occurrence of retinopathy. 
?	May exacerbate diabetes.
http://www.riversidecardiology.com/archive/07151999.htm


?All B vitamins help the body to convert carbohydrates into glucose
(sugar), which is "burned" to produce energy. These B vitamins, often
referred to as B complex vitamins, are essential in the breakdown of
fats and protein. B complex vitamins also play an important role in
maintaining muscle tone along the digestive tract and promoting the
health of the nervous system, skin, hair, eyes, mouth, and liver.?

?Although niacin has been shown to boost HDL cholesterol and decrease
triglyceride and LDL levels, there has been some concern that it may
also raise blood sugar levels. In a recent study of 125 people with
diabetes and 343 people without the condition, high doses of niacin
(roughly 3000 mg/day), increased blood sugar in both groups, but
hemoglobin A1C (considered a better measure of blood sugar over time)
actually decreased in the diabetes group over a 60-week follow-up
period. For this reason, if you have diabetes, niacin should only be
used under the close monitoring of a qualified health care provider.?
http://www.umm.edu/altmed/ConsSupplements/VitaminB3Niacincs.html




Fewer than 3% of participants in one niacin study had trouble with
glucose control, but niacin has been shown to raise blood glucose,
increase homocysteine.

?Niacin is a well-accepted treatment for high cholesterol. Multiple
studies show that niacin (not niacinamide) has significant benefits on
levels of high-density cholesterol (HDL or "good cholesterol"), with
better results than prescription drugs such as "statins" like
atorvastatin (Lipitor®). There are also benefits on levels of
low-density cholesterol (LDL or "bad cholesterol"), although these
effects are less dramatic. Adding niacin to a second drug such as a
statin may increase the effects on low-density lipoproteins.The use of
niacin for the treatment of dyslipidemia associated with type 2
diabetes has been controversial because of the possibility of
worsening glycemic control. However, a recent randomized controlled
multicenter trial reports that of 148 patients, only 4 discontinued
niacin because of inadequate glucose control. Doses of 1000-1500 mg
per day (in a controlled release formulation) were reported as a
potential treatment option for type 2 diabetics with dyslipidemia by
these researchers. Patients should check with a physician and
pharmacist before starting niacin.?

?Niacin decreases levels of cholesterol, lipoprotein (a), and
fibrinogen, which can reduce the risk of heart disease. However,
niacin also increases homocysteine levels, which can increase this
risk. Numerous studies have looked at the effects of niacin, alone and
in combination with other drugs, on the prevention of heart disease
and fatal heart attacks. Overall, this research suggests benefits of
niacin, especially when combined with other cholesterol-lowering
drugs.?

?Niacin decreases blood levels of cholesterol and lipoprotein (a),
which may reduce atherosclerosis ("hardening" of the arteries).
However, niacin also can increase homocysteine levels, which may have
the opposite effect. Overall, the scientific evidence supports the use
of niacin in combination with other drugs (but not alone) to decrease
cholesterol and slow the process of atherosclerosis. More research is
needed in this area before a firm conclusion can be drawn.?

?Niacin can cause significant alterations in blood sugar levels and
insulin. This has been a potential concern in patients with diabetes,
although a recent randomized controlled trial reports that of 148
patients, only 4 discontinued niacin because of inadequate glucose
control (doses of 1000-1500 mg per day in a controlled release
formulation were used). Nonetheless, caution is advised in patients
with diabetes or hypoglycemia, and in those taking insulin, drugs,
herbs, or supplements that affect blood sugar. Serum glucose levels
may need to be monitored by a healthcare provider, and medication
adjustments may be necessary. Although niacinamide is generally not
associated with other side effects, it may affect insulin and blood
sugar levels.?

?Based on human study, niacin may increase blood sugar levels, and may
require dosing adjustments of insulin or prescription diabetes drugs.
In research on children, use of niacinamide and insulin together has
been shown to lead to a reduction in insulin dosage in patients with
type 1 (insulin-dependent) diabetes mellitus.?

!!!  ?The U.S. Food and Drug Administration does not strictly regulate
herbs and supplements. There is no guarantee of strength, purity or
safety of products, and effects may vary. You should always read
product labels. If you have a medical condition, or are taking other
drugs, herbs, or supplements, you should speak with a qualified
healthcare provider before starting a new therapy. Consult a
healthcare provider immediately if you experience side effects.?
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-niacin.html



Cinnamon
===============


Regarding cinnamon, it seems it does help lower blood glucose. One
study found it lowered not only glucose, but cholesterol,
triglycerides and LDL. Sall doses seemed to work as well as larger
doses.


?One gram is just 1/5 teaspoon, three grams just over ½ teaspoon, and
six grams just more than a teaspoon. Over the period of the study,
smaller amounts seemed to work just about as well as larger amounts.?

?Cinnamon seems to have an insulin-like effect in your body. If you
have type 2 diabetes (or even if you don't) add cinnamon to your
coffee (before brewing) or tea, sprinkle it on your oatmeal or toast,
or even add a sprinkle or two to your orange juice. Cinnamon can be
used in baking, cinnamon sticks can be used to stir tea or coffee, and
cinnamon can be sprinkled on salads, desserts, and other foods. Just a
little, used on most days, could have a significant effect on your
health.?
http://vanderbiltowc.wellsource.com/dh/content.asp?ID=1855


Here are more detailed results of the cinnamon study, in Pakistan:
?The mechanism of the effects of cinnamon on glucose and blood lipids
must be determined. Symptoms of insulin resistance include decreased
stimulation of muscle glycogen synthesis as well as defects in
glycogen synthase activity and glucose uptake (18). In addition,
altered enzymatic activities, such as an increased phosphatase
activity and/or seryl phosphorylation of the insulin receptor
substrate by glycogen synthase kinase-3 (GSK-3), have also been shown
to be involved in some cases of type 2 diabetes (19,20).

 Dephosphorylation of the receptor ß-subunit is associated with the
deactivation of its kinase activity and, therefore, is associated with
insulin signal downregulation (21). Maximal phosphorylation of the
insulin receptor is associated with increased insulin sensitivity,
which is associated with improved glucose and lipid levels. Extracts
of cinnamon activated glycogen synthase, increased glucose uptake, and
inhibited glycogen synthase kinase-3ß(11,12). Extracts of cinnamon
also activated insulin receptor kinase and inhibited dephosphorylation
of the insulin receptor, leading to maximal phosphorylation of the
insulin receptor (12). All of these effects would lead to increased
insulin sensitivity. We have shown that extracts of cinnamon also
function as potent antioxidants, which would lead to additional health
benefits of this substance (unpublished data). Dhuley (22) showed that
cinnamon displays antioxidant activity in rats fed a high-fat diet.?
http://care.diabetesjournals.org/cgi/content/full/26/12/3215


There you go! I don?t believe you need to worry about your glucose
level. You are taking several medications that can be raising your
blood glucose, and a slight elevation can be expected as we age.
You?re not overweight, you eat a healthy diet, and you certainly get
more than adequate exercise. If your doctors are not worried, you
should relax. Your result falls within normal range for most labs.

 You do not need to take niacin with Zetia, but you can.
http://www.drugs.com/zetia.html


I am not an endocrinologist, or a doctor of any kind (Unless a doctor
of  hard knocks counts!), but I am health care professional. You?ll
also notice  that I never use junk science or quack medicine sites or
sites that promote or sell supplements as a source of information.
(Although I did use one site that links to some sites that sell
products ? the site offers good information) Instead, I use reliable
and scientific sources.  I have answered plenty of medical question
son Google Answers. Here are a few, so you can see some of my prior
work.

http://answers.google.com/answers/threadview?id=437445

http://answers.google.com/answers/threadview?id=432832

http://answers.google.com/answers/threadview?id=431309


Don't stop taking any medications, however, until you consult with
your doctor. I would relax. You have had two doctors tell you there is
nothing to worry about, and there are several reasons why you may have
a glucose a bit higher now than a few years ago. Watchful waiting
seems like a good idea to e.

If any part of my answer is unclear, please request an Answer
Clarification, and allow me to respond, before you rate. I will be
happy to assist you further on this question, before you rate.

Sincerely, Crabcakes



Search Terms
=============

niacin + effect + glucose levels
cinnamon + glucose levels
age + glucose levels + senior citizens
Fosamax + glucose
Felodipine + glucose levels

Excellent research and analysis - thank you for your time and effort.

Hey,
The answer above did some great research I can't evaluate about
specifics vitamins and drugs and their effects.
I've been doing my own research and can answer more about lifestyle
(food & exercise).

Overall, it sounds like you're doing great work at trying to be
healthy, but the low-fat, largely veggie diet worries me.  You say
it's low GL, but it has to be high in carbs, and even if each carb is
low GL, a meal that's mostly carbs can add up to have a high insulin
resposne in the body.  Also, the Omega 6 fats in vegetable oils likely
mess with your insulin.
Secondly, trace minerals are possibly lacking, and those minerals
affects glucose metabolism in various ways.
Eating low mercury, fatty fish a few times a week (sardines, mackeral,
canned light tuna, salmon) would increase Omega 3, increase mineral
intake, and be low GL.

I would also recommend refining your exercise.  Tabata intervals
provide a significant aerobic boost, and doing more intense weight
training just twice a week gets you more bang for you buck, as well as
promoting fast twitch muscle fibers over slow twitch, while will help
with your glucose and insulin.
Dense muscle does wonders for your insulin.

The following resources are helpful:
http://tbkfitness.org/ ($4 ebook, best buy of your life; goes into why
the low-fat, mostly veggie diet isn't actually scientifically
supported)
http://www.ultraprevention.com/index.htm
http://www.arthurdevany.com/
http://www.arthurdevany.com/webstuff/RevisedEssay.pdf
http://www.thepaleodiet.com/