Statins

[BlueJay]

Hi

I have been type 1 for 8 years now and after reading many posts on this site I decided to reduce my carbs in an attempt to get my sugars under control.
I recently saw my specialist, nurse and dietician in the hope that they would be able to advise me on calculating insulin based on the protien in my food as well as the carbs, as some meals I have are totally lacking in carbs.
Basically what I was told is that there are no guidelines for counting protien and what they want to do is to put me on a constant monitor so that they can monitor my readings with more detail, unfortunately there is only one monitor for the whole of the Basingstoke district and that is currently in for repair so it will be months before I get a look in!
Anyway the upshot of my visit was that since my last visit my cholesterol level has risen and they have advised me to either go back to a carb based diet or start taking statins. Although my cholesterol level is relatavely normal for a non-diabetic, they think that they should be lower. At the moment they are at 5 but they want to reduce thm to 4. (I have to confess that I know absolutely nothing about cholesterol)
I decided that as my sugars are not yet brilliant but a definate improvement on what they were a few months ago, that I would take the statins and I have to go back for a check up in three months.

Can I ask whether any of you low carbers have had the same problem with cholesterol and if so how have you dealt with it as I would prefer not to take the pills but am quite enjoying the new diet?

 

[loopy-loo]

Hi Bluejay,

I am also a relative newcomer to the low carb way, I started at the beginning of April and have never had better control of bg levels.

I purposely started then as I knew that I was due to have my routine bloods done in July and therefore hoped that my cholesterol etc would have settled - as I read somewhere that there is a period at the start of low carbing when your cholesterol can actually increase as your body rids itself of any excess.

However that may not be accurate, so if anyone knows different, please say so!

Also, I believe that it's not your total cholesterol that you should look at, but the ratio of hdl to ldl and the lower the better, tho on saying that, I'm not sure if all of these things are measured when they do a general cholesterol test.

Sorry, not sure if that was any help or not! May have given you more questions than answers. :shock:

Regarding statins, my consultant who was fantastic, (and has unfortunately just retired) :cry: told me that they automatically try and give you statins if your cholesterol and hba1c results are above their recomended levels, it's all about ticking boxes and meeting government guidelines' were his exact words. :|


all the best
lindsey

 

[fergus]

Hi Bluejay,

Statins are yet another subject of controversy, not simply in the treatment of diabetes, but in the general population. I should say that the choice of whether or not you take them should be yours, and yours alone. In order to make a properly informed choice take a look around the forum and read the thoughts of others.
My thoughts are as follows. There is no proven correlation between choesterol levels, outwith the very extreme margins, and heart disease risk. None. The cholesterol hysteria is entirely founded upon unproven hypotheses. Relative levels of HDL and LDL are more significant.
Eating more carbohydrate instead of fat to improve cholesterol levels is utterly daft. Good HDL cholesterol levels are elevated when insulin levels are low. Bad LDL cholesterol levels are raised when insulin levels are high. The single biggest benefit to your cholesterol levels will therefore come from eating foods which require the least insulin. Low carbohydrate foods in other words.
If it helps, I've been low-carb for 7 years now. My total cholesterol level has risen slightly in that time, but my cholesterol ratio has improved enormously (total choesterol divided by HDL). A ratio below 4 is thought to be an appropriate target. Mine has fallen from 4 to 1.1 in 7 years.
Nonetheless, my GP sent me a prescription for statins because all diabetics should be taking them, apparently. He was paid for doing this, whether I filled the prescription or not. I didn't.

I hope that helps?

All the best,

fergus

 

[BlueJay]

A few months ago I would have responded with an answer such as "who would know better than my specialist medical team", ignoring the fact that they have never been able to get my sugars under control. But now I am beginning to realise that the real specialists are those that actually deal with diabetes in in all aspects of their lives not just at work.
The fact that there are no guidlines for injecting based on protein rather that carbs seems to me as being rather negligent as the more I try to find out about the low carb diet, the more people (diabetic and otherwise) I come across who are following it. There must be thousands of diabetics who follow it or enquire about it.
Another comment that was made to me by my dietician was that a high protein diet can damage your kidneys, that and my cholesterol level should convince me that low carb is not the best way of controlling dibetes. I either go back to high carbs or take the statins! My HBAC levels have dropped from 8.2 to 7.6, not fantastic I know but a step in the right direction. so for now I will stick to reduced carbs.
It is interesting that our lives are put at risk just so that "boxes can be ticked".

Thanks for your replies, I think that for now I will take the statins until my check up in mid August, find out more about cholesterol and ask the right questions when I get the results, as I have to confess that HDL/LDL went straight over my head.

 

[sugarless sue]

This BUPA fact sheet gives a fairly simple explanation of the differences

http://hcd2.bupa.co.uk/fact_sheets/html ... terol.html

 

[Nellie]

According to the info on Sue's link. Current UK guidelines state that it is desirable to have a total cholesterol level under 5mmol/l, and an LDL level under 3mmol

You are correct to research and make up your own mind but bear in mind that similar or lower levels are adopted by doctors in countries where doctors do not have NHS targets.
My (French) doctor uses a LDL target of around .8 g/l (about 2mmol) for people with diabetes and a total cholesterol/ HDL ratio of less than 3. She prescribes statins for LDLs above 1.0 (2.59 mmol.)

Incidently, I have been able to maintain cholesterol OK with exercise, and by upping consumption of 'good' fats( avocados olive oil, oily fish etc),in fact I've raised the HDL at a time when it might be falling(menopause). I control BS by carb counting/ dose adjustment, I try to eat healthily and I certainly don't low carb.
this link gives risk charts used in the UK http://www.bassetlawdiabetes.nhs.uk/cv/risk.htm

 

[fergus]

Hi Bluejay,

Could you do me a favour, please? Poke your dietician in the eye with one of their plastic chickens the next time you meet. You know the thing they use to explain to their patients what chicken looks like? :wink:
Look upon it as protein's revenge for the ridiculous old wives tales that persist in their circles. There is no evidence at all of protein consumption damaging healthy kidney function. Those with pre-existing kidney damage may need to limit their protein consumption to arrest ongoing stress on the kidney, but otherwise this is another urban myth.
The protein / insulin ratio is one of those things we have to work out for ourselves I'm afraid. Just as carbohydrate / insulin ratios are particular to the individual, so it is with protein.

All the best,

fergus

 

[sixfoot]

Ive been watching this thread with interest and from what ive seen and a healthy dose of " diet delusion" it is promising to be very informative. There is nothing like experience in the absence of formal scientific fact.

Keep it up
Dave P

 

[wxy]

thank u for a very interesting reply
have an easy day now

 

[BlueJay]

Thanks Fergus, thats a brilliant idea, but I could think of sharper and more satisfying things to poke with!

Thanks for the fact sheet sugarless sue, I will read that when I have time.

 

[bluebird]

I'm having a battle with my doctor at the moment regarding statins. I was advised to take simvastatin over two years ago but because I have been experiencing muscle pain I stopped taking them in March of this year. My doctor wasn't too pleased at the time and when I went to see her this week she once again said that because I was diabetic she recommends that I go back to taking simvastatin. She can whistle I am not going back on them. I am eating an ounce of almonds each day and a benecol drink so I'm keeping my fingers crossed that this has lowered my cholesterol to an acceptable level. Will have to wait until Sept when my next blood tests are done. Another thing that makes me cross they only have a figure for total cholesterol (because that is what the PCT tells them to test). No response when I said how can I tell whether HDL or LDL is within range if they don't provide both figures. She completely ignored the fact that my triglycerides were higher than recommended. Fast losing faith in my doctor even though she is a very nice lady.

Val

 

[hanadr]

I've also pretty much stopped taking my Simvastatin. My Total cholesterol was never above 4 and I've been getting muscle pains. My,absolutely lovely, diabetes specialist nurse told me they weren't casued by the statin, because they are localised and pain caused by statins is generalised. Who can tell me more about that?. I have gradually dropped much of my medication in the last year since I went low-carb.Along with 16 kg of me!! First to go was the Gliclazide; the dreaded weight builder,now I'm almost off the Starlix, unless I give in to temptatioon and eat some carbs. Statins have pretty much gone too. I'm still taking the Metformin. I think it works and seems to be safe. I never even had much in the way of Tummy Grumbles with it.
I also take Doxazosin,Bendroflumethiazide?? and Candesartan for blood pressure. Atenolol went a long time ago.
At what point will I have saved enough money in my "account" to be allowed the 2 test strips per day that I want?

 

[sixfoot]

hanadr, i used to be on Simvastatin but like you got the pains so complained and they gave me lipitor which up to now has been ok

Dave P

 

[totsy]

i too had a bad time on simvastatin and was changed to ezetrol which has given me no problems im aware of

 

[fergus]

And another thing!

I was talking with a doctor friend on Sunday. We got onto the subject of statins, as you do.
He told me that a contemporary of his, who runs a medical practice, said his practice would not survive but for the income it received from prescribing statins. The statins were on the market at 80p a pop, but the cost to the NHS was £8. Maybe we shouldn't be too surprised that they want to prescribe them for everyone, despite their questionable benefits and commonly reported side effects?

All the best,

fergus

 

[Nellie]

The cost of statins isn't high if they do in fact contribute to a reduction in CVD.

Many people complain that NICE guidelines are very much influenced by cost benefit analyses. The one for statins makes that very clear.The risk level at which it recommends statin intervention is higher than that wanted by some (and higher than in other parts of Europe).You may not agree with the sources of evidence used, but they are accepted by many(most?) doctors.

Statins should be prescibed they say to those, with a CVD or at risk of one :
‘

At risk of developing CVD’ means people who have a 20% or greater 10-year risk of developing CVD as estimated by an appropriate risk calculator, agreed by local clinicians, or after a clinical assessment to estimate CVD risk when an appropriate risk calculator is not available, for example, in older people, people with diabetes and people in high-risk ethnic groups.

The guidelines gives the cost of the drugs to the NHS.
The cost of generic simvastatin (supposed to be the first choice because of cost) is far cheaper than suggested by Fergus's friend.

'When the decision has been made to prescribe a statin, therapy is
usually initiated with a drug with a low acquisition cost.'

'the acquisition cost of simvastatin listed in the NHS Drug Tariff (July 2005) is
£1.65 for 28 x 10-mg tablets, £1.48 for 28 x 20-mg tablets, £3.57 for
28 x 40-mg tablets, and £20.29 for 28 x 80-mg tablets. Costs may vary in
different settings because of negotiated procurement discounts.' *

http://www.nice.org.uk/nicemedia/pdf/TA094guidance.pdf

I also found this for another costing example:
*simvastatin 40 mg can cost less than £1 per patient per month when purchased in bulk by hospitals.
source BMJ editorial(BMJ 2006;332:1344-1345 (10 June),)

 

[The Governor]

My GP reckons statins should be put int he water because even if you're not at risk per se they still have a beneficial effect generally speaking...