Diabetic, Hypertension Questions

Factual Questions
1

Sorry about the long OP, but I do have some questions that cannot be answered without the following information:

I am a Wt/male 50+ with a family history of diabetes No history of hypertension.
Chronology:

Feb 18 (Sunday) 6:pm develop a nosebleed for no apparent reason.

Feb 19 (Monday) 7:am develop another nosebleed, this one takes 30 minutes to stop.

Feb 20 (Tuesday) No bleeding all day and evening.

Feb 21 (Wednesday) 6: am a nosebleed, takes about forty minutes to stop. I go to a local immediate medical care place. My BP is taken 165/90. After 30 minutes of rest my pressure comes down to 130/80.

Feb 22 (Thursday) No bleeding all day and evening.

Feb 23 (Friday) Driving into work( one hour each way) another bleed begins. A nurse at work packs my nose and I begin to drive home. As I am driving the bleeding appears to be getting worse, a large clot is forming in the back of my throat forcing me to gag and to make matters worse my contacts are beginning to cloud over. I wipe my eyes as they begin to tear and I see that that tears are “pink”. I finally reach the emergency room. My blood pressure is 194/114. The doctor packs my nose and gives me some hypertension medication . After 30 minutes my blood pressure comes down 130/80. While at the ER the doctor has some blood drawn and a urine specimen. The tests show that I have a 400 blood sugar. Before I leave the ER, the Dr. puts me on high blood pressure and diabetic medication. I see my family doctor that afternoon and he requests that I take a battery of blood tests on Monday, Feb. 26.

Feb 24 (Saturday) I remove the packing and there is no bleeding all day and evening.

Feb 25 (Sunday) 11:pm another bleed which is difficult to stop, and I again go to the emergency room. My BP is 165/90. After 20 minutes goes down to 120/75.

Feb 26 (Monday) Blood tests taken no bleeding all day and evening.

Feb 27 (Tuesday) 2:am another light bleed, stopped quickly. 11:30 am another bleed 30 minutes to stop.

Feb 28 (Wednesday) Go to ENT clinic. Doctor cauterizes blood vessel in nostril causing the bleeding. No bleeding that day.

Mar 1 (Thursday) Blood tests from previous Monday show blood sugar of 225. Blood pressure is 120/80. No bleeding all day and evening.

Mar 2 (Friday) No bleeding as of 10:am ET.

Note: I am not trying to second guess the doctors, but I have several questions that I can’t seem to get answers to.

Question 1.
If my blood pressure was checked directly after a traumatic incident (nosebleed) and was found to be high, but my “normal” pressure is low, do I really have a blood pressure condition that I will have to take medication for the rest of my life?

Question 2
Can a traumatic experience ( severe nosebleed) increase your blood pressure to abnormal limits, making it appear that an individual has high blood sugar. As can be seen on the timetable above, each blood sugar was taken within hours of a traumatic experience (which I understand can raise your blood sugar to abnormal levels).

I feel like I have a chicken and egg question here. Did the hypertension and diabetes really exist before the nosebleeds or did the nosebeeds produce a temporary rise in BP and blood sugar? How can I find out for sure which came first? Over the past ten days and after consuming several glasses of fruit juice and whole fruit before each test I have used three test strips for sugar in the urine and they were all negative for sugar. Over the past several months I have noticed that when my urine dries, it becomes very sticky.

2

No one can or should determine use of a long term of anti-hypertensive drugs based on a very short series of tests. Your doctor should be monitoring your pressure and testing you to see if you in fact do have a hypertension problem.

Blood pressure has no direct impact on blood glucose levels itself. None. It sounds like you may have a complicated problem of some sort here - like insulin producing cells that are on the edge of quitting, or a liver that is dumping huge amounts of sugar at certain times. But as a diabetic for 19 years, I can tell you that the increased bllod pressure itself does not lead to a higher reading on the meter, unless it is inhibiting insulin production or making your liver release sugar. It sounds like you should stop asking here, and start asking your doctor, or another doctor if you don’t care for your current one.

3

You should definitely find an endocrinologist that you are comfortable with. There are some studies suggesting that the high blood pressure could increase the likelihood of diabetes-related complications. A good endocrinologist can devise a glucose and blood pressure control strategy.

4

True…high blood pressure and diabetes spells death for your kidneys, and can greatly increase the risk of blindness. Good to note this combined effect.

5

My family doctor uses the argument that by taking the medication for hypertension and diabetis I will be preventing a problem from occuring. My argument is that I will have to take these medications for the rest of my life and what is the proof that I ever had hypertension and abnormally high blood pressure previous to my traumatic nosebleeds?

6

Do you go for annual physicals? If so, what were the results of last year’s tests? If positive, that’s the proof. If you don’t go for annual physicals, why not? You obviously will be doing that now, I’m sure.

So if there’s no “proof” of htn or dm prior, you’re going to assume you don’t have either one and stop taking your medicine. It’s your life. I think it wiser to take a couple of pills a day than take that risk. And if you do have dm, you’re need more than pills if you don’t take them. You’ll then need insulin shots. Not to mention all the complications that occur with dm, which I won’t. Oh, and then there are also complications from htn, such as a myocardial infarction.

Hey, it’s your choice.

7

First of all, I am NOT a doctor. I do have diabetes and high blood pressure, though, so I’m interested in this subject.

I really, really don’t think that stress and diet, separately or together, is/are going to raise your blood sugar to 400 unless you are, in fact, a “real” diabetic. Take your pills, and do your fingersticks.

I’m going to send this one over to KarlGauss (an endocrinologist), see if he has anything to say about it. I hope that I have his home email, not just his work…

8

I am not an endocrinologist, but I have a good feeling KarlGauss will say something along the lines of what I do. Of course, Qadcop is also an experienced doctor who has diabetes.

Anterior nose bleeds can be caused by several things – dry air, trauma and high blood pressure. If you do not normally get nose bleeds this time of year, high blood pressure should be ruled out. Ideally, this needs to be done with three separate measurements a month or more apart. On the other hand, since you seem to be having symptoms, it would be worth trying a medication to lower pressure if it was high both in the ER and later with your family doctor. Unless there is a record of high blood pressure though, and I don’t know your past history, then you could ask your doctor, at a later date, to see what happens off the medication and may not have to take it forever. What are you on? What dose?

Sugar in the urine is suggestive of diabetes. Better tests include fasting blood glucose and Hb1Ac (a hemoglobin-like measure that looks at “long term” sugar control). I suspect your doctor included these if he did a battery of blood tests, and if these are also elevated you likely do have type II diabetes.

This is a serious disease, and of course was fatal not 100 years ago. Diabetics who do not manage their sugars and pressures well are at much increased risk for problems of the eye, kidney, foot, heart and blood vessels. The diagnoses of high blood pressure and diabetes can and should be confirmed – they certainly can change since your physical last year; you may also consider using the machines available at many pharmacies. When they are, taking the medication is a lot better than the side effects from not taking them. Nothing in life is guaranteed. You may be taking these medications for many years. You may improve, and need less frequent dosing. You may get off some of the medications altogether. But these decisions can’t be made over the Internet, and your doctor will give you good advice.
Dr_Pap, MD

9

Well, I hope I don’t disappoint. And, since I’m always somewhat reluctant to address any one person’s health, I will try to be general.

Regarding diabetes, having a sugar level of over 200 “officially” establishes the diagnosis so long as a person is also having some symptoms of diabetes (eg. thirst, frequent urination, getting up to pee a lot at night, blurred vision, yeast infection in women, and others). So, assuming a person has a sugar over 400 and any of these symptoms, there is no way not to make the diagnosis.

It is conceivable that the stress of a nosebleed, or any significant physical or mental event, could increase the sugar level. This effect is really only of relevance in people who already have diabetes or who are at the brink of developing it (so-called impaired glucose tolerance - IGT). So, even if the effect is operative, it would just confirm the presence of diabetes or IGT. In either case, a visit to an internist or endocrinologist is warranted.

High blood pressure, as has been pointed out, is much more labile than high blood sugar. As Anthracite has pointed out, a diagnosis of high blood pressure requires documentation of a persistent elevation. As with high sugar, it is also the case that blood pressure can go up in the setting of physical or mental stress. And, again, as with sugar going up with stress, a blood pressure that rises with stress is likely a reflection of already established high blood pressure or incipient high blood pressure (the analogy is not completely accurate since the blood pressure rise with stress is not as clearly relective of the underlying condition as is the case as with a stress-induced rise in sugar and diabetes.)

Bottom line is that if someone’s blood pressure goes up to 194/114 for any reason, they either have high BP or they’re at great risk of getting it full time. This is particularly important in someone with diabetes. There is a tremendous synergy between diabetes and high blood pressure on things like kidney disease, retinopathy, and hardening of the arteries (in fact, control of blood pressure may be more important than sugar control in preventing kidney problems). All the more reason to seek medical advice.

10

I appreciate the information and understand that I was not looking for a diagnosis over the web. I will comply with the instructions of my family doctor even though I have/had questions in this chicken/egg queston. I very much appreciate what you have told me. A psychologist friend of mine, actually my boss, told me that in twenty years of private practice, he has never heard of an individual who had a baseline of normal BP who under traumatic and panic circumstances who would display a BP of 194/114. From your experince is this true? I understand that weight lifters can during workouts raise their BP to 250/195 without being hypertensive.

11

Didn’t a UKPDS branch show fairly convincingly that controlling blood pressure is more important than sugar, [b\KarlGauss**? Only one study, but you don’t sound that convinced.

12

Actually, that is the study to which I referred. Here it is for anyone who may be interested.

Blood pressure control is clearly important in people with diabetes. The UKPDS results show as much. Still, that study was in NIDDM. In contrast, the landmark DCCT study, in IDDM, showed decreases of about 50% for renal decline and 75% for progression of retinopathy. These numbers are somewhat better than those exhibited by the UKPDS. It is still moot which is more important - glucose or hypertension control - to prevent complications.

13

I should add that an earlier UKPDS study showed a benefit of “only” 10 to 20 percent with improved glucose control. This, of course, is less than the benefit shown with blood pressure control. Still, it must be contrasted with the DCCT which showed more profound benefit (albeit in IDDM).

14

I’d tend to agree with your boss but have no data to back me up with 100 per cent certainty. On the other hand, people who demonstrate even transient elevations in BP during real life do have a tendency to develop complications that were traditionally associated only with sustained high blood pressure.

15

A traumatic experience that is severe enough to trigger a release of adrenalin (epinephrine) will lead to a transient elevation of blood pressure and blood sugar level.

Adrenalin raises blood pressure by increasing the rate and force of cardiac contractions, and by constricting the peripheral blood vessels. Adrenalin also acts on the liver to promote the conversion and release of “stored” glucose into the blood stream.

However, the likelihood of adrenalin release in the scenario descibed in the OP is small, unless the nose bleed was catastrophic, or insider was extremely perturbed by the sight of his own blood.

Hence why the doctors are looking for other causes.

16

Vasotec 5mg BID
Glucophage 500m BID

Up until my nosebleeds I had been taking:

  One regular aspirin a day for past 14 years
  Vitamin C 3grams time release 1x per day
  Vitamin E 800 units per day
  Chromium picolanate 400mcgs per day
  CoEnzyme Q10 50 units per day
  Beta carotene 2000 IU's
  Selenium 100mcgs

The only things I am contiunuing currently are the Vit C and CoEnzyme Q10.

 Again, thanks for all the information and help.
17

Vasotec is an ACE inhibitor (enalapril). I’ve heard some docs argue that even normotensive diabetics should be on ACE inhibitors, because of the protective effects on the kidneys.

Thanks to KarlGauss for the great medical info–the med students in the house always appreciate it. :slight_smile:

Dr. J

18

The Vasotec and Glucophage seem like reasonable choices to me. If you are drinking a lot and going to the bathroom more o ftne than usual, I think you should consider taking them as prescribed. You may wish to check your blood pressure again at a drug store.

19

Yep. ACE inhibitors are often used prophylactically for diabetics if some kidney involvement is suspected. I’m on Lisinopril ( Zestril/Prinivil ) despite normal blood pressure for just such a reason. Although my kidney functions are otherwise normal, there is a small amount of proteinuria. Also on Glucophage as well - So your “cocktail” is a pretty standard one :slight_smile: .

  • Tamerlane
20

Back now, sorry, major computer crash! Down for 1 week! Now $120 and the services of two computer geeks (my daughter and her boyfriend) we’re online again! But as a physician who is also diabetic, hypertensive, and hyperlipidemic (high cholesterol), a triad known as Syndrome X, just let me say: I agree with Doc Pap, and KarlGauss! Control the sugars, control the cholesterol, control the blood pressure! It will make a difference! Ten years from now, you will be FAR less likely to ponder your failing kidneys, eyesight, sexual function, and infarcted heart, and regret not having taken better care of yourself. Oh, and no smoking, either!

Qadgop