Diet options for high ammonia & a diabetic

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archichik
New Member


Date Joined Jan 2009
Total Posts : 3
   Posted 1/2/2009 9:40 AM (GMT -7)   
Hi all -
 
I just found this forum last night after getting a call from my mom that my father had been rushed to the hospital after a spike in his ammonia levels (again) caused an episode of severe disorientation and loss of bodily function control and belligerance regarding actually going to the hospital.  Thank you so much for having such a great resource of information!
 
A little about my dad:  He has alcohol-related liver failure, but has been sober for 2 years (this month!).  His primary issue stemming from the liver failure is ammonia level control (last night at the ER it was 160, but usually hovers around 70-80), and despite having fatty liver combined with cirrhosis, his other levels have not been that bad.  He's on high amounts of of lactulose by mouth already as well as miralax, and is on an antibiotic regimine as well (I can't remember the name of it), and is being monitored by Dr. Araya at Albert Einstein in Phila.  He also has a multitude of other, unrelated health issues as well, including vascular issues (which make him an unlikely transplant candidate) and diabetes.
 
This latest episode we think was brought on by eating too much protein over the holidays.  And, because of the diabetes, it's been very hard to find foods that are both low-carb AND low-protein.  I've been unable to find very much on google about a diet plan that is both.
 
Any advice for us - resources, menu planning, etc?  I'm hopeful that they'll be able to get him through this latest crisis and when he comes home, we can come up with a more solid dietary plan for him that doesn't pit his liver function against his diabetes.
 
Thanks in advance for any information.  I'm trying to direct my mom here as well, because I think that it would be a great help for her as his primary caregiver.  (Unfortunately, I live 4 hours away and can't be much use on a daily basis, and don't have the ability to be "boots on the ground" with her as she works through this with him....)
 
 

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 1/2/2009 10:22 AM (GMT -7)   

Archichik, welcome to the forum!  I'm so sorry that your dad is battling both liver disease and diabetes.  That is a rough combination.  I think he is fortunate to be fairly stable, aside from the encephalopathy.  You are probably right about too much protein.  The only thing I can suggest is a diet free of beef and low in animal protein, in general.  Beans and eggs can be good substitutes.  Beans are carbohydrates, but like pastas they are complex carbohydrates which are broken down more slowly.  I eat a lot of fresh fruit and veggies, but I'm not a diabetic.

When your dad next goes to see Dr. Araya, have your mom ask about a good diet for him, or referral to a nutritionist there. 

Also, do continue to persuade your mom to come to this forum.  It could be a great source of support and information to her.

Sorry I can't be of more help, but perhaps someone else here knows more about diabetes and can offer more suggestions.


hep93
Forum moderator - Hepatitis


Butterflythree
Veteran Member


Date Joined Oct 2007
Total Posts : 954
   Posted 1/2/2009 7:46 PM (GMT -7)   
Hi Archichik, I just wanted to welcome you to the forum. I am sorry that your dad is dealing with this disease. My husband has cirrhosis. His main problems have been encephalopathy and edema. Since his lactulose was adjusted to every 6 hours, the encephalopathy has been pretty much under control. He had a bleed from varices in his stomach in November. Since he has been home from the hospital the encephalopathy has pretty much diminished. I know how frustrating it can be, although he was never bad enough to be hospitalized from it. When the episodes would come on I could never narrow down anything different that he was doing to cause it.
I think Connie gave you some good advice about talking to a nutritionalist. The balancing act can be hard enough with cirrhosis. Adding diabetes must make it so much harder. It isn't uncommon for a person that has cirrhosis to develop diabetes. It is actually one of the complications that can be caused by cirrhosis. I'm sure that a nutritionalist will be able to help.

I hope you continue to come back and also encourage your mother to check the forum out. There are alot of wonderful, caring people here that have loads of experience with this disease. They have been a lifesaver to me.

I will be praying for your family.
Butterflythree
 
There is always hope!


Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 1/3/2009 10:54 AM (GMT -7)   
Hello Archichik, Just wanted to add my welcome to the forum. I realize how hard it must be for you and your mom. This liver disease ride can be as wild as any roller coaster ride. Nutrition is a big part of controlling some of the symptoms of it. Connie gave you some good advice. Getting your father to a nutritionist is very important.
It would be great if you can get your mom to visit us, but whether she does or not, you are more than welcome to stay and at least get some support for yourself, from people who have or are living with it. The ability to communicate with people who really understand what's going on with this disease and can relate to you is priceless.........it was a life saver to me personally. And as you can see our forum is filled with very caring and knowledgeable people.

Thoughts and prayers........
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


mer
Veteran Member


Date Joined Aug 2008
Total Posts : 613
   Posted 1/3/2009 10:44 PM (GMT -7)   
Archichik,

I just wanted to welcome you to the forum. It has been a life saver for me.....wonderful caring knowledgable people here. My husband has HepC and cirrhosis. He is currently on a transplant list, though at the bottom of the list. We, too, have battled the encephalopathy and high ammonia level issues. He is on lactulose and when I notice him starting to go into left field a little, I just increase the lactulose, etc. I think you have hit the nail on the head w/ the protein issues. My hubby ate alot of protein over the holidays, and he has had a rough couple of days as well. I think Connie gave you good advise.....talk w/ a nutritionist because the liver disease alone is quite a balance nutritionally but adding the diabetes would be a tough thing to balance.

I wanted to welcome you and encourage you to stick around. If you could get your mother to visit, it would probably be a great outlet for her....there are several caregivers on this forum and we are walking the same shoes as she is.......

Hang in there!

Mer

wingk
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 1/4/2009 10:30 AM (GMT -7)   
Archichik,
My husband has the same problem.  He is on a transplant waiting list at Barnes-Jewish is St Louis. He is currently having to have a parasentisis once a week.  This week they will try the albumin infusion to see if that will help delay the parasentisis.  Unfortunately, due to the liver disease he is now also a diabetic.  His serium sodium level is very low, so they have drastically reduced the diertics.  I am having a tough time trying to figure out how to provide him with a low protein, low sodium and low carb meals.  We go back to St Louis next week and I am going to request an appointment with a dietician to try to help.
Still trying to figure out this forum and how to get back to things, respond, post etc. 
Will post any info I receive after returning from St Louis.
Good luck to you...wingk

archichik
New Member


Date Joined Jan 2009
Total Posts : 3
   Posted 1/5/2009 8:15 AM (GMT -7)   
Thank you all for your warm welcome!
 
My dad is doing better - his last ammonia was at 79.  The lactulose wasn't working in the hospital and it had been three days since his last BM, so they had to do an enema yesterday.  (He wasn't too happy about that - but at least his faculties are coming back now!)
 
One thing they noticed on the additional testing is that his gallbladder is now compromised.  He had gallstones, but now the gallbladder is "contracted" and although tests show it is functioning somewhat, the doctors feel that this may have contributed to his latest crisis.  He is not a good surgical candidate, but my mother is going to get a surg. consult today because, of course, it is just another chronic problem for him to manage (add low fat to the low carb, low salt and low protein diet!)  She is also going to try to get him in to see a nutritionist as well, but the first order of business is getting him a little bit stronger so he can come home.  Right now, although he is a lot more "with it", he's weak and tired, and he had a fall in the hospital because he didn't want to get help to go to the bathroom, so now he's sore and they are checking on his old back injury for which he had a laminectomy (sp?) several years ago.
 
My mom is also going to call Dr. Araya today - she wasn't sure if the local doctors had contacted him yet.
 
Thanks again for all your support.  I am going to continue to recommend she come here for herself because I really think she needs to hear more from others in her own situation. 
 
Happy new year, all!

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 1/5/2009 1:44 PM (GMT -7)   

Archichik, thank you for updating us on your dad's condition.  Since his fall, maybe they will put the rails up on his bed so he won't be inclined to go to the bathroom alone.  I hope his back will be okay.  Good to hear that his ammonia has gone down.

I hope your mom will join us, but if not...please keep us posted.


hep93
Forum moderator - Hepatitis


archichik
New Member


Date Joined Jan 2009
Total Posts : 3
   Posted 1/6/2009 9:57 AM (GMT -7)   
Yesterday morning, there were thoughts he might actually come home today, but his ammonia went back up drastically (from 79 to "between 100 and 130" - the nurse couldn't say), so not sure what that means, or how it was triggered, because he's been on low protein and heavy doses of lactulose in addition to the enema he had the day before.... Not good news.

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 1/6/2009 12:30 PM (GMT -7)   

So sorry to hear that, Archichik.  I hope that they can get the ammonia down so he can go home.

Keep us informed.


hep93
Forum moderator - Hepatitis


Butterflythree
Veteran Member


Date Joined Oct 2007
Total Posts : 954
   Posted 1/6/2009 10:34 PM (GMT -7)   
Archichik, I'm sorry your dad is having such problems with his ammonia levels. I will continue to pray for you both.
Butterflythree
 
There is always hope!

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