So I’m going to be on a mega dose of proton pump inhibitors (dexilant 60mg 1x daily) for at least a few months to try to let my throat heal from laryngeal pharyngeal reflux…
I’ve taken smaller doses of PPIs for the same reason a number of times over the years and have frequently wondered but never quite figured out how much the weakened stomach acid will slow down my carbohydrate digestion. Now with such a large and powerful dose I’m a bit concerned I’ll have to relearn everything about bolusing. Any insights based in experience on this subject?
I’ve used PPI’s for many years and currently try to limit their use to severals days in a row with a week or two between episdes. I’ve never taken a “mega-dose” and your reference is the first time I’ve seen mention of dexilant. I’ve made no observations connecting BG control with my lower dosage PPI use (nexium). I would appreciate reading any observations you may make.
A couple of years ago I was on high doses (80 mg/day) of rabeprazole for two months to see if it helped my eosinophilic esophagitis, as acid reflux is part of the allergic response. It didn’t really help, so I went on to other treatments. Several months ago I started back on a more normal dose (20 mg/day) to help control symptoms.
I didn’t notice any change in the way food digested in either case. Although two years ago I didn’t have a CGM, so it’s possible it did affect things and I just didn’t notice.
I’ve had the LPR for probably over 20 years… It’s different from traditional reflux because it’s only affecting the throat and vocal cord and not the esophagus… Meaning that it’s only a tiny amount of acid at the top end where it doesn’t belong (where tissues are not able to tolerate any at all) instead of a whole lot of acid lower down where it doesn’t belong (where tissues can handle a bit without complaining) like most reflux…
I’ve taken prescription strength nexium, back when it was rx only years ago, which helped I think, otc lansoprazole, which I think helped, Otc Prilosec, which did nothing at all as far as I can tell, and most recently after actually being scoped, pretty heavy doses of protonix intermittently-- which definitely helped, but irritation returns shortly after discontinuing.
Of course all the lifestyle mods that would be helpful like not drinking caffine, or eating within hours of laying down, or elevating the head of a bed, or avoiding high fat foods etc seem to be pretty difficult for me to implement given the sort of work I do and my other dietary considerations with diabetes… So now we go to the big guns meds and see if we can beat it down. Maybe if I can get a toe-hold of progress I’ll be a little more inclined to take some other steps…
In some ways, I think PPIs actually make acid reflux worse. I had zero symptoms of acid reflux, ever, even though it’s a common symptom of my condition, until I stopped using that first round of PPIs, and then it came on with a vengence. It was awful, and took many weeks to sort of ween off the PPI to try to avoid those effects.
im certainly hoping to be able to ween off of them and implement some behavioral changes to keep it at bay… Although short of a career change some of them seem next to impossible. My dad has pretty bad barrets and it all started with him hacking and clearing his throat like I do, but thus far I have no esophageal erosion or normal gerd symptoms, just the LPR
I don’t have GERD, either, just inflammation caused by allergy/immune overreactivity (seems 99% of my problems are caused by my own immune system going crazy). I hope the treatment works for you so that nothing progresses!
I have had gerd for years and I’ve been on and off these drugs, mostly on- each time I go off I have severe problems. My recent flair of digestive and bg problems was a few weeks after I went off lanzoprazole. Going back on it has helped.
I will be on them for life most likely. I also have the vocal cord affects, pain in between the esophagus and stomach but the recent endoscopy I had showed chronic inflammation in my stomach with gastritis in both areas I think which is odd since my pain is higher up when the reflux is worst. It also showed a hiatal hernia.
My last endoscopy which was years ago showed pre barrett cell changes but that seems not to have progressed at all fortunately so I’m relieved and these drugs did help me. At that time I had terrible pain and problems so I ate only white rice, plain chicken, yogurt, iceberg lettuce, granola bars and water for a few months. I also took double dose prilosec, drank gallons of water, slept with elevation etc. It did help a lot.
I have been on high dose PPI before. Right now I am on a low maintenance dose (20mg) because of permanent structural damage from constant reflux. I didn’t want to be on it all the time, but each time I go off, I just cause more damage (even with all the right “lifestyle” changes). They started warning me about cancer the last time they did biopsies, so I’ve been scared straight.
For me, the high dose did slow down my stomach emptying. I was often nauseated, would burp up food hours after eating, lose a bit when I bent over, etc. I wasn’t on insulin at the time though, so I can’t comment on how it would change your bolus. It took a few days to build up in my system, so I imagine you’d realize pretty quickly if it was slowing down your digestion.
On the low-dose, it’s not enough to slow down my tummy, and I don’t have any of those symptoms.
I’ve definitely noticed this med appreciably slows down my metabolism of carbs. I’m seeing more delayed spikes than ever before even when not eating super high fat / high protein foods.
Today I ate a 40g sandwich and started testing my bg every 5 minutes without taking insulin. It was a full 50 minutes later that any appreciable rise at all, and then it was only up to 93.
This slowed digestion is much more significant when dosing with afrezza than when using novolog. With afrezza it seems like ge insulin is worn off sometimes when the lions share of the carbs are left still to digest.
Based on today experiment I will wait a full 50 minutes after eating to dose afrezza while taking this med.
Is it free for you? If it’s not free, I totally understand the hesitation as a CGM is extremely expensive to pay for out of pocket (which I do)! But if it’s free or mostly free (covered by insurance), I’d personally go for it and see what happens… Even intermittent use of a CGM can be hugely helpful!
Price is not a major consideration. I had a Dexcom 7 plus and just didn’t like because it was always glitching out and I felt like I didn’t really need it bc my levels were so stable. I agree I actually think their best use in my case would be intermittent…
A common phenomena in CGM adoption is someone starting on it with limited use in mind and then quickly finds they don’t ever want to “fly in the dark” again. That’s when you then see complaints about the long two-hour warmup blackout period!
This is exactly how I got sucked in. Since I pay myself, originally I was only intending to use it intermittently. I do occasionally go a day between sensors, but I’ve been pretty much 24/7 for the past year and a half. I can see how if someone truly had very stable BG, though, 24/7 might be a bit much.
I’m just not entirely convinced. Here are some of the reasons floating around my mind
I only take about 12u basal daily. This is not a lot for a grown man and it doesn’t tend to cause me significant basal lows— even with vigorous exercise
2). Watching meal boluses on a cgm seems overkill to have a device on you 24 hours a day when I only bolus for meals 2-3 times a day and then maybe a correction here and there as needed.
3). I’m not really sure what my goals would be with it? I guess I can continue tweaking my bolus timing and improve it a little bit, especially now that I have a new variable of PPI…
when I used to have the Dexcom 7+ it was always on my stomach. It interfered with sex. I did not like that. I tried it on my thigh once, it went strait into muscle, hurt like hell, and didn’t work. I guess I could try it on the back of my arms.
the Dexcom 7 was a huge POS that alarmed falsely very often and irritated me to no end…
do I want to answer questions to everyone who sees it about what it is and why I have it? Not particularly…
I’m obsessive compulsive enoug as it is, will this cause me to just fixate even more on this issue or will it allow me some freedom?
