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do the asa drugs affect the pancreas?

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Ulcerative Colitis
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Posted 1/2/2008 11:05 PM (GMT 0)
my daughters A1C test came back at 6.0 and her glucose is 166 both are out of range, but the bloods were run by her gyno because her dipstick was high i also had him run all the other bloods we could think of as long as he was drawing them, the others weren't in yet when i spoke to the nurse before work, and he faxed the results to the gastro and her gp, but i was informed by the answering service that she (gastro) will be away for another week, that's 3 weeks and i could call the emergency number if i wanted to.
my concern is that i don't know if the asa meds can cause pancreatitis or diabetes, gyno said they weren't crazy high, but who knows what a few more days will bring. do the gastros monitor the levels or just wait until you present with something awful, or need a blood transfusion or.... is it ok to stop the asacol without weaning, she will still be on the colazol? also i want to tell her to cut out the proctofoam since she is also using the hydorcourt enema, should she also cut out the mesalamine enema and just use the canasa? i should have paid all of you since the dr (that didn't take my insurance) is nowhere to be found. weare happy all of the bloody d has stopped , and don't want to mess that up, but if she screws up her pancreas this early in the game all med will basically be off limits anyway?
please advise. no blood for about a week only going 2-3x times day with some formed.-thanks. her associate will be in tomorrow.
Posted 1/2/2008 11:13 PM (GMT 0)
i read in a book that there is a small possibility of pancreatitis for those taking 5-ASA, but as long as you are getting your blood done regularly, they should be able to keep an eye on it. i had it last january when i was taking azathioprine, and its not fun at all i tell you. the doc told me that the regular enzymes for the pancreas should be no higher then three or four hundred, and at fifteen hundred and above, its indicative of pancreatitis. mine were in the mid fifteen hundreds.

as for the meds being off limits, i went back on pred after my bout with p, and also back on the 5asa. it took awhile, but the levels dropped back into normal levels over time. dont fret too much about it. the blood work will keep it all in perspective. :)
Posted 1/3/2008 1:27 AM (GMT 0)
PLEASE, this is most likely from the steroids. The A1C isn't grossly high, mine was in that range also when I was taking Entocort. My GI and my primary both said it was from the steroids, and the documentation I've been able to find agrees that they can cause type II diabetes.

I would think one source of steroid would be sufficient. If your daughter's inflammation is only in the rectal area, the canasa should address it. If it is higher than that, consider maybe using the mesalamine enemas morning and evening.
Posted 1/3/2008 1:44 AM (GMT 0)
I think you should see another GI to get another opinion. The amount of meds your daughter is on seems extreme and you shouldn't be the one having to worry about deciding what meds she should stop taking or continue with...her GI should be doing that, especially since it's so early on in her diagnosis. These are really questions that need to be addressed with a GI doc, in my opinion.
Posted 1/3/2008 2:14 AM (GMT 0)
Judylyn, you are so brave , i read about your surgery and yet you are so kind - and willing to share your experience-thank you- i understand what you are saying regarding the gestational diabetes, but how do i know when we cross the border, should the gastro be testing more often? and i know we need to cut back on one of the cort rectal meds
so you think the mesalamine suppository could sub for the cortifoam and then keep using the cort enema? i know you're not the dr but curious what you think. of course i'll speak to the associate if there really is one tomorrow. thank you
Posted 1/3/2008 4:39 AM (GMT 0)
Again, if her disease is proctitis (only in the rectum), the suppository may be a good way to go. If it is proctosigmoiditis or left-sided UC, the mesalamine enemas will most likely work better. This is because the suppository only gets the medicine into the rectum, not the higher areas. The meds we use are primarily topical, like a skin cream. They're made to act directly on the colon wall. This is why you'll see us talking about what part of the colon certain medications are released in. If she's having trouble retaining the enemas, try giving only half the volume to start with, and have her lie on her right side after the enema. As her colon heals she may have better luck retaining them.

You could either use the hydrocortisone enema at bedtime or the proctofoam a couple of times a day to see how that works. Using both just seems like a lot, especially when she's showing signs that may indicate systemic effects of the steroids.

And thank you, but I'm not brave. I just take what life gives me and keep on living, because I prefer that to the other choice - not living.

As far as the blood sugar, my internist followed that for me and monitored my program. GI's aren't really trained in that area. Because your daughter is young she may not have a GP or internist, but now that she has a chronic health issue, it's important for her to have a primary care doctor who can find and follow up on all of these sorts of things.
Posted 1/3/2008 3:28 PM (GMT 0)
In the state where I reside (PLEASE also), gastroenterologists have to 1st complete a residency in internal medicine. Therefore, they are expected to know as much about monitoring bloods & following thru on test-reported problems as the internists! The 1st gastro that PLEASE's daughter consulted put her on 5-ASA meds. It seems that he neglected to tell her that they can take as long as 3 or more months to get a patient with left-sided UC to remission. All other problems appear to have followed in the wake of the 1st gastro's omissions. He apparently did not make mistakes in diagnosis or RX; he just did not provide adequate info. to satisfy a new patient + anxious parent. Lack of correct & adequate info. is not atypical in the realm of IBD! (Alas!) / Old Hat (nearly 30 yrs with left-sided UC ... [etc.])

Posted 1/3/2008 6:08 PM (GMT 0)
I developed pancreatitis from Colazal, according to my doctor.  He saw my blood numbers (which I do not recall, unfortunately) and made me stop taking Colazal immediately.  He seemed very concerned about it, and he is usually fairly indifferent.  He said that pancreatitis can be caused by any of the 5-ASA drugs, so switching to another was not an option.  It is a rare side effect, but does happen for a small percentage of people who take these meds.   
Posted 1/3/2008 10:04 PM (GMT 0)
Absolutely GI's have to complete an IM residency, then they do a fellowship in GI. But unless they have a dual practice, they don't deal with other things on a daily basis. Therefore they often aren't up on recent developments and treatments. I was trained in cardiology decades ago when I went to school, but I never worked in that area and I wouldn't want to advise anyone about it today.
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