At elevated a1c numbers 9 thru 14 it is real tough to get numbers back down. I was at 13.3 and found myself in the same places you have been and Doctors screaming what the devil have you been eating.
Such idiotic comments are totally misplaced and that is because the system has no clue how to arrest tough cases.
In my situation, I had been on actos, 26 units of 75/25 humalog mix as well as lantos.
My read for me what I ended up doing to arrest the mess was as follows:
a) get on a real low calorie lower glycemic diet - I used 1200 calories a day .
b) I would check your BG at 3:00am and at 6:00am and see if the darn liver is hammering you up from the dawn phen - 180, 200 238 or higher. if it is; metformin late at night in spaced doses as well as insulin shots
at 3/4 am can help stop the liver.
c) get extra exercise to help burn off excess liver glucose release and unload the skeletal muscles. I walked 1.5 to 2 miles a day!
d) metformin is very helpful if you can tolerate it but the one large a dose a day was useless for me. I ended up taking 500mg doses: 1 at 10:00pm and one at 12:00am and then one dose before each meal - 5:45; 11:00am and 4:00 pm. The liver has bad habit of leaking when it should stop producing glucose when intestines are cranking it out. 500mg dose may be low for some any may need slightly higher doses. Residual metformin is cells is no help to stop excess liver glucose add. Metformin dose in blood stream at high enough dose cuts off the liver nonsense.
4. Cutting back calories tightly to help resolve this mess causes serious lows if you are on the glimperide, ameryal or long lasting insulin doses. Drugs like that demand one eat to that medicine to prevent lows.
5. the other issue is to eat three meals a day , timely and regularly spaced to keep liver from being requested to add more glucose when bg of blood goes too low. Once one gets to these difficult t2 situations; the liver no longer signals properly and adds to much glucose due to poor signalling spiking the blood too high.
Lastly, once the system stabilizes, you can adjust the diet up to reduce weight loss; add some weight.
Jims, you are inspiring me to mix up my meds again. Lately I have been in a slump and accepting my higher than I like fasting. I know I liver dump badly during the night. It actually improves if I eat more carbs before bedtime. I also dump badly with strenuous exercise. I currently take 1mg amaryl before breakfast. Lately I have cut out the second pill around lunchtime which has caused me to have elevated fastings. I take 1000 mg of met ER before bedtime. I also take 1000 in the am which doesn't alter my morning run dump which often pushes me toward 200 even if I'm in the 80s pre run. It doesn't last long though so I tend not to test for it and sort of ignore it since I know the running helps maintain a better bg for the rest of the day.
Becky-You are doing the best you can with no support from your medical team. I suggest finding a new medical team that is interested in helping you learn what your body needs. We are all different and it is an ongoing experiment which just when you think you nailed it changes. I have been T2 for 15 years and have been through many different changes in my needs. The best thing you can do for yourself is to educate yourself-read, ask questions and experiment. With some effort, you will discover what you need to do so you can feel good.
what really helped was to get on cgms so I could watch blood glucose carefully. At these stages; each time when you run blood glucose to sub 70; liver attempts to add glucose and due to low insulin/poor signalling throws the whole buffer at one.
Exercising can do the same. you will force the blood glucose too low and the liver bangs in a large load of glucose. The cgms at least allows one to watch these riots real time and add some glucose tablets to keep numbers from going sub 70 and inviting liver in to add (excess) glucose.
I have exercised the liver through a couple of repeat cycles down sub 70; bang it up to 200 or more; and continue exercising to do it again. Eating small snack before one gets heavy exercising can help keep liver in the cage. Eating on regular schedule with sufficient carbs can also keep blood glucose from running to low after meals.
Using glucose tablets I ended up playiing liver any time glucose when sub-70 in blood and adding glucose. This may seem idiotic but it enabled me keeping liver in the garage and keeping its glucose buffer that it wanted to throw the whole pail at.
You also can use the caveman fingerprick machine doing multiple tests but that gets expensive fast. Prior to cgms I was up to 30 strips a day watching key zones and times on my body. It was like I was out picking blackberries every day!
According to my drs. I don't have a problem so therefore don't need any additional equipment but my allotted 2 strips per day.
I seem to do really well during much of the day and periodically dip below 70 and not get a liver dump. I seem to burn through it pretty fast when I run and since I usually eat before hand I just decided I wasn't going to fixate on it. My morning fastings have been my concern for years. I think you are right and maybe I need to eat a few more carbs before bedtime to prevent the nightime dump.
I have considered trying to go without the amaryl but before I was taking it I was spiking really high after meals. Sigh, sometimes I get tired of the balancing act.
glad to hear you are ok and liver behaving itself. The problem has to do with signalling to liver and insulin levels. It sounds that your islets do not add enough insulin on a meal bolus so without amaryl your levels peak up high after meal.
It sounds if at a basil level your body has sufficient insulin level to prevent liver going nuts and dumping its whole buffer when you go sub 70.
Great. best wishes and good luck with your health.
Discovered yesterday that I can't skip the amaryl. 30 points above my normal after a low carb breakfast. I think I might be going below 70 at night since I liver dump then, just not usually during the day. I ate cheese and crackers Saturday night and was 98 fasting. Last night I ate a piece of bread and was 116 this morning. Besides a bedtime snack I think I've got to stick with all my meds at this point.
Thank you Jims. Some day I will push the drs. to put me on insulin. The last few years I have had to change drs. often and have only had one who would really listen to me. I'm breaking in a new endo and internal med. Life is busy right now but I plan on inundating them with proof they should put me on insulin.
