Anatomy of a High

1

As a preface, I'd like to say that this used to happen before I was put on Metformin. It hasn't happened since then. I am annoyed.

I had a sandwich before one of my classes yesterday. As a rule, I don't eat more than one slice of whole wheat bread, but I was STARVING. I should've known better.

This particular sandwich will usually knock me up to about 150. In the past, I'd be there for a half hour or so and come back down. I'd have some minor exhaustion, a headache, then it would be fine.

Not so this time.

I was 160 an hour later, before class started. I was 193 at two hours. I hovered around 180 for another half hour or so, and then at three hours I was back to 114. (At which point I was dying of thirst.)

Needless to say, I fell asleep in class. I apologized to my professor, but I still hate when this happens.

I find it interesting that I was higher at two hours than at one hour. I find it annoying that I didn't go back to normal until three hours. I also wish that the only solution wasn't upping the Met dose, because this is really annoying and I'll have to wait a few weeks for it to work. Oh, and finals are soon, which will be interesting with BGs and how I actually manage to study while feeling like crap.

I've been watching my BG steadily rising over the last two weeks. I'm getting tired of this. Really, I am. I'm afraid of carbs and I wish this weren't happening. For crying out loud! I'm twenty years old! How the heck do I have IR??

Sorry, just needed to vent.

2

The capability of metformin isn’t unlimited, regardless of the dose… All it can do is slow natural glucogeneis and increase insulin sensitivity.

I’ve been away from home for over a month now at a conference center with banquet style food. I’ve pretty much stopped eating all appreciable carbs here and the results have been amazing. I feel better, have more energy, and my bg hasn’t been over 100 in weeks. That’s coming from someone with an initial a1c of over 11.

Anyway, my point was, metformin won’t make your levels perfect, no matter how much you take, all it can do is make them better than they would be without it. An occasional and brief spike to 180 probably isn’t going to hurt you— just think, the Ada still defines “tight control” as staying under 180 post meal most of the time. It’s all relative, and you are doing great staying on top of it. Don’t let the frustrations that come with this dictate every aspect of your life… That’s my angle anyway.

3

The problem is that I'm a student and can't cut so many carbs out of my diet. What happened that day was a fluke because I never eat like that, but even when I eat fifteen grams of carbs (with proteins, etc) I still hit 150 or so. I don't like seeing numbers like that, no matter how long they do or don't last for, because they affect how I feel. That's why I think I need an increase in the Met dose. (Also, technically I'm on a dose too low to be therapeutic. Though that was fine when it was actually working, it isn't now.)

4

I don't know what type or history of diabetes you have, but it may be time to consider adding insulin. You should discuss with your doctor.

5

Now there's a complicated subject.

I have a personal and family history of autoimmune diseases. I have a limited family history of Type 2 diabetes (my mother's mother had it, but given the time period she might've had Type 1 and no one would've known the difference).

I'm 20 years old, my BMI is juuust over 25. I walk a mile each way to school every day, plus the additional walks around campus (which is big). Though I'm not perfect in what I eat, I've been pretty good about the amount and type of carbs I've eaten for the past four years.

Long story short, I had a ridiculous high blood sugar reaction to inhaled steroids last year, and I was put on Januvia until I stopped taking them. Almost exactly a month later, I started having highs from almost all carbs. It took four months of eating nearly nothing to convince my endo to put me on Metformin. Though I lost weight and was eating about 35-40g of carbs per day, my BG went up.

I'm antibody negative and my c-peptide is high (which only came about as of this past summer). If it weren't for the c-peptide, I'd be begging him for insulin. The last time I saw him (at the end of February), he finally gave me a name, which was "insulin resisntance".

He wasn't happy with it. And he told me outright that he has no idea why this is happening. I'd like to mention here that I NEVER test positive for anything, including things we know I have (like seasonal allergies). The only test I've ever had come back abnormal that wasn't a standard blood count or vitamin deficiency type test was my thyroid antibodies, which are very, very high.

Someone asked me recently if I have diabetes. I told her that, at the moment, we're dignifying it as insulin resistance, but the truth is that we really have no idea what's going on.

No one I've spoken to has ever heard of a high c-peptide with Type 1. Like I said, if it weren't for that one test, I probably wouldn't be on Metformin now. However, wouldn't it make more sense to bring up the Met dose before adding insulin? I'm putting a call in to him on Monday and I want to be sure I'm doing the right thing.