Doctor won't discuss diabetes treatment

I firmly believe that testing too much— is never too much. Even when my sugars are high, I make sure that I test even more to monitor them. I try not to get discouraged when my numbers are high. Testing is knowing.

Although you need about 1000 mg to 1500 mg of metformin to make it work, the side affects of starting at that amount are often severe enough that doctors don’t let you start on that amount. Instead, it is often common to let you start on 500 mg, wait for the side effects to die away, then increase it to 1000 mg, wait for any new side effects to die away, then check if there’s a need to increase it to 1500 mg. Some people even need to have it increased in 250 mg steps instead.

For some advice on the low carb diet, see here:

Does the special diabetes nurse accept the fact that low carb diets tend to be more effective for controlling both diabetes and weight for the people who follow them well than the low fat diet usually recommended, although harder to start? After one to three months, the low carb diets decrease your appetite, though, which makes them easier to follow.

This is the second or third time I’ve read on TuDiabetes recently that Metformin doesn’t work in doses lower than 1000mg a day. Now I’m curious – where are people getting this information? And what is your definition of an “effective dose”?

I’ve been on 500mg a day for almost two years and it seems to be working well – most recent A1C was in the mid-5’s, with no other meds, plus around 100g of carbs and an hour of moderate exercise a day. Maybe the Met has nothing to do with the A1C though? Is there any way to find out other than going off it and seeing what happens? I’m not really inclined to mess with something that seems to be working, but on the other hand, see no point in continuing to take a pill that isn’t really doing anything.


Yvonne - you just summed it up for me. Testing IS knowing. And that’s the 1st step to taking control and managing D. I think we all know what the alternative to good control will be.


Robert - I just met with the diabetic educator at lunch today. This was in preparation for the class. She acknowledged that the ADA recommendations are too liberal for some people and gave me the ACE (American College of Endocrinologists’) recommendations for BG level targets. She still pushed for a low fat diet and wanted to know why I prefer full milk cheese instead of low fat . . . I guess the best indicator will the lipid profile on my upcoming May blood work. I went ahead and did a home A1c test and just got the results tonight: 7.9%. It’s still way too high, but since I did the test 49 days after the original dx and A1c result of 11%, I’m not complaining.

Suzanne, thanks for the encouragement. I asked a diabetes educator today about scar tissue and she agreed with you. It’s not a possibility. As far as diet goes; every body is different. Mine seems to thrive on protein, but maybe my metabolism is just wired all wikky wakky. I think most people do better with more carbs and need them for energy. If I eat too many I just get crazy cravings for more.

Yvonne, too bad you can’t take all of us along to your doc appt. Like one of those phone network ads, but with a mass of people with diabetes, demanding top-notch health-care service!

Did your doctor order a baseline microalbumin (urine check of kidney function)?
Use a monofilament to check sensation in your feet and legs?
Recommend you have a dilated eye exam once a year (more often if problems are noted)?
Check your blood pressure?
Check your cholesterol?

In addition to an A1C twice a year (more often if A1C is high or treatment is changing rapidly), those are basic diabetes wellness checks that a primary health-care provider should provide. And a referal to diabetes education courses or MNT (medical nutrition therapy) would be sugar-free icing on the cake.

It reminds me of a conversation I overheard between a nurse and a patient while I was at my GP, waiting to pay my co-pay. Basically, the nurse told the gentleman, “you need to lower your blood sugars.” No explanation of how, no explanation of why. Sad, but I’m sure repeated in too many waiting rooms every day.

Kudos for the care you’re taking of yourself!