Dr. appt. lost 36 lbs. A1C 6.4 (still)--still won't go down--has to be the steroids


That would be great Rick because those of us new to diabetes aren't aware of how it reacts to RA medications. I can at least guide those who are new to RA on my experiences from NSAIDS, DMARDS, and biologics.


Gosh, Rick, I'm so sorry for you. 500!?!?!!!!? You gotta be T2 like me, right? Otherwise, wouldn't that be solid DKA-land for a T1?

Knock on wood, I don't have any arthritis presenting at age 52. Interestingly, I did have something I thought was A in my right pinkie -- second from last joint was inflamed and painful to articulate off and on, no rhyme or reason. Had all the classic symptoms of an arthritic joint.

This exchange with you is what made me remember it. It's one of those things that cleared up after I got my blood sugars under control. Have't noticed it for several months. It was chronic for at least a year.

So I'm guessing it wasn't A, but rather just some other bad reaction to chronically high BG. A doesn't go away, does it?


I am the same way Rick. At least I think I am. I haven't checked my bgs after my infusion--usually I just crash--->come home and go straight to bed, but I do notice now that I am beginning to nap(i.e., seriously sleep) during my infusions which I've never done before. I assume that is because is rising because of the Benadryl, Tylenol, steroid IV and Remicade given.


How did you get an a1c of 4.9? I weigh just over 100 lbs, run or do some other vigorous exercise for 30 minutes, and eat low carb but can’t get my blood sugars anywhere near that. Do you take insulin? I am doing a short trial of glyburide since metformin and insulin didn’t work. I have a feeling I will be discontinuing the glyburide when I see my PA again since all it does is give me hypos the I get rebound hyperglycemia.


An A1c of 4.9% is not impossible to achieve. It's a question of balancing the level of effort vs. the results. Spending as much time as close to 83 is optimal, but if it requires such intense effort that it impedes your quality of life, it's probably not worth it. Everything I've read so far suggests the incremental benefit every 10th of a point of A1c once your in the 5% range is really hard to quantify, and might even be meaningless. Hence, the difference between a 5.5% or a 4.9% would have little to no impact on your long term health as long as you're managing a tight range with minimal swings into extremes.

Having said that, if you can achieve a 4.9% A1c with minimal or moderate effort while keeping within a tight BG range, fantastic. Keep it up.

Also, if you're a T2 with a good amount of beta cell function left, and not reliant on insulin, it makes the job considerably less dangerous than for a T1 entirely reliant on precise insulin dosing. Your focus is battling insulin resistance, and there are a multitude of lifestyle options and drug choices at your disposal.

Lastly, it's no surprise you're experiencing lows from the Glyburide. It belongs to the Sulfonylurea class of drugs which light up your beta cells independent of when or how much you eat. They can have all sorts of concerning side effects including hypos, hunger and weight gain, and most troubling, beta cell burnout from prolonged use. You're wise to discontinue it, in my opinion.


I am a fairly new type II with a BMI of 21.9. I am eating a very low carb diet following Dr Bernstein's advice (less than 30 g carbs per day). The only oral prescription medicines for diabetes that I am taking is metformin (2 x 500mg per day). My fasting blood glucose has been in the 70's to low 80's for the last several months. I try to keep my postprandial readings below 100 mg/dL (I do see readings around 110 mg/dL occasionally). I have also kept my body in nutritional ketosis since a few weeks after my diagnosis.

At my diagnosis last December I had an A1C of 6.5 and a fasting blood glucose of 133.

BTW: If you have not read Dr Bernstein's Diabetes Solution I recommend that you do so. He is a type I long term survivor for more than 64 years. From what I understand he keeps his A1C in the mid 4's.


Hey OldTech. You're doing a great job and achieving tremendous results. You're one of the few lucky ones who can achieve great control through nothing more than diet/lifestyle changes and Metformin. I think all of us would love to have it be that straightforward. It looks like you caught it early and by treating it aggressively with such tight control, your odds of it not progressing further are very good.

Unfortunately, for many who have low, little to no beta cell function, the good management becomes much trickier. What we do manually with injections (or pumps), your pancreas does quite elegantly on autopilot. Hence my "degree of effort vs. results" statement.

Yes, I'm very familiar with Bernstein. I'm one of his patients. I've read his book many times and also follow his methodology. He's an excellent Dr. and helped me achieve levels of control I thought were impossible.

Keep up the good work and well done!


It is my considered opinion that any T2 that needs beta cell stimulants, like sulfonylureas, should be using exogenous insulin instead.

One has much more control with the latter, and it doesn't nuke the beta cells. Indeed, it may prolong their function, giving them a rest.

This has been my direct experience. After a year of insulin therapy, I've been able to stop continuous basal insulin, and let my pancreas take that job back. Something it wasn't up to the task for a year ago, and now is handling it just fine.

I bolus for food and corrections like I always did, and still have a basal program to handle Dawn Phenomena, as well as what I call "evening phenomena" -- the two times my beta cells can't keep up with what my fasting metabolism (mainly the liver) is doing.


I tried lantus but it made my fasting blood sugars high. Since I came off it, my blood sugars are lower


Kate and Eucritta i will ask if they will allow us to open a diabetes and RA group. I do not think Terrie has much interest but when I write blogs about RA I tend to get fair number of responses. If I get one open I will let you know. I think there is a small group of us who are interested and the administrators will need to decide if we have enough to set up a group revive a group. Either way is fine with me. In the mean time stay in touch. It is a growing concern on this site.

Thinking out loud it may be more feasible to open a group of multiple chronic diseases. We could have a kidney / diabetes section,a diabetes / RA section so on so forth. That might draw enough commentators to keep a group going.

Ok I will check stay tuned.



Sounds good Rick. Thanks so much. I hope there's enough folks and interest for the administrators to give approval.


Hi Dave, the joint pain you mentioned in pinky finger sounds like beginnings of trigger finger, which I just had surgery for.Dr said it is one of those great side effects of diabetes! Anyway,mention it to your dr. I put off telling mine for 6 mo and then he put it in a finger gaurd to rest it for a mo with no luck. Mine was in thumb and as you said 2nd joint would lock when bent and very painful to straighten out. The strange thing is, it's not the 2nd joint that is the medical problem but the the joint connecting finger to hand that they repaired, works fine now. Good luck!


Chris, Reading this blog and other Type 2DM blogs I am seeing ppl with A1C of 11 or more even diagnosed with Type 2 and reversing their diabetes with Low carb diet and Metformin. So my Q is these ppl must have been prediabetic and diabetic for a longtime before the diagnosis, perhaps years. So if the glucotoxicity is causing the death of Beta cells, do they have the ability to regenerate? I am looking for some evidence based info, so it gives me a sense of comfort as I am a new Type 2 with Severe IR: 6.0 and Fasting Insulin: 19.6, A1C:6.9.


Hey Lola:

There is so much misinformation out there about T2 and T1, much of it perpetuated by uninformed medical professionals, and of course your run of the mill snake oil salespeople. There is no such thing as “reversing diabetes.” Once you have insulin resistance, that will never go away. You can reverse the consequences of insulin resistance and elevated blood sugars by moving to a low carb diet, regular exercise and insulin sensitizing medication like metformin (XR is usually better for mitigating GI issues). The latest research suggests that T2 should be treated aggressively at diagnosis, which includes insulin immediately. That way you have an ability shore up your pancreas and give it a rest and an ability to recover, and hopefully also recover some beta cells. In fact, this is the recommended protocol by the respected Joslin institute. The latest long lasting (basal) insulins like Tresiba are amazing tools in getting fasting rates down to normal. Key is that you normalize your blood sugars as quickly as possible. This mitigates the effects of glucotoxicity and all the horrible secondary complications associated with this disease. A poorly managed T2 has the risk of destroying the bulk of their beta cells over time and becoming completely dependent on both basal and mealtime insulin. What you shared suggests you’re still a very long way away from that, which is great. Lastly, “pre-diabetes” is an arbitrary term invented by some in the medical community based on politics back in the '70’s, I believe. There’s no such thing. Either you can normalize your glucose levels or you can’t. It’s like saying half-pregnant. Getting a diabetes diagnosis can be a huge shock. We’ve all been there. The silver lining is that it is completely manageable, and you’re asking the right questions. You’re going to be ok.



Thank you Chris for the detailed info. Happy Holidays



I have a far different point of view than @Christopher5

As someone who’s been told you’re now T2D and need medication for your condition, do yourself a favour and watch this interview with well know Nephrologist Jason Fung

There’s plenty of evidence that going low-carb will reduce and often eliminate your requirements for insulin meds

This comment from a diagnosed T2 is commonplace:

"Was diagnosed with type 2 diabetes (insulin resistance) 2 1/2 years ago. Saw Dr Fung’s seminars on YouTube. Began intermittent fasting (fast daily between [9:00] pm and [2:00]pm the following day) in June of 2015 while taking 2000 mg Metformin, and 5 mg Glyburide.

When my daily readings hit 100 or below I reduced the meds first by getting rid of the Glyburide, and then by August 7 no more Metformin. On August 22, 2015 my 30 day fasting blood glucose level average was 128.97. Then something wonderful happened… The 30 day average began falling every day.

Today, my yearly average glucose reading is 99 with no medications (30 day average is 98) My doctor says I am now “pre-diabetic”. I tell him “No, I am POST diabetic.”


Thank you Jim. I will watch this video and information like this gives me hope. I do understand everyone’s body is different and how the internal clock and hormones work may not be same. But I have 4 friends who I got in touch with having been diagnosed at A1C of 9-12 range, has lost significant amount of weight, with more rigorous work outs, eating everything in moderation and has become insulin sensitive now with A1c range between 5-6. All of them are off meds, doing 1 hr exercise/day, diet control. This information feels very positive to me. It makes me understand that that they were prediabteic at some point to full blown diabetes which didn’t happen over night, must have been yrs, so I feel hopeful. Now, I am constantly worried if I will live until my kids go to college, so they are self sufficient even if I am not around. Writing this makes me feel like I shd also see a psychiatrist. Being a young working mother of 2 children, with husband traveling I haven’t taken care of my self although I had GDM twice with both pregnancies. But now I am working on it, all my body weight is in my Abdomen and arms. I see my Fasting insulin at 19.5 with HOMA IR at 6.5. My understanding is that my pancreas is producing insulin but because of the fat cells I am insulin resistant. I could be wrong, but it doesn’t hurt to try low carb diet, exercise and Metformin.


DEAR LORD IF MY A1C WAS 6.5 I’D BE ELATED - don’t let him tell you different! That is a fantastic # - the only people who want you lower besides the doctors is BIG PHARMA!!! When I was first diagnosed w/T2 about 15 years ago - the AIC guidelines were not above 7!!! Great job !!!


When I was diagnosed 10 years ago yes, the goal was less than 7.0 Times do change and things are reevaluated and currently the goal is recommended less than 6.0
Actuall I have been 6.0 or less for the last 8 years and not on Medications. At diagnosis my A1c was 12.0. It took a lot of work, exercise and low carb eating.
But nothing was paid to Pharma.


Absolutely it is the steroids!! You might see if non-steroid pain management can help. Seems to vary person to person. I take a low dose of oxy plus high dose of an OTC pain killer for my “killer” pain combo of bad arthritis and fibromyalgia. If you are covered for it, I also checked in with a physical therapist for a few sessions specifically focused on exercise that would help and not hurt.

Oh, and so far, by eating no more than 30-35 carbs per day I am 11 years a T2 with no meds. That could change anytime, though, and this wonderful place (my very first online home) has taught me not to be afraid of “the shots”. When the time comes I plan on going right to insulin.

Pay attention to your body. Test a lot to determine what is okay to eat. And remember Judith’s Mantra: To treat diabetes by the book, you need to write a new book for every diabetic. Good luck and keep us posted…