Frustrated

My A1c, is 5.5%,
Fructosamine is 198
Glycomark is 10.3

All seem to correlate with an A1c of approx 6%

I’m on Metformin ER 1500 mg daily, something has happened in the last few months that I’m seeing higher numbers, but my standard deviation is very low. I’m eating less than 20g of carbs per day (eating to my meter). I have an active job, and do weight lifting 3x weekly, bg’s are always the same, no matter what I do.

I wake up at 115-118mg/dl, then it increases to 130mg/dl about 30 minutes after waking up (no food yet) and then it stays there all. damn. day. Standard deviation is 5-7

Endo is no help & seems fine with Glycomark, Fructosamine and A1c

When I told him about the numbers I’m seeing, he just shrugged. I asked about increasing my Metformin and his response was ‘ok, but it’s probably not going to make much of a difference’.

I get the feeling he’s resistant to help me get lower bg’s, so I’m wondering how to go about getting a second opinion or how I should handle him.

Up until this past January, I was seeing double digits fasting & PP bg’s were well under 120, sometimes never moving from 90 or 100 mg/dl (low carb, less than 5g per meal). It just started creeping up since then I now I find myself with a lower a1c than before (5.7%) when the deviation was closer to 20-25.

Any insight would be greatly appreciated.

DP? I don’t see any high numbers though.

I just saw a fasting number of 128.

I considered going for pizza.

Maybe you need some basal insulin? Your numbers are pretty good. I hate the fructosamine test because almost no one does it and it holds up all my other blood work.

I thought basal as well, but talked with endo again today & his response was that if my basal response sucked, bg’s would be higher in a.m.

Right now, they’re the lowest of the day at 115-125…

I asked how we would I know if I am more squarely in T2 territory vs the possibility of 1.5 & he mentioned c-peptide. He agreed we could do it if I wanted, but as drugs begin to fail, that’s generally how we would know. When we run out of road -_____-

I go back in 8 wks for additional labs & c-pep is on the list. In the meantime, I’m certainly hoping for better numbers, however, endo says if metformin 2g daily doesn’t cut it, I’ll need to add more meds :pensive:

The most constant thing about diabetes is change. Type 2 definitely changes, My D has continued to change over my 25 years, sometimes because of me and sometime despite my best efforts. I started with oral meds and today I pump insulin.
Type 2 is a progressive disease for most, even with our best efforts, climbing numbers are not failure, it is time to advance your treatment. There is much more that can be done.

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Maybe you could ask for basal insulin instead of more oral meds. Many places do prescribe insulin, if the maximum dose of metformin is not resulting in targets being reached…

Addition of a basal insulin may bring everything down and get you where you want to be.

Certainly, if you were eating higher carb, your numbers would be far higher.

You hit the nail in the head, that’s kind of where I was going with my discussion with him, adding basal. I don’t think he quite believes I eat as low carb as I say I do. He said ‘if there’s no room for improvement with diet’ then we have to think about adding other oral meds…then he began talking about Januvia Invokana and a few others. He didn’t have a clear plan of action, just a meandering sort of way
=P
I was dx’d when I was 46, I’ve just turned 49 now, he felt like we have 20-30 years to try ‘on’ meds of all kinds. I’m not keen on this line of thinking.

@ justlookin:
I hear ya, but can’t say i feel any better about it :persevere:
I get 10k steps/day, I eat less than 20g of carbs/day & i do weight lifting (heavy) 3x a week…with all that effort, I’m good with adding meds, just not good with the wait & see game. It’s just so…discouraging (pout).
I also don’t like the sound of side effects of many of the newer oral drugs out there…i have a good many years left to be on those meds (God willing) so it’s a little discouraging. Law of averages is just not on my side.
Having laid the groundwork with my endo for further discussions, since he has not disagreed with my desire for lower numbers. I feel like after this next round of labs, I’ll hopefully have more info to make informed decisions.
Really hoping the new Metformin I’m going to be taking (osmotic) is a formula I respond better to. I’ve only got 8 weeks to try it out before he gets on the Januvia kick again :roll_eyes:

I am at 2000 met plus a sulfa and now a med called Onglyza. But the doc recently felt my biggest challenge was insulin resistance and since the doc couldn’t go much higher with met a med called Pioglitizone was added. Numbers are dropping like a rock ( 2 months) to where the doc is concerned I might go low.

There are options. Not against insulin but since you lift it is possible weight training could actually bring the numbers up.

Get antibody levels tested ASAP. If type one go on insulin right away. I would still push for some basal insulin and maybe bolus if you need it. Yep this sucks no matter what😳 but at least you will have better results.

So, weightlifting definitely temporarily raises my BG. LIke in the 15 minute after starting to 1 hour post workout range, but I’ve never heard of anyone having all-day BG rise from working out (unless they don’t produce enough insulin to bring down their BG at all). LIfting weights is a very good way to burn up both free blood glucose and stored glycogen in the liver and muscles (which is why we see a rise after we start lifting intensely).

However, all that heavy lifting means those same muscles are going to take up that free blood glucose your liver dumped trying to be helpful and store it as glycogen for the NEXT workout., Unless of course you need basal insulin because your body doesn’t produce enough to bring your BG to normal range once your muscles have finished their “feeding” routine…

Hook - A1c is not helpful in developing a tactical plan. I compare it to driving a car. While my average MPH maybe 40mph sometimes I need to go faster and sometimes slower. When on the highway I better be doing at least 70mph but if my cars maximum speed is 45mph I am risking getting run off the road.

The great news is we have tools today we did not have 5 years ago. There is no need to guess anymore.
Your first step should be putting together a 24/7 BG profile for at least 2 weeks.

My recommendation is call your Endo and see if they will get you an Abbott Libre Pro. Its covered by most insurance in the U.S. Most Endo’s are now embracing it as its a new profit center for them.

If you don’t want to wait or the Endo gives you a hard time you can buy the Abbott Libre personal sensor on ebay and other sites for about $80 from the UK or Germany. You can download a free sensor reading app for an android or you can buy a reader for about $100. Both the Pro and Consumer sensor last 2 weeks. For $80 you may want to get your own anyway.

During this 2 week period you will want to keep a food and activity log so it can be correlated to the results. Once you have this profile you can develop the tactical plan.

BTW - I very much agree with your Endo, increasing your metformin is not going to make much difference except maybe give you a belly ache. While you are putting you profile together over the next several weeks you may want to watch this video

" www.youtube.com/watch?v=SvZxYmYPXYQ

Al Mann was one of the great minds in diabetes. Al starts talking diabetes at 8:30m but it gets interesting at 11:00m and then at 15:00M he says the following “interesting this lowers insulin resistance… this is even likely to slow and even stop the progression of Type 2 diabetes”

AND, I would also read the white paper at VDexdiabetes.com and look closely at the graphs. Your goal should be keeping the tight range they are showing.

@ Stemwinder_Gary:

I’m 4 years deep in this thing, diagnosed at 46. At this rate of progression, it’s hard to be hopeful. My paternal grandmother died of diabetic complications at the ripe old age of 36. Granted this was many years ago & in Trinidad, where there’s much more faith put into bush medicine than what a doctor might say.

That was also back in the day, when testing involved urine & I could swear my dad said he had to put something to fire & the color green :roll_eyes:

Also, there’s a very strong denial that goes on. I had no idea anyone in my family even HAD diabetes, until at 46, I was diagnosed, started a low carb diet & immediately lost #'s in the first 2 weeks.

That dramatic weight loss got the attention of everyone in my family & that’s when the talk started. Both maternal & paternal grandmothers, no info on grandfathers, all of my paternal grandmother’s children (6).

I guess all of that is starting to get to me. Of the 6 children my grandmother had, all are dead of diabetic complications, or co-morbidities but 2.

I totally agree that it’s time to advance treatment, Endo seems rather comfortable right where we’re at though :face_with_raised_eyebrow: I’m working too hard to get the numbers I’m seeing.

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About the weight training, it never raised me before, but things could well have changed since I tested my responses to it. I’m going today & will go ahead and have a look at my numbers. I actually used to lower my average bg’s over the course of workout day & rest day, waning after day 3.

As far as getting more info with the Abbott Libre, I’ve got all the information I need, it just doesn’t have the same effect on my endo, as it does me :face_with_raised_eyebrow:

I happened to have caught the current pattern, by testing every 1-2 hours, from the time I wake up to the time I go to sleep, for several days. I have plenty of strips, though my fingertips are calloused now =P

Thanks for the input though, I can see where it can be useful! Had I not done all that testing these past few days, it would have been an awesome tool. I’m all about objective data :wink:

That medical attitude is the one that sets my hair on fire. “Let’s wait until it gets worse, then we’ll try something stronger. But only a little bit stronger, not something that would solve the problem once and for all.”

Wait for what? AAAARGH!!

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insulin should only be used with low insulin levels, not high A1c from insulin resistance. This will only make the situation worse, by getting in the more resistance, more insulin loop. The c-peptide test will tell you what is going on. Your bathroom scales are a cheap way of telling if you are insulin resistant or insulin deficient.

I think with an A1c of 5.5% on 1500 met and low carb, your dr is doing the right thing.

It’s an absurd response, I agree :disappointed: and absolutely unacceptable to me.

In reference to my 5.5% a1c, waking up at 130mg/dl and staying there till bed time is.not.normal.

It indicates to me that something is wrong & I’m not shy about saying so.

Expecially when my total carb allotment for the day is less than 20g, and my given activity level.

Update:
In a panic, I increased my daily activity level by 5k steps before I start work at 11am, I’m a dog walker :grimacing: giving me a grand total of 15k steps per day (minimum)

I started having a 4oz glass of white wine at bedtime or with dinner & have been rewarded with lower fbg

Lastly, I began taking a very expensive metformin er dose of 2g/day…the expensive part is another story altogether. I used to pay 9$ for 3 month supply of 750mg met, now, my generic met at 1g tablets, the same 3 month supply is 435$ out of pocket :confused:

However, not worrying about the cost for now, as I am finally seeing encouraging, but predictable reduction in numbers.

Standard deviation today was 2 :laughing:, fbg 109, never rose above 119 all day. The improvements started with the change in meds & increase in activity a couple of days ago. Not sure how long I can keep up the pace, but I have no intention of slowing down :roll_eyes:

Each day my numbers are decreasing & becoming less volatile. Well, I’m off to the gym now, time to pick up things & put them down :roll_eyes::grin::sunglasses:

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Whoah… I’m on a generic XR metformin that only costs me about $40 out of pocket every three months. Is there a reason why you couldn’t use a generic extended release formulation? I think there are a couple of formulations out there, might be worth checking into.

But…the rest of that news is great! Sounds like you’re doing much better :slight_smile: I’m experiencing my current “travel season FBG” annoyances. When fall comes around and I’m flying every other week, my FBG goes all to hell. Part of this is because I find it much more difficult to control my food intake precisely while traveling, and part of it is because my BG gets super whacky when my sleep pattern gets disrupted.

Keep picking up those things! BTW, do you do squats and deadlifts? I’ve found that they are absolutely the most effective activities I can do (other than power snatch and sprinting) to deplete both muscle and then liver glycogen. Definitely get a workout bump in BG, but it drops afterwards and stays nice and flat for about 36 hours (for me).

I’ve seen others say in the past that using 2 of the 1g tablets daily was far more expensive than using 4 of the 500mg tablets. You might want to check that out.