Frustrated

Type 2
21

Its perfectly normal when you are not making enough insulin. I am surprised its not spiking a lot more after meals. The metformin while you are sleeping is suppressing “to some degree” the livers glucose production. When you wake the livers response is to dump some sugar which gets you to 130. The non-diabetic pancreas would release enough insulin to offset this and bring you back to about 83. You are not making enough insulin.

The only help you will get from metformin is to provide some compensation by suppressing some sugar released by the liver. For most people using it never works out well in the long term. One of the big metformin promoters 25 years ago getting it approved in the FDA said this in July “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center) https://diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forum

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About the expense…from what I can gather on bulletin boards & reading between the lines, it appears my endo prescribed generic metformin osmotic xr tabs 1000mg

The osmotic version, is actually generic Fortamet, which only became available on 2016. Even though it is generic, it is terribly expensive by comparison to my old generic met 750 mg.

The cost of the same drug at 500mg is just as expensive as the 1g version :confused: I compared the prices already. Seems the drug companies got hip & closed that loophole.

Yep! tonight was straight leg deadlifts, squats, leg presses, calf raises…boo! Bg shot up to 141mg/dl after gym.

Blew my deviation of 2 to 11, but I’m still glad I’ve spent the whole day under 120.

Sleepy now, time for small glass of wine :laughing:

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The reason my bg doesn’t spike at meals is because I’m eating less than 5 g of carbs per meal/snack.

In the absence of further lab work, it’s all guesswork I suppose. With my increased activity & the higher dose of metformin, numbers are now much more reasonable.

Even fasting is coming down :hugs: I’m hopeful that it’s just insulin resistance, though I feel like I’m working really hard to get reasonably normal numbers…so there’s that =/

It’s discouraging to hear metformin is not effective long term, hoping to get more info with plans to test c-peptide at my next visit.

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Wow! :wink:

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See what your c-peptide results say. From what you are saying, my gut tells me it’s insulin resistant T2 and you continue what you are doing. You could ask about adding a GLP-1, SGLT-2 or DPP-4 if you need to add more carbs to your way of eating.

This will give you an idea of the drug ladder

https://www.aace.com/sites/all/files/diabetes-algorithm-executive-summary.pdf

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Thank you for the drug ladder!!! This is exactly what I was trying to say to my Endo, but I just didn’t have the right words to express what I meant.

I wanted to know where do I go from here, if it’s not working & he forgot who I was, during the conversation (which took place about a week after my visit) and referred to my A1c, not seeing my issue.

Granted, 5.5% is something I’ve been trying to attain for the last 4 years, however, I am now also anemic, due to his wait and see attitude. When my ferritin was low, he ordered a serum iron, when that came back normal, he decided to wait and see. His decision to treat conservatively, now has me squarely iron deficient anemic.

The kicker is that he wants me to see his buddy, the Gastroenterologist to investigate the possibility of a ‘microscopic bleed’. I would’ve followed through with that, however, I have 6 intramural fibroids, so I KNOW where the extra demand for iron is coming from.

I’m an ‘Occham’s razor’ kind of girl, so this is where my resistance on that front is. By the same line of thinking, since the combination of increased activity, and dose of met is improving, I’m also closer in my line of thinking, to T2 insulin resistance than T1.5.

Jack 16: Will absolutely study the drug ladder, as I expect the possibility of change of course might very well come to pass at some point.

Terry: right!!! I was amazed at that standard deviation yesterday as well, then, I went to the gym, it was leg day. My bg shot up to 140mg/dl about 1 hour after, but dropped down to 110 mg/dl by 2 hour mark. Brought SD to 11, but still. THIS I can totally handle :wink:

George44: I will have a further look at the efficacy of Metformin, as I am at the tail end of that road…will update when labs come back & would appreciate any insight you may have to offer. Also, the Abbott Libre Pro is a great idea. Will put that in my pocket for further review to discuss with endo. He does this funny dismissive almost imperceptible eye roll, when I mention the numbers I’m seeing. His nursing assistant did the same thing when I mentioned I check my blood pressure periodically. She actually curled her lip and asked WHY? :roll_eyes:

Uff_da: <<< (the sound I try NOT to make in public when rising from a seated position) :laughing:
Endo wanted to put me on regular Met 500mg 4 tabs daily, but my Express Scripts already shipped the Osmotic formula. I admit I was worried about tolerating the regular Met & regretted agreeing to it. I’m hopeful that when my endo sees the progress I’m making (hopefully it continues) that by that time, we’ll be able to figure something out, making the cost more reasonable.

David49: it totally didn’t occur to me to check my BG’s after a workout. It was so ridiculously uneventful previously, it wasn’t even in my wheelhouse. Though like you, it is a temporary rise, I appreciate being able to predict the pattern. I like patterns, there’s comfort in patterns :smirk:

This is very interesting & I must’ve missed it btw reading on my tablet & phone. Laptop is much better :wink: I can follow responses with ease. Can you tell me more about the scale? Since my numbers started creeping up, so had my weight :face_with_raised_eyebrow:

meee: thank you for your response as well, talking with my endo makes me a little crazy because he’s not forthcoming with why he feels one course is better than another. I am definitely fearful of lows as part of insulin therapy, but for now, will cross that bridge when I get there.

Thank you all for your input. It’s been really helpful to me to be able to work through this with the additional opinions =D

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The solution for you is to get the carbs lower than they are now. You are exceeding your carb tolerance that your body can’t process, even with the excess insulin from insulin resistance.

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If your weight is going up, I would guess you have plenty of natural insulin, as I think the c-peptide test will show. Personally I think it’s a given and may not even be needed. My guess is the higher BG and weight is from increasing your insulin resistance.

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If you add insulin injections to this, it is only going to amplify your insulin resistance and weight gain. Statistically, you will also find over time that your A1c will rise, as the added insulin can’t keep up.

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watch the last half of this video, the whole of it if you have the time.

this is a 20g diet that was used, also google ketogenic

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@ Jack16: Thank you for the input. There’s a lot of information up thread, so you may have missed the part where I said I was eating < 20g of carbs per day.

This was the crux of my problem & why I was considering the idea that I may not make enough insulin, given that I have been on a Ketogenic diet for the last 4 years.

If this were the case though, the additional activity & increased Metformin dose would not have any effect on my numbers.

My weight has gone up about 10#'s over the course of the last 2 years, and has remained constant, give or take a few. This coincides with the increased BG’s I was seeing. In my experience, the pattern I’ve noticed is that weight loss stopped dead if BG’s were over 120 mg/dl & weight creep would begin.

I’ve also noticed that when my BG’s are north of 120, I’m hungry & eat accordingly. As you know, with a keto diet, you don’t need to watch calories as much, since you are naturally satiated by the fat & protein.

I think we’ve both come to the same conclusions, however, took different routes. I appreciate you taking the time to help me work through it :wink:

As of today, using the mySugr app on my phone & tablet to track my stats, with the addition of 5k more steps every day (totalling better than 15K) and the increased Metformin,my average BG for the last 7 days is 122mg/dl, standard deviation is 10, hypos (defined as >120mg/dl) is 2.

Again, this is with a Ketogenic diet & heavy lifting 3x weekly. With results like this, it seems fair to say I’m currently insulin resistant :hushed: so I guess I need to not break down & end up laid up.

On the upside, since I started the additional activity, my weight is going down, appetite decreased, resting heart rate also decreasing!!

This, I can work with :upside_down_face:

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So. :roll_eyes: I’ve only just gotten around to consulting the great oracle, Google about my new, more expensive Rx.

I found this thread from another bulletin board very interesting & I thought you guys might too.

I want to mention though, the thread is from 2010 & according to anecdotal info, maximum dosages changes in 2013, so there’s that.

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Duh :no_mouth:
Might’ve been helpful if I included link =P

Edited for: found the edit button :hugs: to add link

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This thread, also explains the high cost of my new generic Metformin Rx, (script previously written for generic Glucophage) which is apparently proprietary, manufacturer, Lupin. States specifically on the bottle, generic Fortamet

Metformin ER versus Metformin XR and Insurance - #8 by Margie3

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Sounds like your methods are bringing down your sugars level. Exercise has a way of helping muscles consume glucose, even without too much insulin. You are ketogenic diet though, so your body should be well adapted to burning fat, instead of glucose.

Is this current increase in activity sustainable for you as a long-term lifestyle? You must be spending a lot of time moving… If you do have insulin resistance, then you are certainly doing everything you can to address that (ketogenic diet, exercise, wine at night… )

I am waiting to see your c-peptide results, will they test insulin levels and glucose, at the same time?

I am still on the fence and my personal bias is that you may still be earlyish 1.5.

I am also of the opinion, that adding a small dose of insulin, could be a viable option, rather than going for multidrug therapy (more expensive often, and harder on the liver, kidneys, pancreas), considering everything you are doing to address possible insulin resistance / make your body more insulin sensitive.

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@ JustLookin:

I hear where your coming from, and you’ve absolutely nailed my concerns. I’m an active person because I have to be. I’m a pet sitter & walking dogs is what I do most of the day. Starting out with my own 5 dogs, walking one pair for 2500 steps (about 25-30 min), then the second pair (5th dog doesn’t walks with my son in the meantime). Then there’s the weight training…

I AM totally concerned that if I come down with an injury of some kind, or for whatever reason, & can’t do those morning walks, where my body would naturally land. My pups are small & though they enjoy their walks, they used to get by with much shorter walks.

I do plan to do the C-peptide & I’ll ask about insulin levels & glucose too. I am ALL for more information now rather than later as he proposed. He’s a wait and see kind of guy with my health, but not opposed to humoring me, to a degree.

Will absolutely update then, I’m sure I’ll have questions regardless. The idea of keeping up this pace is daunting to me, however, it might well be because I’m early on in the idea that I must keep moving. It really is quite like a monkey on my back right now.

I could get used to it if I had to & right now, that’s what I’m trying to do. Currently the idea of multi drug therapy does not thrill me, so you and I are on not far apart on that front.

I’m an Occam’s Razor kind of girl, but admittedly, I don’t like flying blind, so more info,more better. :wink:

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Wow, very active lifestyle. May not be long-term sustainable, including if your life situations change. Would be much better, in my humble opininion, if you could be physically active because you wanted to / it’s your job, rather than as a desperate measure to try to keep your sugars where you want them.

If your doctor will humor you, do your best into humoring him into a small dose of basal insulin. Joslin and other places, use insulin as second line, if metformin and lifestyle alone don’t cut it.

I’ll be watching how you go and hoping you can get to where you want to be.

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35

you need to watch the protein on keto, too much will put on weight, because up to 50% turns to glucose and needs insulin to get rid of it, as converting it to fat. I would go back to the basics 20g carb, 50g protein and the rest fat, till you get your weight in range.,use something like cronometer, it has a keto setting in profile. you can choose rigorous, moderate or relaxed.

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@jack15: Thanks for the tip about protein, I’m aware of glucogenesis & as a small woman, cannot eat more than 4 ounces of meat at a time. Generally, it’s 2-3 ounces before my system shuts me down with a shudder if I even think of cleaning my plate :smirk:

So far, the additional activity, along with generic fortamet, is working to reduce my numbers. It helps to know I test upwards of 7x daily. When my bg was higher than I’d like, I was testing every 1-2 hours depending on activity or event, in an effort to determine a pattern. Only the last 2 days I’ve started to let myself relax a bit on the testing.

Here are my stats:

last 7 days avg 115 mg/dl, deviation 11, hypos 1 (hypos defined as 120mg/dl or above)
last 14 days avg 119 mg/dl, deviation 10, hypos 6
last 30 days avg 124 mg/dl, deviation 12, hypos 17
last 90 days avg 120 mg/dl, deviation 12, hypos 28

The last 7-14 days is when meds changed & activity increased.

So far, the highest I see is 125. I’m hoping that with a drop in weight, I’m 135 right now, (lowest I’ve been, since going keto is 124) and I’m 5’ tall. As a smallish Asian woman, I could be very happy with a drop of 10 vanity #'s but there’s more room for improvement in activity than there is in food.

Except nuts. :hushed: I eat too many of them & that’s when my scale will creep up…cashews are my downfall. I’ve cut them out in the last 2 weeks though.

I can tell you for sure that for me, it’s a slippery slope. Once I start a backslide, it can take me weeks to get back to where I had been.

I’m jealous of folks that can see a decrease after meals. I don’t recall ever experiencing that. For my bg’s to stay low, I have to start low & eat no starch. I will see a rise of 5-10mg/dl, which will put me in the 115-125 range. In truth, meals/snacks are punctuated with activity, not by design, just how my life works out, so I guess I don’t really know what would happen if I just stayed put :thinking:

Then there’s that pesky thing that rolls around every month to throw a monkey wrench in the works :face_with_raised_eyebrow:, ovulating increases my baseline bg’s, hormonal changes too :persevere:

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I think you are referring to hyperglycemia (high blood sugar) not hypoglycemia (low blood sugar). Your low standard deviation indicates low blood glucose variability. This means that you can safely aim for a lower average without increasing the risk of hypoglycemia. You might consider thinking about hyperglycemia starting at greater than 140 mg/dL and give yourself a little more room for your target range.

A standard deviation of 11 mg/dL is excellent! With an average of 115 mg/dL, that means it’s likely that you’ve spent about 2/3 of your time between 104 mg/dL and 126 mg/dL, an acceptable range. These statistics become more representative of actual experience with more data points but your seven fingersticks per day can start to reasonably show your overall blood glucose experience.

These numbers represent acceptable blood glucose levels even if they are not ideal. Good luck!

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:upside_down_face: Yes, good catch, I DID mean hypers! I never, ever, ever have hypos. I wonder if this is significant in any particular way :face_with_raised_eyebrow:

Now that you mention it though, I’m guessing this is why I am so motivated to try for lower baseline numbers. No fear of hypos, they’re not even in my wheelhouse.

About the 140 range…Unfortunately, I don’t come down from 140 for 3, closer to 4 hours after :expressionless: There doesn’t seem to be much in the way of rebounding for me, hence the super strict starch/sugar restrictions.

It’s rather disheartening. To this end, I can’t bring myself to loosen the reins.

In checking previous stats for this past April & May, I saw double digits fasting & deviation was closer to 20-25. I was worried about the deviation, but figured the numbers I was seeing were at least reasonable. I started to gradually see a creep upwards in June & stopped testing for a while. Fatigue, I guess you know how it can be. :roll_eyes:

In looking at my long term stats, I see my fasting began to go up in the first quarter of 2017. I’m starting to think I started this backward slide last Thanksgiving :flushed: I gave in & enjoyed a normal holiday, not something I ever did before.

Thanksgiving Thursday 2016, ran straight into Black Friday & breaking my rules made it easier to give in to cravings. Then of course, Christmas followed. The occasional indiscretion brought me right into Jan 2017.

I have a history of losing ground & not regaining it or taking weeks to get back to where I had been. Same with my daily numbers, once they start going awry, it’s difficult as hell to get back to where I came from. Sure didn’t mean to test that & turn weeks into months :pensive:

I’m grateful for your insight about the probability of lows for me, it didn’t occur to me before, but will pocket that little bit for use with my Endo during our next conversation. He feels I’m unrealistic & I might well be, but until I exhaust all room for improvement, I just can’t bring myself to loosen up given my track record.

I’m really finding my bg tracking app very helpful in refreshing my memory for what’s been happening. The long term stats refreshed my memory of the past year & previous. There are many points of searchable entries, so it makes researching trends really easy, if not consuming :roll_eyes:

Thanks for the luck!!! I’ll need it for the upcoming holidays!!! I’m hopeful I can get back to regularly seeing double digits again fasting & during the day.

I’m truly hoping for user error vs.decreased insulin, which is starting to look more likely to me, now that I’m gone over my stats for 2016-2017.

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