Just learned my A1C is at an 11. And I'm terrified


#1

Hi Everyone. After not having health insurance for 4 years I finally got to see a doctor last week. I found that my A1C is at an 11! I’m 42 yrs old with a family history of diabetes. My doctor just prescribed metformin for now for 90 days and an aggressive diet and exercise plan.

I tested my sugar last night after a low carb dinner and it was 266! When I woke this morning it was 216. I’m looking for input & strategies to get back to normal on my own. I do not want to go on insulin.
TIA


#2

Samething here. After a month on metformin other meds were added and that brought it down fast.


#3

I think it takes a few days of taking metformin for it to be at its peak effectiveness. How much are you taking? you might need to increase the dose. I’m sure someone here will know, but I seem to remember us having discussions here that suggest a dose of 500 mg/day is not enough for most type 2s.

are you tolerating the digestion upset many people experience?


#4

I have to be honest. An A1c of 11% corresponds to an average blood sugar of 269 mg/dl. Studies have shown that on average metformin alone brings down your A1c by 1 to 1.5 %. A dose of 500 mg/dl is not a physiological dose, meaning that it is unlikely to be enough to have an effect. They often start you out at a small dose and increase it as you become more tolerant.

But the real point is you are not being aggressively. It sounds like you saw a GP who only knows a little bit about diabetes and it’s proper diagnosis and treatment. With an A1c of 11% you should see a specialist, namely an endocrinologist. And most importantly the guidelines from the American Association of Clinical Endocrinologists (AACE) suggest that you should start with much more aggressive therapy (see page 109). For an A1c of > 9% and if you display “symptoms” (i.e. increased urinary frequency (polyuria), thirst (polydipsia), hunger (polyphagia), and unexplained weight loss) then you should start on insulin immediately. If you don’t have symptoms (which is unlikely with an A1c of 11%) then you should start immediately on 2 or 3 simultaneous oral medications to bring down your blood sugars.

So the be honest, you have been mistreated according to guidelines. A failure to treat a very high blood sugar may result in your have a health crisis like Diabetic KetoAcidosis (DKA). You have been given a medication that is unlikely to have any positive effect and you should have been given at the very least full doses of 2 or 3 simultaneous medications or started on insulin.

ps. And don’t worry about the insulin, it may well be a temporary measure to get you back normal and stabilized. But without it getting back to normal may be much much harder.
pps. Should you have the symptoms of DKA you should go immediately to the ER. You can get test strips at any pharmacy to test for ketones which are a hallmark of DKA.
ppps. I don’t mean to scare you. With our help you can and will get through this. Even if your doctors are minimally helpful we can help you help yourself. And it will be OK.


#5

As others have suggested, an A1c that high is quite dangerous, and first order of business should be bringing that down into an acceptable (or preferably “normal”) range. Insulin may be the best way to do that, and there is no shame in taking insulin. It’s the most effective tool for the job when you have BG that is consistently far too high.

As for the others, since I also am on a metformin, diet, and exercise treatment plan, I can make some suggestions:

  • Metformin takes time to get into your system and have an effect, usually a week or so. If you have GI issues from side effects, ask your doctor for extended release (it helps). Most GI issues disappear after about two-three weeks. Metformin is a great drug, and while it won’t fix your issues on its own, it is definitely a tool to keep in the toolbox.

  • Diet: many Type 2s find truly low-carb eating to be very effective, and this can bring down BGs quite rapidly. When I started eating less than 80g total carbs per day (including fiber), my fasting and postprandial numbers started dropping. After two weeks of that, they were in “normal” range (70 mg/dL - 126 mg/dL) about 90% of the time.

  • Exercise is truly a great thing in both the short and long runs. A nice, slow walk after eating can bring BG down by a few points (don’t expect a 100 mg/dL drop), and doing intense cardio will work even faster: a 60 minute bicycle ride at high intensity (15-20mph) will bring my BG down by 100 mg/dL after about 50 minutes. Strength training is probably even more effective in the long run: gaining muscle mass and losing body fat will help maximize your metabolic efficiency, even if you aren’t overweight.

It took about a month or two to really figure out what worked for me. I am on a fairly high dose of Metformin ER (2,000 mg per day), eat very low-carb, and exercise a lot: 2-3 days of intense cardio a week; 3-4 days of very intense strength training. That treatment regimen got me into “normal” range pretty quick. I sort of live and hang out in the 70 mg/dL - 120 mg/dL range these days, and my last A1c was 4.8%. Your Diabetes will Most Certainly Vary! What has worked for me won’t work the same way for you, but I do want you to know that this is a manageable disorder. I was absolutely terrified when diagnosed: a baby on the way, fairly young (I was 40), didn’t see it coming, not much money, new job, etc.

With better day-to-day control, my fears have receded. I know that I can live a long, healthy life and enjoy the company of my wife and son (now 5 months old). I don’t get to eat all the stuff I enjoy (homemade bread, rice dishes, pasta), but I eat very well nonetheless, and have found new dishes that I enjoy (coconut curry soup, roasted green vegetables, and chia pudding). It’s an adventure, but it can be a good adventure! Plus, I’m now in better shape than I have been since I was 25 :slight_smile:


#6

I just want to echo Brian’s sentiment that insulin should not be avoided at all costs. It is a highly effective tool to help manage blood sugar. Even if it’s simply used to bring you back into range and then stopped, it would be a shame if you avoided it. Like many things in life, your fears and concerns when considering some course of action are often not justified once you actually try it.

Good luck. I hope you continue to participate here. The information and support we provide each other is not available from the medical professionals as well as close family and friends who care for you but do not have the experience of living with diabetes. We get it and we have plenty of tactics to share to make your life better.


#7

Thanks everyone. I’m sure feeling not myself and hope the metformin helps. I was prescribed 500 once a day for he first week and increase at week two. I meet with the diabetes center here tomorrow morning and will address the insulin need as well.

I’m definitely calling my doctor about it now.


#8

And just so you know, the current thinking on Type 2 is a bit different than it once was: insulin therapy is often used to bring BG down to “normal” ranges and then discontinued in favor of orals, diet, and exercise. This appears to have great benefits for many Type 2s, since the rapid “normalization” of BG seems to spare the pancreas some of the heavy lifting associated with trying to bring BG down on its own. Plus, it’s really important to avoid the damage that even moderately high BG will have on your blood vessels and organs.

Glad you’re feeling a bit better about it, and your educators at the center will be able to help a lot! Please keep us updated on how it’s going, and ask all the questions you want! Pretty knowledgeable (and compassionate) bunch of diabetics in this particular corner of the internet :slight_smile:


#9

Just sort of piling on to the points that have been made, and adding my voice to the chorus . . .

I agree that you are being mistreated, or more precisely, _under_treated, probably based on out of date or simply superficial understanding. 500mg of metformin isn’t going to do the job. First, it’s a low dose, close to the minimum, and second, even the maximum dose (which, depending on which expert you ask, is between 2000 and 2500 per day) is extremely unlikely to get an A1C of 11 back down where it belongs.

Nowadays there are far more effective tools available to deal with chronically high blood sugars. Insulin is just one of them, although it’s by far the most powerful weapon in the arsenal. The Joslin Diabetes Center, pretty much the institutional gold standard of diabetes clinics, frequently puts newly diagnosed patients on insulin regardless of their specific type of diagnosis, often just temporarily. The idea is to get blood sugar back down where it belongs now, then use the breathing room thus acquired to map out a long term program and strategy.

But a much more fundamental problem with insulin is the stereotyped attitudes toward it. Although it’s beginning to change (glacially), our culture, led by the medical profession, has been deeply indoctrinated with the belief that insulin is a “last resort” and somehow an admission of failure or desperation. What utter nonsense! If you have a problem to solve, don’t you want the best solution available?

Think of it this way. If you had a broken leg, would you try just keeping off it for a while, and only have it set and put in a cast as a “last resort” if nothing else was working? It’s simply a matter of the right tool for the job. Full stop.

I’m not saying that insulin is the right answer for you. That is something that needs to be decided between you and an endocrinologist. What I am urging you to do is not to foreclose your alternatives before you even start. Keep your options open.

And one last point: an A1c of 11 is way too high and needs to be gotten back down, obviously. But it’s not a cause for panic. Mine was a great deal higher when diagnosed 21 years ago, and I’m still here and (so far) complication-free. You have time to solve this. Take a deep breath and proceed. And remember that you have a whole community of people behind you who (a) get it, (b) care, and © are always here for you.


#10

So far so good on the stomach upset but like i said its only been a day. I’m really glad i found this forum to talk about concerns and questions without feeling silly.


#11

Thanks so much! I will keep you all posted!


#12

[quote=“Brian_BSC, post:4, topic:58224, full:true”]So the be honest, you have been mistreated according to guidelines.
[/quote]While I agree 100% with Brian’s post (including how I expect he meant “mistreated” above), perhaps “inadequately” treated, or something like that, is a bit clearer. “Mistreated” can easily be misinterpreted to imply malice or gross indifference, which I think we lack any facts that this was anything more than the usual GP doing what they know, not what is best.


#13

Also… inadequately treated per “those” guidelines… it’s not As if there aren’t near infinite sets of guidelines. It is a very responsible course of action to start with the most conservative treatment, evaluate a patients response to it, adjust as necessary. I do not agree that there is anything wrong with the treatment initialized as long as the follow up is there to adjust as needed after evaluating response. Conversations on the internet like these are what make doctors hate the internet;)


#14

Sam, didn’t you know that most doctors are greedy and uncaring, only in it for the money?


#15

And all only marginally competent at best. And each of us is the first case of diabetes they’ve ever seen… they have likely only briefly touched on the subject in medical school-- most have never seen a real diabetic… much like a Sasquatch or a unicorn


#16

I’d also like to chime in that you can do things immediately to help bring your blood sugar down. First, I suggest you adopt the meat, seafood, egg, cheese and salad diet. No grains, potatoes, flour and nothing with sugars or sweeteners in them. Every time you eat something with carbohydrates in it, whether it is candy or just a slice of whole wheat bread, it will raise your blood sugar.

Oh, and drink lots of water. Your body fights high blood sugars by having you excrete glucose in your urine. Helping that process along will help bring down your blood sugars.


#17

Thanks all.
I’m going back i tomorrow at 4. Hoping to get more insight w the educators and get a handle on this. My mouth feels like metal. I’ve already drank 8 water bottles today I rested at lunch because I felt week. Planning on walking this afternoon and testing as soon as I get home. No carbs today just veggies n protein. I will keep you updated.


#18

I was sent to the hospital when I got diagnosed. My A1C was over 14, my Bg was over 600, and I was in DKA. It was a week before my 42nd birthday. I was immediately put on an MDI program with a rudimentary lesson on how to manage it. After discharge, my GP took me off of the bolus and advised me to adjust my basal insulin until my numbers were in line. I went from 200 to 100 within about a week and a half.

I was fortunate in that no one used the possibility of insulin as a threat to get me to eat better. For one, it wasn’t necessary. DKA will put the fear of God into you once you realize just how serious it is. I think that mentality is slowly disappearing from what I’ve read, but too many doctors (and CDEs) have used the prospect of insulin as a threat. It’s a treatment option, and nothing more. My dad thinks getting off of insulin should be my goal. It’s not. My goal is to get my A1C below 5, but I’m happy with 5.7 and 5.8 (my last two). If I get it under 5, I’ll consider life without insulin. If not, I’m perfectly fine with a daily injection.

“Reduced carbs” means something different to different people. 150 grams per day is reduced to some, but to people who eat low carb, it’s high. I’ve normalized between 80-100 per day, and am trying to get lower (lifestyle is an obstacle for me here).


#19

@WenInNaples – Any updates?

I highly recommend TuDiabetes member @phishery 's helpful website, D-Solve.


#20

Welcome to this great site. Take a breath,things will get better. There are several things that can help you reduce your numbers.

  1. Education ,learn things from members,read books, visit a CDE. Certified diabetes educator in your doctor’s office.
  2. Monitor your blood sugars
    3.Exercise you can simply walk or do whatever you enjoy. ( I go to my Y.)
    4.insulin is not a bad thing, many of us as type 2 s use it very successfully.
    Type 2 for almost 24 years. Nancy