Meds not working anymore

Well, something isn’t working anymore and my numbers have are high in the am, high after meals even though I am still adhering to my low-carb diet. As I have trouble keeping weight on, I don’t want to go lower because I know I will loose the weight I struggled with putting on. (Yeah, I know opposite problem). I take 3 metformin per day at 500 mg but have added another dose which doesn’t seem to be helping much. I will see my endo soon but he adheres to the ADA standards and I know he will most likely not be very helpful. My A1C is 5.8 but I’d like to get it down to 5.4 or lower. I exercise everyday and am very active and am at a loss at what to do next. I get frustrated when I see my high numbers when I am really very strict with my diet. Any suggestions? I did the raw/vegan thing with some good results but I lost too much weight (7 pounds in 2 weeks). I am open to suggestions as I want to get this back under control again.

Your A1C is great. So, how high are your numbers? you need to see the doc and maybe discuss adding one more dose of metformin? I take 2000 mg a day, probably for nothing but it makes me feel better. If that doesn’t help then maybe you need some insulin, or another oral added into your protocol?

Maybe try the 6-small-meals a day? Take your current intake and split it up into smaller meals, your spikes might be a lot lower?

Seriously though I think a doc appt is the way to go. T2 is progressive for some, like me.

How high are we talking about numberwise? It’s hard to imagine they can be that high with an A1C of 5.8.

Hi Spirit7: Just a possibility, but have you ever considered that you might have slow-onset Type 1 diabetes (aka LADA)? Have you ever had antibody testing (glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), and insulinoma-associated (IA-2) autoantibodies) and/or c-peptide test? Your situation sounds like so many people here on TuD, who were initially misdiagnosed as having Type 2 diabetes but later were found to be antibody positive and have Type 1 autoimmune diabetes (another possibility is MODY, but that is a bit rarer than T1a). Have you considered that you might need exogenous insulin to control your blood glucose levels? Check out the LADA group and my blogs on misdiagnosis–unfortunately, misdiagnosis of people with adult-onset Type 1 autoimmune diabetes as Type 2, strictly because of age not etiology, sadly remains really common. Just my two cents.

Thanks so much for all your advice everyone. The A1C was a month ago and since that time my numbers have gone up; I know that my endo will not think they are bad because they are still within the ADA guidelines, however, I believe after researching for some time and believe that the ADA guidelines are too high. My am readings used to be under 100 most of the time, now I have been getting readings of 110 and higher in the morning. My after meal readings go anywhere from 124-136 or a bit higher. Previously the after meal numbers were under 100 most of the time with occasional readings higher so I am trying to figure out what is going on. I am eating the same meals and my lunch numbers seem the highest no matter what I eat.Even if its very low carb. I have done the smaller meals previously and should probably try that again. I did have the testing for LADA (c-peptide) which proved negative. My doctor seems to believe I developed Type 2 from low birth weight. There have been studies done that show babies with low birth weight (I was 5 pounds) are prone to type 2. It doesn’t run in my family and I was overweight but worked out regularly. I think stress played a big role. I am kind of anal about my numbers and strive to keep them down so I can be here for my family in years to come. Again, thanks for the suggestions and advice, I always find this site very helpful and I really don’t have a support system other than the net. Thank goodness for that… Best to all.

I have one important word: insulin. If you are losing weight, it doesn’t matter if you are Type 1 or Type 2 – you’re not making enough insulin to keep your weight up. Insulin is the fat-storage hormone. So it follows that if you want to keep your weight up, you need more insulin.

Second, as many as 10% of Type 1’s don’t present with antibodies. So it doesn’t matter if you’re “proven” to be a Type 1 or not – if you need insulin you need it, and that’s that.

If you’re stubborn and crazy like I was, you will go off your carefully constructed diet and let your BGs REALLY go up in order to prove to your doc that you need insulin. I did that because I didn’t have the patience to wait for the doc to discover that the oral meds weren’t working, and that if I ate the way everyone else eats, my BGs were definitely uncontrollable.

Going on insulin was one of the most relieving days of my life. FBG immediately went down from ~180 to 116. However, since he only gave me NPH at night, my PP’s were as bad as ever. But the door had been opened, and I eventually ended up on the pump, and my life has become MUCH easier.

So think about it!

Hi spirit7. I will repeat Natalie’s word: insulin. Whatever type you may be, when you need insulin, you need it.

I will second what Natalie and Trudy have said, which are wise words indeed. Also, Spirit7 had the c-peptide test, not antibody testing.

Well, I went through several years of ineffective medication. I went on and off maximum metformin. I tried double and triple therapy adding Actos, Byetta and Victoza in various combinations. And I never saw much improvement from the medications. I basically had an A1c 6-6.5% no matter what (and I also followed a low carb diet). And while my fasting numbers were out of range, my levels were never “bad enough” for my doctors to prescribe insulin. And I asked repeatedly. Eventually, I made the choice on my own.

In your case, you have only used a partial dose of metformin, some might argue it is barely an effective dose, and you blood sugar levels are not particularly bad. I am just saying that while insulin would work and I think it is good to keep an eye on things and you could try a maximum metformin dose and other medications before insulin.

I understand how you feel, I am obsessive about my bgs, too. I finally got them below 100 and if they go much above it drives me nuts. Sometimes with diabetes our bgs just go wonky for a few weeks. Last summer I had a lot of inflamtion which drove my bgs to 200. Even though I ate lower carb and exercised the inflammation and stress hormones trumped my lower carb eating. Finally I found the cause of the inflammation - statins and stopped them and bgs gradually fell. So sometimes something else may be going on in your body. Another thought after this happened to me I switched to a more organic diet using tons of Coconut Oil. I do think the CO really helped my bgs.

Curious that you should mention LADA! I just dumped my endo from Joslin. He wouldn’t answer my questions, I found him to be very patronizing and he said his way and wasn’t willing to discuss anything. I went to them when first diagnosed but never impressed by their service. I found Dr. Berstein to be much more informative and insightful! Well, I have questions I want answered and in that I am not only curious and I interested in keeping healthy. So, I found a new endo. One who answers my questions fully and completely and he believes strongly that I have been misdiagnosed. I had mentioned this to Joslin about further testing to which he replied, “it wasn’t necessary.” My new endo did a much more complete history on me to find out several facts, diabetes does not run in my family, no one has ever had it. Auto-immune does! Everyone in my mothers family has a thyroid issue including both of my sisters, I do not. Guess I got the diabetes instead… Anyway, its good to be with a doctor who is most helpful and I’ll find out in a week or two if I truly have been misdiagnosed. Thanks for your 2 cents!

Check out my blog Bill of Rights, you may see yourself there. Good for you for being your own best advocate, and “firing” a doctor who wouldn’t do appropriate tests for you. Your new endo sounds excellent.

You got it right when you said “I am kind of anal about my numbers.” I don’t use any meds, I wake up around 120-140, my A1c is 6.0% & my doctor says I’m doing fine.

Since you say you got results from it, you could revisit a raw/vegan type diet for better overall health & add more plant-based fats (nuts, seeds, avocado) & snack more often to prevent weight loss.
In my opinion, you’re stressing out for nothing.

Well my new endo did all the testing and I am not a LADA however he is still questioning the type 2 diagnosis and believes I may be MODY.I would need genetic testing which is not covered by insurance but he is starting me on new meds tomorrow as I have been taking the maximum dosage of metformin which had worked previously. I am starting on glimepiride 1mg in the am. Anyone tried this? Evidently this is the preferred treatment for MODY. We shall see!

Well, it sounds like your endo is open to all possibilities, which means you got a GOOD one! :slight_smile: We should all be so lucky!

Even if it takes some experimentation, I’m sure he’ll find the right treatment for you, which is what really matters. So hang in there, and good luck! :slight_smile: