Metformin and Levemir driving me crazy!

Type 2
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Hi everyone! I am not a new T2 but I could say I am new at taking the responsable approach. After taking 14-15 months off my medicines (I was only taking 500mg metformin twice a day then) a kidney stone passing revealed a 400 BG. I thought things were under control with natural herbal medicine, but I was wrong. Went to see my doctor (who I know before he became a doc) and he was VERY UPSET! To make it short (shorter :blush:) with an A1C of 11, when my previous result 14 months before was 7.3, we had to get very serious. I started around 2 months ago with 1000mg Metformin twice a day and I saw some improvements but morning BG was around 200-215. I lost 10lbs with diet and exercise and still BG wouldn’t go below 150 in the mornings. I added 10, 12 and now 14 units of levemir once a day before going to sleep and now I went back to 200 BG in the morning. Am I doing something wrong? 16 months ago, before leaving a twice a day 500mg dosage of metformin I had my BG in the low 140’s in the morning. Can 1+ year of carelessness create such havoc? should I be concern and look for more aggressive treatment? or should I give my new responsible approach time to do it’s job? (almost 3 months since 1000mg metformin twice a day and only a month of 10-14 units levemir)

I decided to signup to vocalize (in writing) my experience thanks to reading your posts in the forum. I thank you in advance for the courage each one of you had to share and not hide diabetes. It made me feel “normal” again

Gus :smile:

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Unfortunately things can turn bad pretty fast with diabetes. Once you get off the narrow path your diabetes can sort of suck you into a black hole. Your blood sugars get high, your pancreas can’t keep up, your blood sugar goes even higher, your body becomes insulin resistant as a last ditch effort to protect your cells against high blood sugars and the next thing you know you have an A1c like yours and things are really bad.

But look up, you seem fortunate that have been able to get things back on track. Having uncontrolled diabetes doesn’t mean you will always have uncontrolled diabetes. You just need to take care of it. You have to get your head about the reality of diabetes and you just need to be constantly diligent.

As to your regime, you may find that you have to adjust your Levemir in order to control your fasting and morning blood sugars. After having very high blood sugars you may have lost much of your beta cell function and having T2 you may find that you need much more than 10-14 units of Levemir to get things under control. I would just suggest you work closely with your doctor to find the proper dose. It may take weeks and even a couple of months to get things straight. You don’t want to rush it.

Thanks for sharing your experience, hopefully your experience will help others.

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Hi, I agree with Brian. Yes going off the beaten path can cause some difficult issues. This is not to say your situation is automatically bad. I suggest you get back in touch with your doctor. There may be some immediate corrective action that can be done to get back on track, or you might find resumption of the typical method will be helpful in regaining control.

It is true bad things can and do happen, but if they have time is not on your side. What is on your side is to visit your doctor and reassess.

I wish you the very best in your journey. I went off the track for several years and was able to get back together. Yes, I had done damage, but I am grateful for the now time. I hope you will be grateful as well.

Best

Rick

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Gus,
Have you had the testing necessary to rule out T1/LADA? For many adult patients called T2 due to age, when they have progression of insulin/medication needs can be an indication that they were really a slow onset adult T1, Latent Autoimmune Diabetes of Adult.
And since you are having a lot of trouble getting back on top with just basal insulin and metformin, could be indication that you also need mealtime insulin as well. Getting a Cpeptide, and the full antibody panel is important to correct diagnosis and treatment plan, not to mention the correct insurance dx coding allowing best coverage.
I was called a T2, but was really T1 once I arm twisted my MD for all the tests.
GAD, ICA, IA2A, plus cpeptide. Was low cpeptide and ICA positive and was seen by endo with in week of all testing came back.
Getting the correct dx and treatment made a huge difference in what numbers I could achieve.

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Thank you Brian for your input. I can see how the many variables that affect sugar control can be adjusted to achieve a better result. I will stay in the correct path :smile:

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Hi Brian, Rick and hobbit!

I tried adjusting a few things to see how much depends on me and how much on medication. And these are the things I got. For the past 2 dinners I changed the schedule to have them an hour before (around 8:30pm) where I live dinner is served around 9:00pm-10:00pm. Limited my cards to 5gr and a much leaner fat intake (chicken breast, lean meats) and the results were VERY interesting. Before I had a 2 hour post dinner BG level of 180-190. These last 2 dinners sugar level after 2 hours of my first bite of food were 140’s-150’s. No levemir before going to bed, and a morning BG level of 146!!! it is the best I had it in a long time! I was limiting my carbs to 20-30 per meal, but it looks like at night every gram of carb impacts my fasting glucose level tremendously. I am starting a 30-40 mins walk with a pair of 4lb weights in the morning to see if that also helps. Question to all of you… In the past I suffered fainting episodes after an hour exercise a couple of times due to sugar fluctuation. Is there anything I can do to avoid that? something I should eat? correct BG level prior to exercise?

Sorry if I am abusing with so many questions, I feel doctors who are not diabetic follow a very structured set of procedures that might not be appropriate for everyone. Thanks again for responding!

Gus

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I may be way off base here but it’s been my experience that mixing sleeping with digestion is nothing but problems for me. I find I get better rest when my whole body, including my digestive tract, can rest. I like to leave a minimum of three hours between my last bite and my head hitting the pillow.

You could easily test this hypothesis by eating much earlier than is your social custom and see what your blood glucose numbers do. I like the practice of eating later in the evening but my body objects.

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Hi Terry! I go to sleep around midnight every night. Perhaps I should try eating a bit earlier. How do you deal with a “right before bed” snack? and one more question… Are beans/legumes considered protein or carbs when creating balaned meals? I read in your profile “moderate protein and high fat”, can you explain what foods are involved and quantities?

Thanks!

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I try to minimize and totally avoid, if I can, evening snacking. I’ve found an ounce or two of nuts do not upset my situation.

I limit beans and legumes in my diet to about a half cup. Beans and legumes are higher carb along with their protein. A half cup of lentils has 12 grams of carbs after subtracting the fiber, an acceptable amount, but doubling it to one cup becomes more problematic.

I try to limit my daily carb grams consumption to 50 or less per day. So, a cup of legumes like lentils can take up 50% of that amount.

I eat eggs, cheese, full-fat cream, greek yogurt, full-fat cream cheese, sour cream, meats including beef, chicken, lamb, and pork. I also eat fish, low carb veggies like broccoli, cauliflower, tomatoes, onions, cucumbers, avocados, and all kinds of nuts. I do avoid/limit peanuts since they are really legumes. For fruit I like to eat all kinds of berries including raspberries, blueberries, strawberries and blackberries.

I do not eat or severely limit bread, rice, pasta, noodles, and potatoes. This “avoid” list caused me to put off adopting this way of eating for two years. One I decided to try it, it was much easier to make stick than I thought it would be. I went low carb, high fat (LCHF) to regain blood sugar control and was happily surprised that I lost 25 pounds of body weight in 90 days with very little expenditure of willpower. That was over two years ago and the weight has not returned.

This is a controversial topic with people with diabetes and medical professionals. I have observed so many healthy effects of this way of eating that I am sold. I started eating this way in May 2012 and I’ve never looked back. For me it is highly sustainable. I lost weight. I use less than half the insulin I did before and my blood glucose control is superior. I have way more energy and my risk of severe hypoglycemia is greatly diminished.

For quantities I encourage you to use the Calorie King online app. It presents nutritional info in a standardized nutrition label format. I usually eat meat in moderate portions, like a six ounce steak. I eat an eight ounce salmon fillet. For most of the vegetables I mentioned, I can eat a generous portion. I just let my body and blood sugar meter be my guide. I stop eating when I’m full.

Finally, I do enjoy treats. I like red wine and will have one to two glasses at most. Five ounces of red wine is five grams of carbs. I like chocolate but I keep my portions small. LCHF does not leave you feeling deprived, a major difference for most of the popular diets.

I left you with more than you probably wanted to know! Good luck with your journey.

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Unbelievable amount of info Terry! Do you allow yourself a slice of pizza? if you do, any special diet to compensate? How is your cholesterol doing with all the full fat foods?

I should have my doctor visit the website and read about “Real Diabetes”

Thanks everyone!

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you might be interested in this interview we had with Gary Taubes recently.

and this article in the Washington Post

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My cholesterol numbers are high but many LCHF’ers report normal in-range numbers. I’ve yet to read the cause and effect scientific smoking-gun case between cholesterol and cardio vascular disease (CVD). If high cholesterol caused CVD then every person with high cholesterol would have CVD. And heart attacks and strokes would not happen to people with normal cholesterol.

I’ve also witnessed a large increase in diabetes diagnoses, heart attacks, and strokes during the same period that all the medical professionals demonized dietary fat. None of this adds up in my sense of things. I’m sure your doctors will all disagree with my take on things. If I listened to doctors I’m sure I would not be spending more than 80% of my time in the 65-140 mg/dl range with less than 3% of the time hypo.

In case you might think I’m a complete medical renegade, I do take pills for my high blood pressure and low thyroid. I think normal BGs are the big prize in my world.

Your mileage, of course, may vary.

@MarieB, thanks for the Gary Taubes interview reminder. I missed it and I really like his style.

edit: I didn’t miss the original Taubes interview. In fact, I not only watched it live, I asked a question! (If I had a better memory, I would be dangerous,) It’s well worth a second viewing.