New and Confused

Hello all! I’m a new user and diagnosee, been lurking and reading for a few weeks now. I’d really like some advice and some tips to try. So far my trial and error method has produced a few results but not the ones I’ve been hoping for😧 A bit about me: I am 34 (female), and overweight at 5’4" and 185 lbs. I am slightly active - normal activities with a nightly or so neighborhood walk (about 2 miles). I did have gestational diabetes with my second pregnancy 4 years ago. Earlier this year we had a health fair at work, and my random finger prick showed a bg of 248. That was scary, so I set up a Dr’s appt and fell back on what I remembered of my gestational diet. My bloodwork at the dr was a fasting bg of 210 and an A1C of 8.9. Dr had me start on Metformin and I met with a dietician and a CDE. I worked my way up to 1000mg of Metformin twice a day, so 2000 total. After 6 weeks of not a huge improvement and watching what I ate, my dr also gave me 100mg of Januvia once a day. I’ve been on both meds now for 3 weeks, along with diet changes, and my bg is still above range. What else can I try?

  • Morning/ fasting is 140-160
    -2 hr pp is still a very wide range, anywhere from 150-210. I eat 30-45g carbs per meal based on the dieticians advice. She wants my daily total to be 190 but honestly the metformin kills my appetite so I’m usually 140-150g at 3 meals and a snack. I don’t have sweets at all and mostly stay away from refined carbs. Most of my carbs come from grains (quinoa, brown rice, Ezekial bread) fruit, or beans.
    -I do walk almost daily, but haven’t kicked up the mileage yet due to time constraints.

I called the dr earlier this week to voice my concerns about my numbers not being in range and was told to keep doing what I’m doing until my follow up in August. Is there something else I could be doing? I’m frustrated and confused, and would like my numbers to be much lower.

Perhaps some additional labwork (other than strictly BG and A1c) to confirm the T2 diagnosis?

You may have to cut carbs more. Although each person’s diabetes varies, I cannot eat any of the foods you listed. In addition to avoiding sugar I must also avoid starch.

A technique that has helped many of us is called “Eat to Your Meter”. You set a goal, mine is to never go over 140, others are stricter. You can then experiment with various foods and see which are causing you problems. Although most people understand that sugars are bad for diabetics most are surprised to learn that starches can cause problems.

Through trial and error you will find which foods you must avoid completely and which you can just cut back on quantities of.

The internet is full of Low Carb recipe sites. You will find there are lots of foods you still can eat that can be prepared in interesting ways so you don’t get bored. Many of us have found we can tolerate berries as a substitute for fruit, again your meter will tell you which ones work for you and in what quantities.

Many assume this kind of diet will be heavy on meat. In fact its heavy on non carby vegetables. One good way to think of it is keep meat quantities the same and substitute more vegies for the starch.

I found the Bloodsugar 101 website very helpful when I was first diagnosed. You also might find searching this website for “Eat to Your Meter” and “low carb” to be of help.

Changing my diet was quite a drastic change but my meter told me it was necessary. I have been eating low carb for 8 years now and it has become second nature.

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I went on Metformin 2000 mg two years ago. Gained a lot of weight. I just started a dpp4 inhibitor similar to Januvia and my weight has stabilized, and because this new drug controls my appetite I am sure the weight will start going down. That in itself will help with control.

a good portion of women who had gestational diabetea go on to develop type 1 diabetes. minimal to no response to oral meds raises a big red flag.,
thorough testing (antibodies, cpeptide, insulin levels)should be first order.

the dieticuan is old school. you may have bettwr success with lower carb / eat to your meter.

I am 24 years type 2, had 3 kids,no gestational D. I am 64. Fruit ,beans make my bs go up. I need to exercise right after I eat them. Berries in season are my best fruit. Night meal I eat lower carb veggies,meat. 15 carb snack at night. Again eat to my meter. Swim,walk are my to go exercise. Takes time to figure this out. Nancy

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One reason I wanted to go back to the dr now vs waiting until my follow up in August was the additional tests. I’m going to keep pushing on that front.

As far as low carb goes, I’ve done Keto before (last fall, before diagnosis) but was absolutely miserable for 6 weeks. I didn’t have the “flu” symptoms, but it really tore my stomach up. To add insult to injury, I gained a few pounds instead of losing. I’m hoping I could do more of a modified low carb but I feel like I’d have to do something like the Keto to be able to get to a normal range and eat to my meter. I’m rarely under 140 as it is, even when eating a low carb meal or going a long time between eating.

@McChesney Yes, I’ve noticed a huge decrease in my appetite as well! It does make portion control MUCH easier.

I eat oatmeal ,berries every morning,1 slice bread at lunch,milk9+3 , yogurt sometimes… I could not do low carb. I am busy all morning. Exercise,gardening,yard work, Y. Nancy

I am often able to “request” via email/phone the Doc to provide an order for the particular tests that I want done. I then take the order to an outpatient (my preferred is Quest Diagnostics - convenient and good) location for the blood draw. Most lab work is resulted overnight - some specific tests take a few days longer. Then when I actually have my Doc appointment, the results are in and the Doc and I can discuss the results. This could save an entire Doc visit.

A side comment about medications:

There is a class of widely used medications called sulfonylureas. There are a number of them and they work by stimulating the beta cells to produce extra insulin, in effect kicking them into overdrive. There is a widely held school of thought that doing that can hasten the day when the beta cells give out entirely (or nearly so), and so some people avoid these drugs and pursue other avenues for that reason.

Now, Januvia is not a sulfonyurea. It belongs to a class of drugs called DPP-4 inhibitors. The name doesn’t matter, but it is important to understand how it works. It doesn’t directly stimulate the pancreas in the way that sulfonylureas do, but manipulates some hormones that can have an indirect effect that is somewhat similar in its end result.

Probably TMI. Sorry! :laughing:

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no TMI imo David. I have a family member who recently needed to add something to the Metformin, after taking Met for 25 years. His doctor suggested Januvia, and I was concerned about it possibly putting stress on the beta cells. I have no idea if this is really the case, but anyway, he’s recently started basal insulin.

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Another reason to reconsider taking sulfonylureas, many people have experienced significant hypo events seemingly “out of the blue” while on them. I ended up in the hospital several times due to sulfonylureas…

That can happen, yes. Just as overdosing on insulin and undereating can cause a low, the same thing can happen with a sulfonylurea since it generates “extra” insulin.

Insulin has another advantage over sulfonylureas, aside from the obvious one of not further stressing the pancreas: insulin dosage for a given meal can be adjusted with fair precision to match the food being consumed. Since sulfonylureas come in pills with fixed dosages and much less flexibility, the meal has to be adjusted to match the medication.

So now that I started the dpp 4 which is working great I actually take slightly more of the Sulfa I have been on. . They work well together. The folks that hate sulfa drugs manufacture drugs that are not meant to be taken along with sulfa medication.

Its great news you are proactively facing your BG. As you probably already know about half of all gestational diabetics develop T2 later in life.

The first thing I would do is put a 24/7 profile of my BG together for the next 2 to 4 weeks. This is most important prior to going to your doctor so you can have a well informed discussion and formulate a plan. Your August appointment will then be perfect timing.

Without poking your finger a lot the easy and rather cheap way to do this is with Abbott’s Libre. If you are in the U.S. you can get it on ebay or other internet sites and then download the sensor reading app for free. Get 2 sensors which last 2 weeks each.

Very important is to log each meal and the BG before and 1hr, 2hr, 3hr after. Of course you also want to take it when you wake and before bed. The Libre data can be loaded into an app or you can just keep a paper log. Here is a weekly log from Gary Scheiner’s site Printable Diabetes Logsheets | Integrated Diabetes Services

Concerning the metformin, it will never ever give you meal time control which is the principle issue for T2s. BTW, neither will all the other T2 meds. The only thing which will directly address the sugar spike is a meal time insulin. By far the best for T2s is afrezza since it mimics phase 1 pancreatic release and is in and out of you body limiting the chance of hypoglycemia. Its also the same molecule as the natural human insulin molecule and it contains no preservatives which can cause other issues.

No other insulin but afrezza can mimic phase 1 release which is very important to signal the liver to stop glucose production and to also blunk the sugar rise. Ideally you want to keep it under 140 but never go above 180. This may take a little titration practice but not much. Always take more than less with afrezza. Your liver will kick in to prevent the hypos with afrezza, just like your body naturally works.

What we also know is early insulin intervention provides a pretty good chance of stopping the progression and if you keep tight control 70 to 150 which should be pretty easy to do with afrezza you have a fighting chance of seeing at least some beta cell regeneration.

Most metformin users are not hitting a 7.0 A1c which is an average BG of 154 and overtime see a progression of T2. Microvascular damage starts at 140. I would stay away from all other T2 meds as no one is sure of the long term issues. We have seen others like orinase and avandia and what a mess they made. Now we are starting to see issues from the rest like Invokania. With Januvia there are already lots of lawsuits linking it to pancreatic cancer. IMO, there is no need to take this risk as none of the T2 meds will address the main T2 issue, meal time sugar spikes. In the end they all just make a big mess.

Best of luck. If you can keep a tight range for 3 to 6 months you just may see a significant improvement.

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I will second what @JustLookin and @Tim35 said, it may be important to determine if you actually have Type 2 diabetes, or if you have Type 1 autoimmune diseases. Autoantibody testing (GAD, ICA, IA-2, IAA, ZnT8) can be used to differentiate between autoimmune (will be positive for one or more autoantibodies) or non-autoimmune diabetes (Type 2, etc.). About 10% of women with gestational diabetes are positive for the autoantibodies, and have autoimmune gestational diabetes. Here is a blog that I wrote on autoimmune GDM that I hope you find useful. Also, the autoantibody tests are described in this Diabetes Forecast article.

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Thanks all. Yesterday morning I finally convinced my dr to rethink this. I’m going back in tomorrow for more labs, so we’ll see what the results are. Hopefully the labs can direct me to the best course of treatment, whether it’s insulin of any type or something else. In the end that’s all I want - treatment that works.

Interesting notes on the links. I don’t have family history of any sort of diabetes, but my mom has lupus and hypothyroidism. I see from the links that the 1.5’s are more likely with a family history of autoimmune disorders.

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Great job staying on top of this. Your doing a great job. Don’t panic.Your gonna figure this out, but its gonna take a little time. :slight_smile:

My mother’s BG was once 43 on a random test in her doctor’s office when she was on a sulfonyurea. The fact that she did not know would indicate (to me) that this was a regular occurrence… He took her off that med immediately.

Good point. I experienced some scary lows early on.