I think you are right thinking, Beth. I too am a data person. I spent my whole working life measuring and recording metrics. I’m lucky with my doctors that they take me seriously.
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Yes, we data-driven engineering types tend to drive our endos nuts. My endo is a lovely compassionate Harvard medical school graduate but I don’t think she could balance her checkbook. She asks me what she should prescribe and how much and writes the script. It works for her and works for me. This is especially true since I am unique at Joslin where they have not been able to type me over the past 30+ years I have gone there for treatment. They were finally convinced I was MODY, even though there is no diabetes in my family. I took a MODY test a few years back, which came back negative. She is now asking me to take a new MODY test with 60+ biomarkers as my last test had only 6 basic biomarkers. In the meantime, I continue to be a complete mystery to them. I am diabetic. If I don’t take fast-acting insulin with every meal and a few additional shots during the day, my BG immediately goes through the roof. I am unable to take Basal insulins such as Lantus or Levemir as they cause me to go dangerously low, especially at night.
I keep my A1C/GMI index around 5.7% and my TIR at 97%+. The only time I really go out of range is in the first 24 or so hours of a new Dexcom G6 sensor. The G5 was more reliable for me.
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I would get a c peptide along with your next a1c.
It will tell you if your pancreas is still being overworked.
It’s possible to maintain good glucose control, but still be hammering your pancreas.
Your doctor is not totally wrong suggesting more metformin, because it can help preserve your beta cells longer.
Yes type 2 diabetics can lose beta cells due to over working them, where type1 s lose beta cells from immune response.
I think it’s fair to check it out in 3 months to see how you are doing before jumping.
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See, I wish he would have told me this or I would have known this because this feels like an actual good reason to up my dosage.
I don’t want to overwork any of my organs. I want to work on being as healthy as possible. I’m fine with interventions as long as they make sense.
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Your Dr. is probably not really qualified to treat you specifically since you have questions and he isn’t able to go off of experience. Get your C-peptide checked. Insist on it. If your Dr. won’t do it then get a different Dr.
It won’t hurt your pancreas to wait until your next A1C test. Beta cell death in non acute type 1 or type 2 cases is very slow.
i agree with luis3 and firenza on the c peptide test, especially since you are newly diagnosed… and i agree with mm1 on the libre or libre2…youll notice you are probably often high bg when you feel normal, and the libre gives you graphs and tons of data that you will become addicted to…it will also help to see if the new medications or increased meds help…there are also many combinations of type2 medications that may help tremendously… i have a friend that was a mess until he was put on trulicity, but he tried metformin, insulin, different combinations, etc… seems like an endo or nurse practitioner specializing in type2 would probably be your best bet…and always remember to find out which medications are preferred by your insurance company… many are very similar…good luck and welcome
This image from diatribe should be in every endos office. It really shows the limitations of the HbA1c test.
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That graph is really interesting, and definitely aligns with what the diabetic educator told me. She said the stability of your blood sugar readings is just as important as a1c because if they’re all over the place with extreme highs and lows, you can still have a “good” a1c without having stable blood sugar readings. I like having the visual, thanks.
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Welcome to the group. The only thing I want to include in my opinion type2 diabetes is a disease in motion. It is progressive ,with all new medical changes we can live a longer life.Education is the key to self advocacy. Nancy50
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On the mark, Nancy, type 2 requires constant vigilance and the ability to change things up when needed.
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Forget what you believe the pharmacist said. It’s wrong.
The pharmacist may have used a few words that escaped your notice. or what he was looking at was either not an A1C test, or he did not know your last test date. If none of those are true, he’s dangerously incompetent. He doesn’t have enough of the right data. That’s possible but unlikely and in the US pharmacists can’t practice medicine; they can’t prescribe.
Your BG level at a point in time, or even for a day is not reflective of the A1C measure. It’s an average over 90 days.
Your diagnosis was less than 60 days ago. If your lab-tested A1C on 4/28 was 11.7 and three weeks later on 5/18 it was 9.0, you are already having blood glucose levels that if maintained would give you an A1C well under 7.0.
It’s basic math.
By itself an A1C of 7.0 is NOT even a reliable measure of your quality of BG management. That’s like an average BG of 154. If your BG was 70 half the time and 230 the other half, the average BG of (70+230)/2 =150, or close to an A1C of 6.9.
If you are worried that after 7/28 your A1C won’t be under 7.0, the next rational step would immediately ask for a professional CGM for ten days. Combined with a food, sleep and activity log, you will be able to see what is happening between fingersticks. You might be able to change what you are at one meal oper day to bring
Your daily glucose profiles plus your time in range will give you enough information to see where you can make the biggest simolest improvements and how much is necessary.
imo, ayone who is treating diabetes without CGM data today is operating in the derk.
So new update. I feel like every time I think I understand my blood sugar needs, I don’t. Two weeks from last Thursday, I started working on some past trauma with my therapist. My blood sugar levels were really high for me (doctor thinks it was stress related). Like 140-160 in the AM. So, I caved, and started taking the full dose of Metformin, and it brought things back to blood sugar readings that I’m used to (115-120s). Well, it’s been a week on the new dose, and I feel like it’s too much, but idk.
The reason I think it’s too much is 7/2 Saturday, for breakfast I had a spinach and bacon soufflé from bread co which normally fills me up and sticks with me for a while. Two hours later I was starving, but didn’t have a snack with me. 3 hours after my soufflé, I was shaking to the point where I felt like I was shivering and my teeth were chattering. I tested my blood sugar and it was 90 which is the lowest I’ve tested so far. My husband made me lunch (chicken, salad, corn, beans, and I had a spoonful of peanut butter after), but 2 hours later I wasn’t feeling much better. I tested my blood sugar again and it was 97. I wasn’t hungry, but I ate some ranier cherries, and finally started to feel good enough to go about my day. (I’m guessing the sugar helped?)
It happened again today. I didn’t test right when I started feeling shaky, but I grabbed a jolly rancher because I was afraid I would lose a ton of my day like I had the day before. 2 hours after the jolly rancher, I felt fine and blood sugar was at 111.
I don’t know if this is just normal as my body recalibrates to actual normal blood sugar levels or what. But I hate this. I feel like I’m eating sugar just to eat sugar at this point, and it doesn’t make sense to me. I don’t understand how a 90 or 97 can make me feel like complete crap, but then 111 feels fine.
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Yea I think you figured it out. Our bodies get used to high sugars and they feel normal.
I don’t feel lows until I’m under 60.
I try to not chase low sugars. It’s easier to bring down high than bring up a low so maybe take less metformin
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This is pretty much a universal truth when it comes to blood glucose management. With the exquisite balance of the hormonal management system malfunctioning it becomes very difficult to be perfectly in range every day.
For us type 2 DMs there are so many things that increase or decrease cellular insulin resistance. Leaving out the use of oral/injectable drugs, all stress increases insulin resistance. This can be emotional, physical, mental or spiritual. There are lots of ways to reduce the stresses of daily life. For me, it is doing a long steady bike ride.
None of the T2DM drugs are miracle drugs. All are meant to work in conjunction with proper diet and daily exercise. Every ad for these drugs make that clear.
Metformin is not a usual culprit in causing hypoglycemia. It does not actively decrease blood glucose levels, working in 3 ways. The first is to decrease the amount of glucose released from the liver, the second is to slightly increase insulin sensitivity of cellular receptors, and finally it slows the digestive system a bit.
The action of Metformin to bring blood glucose closer to normal is not immediate. One must take it regularly for a period of time for it to work. If a dose is missed or increased, it is not going to cause an immediate change. A high carb meal, stress and not exercising will.
What you experienced is what I call a false hypo. It is a fact that our bodies get used to elevated blood glucose levels and will cause a hypo feeling when it suddenly falls, even though it is in the normal range or even quite high, say a drop from 400mg/dl to 200mg/dl in an hour.
Reactive hypoglycemia is common in people who later develop type 2 diabetes. It is probably the result of over secretion of insulin in an attempt to counter cellular resistance. I had it all my life, and thought everyone felt like that when hungry.
Pure type 1s generally don’t have these problems, being able to manage their BG pretty precisely with proper dosing of insulin. Some type 1s, though, have problems with insulin resistance as well. They are sometimes called double diabetics. These type 1/2s have the same issues with gaining really good time in range.
Anyway it sounds like you are on the right track. Don‘t be frustrated. Be careful not to overtreat hypos, especially those that are at normal or higher than normal. This can cause a rebound where your BG spikes really high and your Beta cells go into overdrive.
Anyway, your body will get use to being closer to normal.
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Im trying not to overtreat. I’m trying to pick like a piece of fruit, or something on the carbier side that isn’t too carby. I hadn’t had any candy since I was diagnosed except for yesterday because I was scared of another false hypo (it feels real, and it’s scary to me), and it seems like my body is not spiking like it would have in the past afterwords.
I might give it a couple days and back off one 500mg pill. I don’t feel safe exercising right now after yesterday and the day before, and exercise is an important part of my routine, controlling my blood sugar, and losing weight.
And I hate this but I don’t feel like I can trust my doctor to advise me to adjust to a lower dose 
. I don’t feel like I should be making this decision on my own.
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Your doctor needs to be in on the discussion but you need to be in that discussion too.
There is no magic pill. There is only trial and error and a multi pronged attack.
Before I had cgm. I would wake up in the night sweating and crazed I would end up eating 2000 calories at one time.
I generally don’t have severe lows like that any more, but I do know how awful feeling low is. And it doesn’t matter what the number is. You just need to give it time and let your body adjust to normal levels.
Can you get a pill cutter and take half the pill?
I’ve never taken metformin but I don’t see why you couldn’t.
As for exercise, it’s best to do just after you eat so you won’t need to worry so much about going low.
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I think I need a new doctor. He did not seem concerned, and his thought is basically to just power through it.
I’m also having short stabbing ‘dots’ of pain that I’ve never felt before, and tingling in my ankles, and I’m concerned about it, and he says it doesn’t seem related to my diabetes because I have a knee injury. The problem is that it’s happening on both legs, so how is it related to both when the knee injury is on the one leg.
I’m so exhausted. I feel like I’m trying so hard to do everything right, and it just doesn’t even matter.
Yea a new perspective would really help. If you can find a endo or an internal med doc, you might have a different experience.
Tingling bilaterally is a big concern for neuropathy.
It’s not something to ignore.
Getting your sugars in line is also going to relieve that if that’s the issue, but it takes months of good control to allow nerves to heal.
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You need to exercise ,it is so important in the management of diabetes. Even a 5 minute walk is a good way to start then increase it in a week. Set a goal. Your body will adjust. It is not only good for your body, blood sugars, but also good for your mental health. Good luck figuring this out.
Nancy 50
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Heybeth - I don’t often post here but I was out looking for any experiences with Mounjaro but I saw your A1C and it looks like you are wanting to learn more.
You have already gotten some good advice so I don’t want to confuse things. Simple things like Nancy’s suggestion to do some walking is a great one. Start slow and in no time 2 or more miles is nothing. Exercise will allow your body to better use the insulin your body is still making.
I am not sure what your current A1C is maybe around 9. Without an AGP (ambulatory glucose profile) and a food log its really hard to put meaning to that number. Its like driving from NYC to Miami and saying your average speed was 55mph not knowing if you drove 120mph sometimes and 25mph others?
The one thing to remember is diabetes is a self managed disease. The T1s usually have to put more work into self management than a T2 but if you want to properly manage your blood glucose (BG) its going to take some work. Most general practitioners (GPs) can’t really help you and even with a good endo you are still going to have to do most of the work. Their are some very good coaching services but they are not cheap.
Your GP is going to treat your diabetes following the ADA’s standard of care (SoC). Its basically a recipe of drugs to prescribe based on the current situation. It is a “treat to fail” protocol. The ADA expects the first drug metformin to eventually fail. The standard then outlines what to prescribe after that and then when that fails the next one until everything fails and they put you on a basal insulin and then a mealtime insulin. Of course they could have put you on the mealtime insulin first but the fear is hypoglycemia and needles created an industry.
Being a T2 basically means your body is still making and still using “enough” insulin for your body’s needs when you are not eating. Eating screws everything up because you are no longer making enough insulin to deal with the sugar the food put in your blood.
So, the first thing all diabetics lose is post prandial glucose control - the after meal sugar spike caused by eating. Jenny Ruhl’s Blood Sugar 101 is a great primer if you want to learn more. Its not 100% correct but its good. She also got Richard Bernstein’s endorsement which says a lot.
A typical non diabetic A1C is going to be less than 5. Thats an mg/dl of 97 which includes post meal sugar spikes. Fasting glucose will be around 87 mg/dl. An A1C of 9 is an average mg/dl of 212. What we do know from extensive research is having an mg/dl over 140 for 2+ hours is when micro/macro vascular degeneration occurs. This is what you want to avoid. You want to blunt the post meal spike and get your BG below 140 mg/dl within 2 hours and keep it over 70. Richard Bernstein’s approach in doing this is through strict dieting. Personally I could never do what he does. He has some good books on this.
Now here is the thing. Just figuring out how different foods affect your BG without a CGM is hard. You can do it with a meter but you are going to end up like a pin cushion. For at least 2 weeks you are going to want to test when you wake, before each meal including snacks and then 1 and 2 hours after the meal. You will also want to get your number before bed. You will also need a food log to figure out how different foods spike your sugar. IMO its well worth getting the CGM for at least a month. Abbott’s Libre is pretty reasonable these days. The Libre3 was just approved by the FDA.
Assuming you get the CGM now you can see what your metformin is doing or not doing. Metformin will do nothing to blunt the post meal blood sugar. Now I will give you the bad news. Ralph DeFronzo was the guy who highly promoted metformin years ago and worked to get it FDA approved. Now Ralph thinks its not so good. His quote from Diatribe a few years back
“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)
What you will also see with your CGM is the GLP1s/SGLT2s/DDP4s which are the next “steps” in the ADA’s SoC will do little to control the post meal spike. The only thing which can is insulin and the only insulin which works fast enough is afrezza. Long story short is all these T2 antiglycemics are dealing with trying to deal with your blood sugar when you are not eating. The problem you have is while you are eating.
They are either trying to reduce sugar released from your liver when you are not eating or slowing down your digestion in an attempt to blunt the spike. In the case of SGLT2s they cause your kidney to spill sugar out of your blood into your urine at a lower level than it normally would around 200 mg/dl buts thats no where near 140.
Now, you may be saying this doesn’t make much sense. Why does the ADA have such as protocol? Thats a story for another day but what your GP is going to do is follow this SoC. If you go to an endo with an A1C of 9 they will put you on insulin but they will probably put you on a basal - long acting. Again the problem you are dealing with are sugar spikes after eating. You will want a prandial - RAA or afrezza and as I said the only one which is really fast enough is afrezza. Unlike the RAA’s its human insulin and it appears to the body like your pancreas released it so unlike the RAAs it works with your liver to prevent hypoglycemia which is the big reason we have all the antiglycemics to start with along with people don’t like needing to inject with a needle. Afrezza is taken with an inhaler, no needle.
The bad news is most GPs and endos will not prescribe. Then getting it is kind of difficult. It will run you $99 a box. Your insurance will probably not cover it. The box will last a month or less. The great news is if you get your BG under control you very may well be able to stop the progression and afrezza can help you do that. Here is an article which has some good tips on getting it.
One last thing before I really confuse you is the CEO of the company that makes afrezza was recently diagnosed as a T2. According to this article he is not using metformin/GLP1/SGLT2 or the rest. He is not following the ADA’s SoC. He is using afrezza and for good reason.
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