Hello everyone, I’m so grateful to have found this site and hope it will provide the support and advice I’m looking for! Here is my story, and I am desperately seeking some answers:
I was diagnosed a year ago, Type 2 following gestational diabetes. A1C was 6.0, endo wants it below 5.7. In the past year I have worked really hard to lower this with diet and exercise but I can’t get the A1C to budge! Even after going down to 15g per meal or snack (low glycemic), exercising mod-high intensity every morning, dropping extra pounds so BMI is now 20, the A1C came out 6.0 and 6.1 the next two times. Now I’ve been on Januvia for almost 3 months, next A1C is in two weeks, but even with Januvia I saw no change in my levels. In fact, they seemed to go UP almost to the day of starting the meds. So, right now morning and fasting levels are around 5.7 (102.6, same as at diagnosis) but after I eat 15g of low-glycemic carbs, my levels are around 9 (162) post-prandial. This is worse than six months ago, before I started the militant diet, exercise and med regime.
Does anyone have advice for T2 that does not respond to anything? Could it be that my diabetes is progressing too quickly for any of this to have effect? I am getting very frustrated at seeing no results whatsoever. My GP had said “Oh, you’ll be able to control this with diet and exercise for YEARS” yet here I am, just one year later, already on meds that have not for one day shown to have any lowering effect on my numbers.
Thank you for any advice or suggestions as to why my body might not be responding at all! VERY FRUSTRATED and out of ideas!
Your numbers are pretty good right now. A1c just needs to be below 7.
First of all, please try to relax. An A1C of 6.0 is like being 5 pounds overweight. Yeah, 5 lbs is 5 lbs, but it’s not morbid obesity.
Please don’t focus on a single number and let it run your life. Your GP is correct that you MAY be able to control it with exercise and diet for years, and 6.0 is NOT out of control. It’s a slightly elevated. One year of 6.0 is not going to kill you. There are people here who would kill just to have YOUR A1C for a year. (Me included.)
The ‘normal’ range for the A1C is 4-5.9%. You’re very close to the mark and you seem to be doing all the right things.
Don’t let the endo bully you, either. If the endo wants to help you get it down below 5.7%, talk about other medications you might take in addition to or instead of Januvia.
You’re doing good, believe it or not.
Terry
Welcome!
Great you have an endo who has high standards for A1cs. Most are content with ones over 6.0 & don’t think patients are capable of doing better. Sorry for the frustration when you’ve been working so hard.
Have you tried Metformin? It’s been around for a while & many believe it’s far safer than Januvia. There’s also a combo med of Januvia & Metformin caled Janumet, but I don’t how safe it is.
Has your endo done C-peptide & antibody tests to determine you really are Type 2? There’s the assumption that adults are T2 when in fact Type 1 can occur at any age. I was diagnosed T1 at 53 with no family history. Many, many stories here of people who were misdiagnosed T2 for years based on age &/or weight. Discussions here about LADA for you to search.
If you are indeed T2 & oral meds don’t help, T2s are put on insulin to keep BG level. This also prevents beta cells from burn out & doesn’t have the side-effects of meds. With your readings, you’d need low doses. Some just use long acting background insulin (basal insulin) & others use rapid acting (bolus insulin) to control post-meal spikes. Still helpful to eat low carb & exercise. Insulin isn’t a license to eat anything:)
Your numbers are good, yes they could be better but at what cost. I am a type 2 and in the past I have been in Januvia and it made sick to my stomach and almost ruined my life. Also for a year I was on Lantus and Humalog only with no pills. My endo at one point was in the school of tight control but he wanted to mix in a bunch of pills to make it happen. The tight control he was trying to achieve left me almost insane with worries about getting lower than a 6. I am at a 6.3 now and my new endo does not seem to mind that I am at a 6.3. According to my meter my avarage is 120. I would like it lower but not at the cost of making me insane and throwing up every day for every meal. I just started excercising like a mad man and that suits me fine instead of popping 6 pills a day for diabetes. I love to be a on a bicycle so I like that better than pills.
I told me next endo that if we needed to get lower it would be with insulin and not with more pills that have bad side effects. So now we work on diet and excercise and an A1C of 6.3. The dietician alos seems to help me a lot. I went from 7.1 to 6.3 A1C.
Thanks for the responses, nice to get such immediate feedback! Yes, endo would like it to be under 5.7 since I am in my 30’s and have (hopefully!) a good 50+ years to fight this thing. He said to aim for normal numbers now and as long as possible; it may not seem to make much of a difference now, but it will make a world of difference when I’m in my 60’s and 70’s and beyond. My frustration is mostly at seeing total lack of response to the changes I made. If I could achieve 6.0 while eating cookies, muffins, mountains of pasta, and other horrific junk, while exercising maybe once or twice a week at best, wouldn’t one think drastic dietary and exercise changes would have SOME effect on the A1C? Or at least the Januvia? Maybe even 5.9? A glimmer of hope? Please??? I guess I might as well get used to many years to come of this…my dad is Type 2 and tells me one can never expect the body to ‘behave’ as desired. Numbers go up, down, in and out of control, no correlation between cause and effect. Sigh. A hard lesson for a Type A control freak to learn. 
Thanks, Gerri. This is really helpful. I have poked around online and am beginning to wonder if I might be LADA, though I know next to nothing about it. I will ask about the tests at my next appt. I would almost prefer going on insulin because I am not a fan of meds and their side effects. i am particularly afraid of their long-term side effects, esp. with a brand new one like Januvia.
Diet and exercise only? Are you off all pills? that’s great! I am similarly anti-meds. Unfortunately, my endo is head of research and keeps trying to get me to enroll in his clinical trials for new medications. I feel like he sees me as a lab rat. Luckily Januvia does not make me throw up, but then again, it doesn’t lower my numbers, either. A very expensive placebo!
Mine’s a minority opinion because I also believe that as close to normal is something to strive for. Please keep doing what you are with exercise & food. If you’re becoming more insulin resistant without control of carbs & exercise, your numbers would be higher.
Hormonal changes can play havoc with BG, if you noticed higher readings during your period & also when you’re ill.
Januvia doesn’t help everyone. Metformin doesn’t either, but worth discussing a change with your endo to see what works for you.
There’s always cause and effect with BG levels, it’s just that the variables are hard to keep track of and measure so it looks like random noise. You’ve made some great changes in your lifestyle and diet that are going to pay dividends down the road. If you’ve dropped your BMI, they are already paying dividends. Those changes, however, have added more variables to deal with. You’ve only had a year to sort them out. Exercise alone is going to take a bit of working with to figure out what your BG is doing and how it is contributing to to overall control.
Like others have said, your A1C is just one number, an important number, but just one number. Like Terry said, you already started with a near normal A1C, and by changing your diet and exercise and medication, you’ve added complexity that can’t be expected to improve your A1C number without more tweaking. Heck, look at some of the discussions in the past few weeks and you’ll read about how stress alone can really screw with your BG. If you are a Type A, stressing over every detail could be counterproductive.
You’re doing great! Please remember that! Now take your Type A personality and put it to some good use by testing, testing, and more testing. Follow that with logging, logging, and more logging. Patterns will reveal themselves and you’ll start to make sense of things.
It’s irresponsible to make a diagnosis with appropriate tests, though this is common. Since your endo is the head of research, hopefully you’ve had these tests before he’d suggest enrolling in clinical T2 trials.
I’m not a fan of meds either. I have to be near death before even taking an antibiotic, Januvia has had some bad press.
Jenny’s site is great http://www.bloodsugar101.com. She does a lot of research & explains things well. Though rarer, there’s also another type called MODY. This is determined with a genetic test.
My first endo wasa researcher as well. I was a regular subject in any number of his studies for 20 years. I’m still on the list at his former practice and still get called in occasionally. My situation is a bit different because I’m T1 and had little hope for not being on at least insulin the rest of my life, but I have had access to treatments and testing you can only get as part of cutting edge research, with what I would consider minimal exposure to risk.
…you need to go paleo and get off the high carb ADA meal plan.
You can email me for free advice cooksey.steve@gmail.com
I WAS on 4 shots and 4 meds…now… nothing.
OR you can stay on the meal plan and continue a slow road to … well we all know where it leads.
Hi Ligeta,
I am T2 and I have very good results with the Metformin. I have never had Januvia though so I can’t really compare. I also eat low carb and I sometimes have more than 15 per meal but not go over 120 (because I start lower before I eat). I think the Metformin might be what is helping so much. I am new (only 3 months in) so I can’t give too much of history. I get my A1C retested againt his week - it was 9.2 3 months ago - with my numbers almost all below 140 99% of the time I am expecting good A1C this time. But 6 sounds good to me. I don’t know why your doctor wants that 5.7???
Although different doctor will say different things. Some will quote you different numbers of A1C that they want you at or that they think is “normal” range. Your numbers don’t look bad - the only thing that might be of concerned is how often you go above 140 (the 162) but even that isn’t that bad - maybe that is what your doctor is looking at? Over 140 is when damage is supposed to occur. If it is getting harder to keep your numbers down, you might need a different approach.
And yes definatley find out about your C-peptide - that can decrease with time. A higher number means you are a T2 but apparenlty it can change as this disease progresses. (ie mine was 12 so that puts me in the T2 althoug my dr never really said - you are a Type 2 - I had to figure it out on here!) So you need to keep your eye on that number. If you dr did a full blood panel on you, I bet they probably tested for it but, like most doctor, they don’t discuss it with you (I was super nosy and asked my doctor every thing) and get copies to if you can!
Educate yourself on things like this because the doctor will just figure you don’t know what you are doing and not tell you your results. If you know your results and what they are and understand them, than you can be smart when you go and see your doctor (and also help you decide if you don’t like the direction your doctor is going and you need to go shopping for a new one! ) You will have this for the rest of your life (i know sad though) so you might as well learn as much as you can about so you get the proper care. I have no qualms in switching doctors if I think I need too - some people feel weird about it but not me.
Stay on this forum - you will learn lots!