Please help... Can't get BG down below 175

Hi all - sorry for the SOS but I’m getting so frustrated and so confused. I’m a Type 2 and I have been on Metformin for about 2 weeks. First week 1000 mg once a day. Then I eased into my prescribed dose of 2000 mg (1000 mg 2x a day) and had terrible nausea, stomachaches and loss of appetite so my doctor put me on Metformin ER (extended release) to ease the symptoms and it really did help knock out the nausea. However, my BG has been testing high consistently the entire 2 weeks. The lowest I saw in the last 2 weeks has been 168 first thing in the morning about a week and a half ago. This is despite eating veggies, very few fruits (only one apple a day), cutting out 90% of the carbs I was eating and only allowing some good carbs. I’ve poured over every site, every book, every Diabetes resource to try and find a way to understand why I’m still high.

No matter what I eat or don’t eat I stay between 175 - 289. AND on top of it all, I’ve been exercising everyday and after exercise my BG goes UP! Is the Metformin not working? Or does it take some time to bring my BG down? Should I just be patient and not stress out? I’m at my wits end and am testing about 10+ times a day. Please help me figure this out. I feel like the stress alone is making me spike more and I really would like to understand what’s going on and what I should do to get this under control. I would really appreciate any advice you have to offer. thank you all.

This is a real medical situation but I believe that your pancreas is working very little at the moment. This can be controlled by your MD or endo. I think it’s time for you to start insulin.

You need to talk to your doctor immediately. Either you are making very little insulin, or you are VERY insulin resistant. Metformin is not working for you. There are other drugs your doctor can help you to try. Also have your doctor check the function of your pancreas itself. But please call your doctor ASAP. You may not actually be type 2 at all!

I guess my thought would be to give it a while. I’m thinking it may take a while for the metformin to do its job. But it would be good to talk with your doc about the issue, and perhaps–well, instead of racing to go on insulin, I’d ask about taking some glyburide to try to get the sugars down, at least until the metformin starts to work, if that is the problem.

What’s wrong with starting insulin? It’s the most natural thing you can take… The glyburides are expensive aren’t they?

Actually, no. The brand name ones might be a bit more, but glyburide is the generic and very cheap. There’s nothing wrong with insulin, but I have avoided it. I watched my mother take it for years and I’d personally like to wait till it’s necessary before starting that process. If I can get my sugars down by, first, taking metformin to get the insulin coursing around my body into the cells where it belongs (that is, fighting insulin resistance), and if necessary, a little glyburide to help my pancreas create more insulin, that makes sense to me. When it comes time that no longer works, then insulin.

Hey, lilypad. when I started metformin, I had the nausea too. doc prescribed omiprazole 20mg X2. solved the nausea and eliminated acid reflux, too. You might want to mention it to your doc`. It is an older drug and resonably priced at walmart.
You really need to get the BS under 140. It is all up to you. About 4 months ago, my doc added glipizide to my meds. It made me ravenously hungry and I was constantly fighting lows which forced me to eat more than normal. It also made me sensitive to sunburn. I dropped it after a month and doc put me on insulin. I had mixed feelings about giving myself multiple shots a day. The thought of sticking myself scared me, but the other side of me thought it might help me feel better. I’ll skip over the details of my first injection, but trust me I couldn’t have spit if my life depended on it.
Now, it is three months later. I have my bad days, but yesterday my BS never went over 150. I feel better. I sleep better. I have no “opathies”, and I am optimistic about the future. My depression is better and my appetite is “normal”. I am losing weight, too.
so, tell me what is wrong with this picture? Everyone I have talked to have said the same thing…Every one was irritated that they took so long to start insulin. Also, all the oral meds have long term side affects and the new ones have unkown side affects… Insulin is natural.
Can you explain to me how you will benefit from waiting to start insulin?
Peace and health

I am not opposed to taking Insulin but I just really wanted to hold off taking that step if it is avoidable. Being only 38 years old I’m afraid of what that means… not to mention my extreme fear of needles. Lancing myself for testing is already so traumatic that I’m not sure what daily insulin shots will be like. I’m sorry to sound like such a baby - I’m just being honest about what I’m feeling. If I really get to the point where I have to go on insulin, I will. I’m just wondering if perhaps there are other avenues I might be able to explore first. I have read that it can take Metformin some time to work, is this anyone else’s experience? Also, I just switched from Metfmorin to Metformin ER - is there any difference in it’s ability to effectively control BG? I will also call my doctor today and ask if I should be concerned yet and if we should pursue another line of attack here. I will also try for the next few days to cut all carbs out and see if that does anything.

Oh, also - what is Glyburide? Is it common to take Metformin with something else to help level out BG’s faster? Thanks for your help.

I have never heard that Metformin has a cumulative effect, which is what would be implied if it took a while to work. It may take a while to find the right dose, but the OP is at the maximum on-label dose, if I am not mistaken. Metformin works within a couple hours of taking it, the ER version starts working the same amount of time after you take it as the normal version, but lasts 24 hours.

I was nervous about injections too, but I have just finished my first cycle of fertility meds, which included two different injectible meds. No pain AT ALL. Dr. Bernstein’s book talks about the techniques for painless injections and they really work. “Mind over matter.”

I take Metformin and Avandia together. They work in different ways. Of course Avandia is pretty controversial. I can’t speak specifically to Glyburide, having never taken it.

Glyburide is the generic of the med Danny mentioned, Glipizide. It’s cheaper, of course, in the generic form, and just as good. Several months ago when I was having some issues that caused the metformin not to completely do its job (some juggling of blood pressure drugs that I won’t go into), I went on the smallest dose of glyburide in addition. I split the pill and take half at night and half in the morning. Yes, I have to watch that I don’t go too low, just means regular testing and watching out for those “low” feelings, but it has helped me keep my control.

Oh, and I forgot to mention. Glyburide/Glipizide is a “simpler” med I believe than Avandia and some of the other oral meds, without the scary kidney side effects etc. What it does is stimulate the pancreas to produce more insulin. It’s what they put me on when I was first diagnosed, and I finally found an endo and got on metformin instead, because it didn’t make sense to me at that time to work my pancreas to make more insulin when, as a Type 2, my problem was that I had lots of insulin in my body that couldn’t be used as it couldn’t get into the cells, which is what metformin helps. It just makes sense to me to do that before doing things to add more insulin.

I noticed you said that you were only eating some good carbs. Are you aware that ALL carbs make your BG go up? I would give a try at cutting out almost all carbs for a day and testing a lot to see what makes a difference. That means high carb veggies too- potatoes, squash, peas, corn, tomatoes, carrots etc. Try eating just protein, fat and non-starchy vegetables for a couple of meals and see if that works. Also, do you know for sure you are Type 2? If you are late onset Type 1 (LADA) the oral meds won’t work for you.
Good luck,

It is my understanding from the research I’ve read, that by the time a person is diagnosed with T2, 50% of their beta cells are dead which is why new diabetics have high post prandial BS readings. As your beta cells die off, your basal BS begins to rise which accelerates the beta cell death rate which leads to a higher and higher fastin BS. At that point you are in real trouble and presenting as a T1 dependent on insulin to live.
By starting insulin as soon as possible, you accomplish too things. first, you reduce Basal blood sugar and if you can get it below 140 your loss of Beta cells is reduced or eliminated and sometimes they may even begin reproducing.
Secondly, by using insulin you reduce the strain on your existing beta cells which then gives you a reserve you can draw on if your insulin needs increase. This is why it made no sense to me to use glipizde. for me it seemed to depleate my insulin reserve. Also, the research I’ve read suggested a sulfanylurea (glipizide) works well, but only for about 18 months, after which BS will begin rising again.
for all these reasons, I opted to begin insulin now to preserve beta function. I may not have to use it forever, but if I do I am going to be very knowledgeable of it.

I completely understand your fear of needles. I used to be bad, too. The first time was hilarious and I would have laughed about (I do now). The first time was with saline, and everytime I got close to my abdomen some mysterious force divertedd the needle and I missed about 20 times. Eventually, I became more afraid of the nurse than the needle. she kept inching closer and closer to me, so I aimed the needle and slooooooowly pushed it in. I was stunned. It was painless. Now, I fill the needle, stick myself and go about my buisness. No big deal.

BTW, something else you might want to investigate is Janumet. My girlfriend takes it and it dramaticly reduced her need for insulin. She only takes 10u of 70/30 to maintain her Basal BS. Also, You might want to check out some Alpha Lipoic Acid. It is a super antioxidant and willl jelp prevent /reverse the “opathies” common to high bs. The cheap stuff from walmart works as well as the ghigh dollar stuff from GNC.
I’m puitting a link below to the BD site. My story is here. can you guess which one is mine?



Here are some tidbits of motivation for you. I was diagnosed type 2 about 6 weeks ago and followed the metformin path that you’re on. I was diagnosed with fasting glucose at 320 and I was only moderately overweight (BMI of 27). I too went on an aggressive diet, started really exercising, etc and became freakishly obsessed and depressed about my readings. It was a good two weeks before I consistently “scored” under 200. My doctor gave me a very low dose of glipizide (glucatrol) and my BS readings dropped about 40 points. Three weeks ago I was waking up to 150’s, two weeks ago 140s, this week under 110. I feel like I have a new lease on life and never expected to have this type of turnaround after my first month’s struggles.

I also had very high cholesterol (259) and low HDL (33). I go to the gym each morning before work and do 30 min of cardio and 20-30 min of resistence training (weights). This morning, the YMCA was screening for blood glucose and cholesterol and I ended up with a 106 (after breakfast and treadmill) and my cholesterol was so low that the meter didn’t return a number. The screener told me that only cholesterol levels exceeding 150 show up. Needless to say, I was totally thrilled.

I mention all of this because I went through that very mental nightmare last month and will tell you to stick with it and be strong. It does get much, much better with proper diet and directed exercise. BTW, my blood glucose also rose after exercise the first month. I understan glucose is literally exited from your muscle fibers when you are going through the “detox” phase. This is actually good thing. Hang in there!

I had a similar experience that Jason did with my BS readings. I was diagnosed in July of 2007 with a A1c of 12.7. When I started taking insulin, I was on Humalog mix 75/25, at a very low dose, 12 units per day right after I got up in the mornings. My numbers started dropping at a pretty rapid rate.

After about 10 months, in May of this year, I had another A1c test, I had a couple others in that time period that were coming down, that was down to 5.69. When my numbers got that low my doctor allowed me to begin taking Metformin ER 500 mg 2 pills per day. My readings are still in the 95-110 range almost every morning, sometimes in the 80’s in the afternoons. Saw him last week and he said to keep doing what I am doing, as everything is under control.

I was like Danny, scared of needles, but these shots don’t hurt nearly as much as it does to test your blood some times. Very thin, very short, hardly ever hurt at all. Don’t be scared of insulin, it is your friend and I am walking proof that you don’t always have to stay on it. I may be the exception, but I am glad my doctor put me on it to start.

Thanks Big Al. Your story inspires me. Maybe in time I can get off the meds too, but if I don’t at least I have the tools I need to control the situation. I’m complication free and delighted to keep it that way.

Hi Lilypad,
I am so glad you are talking about your meds. I too was first placed on pills. They didn’t work, but things kept getting worse. We tried byetta. Same problem. Well I really didn’t want to start the insulin and was scared. I wasn’t afraid so much of the shots as trying to figure out the dosages. I am so happy the doctor had me try the insulin. Right from the first I felt better. Taking insuluin shots is just like swallowing pills or tying your shoes or shampooing your hair or taking a shower It is simply a part of what you do to take care of yourself. Everyone has given you very good reasons to do whatever you have to do to accomplish your goal. So I will only add that we are all here for you. Whatever you need to get through we will all help. My best to you.

Thank you all for your advice, your words of encouragement and your personal stories. I am feeling so much better emotionally today after reading all your responses and also after visiting my doctor this afternoon. She explained that because I had been high for so long that the Metformin is going to take a little time (3 - 6 weeks) to really bring my base back to the 100 level. She suggested I stay on course with diet and exercise and keep up my Metformin and we’ll check in again in 2 weeks to see if any change in medication is necessary.

My doctor also explained the same phenomenon that Jason did about exercising and a rise in BG levels. She said that because the exercise was such a new thing that my body is releasing more glucose to compensate but that over time my body will get used to the exertion and will learn not to react that way. She also mentioned I shouldn’t get to “obsessed” about testing 10 or more times a day because the stress of it might also cause spikes… All in all, I will stay the course and keep working. I am not ruling out Insulin as my doctor and I did discuss it. But she and I both agree that it’s so early in my plan that we can try a few other things first before taking the Insulin route just yet.

Thank you all again