Background - I was diagnosed T2 in 2007 with an A1C of 12. Doc started me on 500 mg of metformin and with exercise and diet changes I lost some weight and had my A1C down to 5.0 by the end of that year.
I've been maintaining A1C's between 5.5-6.2, with FBG under 110, for four years.
Now all of a sudden my last A1C (in Sept) was 6.7 and my FBG has been rising steadily since the end of the summer. Lately it's usually in the 150s. This morning it was 181. It runs high throughout the day too; the lowest I've been able to catch, after exercise, is 114.
I haven't changed my diet, except lately to cut back on carbs again - most days under 150 gm. My exercise has slacked off quite a bit and I've gained back about 15 lbs (of the 35 I lost initially). I'm also under a lot of personal stress over my situation at home, with an addict husband whose behavior is getting more and more intolerable. I may need to move out soon and have no idea how that will work out ... So that's probably a factor too.
I was on antidepressants for a year, ending them in August because I felt they were causing carb cravings & contributing to my weight gain.
I made a dr. appointment for tomorrow to start antidepressants (again) but I also want to talk to him about my numbers, and I'm not sure what to ask, or say. I want my numbers back where they were but I don't understand why they're rising so fast, so I'm not sure what to do.
I've been reading this forum and sort of freaking myself out. Is my pancreas dying? Am I possibly really T1 and that's why the meds aren't working anymore? Is it dawn phenomenon? Should I ask about insulin? Should I increase the metformin?
I've never seen an endo or a nutritionist. Should I do that now? I'm very willing to change my diet to even lower carb, if that will help.
I'm just feeling very scared and overwhelmed, and looking for input and support.
I'm Type 1 since childhood so don't have any first-hand experience, but from what I've read it's not uncommon for Type 2s to need two or three medications to control their blood sugar. It seems like you are on a low dose of just one medication, and maybe that's not working as much anymore. It seems that from what I've read, those who are really Type 1s tend to have very high blood sugars despite extreme effort (such as eating very low carb, like under 50g a day, and exercising every day and still seeing numbers in the 200s and 300s). I may be wrong on that, though, maybe some LADAs can chime in.
Also, from personal experience, stress can raise blood sugars a LOT. If I am really stressed I can eat nothing and find my blood sugars in the 300s easily. So if you are really stressed, that could definitely contribute to higher readings, especially if you've also stopped exercising and gained back some weight which would increase insulin resistance.
It might be worth seeing an endocrinologist as they understand the medications better and, if you are interested in insulin, would be able to give you more information on it than your GP would be able to.
write all your questions down, and everything you've noticed about your situation and your current numbers. Do not guess at what is going on. There are so many variables; it is too difficult.
Take all of this to your Dr and see what he/she says. Also, make an appointment to see an endo to gather more info, regardless of what you GP says. gathering info from several sources always helps calm my nervous.
After you have seen the Dr's take a little time to digest what they have said. whatever the advise they give you, do what feels right to you - if it's more medication, or some blood work - whatever it is, make sure you are comfortable with the plan the Dr's are giving you. For example if you feel strongly you need to see a nutritionist, but the Dr thinks you just need to go up on your meds, get yourself to a nutritionist. it will calm your nerves.
remember: be calm and rational
listen to your inner voice
take a deep breath
our bodies are so tricky and complicated, but you have plenty of time to figure this out. trust yourself.
Increased weight and reduced exercise probally has a lot to do with your increased numbers and the stress your experiencing isn't helping either. A lot of T2's increased blood sugar levels are due to insulin resistance. Increasing weight makes insulin resistance even worse. Exercise helps reduce insulin resistance. It looks like your are experiencing a double blow to you ability to control BS by reducing insulin resistance.
The good news is that you can correct both these situations. You can get back into your exercise routine and you can lose the regained weight. You've taken the right first step by seeing the Doc to get help with your depression.
Thanks, everyone. I guess I could have been clearer -- it's not like I'm not exercising at all, I still walk 1-3 miles a day (I have dogs) and do yoga. But with my previous job I was also riding my bike to work and back, 45 minutes to an hour a day, six days a week. Now I'm working in the next town and that's no longer an option, and so far I haven't figured out how to replace that time on the bike. I loved my bike commute and miss it!
I guess it just feels overwhelming to think that I'm going to have to find time for that much exercise, every single day, FOREVER. I remember when I was first diagnosed and all gung-ho about making all these changes, people warned me that over the years you can get pretty burned out and discouraged ... Maybe that's what's happening.
Anyway, I did feel better when I was doing more exercise. As for "forever," it might be a long time but it still only comes one day at a time ... I just need to DO IT.
Getting back on depression meds should be a big help too. I hope. My home situation is so emotionally unstable and I'm finally starting to accept that it probably always will be. So I have some big decisions to make and will need to be as healthy as I can to get through.
Thanks again for the support and ideas. The doctor's appointment I was given is in less than three hours, at 11 am on 11/11/11 -- I'm taking that as a lucky sign!
When you cut back on exercising - did you cut back on carbs/calories total for day or maintain as always. From discussion, it seems you had excellent T2 control and good A1C numbers.
Issues usually revolve around:
a) medical changes and issues, organs and liver and increased liver glucose release.
b) change in exercise - reduction increases the energy input/burn balance off set.
Yes, unfortunately it's not as some people think, that we eat like pigs. It's more like eating like a rabbit and exercising like an Olympic athlete are mandatory. I thought at some point I'd reach a target weight or something and be done but apparently our obligations are endless.
Disguising exercise helps sometimes. Yesterday I volunteered to pass out political leaflets from door to door. For a few days at least I'll forget I'm exercising.
Stress can make a huge difference. At a recent job my fastings popped from the 80s to 135+ for no reason other than stress. Not going to work there anymore because in the long run the health consequences would be unsustainable.
Some time back tracking can be helpful in identifying what changed.
Another issue not discussed much but research shows is an issue for T2 diabetics is the excess glucose making and release by liver.
The energy balance issue is really carbs from food eaten plus excess glucose released by T2 liver needs to be balanced out by energy burn, process etc. Sometimes the reason for lots of exercise is to burn off the liver's extra glucose release. mine actually continually leaks and then does huge dumps on the proper liver functions of dawn effect and BG sub 70.
The only way to catch this is with a cgms and watch the bg from bg low and eating a meal and watch trends .
Insulin can be very helpful but always remember Insulin is storing the liquid energy, glucose always needs burning off so that storage cells do not over fill and turn insulin resistance on. i.e. Exercise still key!
Met actually shuts down liver excess glucose making and release. Timing of doses can make performance better in some individuals. Always check with your health care provider before making any changes.
Thanks for the input, Aimee -- glad to hear insulin is working well for you. At my appointment today my doctor agreed that my depression and stress at home are probably contributing to the rise in FBG, so I started an antidepressant again. We'll check in again in a few weeks and see how that's going before considering other changes, like new medications or insulin.
Personally I would almost rather start insulin early, rather than go through all the oral meds until they stop working. It seems more natural, and definitely easier to fine-tune the dose. Have you read the book "Think Like a Pancreas"? I keep seeing it recommended here and just ordered a copy, so I can be learning and thinking about next steps well in advance of when I might need to take them. What resources were most helpful to you as a T2 using insulin injections?
I know increasing my exercise is probably the other "best" thing I need to do. It was so easy when I was riding my bike to work every day; I just got into the routine of doing it, and I had to go to work anyway, so it never felt like it was cutting into my "spare" time. I've been at this new job a year though and it's clear I'm going to have to figure out a way to get into a new routine.
Best to you, and thanks again to everyone for your thoughtful responses.
Hi Sweetpotater, sounds like you were doing all the right things, to keep your BS down. However, that stress will throw a monkey wrench into your program. My job is very stressfull at times, and I've monitored my BS when it gets stressfull around the office. My BS could be in the mid 80's to low 90's, and soon as stress hits me, my BS shoots up in to the 120's to 130's. No matter if I've worked out, ate right, watched my P's and Q's, etc. It's the stress that does it to me.
Aimee's comment offers one possibility. I was fine on d&e only for my first three years. Then my FBG and A1c both started creeping back over 6 (mmol/l and %) and I added metformin.
I accepted that I had done a lot of damage in the years prior to diagnosis; I probably lost a few beta cells along the way too. I have always presumed that the best I can do is slow down the rate of progression. I've done that pretty successfully, but I know I haven't stopped it totally and that some day I may need an additional med or insulin.
I don't fear those additional meds - provided they are needed - but I do fear the complications. I am hoping to delay those until after I depart.
There is another possibility. You may have changed something subtle in your lifestyle or menu that is having a significant effect on your blood glucose levels. Sometimes a change that seems innocuous can have startling consequences.
The stress in your lifestyle is another factor.
Consider using your meter to do a thorough review of your lifestyle, testing after meals and any other times that seem appropriate to see if you can improve things. This may help you do that: Test, Review, Adjust
Cheers, Alan, T2, Australia. Everything in Moderation - Except Laughter.
Blown up full size on your profile page your icon looks like a sweet potato. Small in the forum it looks like a chicken heart. Eek!
I hope you're seeing some progress since your post. That's one of the many reasons I favor bgs over A1C. Instead of waiting weeks or months we get positive feedback for our habits within 1-2 hours. Keep up the good work.
Excellent advice from emmy. One needs one's Doctor on the job to approve any meds change.
One of the tragedy's is that we are not told the whole story how body sets fasting BG levels when no glucose from gut/over.
This is a waltz between liver who is always releasing at low levels some glucose, the pancreas that issues basil insulin and balance of system - skeletal muscle cells - fat cells that keep absorbing the glucose if they have room.
As he body ages, the liver releases increase and the pancreas basil insulin releases drop. The whole set point moves up. BG now higher.
As one who has fought his liver now for 4 years, the only thing I have found is metformin that will arrest cut back the liver's low level releases and its major dumps.
On my CGMS, the only thing that can send my CGMS two arrows up is the liver in a dump/fire fight.
Gut rarely gets up to one arrow staright up ( except munching glucose tablets) and at best usually one arrow angled up.
For me, insulin levels have no effect on this nonsense and liver over release. See Salk Institue, John Hopkins research papers on role of metformin and strategic dose used to stop the shenanigans.
As always use your diabetes care doctor/help to guide and assist. Liver leakage and over release is a major issue in type 2 diabetes currently ignored and not appreciated by the "industry".
In process of editing/correcting I see a major part dropped that was as follows:
As the liver ages and increases the leakage and the pancreas drops the basil insulin, the leakage gets to the point that the fat/skeletal muscle cells get filled to the top and insulin resistance turned on and enforced.
This is full type 2 diabetes.
Correcting this situation requires heroic action that is fraught with dangerous issues. If one gets the leakage /glucose production clawed back and fat skeletal muscle cells reduced of their local store glucose, the pancreas in some cases can go back to work and the skeletal/fat cells will start using the body's own insulin. This results in a unpredictable point that the body now has twice as much insulin working causing severe lows and requiring patient action to adjust back the external pills/insulin adds to correct proper operating point.
For saftey; your diabetes care doctor must be working this with you - no exceptions and a CGMS must be used and alarms set to catch the switch over point.
At all times, the carbs control and hearty exercise are critical to energy balance and keeping the fat and skeletal muscle cells from filling up with glucose and enforcing insulin resistance.
Folks: Please ignore my prior two posts as I had made a mistake in my posting causing a deleteof part of my response. I made matters worse by attempting to post.
Here is what I wanted to say and humble apologies for all teh mistakes and confusion:
Excellent advice from emmy. One needs one's Doctor on the job to approve any meds change. One of the tragedy's is that we are not told the whole story how body sets fasting BG levels when no glucose from gut/over. This is a waltz between liver who is always releasing at low levels some glucose, the pancreas that issues basil insulin and balance of system - skeletal muscle cells - fat cells that keep absorbing the glucose if they have room. As he body ages, the liver releases increase and the pancreas basil insulin releases drop. The whole set point moves up. BG now higher. This is pre diabetes and can be easily corrected by carbs and hearty exercise. As the liver ages and increases the leakage and the pancreas drops the basil insulin, the leakage gets to the point that the fat/skeletal muscle cells get filled to the top and insulin resistance turned on and enforced. This is full type 2 diabetes. Correcting this situation requires heroic action that is fraught with dangerous issues. If one gets the leakage /glucose production clawed back and fat skeletal muscle cells reduced of their local store glucose, the pancreas in some cases can go back to work and the skeletal/fat cells will start using the body's own insulin. This results in a unpredictable point that the body now has twice as much insulin working causing severe lows and requiring patient action to adjust back the external pills/insulin adds to correct proper operating point. Prior to this point, the previous external pills and insulin MUST be used till the switch point. For safety; your diabetes care doctor must be working this with you - no exceptions and a CGMS must be used and alarms set to catch the switch over point. At all times, the carbs control and hearty exercise are critical to energy balance and keeping the fat and skeletal muscle cells from filling up with glucose and enforcing insulin resistance. As one who has fought his liver now for 4 years, the only thing I have found is metformin that will arrest cut back the liver's low level releases and its major dumps. On my CGMS, the only thing that can send my CGMS two arrows up is the liver in a dump/fire fight. Gut rarely gets up to one arrow straight up ( except munching glucose tablets) and at best usually one arrow angled up. For me, insulin levels have no effect on this nonsense and liver over release. See Salk Institute, John Hopkins research papers on role of metformin and strategic dose used to stop the shenanigans. As always use your diabetes care doctor/help to guide and assist. Liver leakage and over release is a major issue in type 2 diabetes currently ignored and not appreciated by the "industry".
