I am a recently diagnosed 52 year old female type 2. My a1c was 10.7. I have been on 1000mg of metformin, 500 x2/day for the past month. In addition, I’m keeping carbs to about 25g/meal and walking 1/2 hour per day. When diagnosed with type 2, I also was diagnosed hypothyroid and am taking 25mcg of synthroid per day, and was told to take 5000iu of vit d for deficiency, also 1 per day. I am significantly overweight, and am an “experienced” dieter - I am eating about 1500 cal per day and should be losing weight and haven’t dropped a pound.
But what’s really worrying me is that my BG is always around 200 fasting. I’ve tried taking it multiple times a day: fasting, pre-lunch, pre-dinner and 1 hour & 2 hour post-prandial. My BG is always around 200. Even after eating. The average is 221…it does move around but not much. I’ve had exactly 3 readings under 200 since starting the metformin - a 170, a 180 and a 186. They were memorable. My meter is fine - in fact I have two, both Once Touch Verios, both checked with the control solution.
I’m seeing my doctor next week - I had the appointment moved up a couple of weeks. Has anyone had this? Is it just that some people don’t respond to metformin? I haven’t been able to find out much about a problem like this by surfing - any ideas what I should look for?
I will reply to myself with another data point. Dinner was a 5 oz turkey burger, spinach, and homemade sweet potato fries, oven baked. I ate that at 7:30. Had a bowl of edy’s light caramel ice cream at 10pm. It is now 11pm. BG is 238. ???
It might not be a bad idea to ask the doctor if they would screen you for antibodies to make sure you’re really Type 2. Type 1 can strike at any age, and the thyroid issues could be autoimmune, which would raise the chances of it being Type 1 as well.
They can also run a C-Peptide test to check your insulin production levels. If they do that, and it’s low, you’re probably Type 1/LADA. If it’s high, then you’re T2.
There are two scenarios in which blood sugar can be out of control and require intervention: fasting, and post prandial (after eating). They present different issues and have different solutions.
The maximum safe dose of metformin, depending on circumstances, is generally held to be in the range of 2000 to 2500 units a day, which you are nowhere near. So it might be time to consider increasing the dose. That, of course, is a conversation you must have with the doctor.
But let’s be quite clear about what metformin does. It has a mild beneficial effect on insulin sensitivity, but its primary action is to prevent the liver from releasing stored glucose into the blood. Translated, that means that metformin is useful for lowering your blood sugar in the background, i.e., when fasting. What it does not do—and it is critical to understand this—is to control or lower post-meal spikes caused by the food consumed. If you are experiencing consistent uncontrolled spikes after eating, metformin isn’t going to be much help.
It may be time to consider other medications such as DPP-4 inhibitors, insulin, or something else. Again, this is something that must be explored with your doctor. What’s clear is that what you are doing now isn’t getting the job done. You need something different.
I was diagnosed Type 2 on my 50th birthday - my A1c was 11.8 at the time. Though, like you, I was an “experienced dieter,” I was not overweight at diagnosis and was active on a daily basis. Metformin alone did not get even my fasting BG under control - though, admittedly, I did not go above 1000mg/day due to side effects. I was tested for Type 1 (c-peptide and antibodies), c-peptide was low-normal, antibodies were negative, so my Dx remains Type 2. I ended up switching to insulin after 4 months, and it has been quite a good change. My most recent A1c was 5.3 - something I could never achieve on Metformin.
In all likelihood, you will need some additional medication to get things into line, at least in the beginning (if not on an ongoing basis). I’m glad you pushed up your appointment with your doctor - you should discuss alternative options to get things under control. With numbers hovering over 200 much of the time, it’s a good idea to take an aggressive stand, I think - but, of course, that will be up to your doctor.
Aside from that, you have to experiment with various foods to see what spikes you and what does not. Sweet potatoes send my BG high and keep it there for hours, for example. Almonds spike my BG, but peanuts and cashews that have more carbs than almonds barely nudge my BG at all. Everyone’s body reacts differently, so what works well - or not well - for me may be fine for you. Only personal experimentation will help - and note, that diabetes tends to change, so what works now, may not work next year, next month or even tomorrow!
My heart goes out to you. It sounds like you have actually had diabetes for some time. I have to be honest, if you do a very low carb diet (like Bernsteins 30g /day) you may be able to make dramatic progress in controlling your blood sugar. But it just may not be enough. Even a max dose of metformin will only on average bring your A1c down 1%. The AACE advises that anyone starting with an A1c > 9% start with insulin. I know it sounds scary but your pooped out pancreas is just exhausted. And those high fasting blood sugars are an example of how bad it is, you are not producing enough insulin to restore a normal blood sugar even when you are not eating. You should probably start a basal insulin. This doesn’t mean insulin forever, you are likely to find you can get better and stop the insulin. And despite that many of us use insulin and do fine.
My suggestions is to continue the low carb, that is absolutely great. But make sure it is a very low carb high fat diet and skip the calorie restriction. Calorie restriction won’t help and it will just make you hungry and destroy your willpower. But most importantly, get with your doctor (preferably an endo) and in an earnest voice ask for a basal insulin to get your blood sugars under control. Once you are under control you have a good chance of getting rid of the insulin.
Thank you all so much. What I find strange about my numbers is that I don’t spike - I think the highest I’ve seen is 270 something, and that was after something like a baked potato. Last night when I threw carbs to the wind and ate those sweet potatoes and then some ice cream, I went up to 238. This am’s fastting BG? 212. It doesn’t go sky high, it never comes down. It’s just somewhere in the 200’s, usually low to mid 200’s, all the time.
Thank you all for explaining what metformin can actually do and your experiences. It makes me feel less like I’m doing something wrong. I’ve had hypertension for years and have always felt like my need for meds is some sort of personal failure - like I should be able to fix it or something. I just feel broken right now, and very confused, and I don’t like confused at all.
I would second the advice to talk to your doctor about a increasing your metformin dose, which was probably the plan already, and adding a basal insulin sooner rather than later. Metformin is generally introduced slowly to avoid gastric distress as it can cause flautulence and the runs if your stomach doesn’t handle it well. It does take a couple of weeks for each dose increase to reach its peak effectiveness. Your doctor may or may not want to increase your metformin dose first, let that stabilize, and then add insulin so that you are only changing one medication at a time, which is reasonable.
Personally, I’m not trusting of the “newer” meds such as the DPP-4 inhibitors. There’s just too many black box warnings, and too many cases of complications of these new medications coming to light only years later after they’ve been on the market for years and the damage has been done to thousands of us. I’m so tired of feeling like we’re lab rats - but I’m verging into rant territory.
I’ve tried some of the other non-insulin injectibles like Symlin and Byetta. I found with extensive testing every hour for four hours after several meals that all Byetta was doing for me was delaying my post-meal blood sugar spike by 4 hours, pretty much rendering my bolus insulin dose utterly useless.
Insulin is tried and true, and one of the most easily customizable medications out there.
This is not a 25g meal. 4oz Sweet potato fries= 24g. 1/2 cup spinach= 4g. The ice cream was probably about 20g. Read carbohydrates on labels. Weigh and measure everything accurately. Calculate.
You are correct and I was unclear - that meal was a test to see what my BG would do if I hit it with more carbs. It was also me being angry at the situation but still trying to make better choices than an actual hamburger and white potato fries and whole fat ice cream. I am in the habit of weighing everything due to dieting…I confess that carb counting is new to me (never been an Atkins girl) but I’m logging everything in My Fitness Pal which seems pretty reliable.
Check the labels on the cartons. Sometimes the lite/low fat version is higher in carbohydrates because fillers replace the fat. Blood sugar will spike more.
For a diabetic, “whole fat” ice cream is less of a problem than whole sugar ice cream. Fat slows down digestion, thus slowing down the absorption of carbohydrates.
What’s good for calorie reduction (fat-free salad dressing, for example) isn’t always good for blood sugar control because when fats are removed they are replaced with carbohydrate. In the case of creamy dressings they replace the fat with carbohydrate thickeners to keep the same mouth-feel. The same is sometimes done with low-fat ice creams. In the case of Edy’s they use tapicoa starch, which is a fairly high-glycemic starch and guar gum.
I’ve recently come across a product called “Enlightened Bars” in the frozen novelties section. They aren’t cheap - about $4 a box for 4 ice cream bars, though my store often has $1.50-$2 off coupons that make them more reasonable. They’re only 80-90 calories for a large 73g bar (about equivalent to 1/2C of ice cream), with only 5g of sugar. They are sweetened with a mixture of cane sugar, erithrytol (a natural sugar alcohol with little to no glycemic impact), and monkfruit extract. They have recently started selling ice cream in pints, but I haven’t seen it yet.
. . . but I can’t let that one just slip by. The feeling that it must be our fault when the body decides to go haywire is amazingly common. And it’s nonsense. (I was going to use a stronger word, but this is a PG-13 forum). It’s bad enough that things go wrong physically; we can do quite nicely without adding self-inflicted mental damage to the cocktail.
One of the most pernicious ideas, and one that causes us untold grief, is the idea that diabetes is self-inflicted. That belief is so deeply rooted in the media and the public consciousness that it may take forever to get rid of it. There has been some glacial progress toward eradicating it, but it’s really only a drop in the bucket. We call that the “blame game”, and newly diagnosed diabetics are especially vulnerable to it.
You didn’t do these things to yourself, and they aren’t your fault. Like so many of us, you are just a beneficiary of the Luck of the Draw. It just is what it is.
Thank you - just had a brain shift realizing that I now need to think about fat differently. I have 25+ years thinking fat = bad that I need to recalibrate. Will look for the ice cream bars you mention. Sounds like a good choice for me. I really look forward to that treat in the evening…I don’t eat cookies or cake, but need my frozen goodie to be happiest. Appreciate your input.
Thank for for your kind words. Will try to stop the self-flagillation. When diagnosed my doctor said my type 2 was probably because of years of significant weight gains and losses (I’m exceptionally good at losing weight - except for recently - but am horrible at keeping it off) so I’ve been beating myself up over it. I know the thyroid is blameless, so hopefully I can generalize to the other system changes too.
First, there is still a lot of gray area and research waiting to be done, but the science is starting to shift away from the traditional idea that obesity causes diabetes. There is a growing suspicion that obesity and diabetes may both be results (symptoms, if you like) of a common underlying cause. There is still a lot of work to be done, but investigation is ongoing and the view really is beginning to tilt. But be warned: it hasn’t yet registered with the majority of doctors (not to mention the general public).
Second, the fat/cholesterol/CVD model that we have been indoctrinated with for the past half century really is turning out to be . . . oh, let’s be nice and just say, “doubtful”. If you want to really learn about this, there are some terrific materials out there. A great starting point is Gary Taubes’s book Good Calories, Bad Calories.
I see others have already mentioned the possibility of Type 1/LADA. Did your doctor test for it at diagnosis? The hypothyroid diagnosis would seem to be a huge red flag that you might have autoimmune diabetes. I was diagnosed with T1/LADA at 46 and I’m also hypothyroid.
Regarding consuming fat, I also had to make that mind shift at diagnosis and I can honestly say it’s the best thing that happened to me. Now I try never to eat low fat anything and find that fat helps a great deal with satiety.
