Updating and downgrading


#1

something has happened. I will throw it all into a pile and see what you good folks can tell me.

  1. First blood test of my life at age 61. 134 FGL and A!c 6.6. Doc had me retest 6 month later. I studied up, lost some weight , changed diet to 100 -150 Carbs/day, got to 126 FGL and A1C of 6.5. I maintained both those numbers for nearly 1-1/2 years.

1a). I only got the bloodtest because GP was mandated by O’care to do this work. I have never reported to any doc for any symptom related to Diabetes. thanks Barry!

1b). In hindsite I do remember great fatigue after rigorous exercise. that is mountain biking in the mountain, maybe burring 1000 to 1500 cals an episode. I would be lethargic and drowsy for several days. then back on the bike. I never thought about diabetes. I figured over-exercise.

1c).In last 3 years I have tingling at the bottom of my feet. Now hold on, don’t jump to conclusion. I wear do eliptic every other day and wear crocs all the times. especially when I garden on a sloped yard, meaninIng am slipping in my shoes all the time . Tingling seems only to happen after workout or gardening.

  1. Most important though. In the last 6 months my diet has gone a little more hi carb, usually around 200gm/day. but my FBG now is usually always above 130 and A1C has gone up to 6.6. I now take 500mg metformin before bedtime and am getting these results.

In the last several months , an FBG around 140 seems to be the norm.

  1. so whilst take 500 mg metformin my avg AIC had gone up a tenth, and FBGL avg. have gone up to 130. In the last 3 months I have stopped drinking mostly and FBGl has gone to 140.

so that’s it . what do you think?


#2

Have you tried BG testing after meals to see how high it is going? A1C of 6.5 means average BG of around 140. You may be spiking to 180 or more after meal, then dropping to 120-140. If you keep logs of what you eat, you can experiment to see which foods cause higher spikes. Higher carb meals will spike sooner and higher than meals with complex carbs, fats and proteins. Higher post meal BG will result in higher A1C. You may need to increase metformin dose, and take with meals.


#3

Start testing two hours after eating and keep a log of what you ate, how many carbs were consumed, and what the resulting two hour post-meal BG reading is. Just as MM1 said this will give you some much needed insight to what your BGs are doing throughout the day. If I were you I’d also test right before you sleep at night to see if you have dawn effect or if your BGs just run high throughout the night. You should test 5x day: morning fast, post meals, and bedtime.

You’re on a low dose of metformin, if you aren’t on the extended release version you might consider that as it’s effective longer and has less side effects especially if your dose might increase after consulting with your doctor.


#4

Testing multiple times a day is good, but only goes so far.

I’s suggest you purchase the starter pak for Freestyle Libre CGM (about $150US).

You’ll get more useful info from the CGM than weeks of blood testing would ever give. Especially helpful in identifying trends and whether or not you experience Dawn Phenomenon.


#5

your comments noted.

I stopped testing except FBG because is was always in range of 140 to 180 after 2 hour meals. so it seems its is (was) only a FBGL problem. I as recall from you all’s previous comments this represented a different kind of problem. some suggested late onset type 1.

one comment I would make, for the 1st 61 years, I seemed to be pre-diabetic and did nothing regards diet except eat lots of carbs and drink beer. Once I got tested I started paying attention and over 2 years my stats have gone into diabetic ranges.

thanks again to my buddy Barry, and not withstanding any court ruling I have another year of O’care. I didn’t even bother my GP while my levels were within pre-diabetic levels

per your advice I will start testing during day.


#6

I should add I bought 6 month supply metformin in mexico. I assume it was both good and maintained strength when stored at room temp


#7

It sounds to me like you are a person with T2 and your T2 is doing what it often does, it is progressing. The saying that nothing stays the same with diabetes is true, especially with T2.

500 mg metformin is a beginning dose, if my memory serves me 2550 mg is the max dose. In addition to metformin there are a multitude of other T2 drugs up to and including insulin.

Many people chose to attack the problem with a lower carb diet, it is a good strategy, while not absolutely necessary it is very helpful.

It seems that you are at a decision point. What is best for you may be a combination of the two options I have listed.

One piece of advice I gave to my brother is that you cannot medicate yourself out of a T2 diagnosis, it takes more, believe me I have tried.


#8

I know one data point tells you nothing, but today after FBG of 147 taken at 7 AM, I ate 30 gm carbs at 8am, tested four hours later at 12 noon, viola 136. I then ate immediately 15 carbs and tested 2 hours later at 2 pm. viola 112.

it makes no sense.

is there any chance that eating a threshold level of carbs, say 25 gms vs 20 gm, would jump up BGL?


#9

You are right it makes no sense!, But then it does. Well controlled T2 here.

For me I find consistency is my key, no big changes or large amounts of carbs

I have come to the conclusion that T2’s are not not good at processing insulin at all.

There seems to be a lag time to produce the insulin, and then it does not shut off on time. So If I at like 30 carbs. I would spike yes, but then go lower (reactive low)

So unless I keep things on an even keel, my exact bg level is unpredictable.

So diet and exercise only 10 years on. Fasting typically 95-105
After meals or snack, I try to stay between 120-130.
I have been doing this for 10 years 8 without metformin. No real change in my A1c numbers.
DX 12.0
6.0 at stopping metformin, My low was has been 5.6. Last test was 5.9.

Low carb WOE.


#10

Type and amount of carbs can make a difference. So can the time of day.

For me personally, once I eat more than 40ish carbs it becomes hard to predict the resulting blood sugars two hours later. I also do better choosing whole grains and low glycemic foods which avoid steep spikes and yucky crashes.

Morning is especially tough for me. I have dawn effect and insulin resistance in full force which is a one-two punch so I tend to eat minimal carbs for breakfast opting for protein/fat. My BGs tend to calm down after 11am-12pm and remain predictable for the remainder of the day.

Keep a food log writing down everything you eat and how many carbs are in your meal plus your 2 hour post meal read. There are also apps like mySugar if you are tech friendly.


#11

I asked elsewhere but you are saying that there is a threshold carb amount for you, around 40 gms? above that and things are unpredictable?

you also reminded me about the types of carbs. I am definitely taking in refined sugars , limited to around 100 gm/day but still they are slices of pizza, cup cakes, etc.

that will make a difference?


#12

I never was in those ranges. With low carb diet and/or metformin. Always in pre-diabetic to diabtetic ranges. 126/130 FBGL - 140/180 post prandial


#13

I am in the 30 to 50 carb range and I am a runner. I do add some carbs for long runs.

I actually don’t remember eating more than 100 carbs a day and that was when I just started out low carb. Definitely low glycemic , it makes a big differece me .

No grains, no pasta no rice, no cereal, no bread, no sugar or sweetener real or artificial , I just quite eating all that crap.


#14

I started out at diagnosis fasting BG at 325, so I had a lot of incentive to eat to my meter.
Also I don’t have any dawn phenomena issues.


#15

@frog For me personally, yes the type and amount of carbs matter. As we always say Your Diabetes May Vary (YMDV)!

When I eat more than 40-50g carbs my BG tends to shoot up more sharply and takes longer to come back down. Sometimes I eat 60-70g carbs but that tends to be occasional. You should be able to figure out what your own best fit for carb consumption is based on keeping a food log and resulting BGs two hours later.

Not all carbs are created equal and like @T2Tom, I don’t eat added sugar, cereal, rice, and if I do eat bread or pasta it’s of the whole wheat or garbanzo variety in small quantities. Eating foods that are lower glycemic helps avoid the spikes and crashes that many people experience. There are many resources online with lists of ordinary food items and their glycemic index score. Generally I try and stick to the low and moderate items.


#16

that describes me except over the last year my FBGL seems to have gone up to high 130’s. I have never woken up , no matter what I did previous the day and had a FBG below 115. for several years it maintained mid 120’s to 130. even using 500mg metformin before bedtime.

the only thing I can tell, beyond metabolic changes, is I have cut back on alcohol. I read some place that alcohol can lower BS.