Would you be happy with an A1C of 6.3?

i just got bloodwork done this month and its 7.3 =(

i always think its gonna be lower and lower.. and it never is.

The maximum dose of Metformin is 2500 mg/day. The maximum dose for Metformin ER (the extended release version) is 2000 mg/day. I take the maximum.

Some thoughts:

Max dose in 24 hours for standard met is 2500 mg total.
Be sure you are working with your Doctor/medical diabetes team on any changes.

Met during day generally not a worry as one is wake , alert and can quickly counter any lows. Should your met shut/cut back liver at night, having a cgms running is good back up against any glucose brownout while met hauling back on liver.

Here again re:food and snacks - eating late creates problems as digestion/intesting shut down when one sleeps.

It may take some detective work to sort out. Me I religiously keep any items off the list late at night if digestion is needed to process. is no snacks after dinner at 5:00 to 6:00 pm.

The other issue is if one wakes up, the liver gets booted to output some glucose. ( in addition to dawn effect)

Exercise should really help as I find that if I do not get sufficient exercise in day BG tends to crawl up and wander. Sufficient hearty exercise seems to keep a good constant load on the glucose.

Here again be sure to work with your Doctor at all times.

If you have CGMS running, I typically see the Blood BG drop as standard metformin comes up to full strength in blood stream in 2.5 hours up time on my body assuming gut empty or not putting out glucose.

Timing for met ingestion has a couple of issues. Dawn effect cutback is generally affected by late night doses.

Doses during day help trim back the leakage rate of liver's regular low level release used to set body glucose setpoint when gut empty/stable. It also can stop extraneous/spurious liver dumps during day when bg is usually above 100.

taking met with meals helps to pull back liver leagage as intestine digestion glucose output increases reducing peaks.

Typically; for me; 10:00pm dose is up full strength from 12:30 am to 2:30 am while 12:00am is up from 2:30 through 5:00 am. This has to checked on each body. I am large body/large organ and my timing may be more or less on someone else.

on my body the doses do not seem to collide.

119 through 140 is not large from dawn effect perspective and if me I would have not pestered my Doctor to jump on and been happy as is. I was only motivated as the 238 in am meant I had to walk 2 miles to burn off excess glucose each and every morning every day to get my BG back to 140 and less. That got old/stale fast.

Thanks for all the info Jim...
Its not me so much as my Dr who is not happy. He continues to mess around and make changes with my medication and its getting really old. I was up to 2500mg of Met a day and it wasn't doing the trick for me anymore. A1C went up from 5.8 to 6.7 and then 6.8 when he made the change to Victoza. After a month my A1C went down to 6.7 again and he wasn't happy enough with that and added back in the Met 1000mg a day. It still isn't bringing down my overnight BS but during the day I am fine. I go back in June and if its not lower he will again make a change. He is after me to try Actos but I don't want to do that as my father had bladder cancer which shutdown his kidneys. I am not willing to go there.

I just started taking 1000 mg met before bed which has really helped my dp. I used to take 500mg 3xs a day, now I take 1000mg morning and night. So far it seems to be improving my readings.

My dr. pointed out the other day that since waking up causes your body to dump glucose, waking up to do readings can create high readings. He changed my dose making the assumption that my problem is caused by dp and not as compensation for hypo in the middle of the night, which I believe is correct in my case.

Caveats first:

I am supplying data on my experience and what I learned on working on my T2 diabetes with my Doctors and whatever one does, you need the review, approval and advice of your diabetes medical team at all times and be carefull:

For information only:

1. Latest info on meds and cures is ahead of approved/standard cures.

2. My data suggests that metformin while not a cure all, but in sufficient dose (for me) 500mg or slightly more can cut off the excess glucose release of liver.

3. Timing is a pain as late night affects dawn effect for some and for others during the day helps slow down excess release and overpeaking digestion glucose release and stop spurious liver dumps ( liver emergency glucose add service.

4. See Salk Institue and John Hopkins Childrens group on metformin studies and data and for what they think metformin does, the dose in blood stream needs to be at some minimum dose to get affect. Below that not much improvement. Also affect only lasts as long as the up to strength of met in blood stream while residuals and lower levels have no effect. This is why one large dose is useless while carefull spreading and timing of sufficient size doses ends up providing for some better response. But realize that cure stratagies and approval has not caught up with this data. All so, PITT group on their work on the fox switch and excess liver glucose release.

5. Obviously in a multi organ, multi hormone system and as I indicated the lack of sophisticated 23rd century tools to catch a complete picture ( not one hormone and one test at a time serially of what is off base, it can be difficult. We now are starting to track glp-1 and gpp-5 hormoners and there will be others.

Unfortunately, and in many ways having a single silver bullit is most desireable but in the end one ends up with a quilt work suite of meds, carbs control, hearty exercise to cage the monster back. As one gets older, the problem gets worse as organs age, go intermittent and slowly drop their response and control.

Today, I suspect your Doctor is doing what can be best done and that is to carefully test and vary medicines and choices carefully to smoke out where the miss performance is and what best modifies it. If testing cannot exactly snag issue, carefull med treatment modification may reveal the offending parties.

I was on actos and my kidneys started to go down 3 yeras ago before my doctors/me got this mess tamed. My kidney doctor asked me (instructed me) to get off the actos. I finally did after mess tamed and booted actos. Kidneys stabalized and showed slow improvement for last year and half on tests.

One of the big missed issues in my mind is the issue of glucose saturation and insulin resistance. My experience has shown that hearty exercise - walking 1 to 2 miles a day really helps get the excess glucose marched out of body. In addition, I use a diet of 1200 calories a day as well carefully controlling carbs.

That number is not hard and fast and only tracks the amount of energy I burn on average daily. At some point I will up that if weight goes too low. If one is working on Paraoh Ramses 2 funeral temples moving 2 ton stone blocks by hand - well - all bets are off and one probably needs all the rich carbs one can eat.

Today there is some incredible research going on with Magnetic resonance imagery spectrography where glucose, pancreas activity can be watched live revealing new and little understood facts about human body pancreas and skeletal muscle cell operation where one can actually see the glucose in the temporary storage in the skeletal muscle cells.

In summary though, religiously doing my meds, carbs control and exercise - especially regular hearty exercise, my BG is holding steady under what is considered acceptable for T2. My eye hemorages are gone, weight down, kidneys stable and excess water disappeared. My a1c is down from 13.3 to 6.4.

Best wishes and good luck on your quest and hope you get help and improvement.

As indicated be carefull.

One of the major frustrations dealing with this mess is getting sufficient data in short time on all aspects of body, diet, exercise and body misfires to make a call and sweat/parse out the issue.

In my case, I have been working last 4 years in detail logging numbers , diets - carbs control , exercise and started on 30 tests a day fingerprick to now where I am on a CGMS and still 10 fingerpricks a day of the caveman machine.

I once said to my Doctor, how the devil do you work this stuff with so little data and feedback.

Answer was carefully, with great difficulty.

One has two choices - In a hospital day after day and technicians logging every data bit - guess what that costs?; or yourself at home trying to get as much data as one can, - hey wait a minute I have to work full time.

One quickly arrives at the point that diabetes is a full time riot/job on top of anything else one has responsibility to do and jobs.

Hello to everyone! I am new here and just joined a few days ago even though I have been reading post here for many months. Congrats to neilf66 on his 6.3 A1c. I finally got my A1c down to 6.5 on my last office visit 2 weeks ago and I feel that I have made great strides, along with my internist and his nurse assistant, to get my A1c below 10.0 which is what I was at for years. The one thing that I am learning is that there are no 2 people alike when it comes to which DM meds work and our BG readings. I have gotten much better since I was put on Levemir and Novolog by my doctor in Sept. and some of my complications have gotten better and I assume will continue to improve if I continue to be mindful of my weight and diet. I used to be ashamed to say that I was on insulin and that my TDD is 140 (Levemir split 35 - Novolog approx. 70 spread out over 2 meals and 2 snacks) because I thought that was too much insulin and that I was a failure, but I have since found out different after I started to read the informative post/comments here. My doctor says that I am insulin resistant and it is no fault of mine, which is a relief. I am 6'5" and weigh 270 and have been this size for most of my adult days. I am very active at work and need the energy so I tend to eat a few more carbs than most (a lot more), but so far I have had very good numbers including postprandial glucose readings of 95-120 most of the time. Now if I can bring the fasting BG's under 110 consistently. But this is an everlasting experiment as I am seeing. Again hello and thanks for all the welcomes!

Than you for writing and sharing.

You are working the problem and congratulations. No shame in that.

I would control carbs carefully and ensure sufficient hearty exercise.

Other than that - thank you for joining us, welcome aboard, best wishes and good luck with your health.

Thank you!

Congrats on the 6.3! :)

NB: i too am experiencing slight DP, im waking up with 6mmols now when beofre i was 4.5-4.9. Im thinking i need to bump my lantus :(

I assume 6 mmols is 108 (6 * 18). and the A1c of 4.5 - 4.9 looks pretty good.

I wish I had that. If my numbers are correct, you seem almost "normal" in some folks parlence.

Great to hear. Have good day!

On the original question which is well asked.

I was surprised when my eyes were found clear of hemorraghes, my kidneys stabalized and efficiency went up instead of further falling like a stone and my weight dropped from 330 pounds to sub 250 pounds. Off the actos and starlix, reefed back on the 75/25 insulin.

That was when I got to 155 bg average and a1c of 6.9. My latest a1c was 6.4.

As we all want to be back as we were young, much praise needs to shared with one who got to 6.3

Is 6.3 good enough? If one is stopping the rot, answer should be heaven's yes.

Best wishes and good health.