Diabetes Control

I was diagnosed with Type II Diabetes November, 2011. Started 500 MG metformin twice daily. My AIC went down from 7.2 to 5.9. Have been able to lose close to 20 lbs & am watching what I eat--trying to lower carbs.

My question to you all is--I'm still getting morning fasting levels too high. I've had a few over 200 & several in the 140-160 range. I've had about 3 normals in all this time. Other times are better--especially the meal taking metformin. But to get that low A1C it seems I must be having some lows sometime.

Spoke to Dr. today & he seems satisfied even with the too high readings. Asked him about extended release Metformin & he seemed to not know it existed. Thinks as long as the average on A1C is ok, then it's ok. I told him I'm aware that average is a good tool but disregards highs & lows. So he became sarcastic & asked me if I wanted to be sticking my fingers every minute of the day.

Fellow diabetics & medical people--what do you think? I'm considering seeing an endocrinologist.

Having a very low CBG can be

Having a very low CBG can be VERY dangerous. I would be sticking my finger first thing in the morning, at lunch, supper, and before a bedtime snack. Keep a log of what you're eating, and your activity level, and if you do exert yourself with exercise, give yourself an extra poke. Keep a log of your CBG's.

Look for patterns. Analyze and discuss the patterns.

Your AIC is very good at 5.9, but my concern is that you may be hypoglycemic at times and not know it because your body has become use to being low. The problem with that is that you could become dangerously low and not realize it.

Type 2 diabetes can sometimes be managed with diet and exercise; sometimes metformin is not needed. I would see an endocrinologist for insurance.

I studied diabetes in 2005 and my thoughts may be outdated, but I think it's important that you know that you may be going hypoglycemic and not knowing it.

And, congratulations on looking after yourself! Smiling

Hi, Wanda It is very common

Hi, Wanda

It is very common to have a high fasting glucose with a normal HbA1C. There are several possible reasons for it.

The dawn phenomenon: During the night your body releases glucagon, growth hormone, and cortisol - all of which counteract insulin. This causes gluconeogenesis, production and release of glucose form the liver. If your HbA1C is normal, you don't have to do anything about it. If your HbA1C is high because of this, and this only, a small dose of bedtime insulin can correct it.

The Somogyi effect: Occasionally someone can be having a LOW blood sugar during the night, leading to a rebound HIGH sugar in the morning. This is usually caused by too much insulin at night. The treatment for this high am sugar is to take LESS insulin at night.

As long as your HbA1C is normal, you should be happy. Low blood sugars can lead to serious problems

Twain wrote: Hi, Wanda It is

Twain wrote:

Hi, Wanda

It is very common to have a high fasting glucose with a normal HbA1C. There are several possible reasons for it.

The dawn phenomenon: During the night your body releases glucagon, growth hormone, and cortisol - all of which counteract insulin. This causes gluconeogenesis, production and release of glucose form the liver. If your HbA1C is normal, you don't have to do anything about it. If your HbA1C is high because of this, and this only, a small dose of bedtime insulin can correct it.

The Somogyi effect: Occasionally someone can be having a LOW blood sugar during the night, leading to a rebound HIGH sugar in the morning. This is usually caused by too much insulin at night. The treatment for this high am sugar is to take LESS insulin at night.

As long as your HbA1C is normal, you should be happy. Low blood sugars can lead to serious problems

I have no idea about the american blood sugar readings, but there is another possibility for a normal A1C in this scenario and potentially poor glucose control:

1. Low and high sugars, leading to an average of a normal A1C. For this reason, an A1C does not always provide the entire picture.

2. In this setting, it would make a lot of sense to perform a diary of i) fasting / morning readings and ii) readings 2 hrs after supper ( usually the largest meal of the day).

Then bring the diary to your doctor to get an idea if you are on target, and how often you are going low.

chrisaldridge wrote: Twain

chrisaldridge wrote:
Twain wrote:

Hi, Wanda

It is very common to have a high fasting glucose with a normal HbA1C. There are several possible reasons for it.

The dawn phenomenon: During the night your body releases glucagon, growth hormone, and cortisol - all of which counteract insulin. This causes gluconeogenesis, production and release of glucose form the liver. If your HbA1C is normal, you don't have to do anything about it. If your HbA1C is high because of this, and this only, a small dose of bedtime insulin can correct it.

The Somogyi effect: Occasionally someone can be having a LOW blood sugar during the night, leading to a rebound HIGH sugar in the morning. This is usually caused by too much insulin at night. The treatment for this high am sugar is to take LESS insulin at night.

As long as your HbA1C is normal, you should be happy. Low blood sugars can lead to serious problems

I have no idea about the american blood sugar readings, but there is another possibility for a normal A1C in this scenario and potentially poor glucose control:

1. Low and high sugars, leading to an average of a normal A1C. For this reason, an A1C does not always provide the entire picture.

2. In this setting, it would make a lot of sense to perform a diary of i) fasting / morning readings and ii) readings 2 hrs after supper ( usually the largest meal of the day).

Then bring the diary to your doctor to get an idea if you are on target, and how often you are going low.

Thanks everyone!! My concern is that I might be having the too lows & too highs average out to what looks good but really isn't. I will try the diary idea.

wishandaprayer wrote: Having

wishandaprayer wrote:

Having a very low CBG can be VERY dangerous. I would be sticking my finger first thing in the morning, at lunch, supper, and before a bedtime snack. Keep a log of what you're eating, and your activity level, and if you do exert yourself with exercise, give yourself an extra poke. Keep a log of your CBG's.

Look for patterns. Analyze and discuss the patterns.

Your AIC is very good at 5.9, but my concern is that you may be hypoglycemic at times and not know it because your body has become use to being low. The problem with that is that you could become dangerously low and not realize it.

Type 2 diabetes can sometimes be managed with diet and exercise; sometimes metformin is not needed. I would see an endocrinologist for insurance.

I studied diabetes in 2005 and my thoughts may be outdated, but I think it's important that you know that you may be going hypoglycemic and not knowing it.

This is what I've been concerned about--with the highs I'm getting, there must be some lows happening to get that A1C level. I'm going to try Chris' suggestion about the diary.

I was hoping the diet change & weight loss would help but doesn't seem to have yet.

Thanks for your advice!!

And, congratulations on looking after yourself! Smiling

I would also get readings

I would also get readings after being more active than usual because often that is when people go low. It is possible to become insensitive to being low, and if that is the case, you need to talk with your doctor about that.

If your CBG is less than 4, you need to treat the hypoglycemia immediately, and discuss it with your doctor.

Thanks, wish. Do you have

Thanks, wish. Do you have information about weight loss with diabetes? I have been dieting pretty strenuously with little to show for it. I am trying for less carbs with more protein & a little more fat. I try to interrupt the diet with a couple of days of more food to ward off the starvation metabolism thing.

I've never had so much difficulty losing weight. I thought the Metformin might make it easier from what I'd read.

I've never seen anyone have

I've never seen anyone have long term success in losing weight by relying on diet alone. Unless exercise is part of the plan, it's doomed to fail. Start off walking 20 minutes a day and increase it by 10 minutes every 1-2 weeks, until you're at 1 hour every day. The pounds will melt away, unless you stop on the way home at the ice cream shop.

impatientpatien

impatientpatien wrote:

Thanks, wish. Do you have information about weight loss with diabetes? I have been dieting pretty strenuously with little to show for it. I am trying for less carbs with more protein & a little more fat. I try to interrupt the diet with a couple of days of more food to ward off the starvation metabolism thing.

I've never had so much difficulty losing weight. I thought the Metformin might make it easier from what I'd read.

From what I recall from 2005, I learned that if you are an insulin dependent diabetic you can lose weight very easily by keeping your blood sugar high. I was told that some young girls will do that deliberately. Unfortunately, by the time they are my age, they may have lost their vision, a kidney or two, and one or two limbs.

I recall that a patient raved about Atkins. She said that she was doing that and her weight was coming off. Her blood sugars were under control at the time, but I don't know how she did long term. I don't believe that it is healthy to severely limit any source of good nutrition. I believe that Weight Watchers is the best diet.

Weight Watchers has changed their diet many times since I was a teenager. I've been going off and on, since I was a teenager, when you had to eat fish 5 times per week, and liver once a week. I made it down to goal (well, not quite - 141 - their goal if you were over 40 and I wasn't, but I told them that I felt like I was 40, and they said that 141 was good enough for me); at that time you could eat all the fruit that you wanted, and that worked for me.

Now the WW diet is even more flexible and more forgiving, and for me that's key. I'm hard on myself and consider myself a failure if I "cheat", but cheating is built into the program.

I had a hard time adjusting to this new way of eating and I packed on many pounds because I stopped going for the monthly weigh-ins, and I stopped going to the gym. I made a bet with a couple of girls at work in January, weighed in, and thought that I could do it on my own. By February my weight was even more than January.

I lost the bet. So - I decided that I needed to pay the monthly fee, and go weekly, and I'm also using the website. The weight is slowly coming back off. I'm down 16.3 pounds since February. I've been pretty stressed out the last couple of weeks, and my weight loss seems to be going very slowly because of it. I was thinking that I would quit paying the weekly fee and just see if I could do it on my own. I had a terrible time making the decision, and drove Frank nuts while I was trying to decide. I want to be down to life-time by May. If I get down to life time, then I will get the e-tools free, and get to attend as many meetings as I want so long as I stay within two pounds.

I'm not getting any prettier with losing weight. My face is getting wrinkles, but I don't care. I really need to lose the weight for health reasons. I got all excited because I read that maple syrup helped with wrinkles and I thought that I could put that on my waffles in the morning. But it was just an April Fool's joke.

Twain wrote: I've never seen

Twain wrote:

I've never seen anyone have long term success in losing weight by relying on diet alone. Unless exercise is part of the plan, it's doomed to fail. Start off walking 20 minutes a day and increase it by 10 minutes every 1-2 weeks, until you're at 1 hour every day. The pounds will melt away, unless you stop on the way home at the ice cream shop.

Exercise is good advice, but walking may not be the answer for everyone. You have to find an activity that you enjoy (for example, country music + the elliptical), and that you can stick with.

Also, I believe that you need to do some muscle building exercises because when you lose weight, you also lose muscle, and when you lose muscle, your metabolism slows down.

Often people gain the weight back (it's harder to keep the weight off permanently than lose the weight, if you ask me), because over time they stop exercising and start eating mindlessly.

But they don't put the muscle back on, they pack on fat, which doesn't burn as many calories at rest. That makes it harder to lose the weight the next time. Also, as you get older, you naturally lose musscle; a double whammy.

Adding some squats and lunnges to your walking would help to build muscle.

And, I suggest that you make a walkmiles card, and when you hit your goal (whatever goal you choose), reward yourself with some of that ice-cream. And, while rewarding yourself with food, may be wrong, it's hard to teach an old dog new tricks, which is why it probably took me so long to adjust to WW's new program.

WW lets you earn activity points. I collect those and with my 49 optional points, the diet becomes a lifestyle.

26 points, without using free fruits, vegetables, and my collected points, wouldn't fill my back tooth.

Well, sitting here at the computer isn't burning many points. I better get moving.

That's what WW says, "Get moving!" It doesn't matter what you do, so long as you get moving, and stick with it.

wishandaprayer wrote: My

wishandaprayer wrote:

My face is getting wrinkles, but I don't care. I really need to lose the weight for health reasons. I got all excited because I read that maple syrup helped with wrinkles and I thought that I could put that on my waffles in the morning. But it was just an April Fool's joke.

You're not supposed to EAT the maple syrup. You're supposed to rub it into your wrinkles

Another thing - once you

Another thing - once you start exercising you'll build muscle, which weighs more than fat. So your weight can actually go up at first; people can easily get discouraged by this. That's why it's important to go by dress size, not weight, to judge how much fat you've lost

Twain wrote: wishandaprayer

Twain wrote:
wishandaprayer wrote:

My face is getting wrinkles, but I don't care. I really need to lose the weight for health reasons. I got all excited because I read that maple syrup helped with wrinkles and I thought that I could put that on my waffles in the morning. But it was just an April Fool's joke.

You're not supposed to EAT the maple syrup. You're supposed to rub it into your wrinkles

I think that I read that bathing in it was the best.

Twain wrote: Another thing -

Twain wrote:

Another thing - once you start exercising you'll build muscle, which weighs more than fat. So your weight can actually go up at first; people can easily get discouraged by this. That's why it's important to go by dress size, not weight, to judge how much fat you've lost

Heh...Twain have you seen dress sizes these days? They are off-the-wall inconsistent. No rhyme or reason what so ever. My "dress size" ranges from two to an eight, with six being the most common.

Years ago I decided that I was fine with my weight so long as I could wrap my arms around my waist and touch my elbows on the other side.

Katherine wrote: Years ago I

Katherine wrote:

Years ago I decided that I was fine with my weight so long as I could wrap my arms around my waist and touch my elbows on the other side.

I could probably do that too if my arms reached down to my feet.

I heard that a glass of wine

I heard that a glass of wine or other alcoholic drink in the evening will help with high morning glucose readings. Apparently it "distracts" the liver from releasing glucose. I have tried this twice & it seems to work. But is it safe to do this?

impatientpatien wrote: I

impatientpatien wrote:

I heard that a glass of wine or other alcoholic drink in the evening will help with high morning glucose readings. Apparently it "distracts" the liver from releasing glucose. I have tried this twice & it seems to work. But is it safe to do this?

Right, the liver can't release sugar as it's processing the alcohol. But this apparent benefit may also have a dark side to it. If the sugar goes down while you're sleeping, your liver may not be able to raise your sugar to a normal level, and you can suffer the consequences of hypoglycemia during your sleep. So, if you do take a drink before bedtime, once in a while check your sugar level at 2-4 am

And, stick to the recommendation - maximum 2 drinks/day for men; 1/day for women

Katherine wrote: Twain

Katherine wrote:
Twain wrote:

Another thing - once you start exercising you'll build muscle, which weighs more than fat. So your weight can actually go up at first; people can easily get discouraged by this. That's why it's important to go by dress size, not weight, to judge how much fat you've lost

Heh...Twain have you seen dress sizes these days? They are off-the-wall inconsistent. No rhyme or reason what so ever. My "dress size" ranges from two to an eight, with six being the most common.

Years ago I decided that I was fine with my weight so long as I could wrap my arms around my waist and touch my elbows on the other side.

Men have it easier - they can use belt size. I guess women can do that too

Wanda, with Hugs & Love &

Wanda, with Hugs & Love & prayers.

Thank you, MsD. I hope

Thank you, MsD. I hope you're well & will have a wonderful Easter.

I've been keeping my blood

I've been keeping my blood glucose tightly controlled in the "non diabetic" numbers (which really aren't NON or PRE) for over a decade using a low carb diet alone. Initially, after it rid me of painful peripheral neuropathies due to a decade at least of delayed diagnosis (I reversed long standing kidney damage, too)I also used alpha lipoic acid to get rid of some residual numbness, but take nothing to control bg now.

Fasting may be high even if post meal numbers aren't for a couple of reasons. One reason is that you may be oversecreting cortisol during sleep hours; this is a common but unsuspected cause of many cases of type 2 DM. Urine, saliva and especially midnight serum testing can help to evaluate this.

Sometimes fbg will be high if your carbs are still too high for your remaining pancreatic beta cell mass, 50% of which is gone by the time most type 2 DM is diagnosed. Cutting carbs more the day before should help to lower fbg over the next few weeks.

Also, a small snack of protein at bedtime, or protein with a high fiber cracker like Wasa fiber rye helps a lot of folks achieve better fbg.

At 5.9%, you still have a ways to go to get into safer territory; CVD mortality actually begins to rise at 4.6% and precipitously at every increment above 5%.

Additionally, you should use the testing method described in the flyer on this site and read about the levels of glucose that cause damage (anything over 140 at any time) to organs and nerves, as well as the way in which glucose control deteriorates. www.phlaunt.com/diabetes
I disagree with this author on some issues, but she's collected a lot of information of great value to those seeking to avoid diabetic progression and complications.

Don't worry about a drink of red wine lowering your bg so low overnight that you're in danger; growth hormone is still going to rise during the overnight hours, stimulating cortisol release by about 1 a.m. and especially at dawn to keep your bg high enough.

Congratulations on choosing the right way of eating, and on your results so far!

You could try increasing the

You could try increasing the fat and cutting the starches, replacing with colorful high fiber veggies. Wheat, especially, causes huge bg and weight issues out of all proportion to carb counts.

Fat stimulates neither insulin nor glucagon, so it's a weight loss dieter's best friend, along with carb restriction.

I have mostly lost weight without an exercise component eating this way. And bg control is rapid, too, even without any weight loss, studies show. My diet is about 50% fat, mostly from nuts, wild caught fish, olives, grass fed meat and dairy.

Reference jeans. One pair

Reference jeans. One pair that are too small no matter how they're size marked, try them on periodically. Jeans are pretty unforgiving, just don't use the elastane or spandex augmented ones.

I've had jeans that fit me at the same time from the same brand that ranged from size 4 to 10.

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