Hi I haven't been here for awhile but am looking for advice. I am a thin type 2 and am not on any type of meds. Just using diet and exercise to control bg. well my post prandial numbers are in the 200 's but it always come down on its own. The problem is my endo doesnt feel ther is any need to be on any meds. Is damage being done to my body with the pp bg spikes? Should I be on meds or not?

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Maybe you should get a second opinion if you are concerned. I'm new to Diabetes myself as my daughter was diagnosed about a year and half ago. Have you taken an A1C test? Personally I would be more concerned with a high A1C in relation to long term effect.

Nice to hear from you!

BG over 140 causes damage, so your endo is being rather cavalier. I'd find another endo.

I'm a thin prediabetic (on my way to T2.) My endo doesn't even want me to get to those numbers, so I've tried a number of medication already. I've learned it can be hard to control with just diet and exercise, from my personal experience. I would get a second opinion if it's not making you feel well.

Numbers in the 200s at any time are not good news even if they do come down on their own given enough time. Such high sugars will be poisoning your pancreas. I say definitely you should be on meds (metformin is usually the first line). Don't go for the sulfonureas as these cause the pancreas to burn out faster. If meds don't work, then insulin.

Post eating should ideally be < 120.

What are you eating for meals? How many grams of carbs per meal? You could try reducing your carbs further. Stick to non-starchy veges for your carbs / avoid grains and things made from grains / limit fruits.

Second opinion is called for if your endo won't act.

Yes, what is your A1C?

You should be treated to acceptable targets. It doesn't matter what your A1c is, your fasting Blood Sugar (BS) and your readings 2hrs after meals are perhaps even more important. The Amercian Association of Clinical Endochronologists (AACE) Practice Guidelines give you the "standard" target goals. These goals (see Table 7) are to target a fasting BS < 110 mg/dl and a 2hr postprandial BS < 140 mg/dl. You should be able to hit these targets "most" of the time. Sure, if you are old, have complications, you may individualize to less aggressive goals.

You can print out the practice guidelines and bring this to your appointment as a talking point. In my opinion, if you are regularly in the 200s 2 hrs after a low carb meal, your doctor should be talking to you about some medication. Good medications to consider are metformin and for postprandial control Byetta or Victoza.

Below is a response to a question as to why A1C is critical. Now the question I have is momto3 mentioned that after eating the blood sugars go into 200's but come back down to normal. How long does it take to get back to normal? With my daughter after she eats she sometimes she is in the 200's within 2 hours she is back down below 140, is that bad?

"Robert Gabbay, MD, PhD, responds: You are right that A1C is a very important measure of how a person's diabetes is doing. It is the best indicator and determinant of risk for developing complications of diabetes, as you describe. Since A1C averages blood glucose for the past three months, it gives a good measure of blood glucose control over time. It's important to measure A1C in addition to your regular blood glucose tests."

I am sure you have a good doctor, and there is nothing wrong with the A1c as a important measure of blood sugar control. However evidence suggests that postprandial glucose levels are an independent (of A1c) risk factor for complications and that is why the AACE has specifically called out a target for fasting and postprandial blood sugars. I can list a ream of studies on this matter if you want.

If your daughter is surging to the 200s at an hour, but routinely is back down below 140 mg/dl at 2hrs then she is right on target with the AACE recommendations. Momto3 is not taking medication or insulin, so she is having much more difficulty attaining these targets.

The reason I mention this is that for years I had what was considered an "ok" A1c, 6--6.5%, corresponding to an average blood sugar of 126-140 mg/dl. I followed a very strict diet and exercise regime and tried all kinds of medications eventually in combination. In my situation, I had impaired fasting glucose and I could never meet the fasting blood sugar or postprandial targets. I was "not ok" despite having an ok A1c, I had to be insistent that my doctors understand these targets and it eventually helped lead me to better treatment.

Thank you for all the advice. I guess the reason my endo is hesitant to put me on meds is because my numbers do come down on their own. I eat healthy and walk/jog 3 miles a day and eat more protein than carbs.I put a call into the endo and will be having some labs done. I don't think the labs will tell anything because my fasting numbers are good. Around 100. I just have trouble when I eat. The endo has proof of that when they did an OGTT and failed it. Im not even sure that the diagnosis of type 2 is correct. They had mentioned MODY as a possibility but never said for sure. Really don't know where to go from here. Mabe I should not worry about it.

thanks for that AACE info bsc!

Good advice here, but a second opinion is needed.....numbers in the 200s are not good at any time. After your largest meal I would test every hour for three hours. Take that log to a different doctor. And get an A1C test. Good luck!

Begin here, with this excellent page of Jenny Ruhl's: Research Connecting Organ Damage with Blood Sugar Level

Then continue here: Test, Review, Adjust

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter.

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