A Short Story:
I was 48, young and virile a young man extremely atheletic and very active in that I exercised everyday (cardio as well as free weights). In 1992 I was diagnosed as a borderline diabetic, but so what that meant nothing to me after all I was the perfect specimen of health 6 feet tall 170 lbs and great body definition, why should I be concern.... RIGHT.
Well, in 2003 I began to start feeling lethargic and decided to pay a visit to my doctor the blood work revealed that day my MGDL was 321 and my A1c was 11.5, yet still those numbers did not mean a lot to me because I of course did not understand the ramifications of this thing they call Diabetes Mellitus.
To add insult to injury I hate drugs (up to that point in 2003 I had never put any drugs in my body, not even aspirin)because I believe drugs alter the natural flow of the human body and more times than not the side effects of drugs are far worse with side effects than the disease itself.
So despite all of this I continued to be in denial and not do a lot of life style changes to combat this disorder of diabetes. In May of 2010 I was playing golf and afterwards as I was taking of my shoe I observed a shoe full of blood after removing my sock I noticed a destroyed toe by a golf ball that was in my shoe that I never felt, 2 weeks later that toe was amputated, NOW THIS THING CALLED DIABETES HAD MY FULL ATTENTION. I am now 68 years of age and since 2010 I have been on top of everything, my goals has been to keep my MGDL under 140 all day and ti have my fasting counts under 100 and truly I have been very diligent in maintaining these goals through diet, exercise, glimepiride as well as arcabose, I know I am now ingesting drugs (especially a sulfonylurea
Now here is where I need some help if it is possible. As you know the human body is such an amazing machine. I take my blood count 4-6 times a day 1 hour after a meal, 2 hours after the meal and four other times at random, andthat I am nothing short of perfection in keeping these counts throughout the day between 110 and 130. Yet I cannot control the liver and pancres at what is known as pre dawn syndrome, this of course is when glucose is dumped in the blood stream at pre dawn to supposedly prepare you for the coming days activities. This causes my fasting MGDL to be up between 150 -155. SO WHAT DO YOU THINK? I am of course aware of the DPP4 drugs (januvia and Onglyza) but remember I hate drugs especially those that shake down organs.
I use a small dose of lantus at bedtime to calm the rise. You didn't mention using Lantus, so you might add this basal type insulin in kahoots with your physician, of course.
My brother also is diabetic and he chose insulin and we match numbers pretty frequently and I find that I am beating him like a drum. His fasting MGDL is almost constantly 10-12 points higher, and he checks as often as I do and we find that his Mgdl throughout the day falls between 130 and 160. Of course I really don't believe he is as diligent as I am with his diet.
I am a T2 as well and I was never able to control my fasting blood sugars. I gave it every effort. I followed Bernstein's "Diabetes Solution" diet and kept very strict and I rotated through a wide combination of drugs. In the end I moved to insulin and I am now much more successful with controling my Darn Phenomenon (DP).
The other thing I would like to point out is that the sulfonylureas like Glimepiride are not durable and on average they fail after about 7 years. It may just no longer be very effective anymore and insulin may give you a lot more latitude to not be so strict on yourself. So I second what Leo2 says, a basal insulin may really help.
ps. Also I found that I had sleep apnea which made my DP much worse, that was the second pillar that helped me.
were you leary or jumpy regarding insulin intake daily. Most people including myself would do anything to stay away from needles, though I acknowledge as you pointed out that not only sulfonylureas but all oral diabetic drugs will cease to be functional eventually, and I do will be doing needles whether I want to or not.
What are you taking Lantus?
I also used to fear needles, but I overcame it. As you become exposed to injection it becomes routine and the fear dissappears very quickly. The desire to be healthy overcame any fears I had. And besides, I had already had to do injections with Byetta and Victoza.
I'm currently on Levemir which I split into 2 doses and Humalog. I typically take 4-5 injections daily.
I don't see mention of metformin in your post. Metformin works by helping to control how your liver releases glucose and it also helps with insulin resistance. I know it's another drug but it's worth condidering. I believe it is the most prescribed drug for T2.
I also suggest that you look into insulin, Lantus or Levemir are both long acting basal insulins that will help with your dawn phenomonon. In my opinion insulin is better than oral drugs. It replaces what is missing and doesn't beat-up your organs up as you described. When I started insulin I was able to stop all the other drugs after a while.
I'm another that seconds what Leo2 says. Talk to you doctor about insulin.
You are correct in your statement regarding metformin as it is indeed the first line defense, however due to my reluctance in accepting this disorder I have apparently caused damage to my kidneys and they will not prescribe Metformin. As a matter of fact I have been recommended to a nephrologist for a second opinion.
Kidney problems make basal insulin an even more attractive option. Unless I'm way off base here I will guess insulin has no effects on kidneys. I'm not sure they can say that about most oral medications if any.
Everyone fears the injection but soon find it a non-issue once they get started. It soon becomes just another part of what must be done.
I "only" have T1 but it sort of disturbs me that your doctors went along with "you 'only' need [pills]" while your BG leads to a condition where you've suffered complications. It seems as if they 'enabled' your aversion to medication including shots. I had a different path, in that I was in such horrible shape prior to dx that I was ready to do *anything* to feel better. I agree with the folks recommending exploring basal insulin for what you are describing.