Replies to This Discussion

Permalink Reply by Brian (bsc) on April 16, 2010 at 6:06pm

I'm personally just get a bit freaked about having a fasting of 120 mg/dl. The AACE recommends a target of keeping your fasting less than 110 mg/dl. For many type 2s, having your fasting degrade is the last thing to occur, and having a fasting that diverges above 110 mg/dl probably represents essentially a loss of blood sugar control. In my experience, when I have a fasting of 120mg/dl I have a total loss of phase 1 response and a total intolerance to carbs. If my fasting is 120 mg/dl, I probably would only be able to eat 5-10 g of carbs/meal and still meet the goals of 140 mg/dl at 2 hrs.

In my view, normal blood sugar numbers are having a fasting of 83 mg/dl and being able to eat "some" carbs and stay below 140 mg/dl all the time.

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Permalink Reply by KimKat on April 17, 2010 at 7:39am

Diane can i ask you a question?

I am on Metformin and my fasting numbers are often under 83 - I never got to try controlling in without meds because my A1c was 9.2 and my doctor wanted me to go on the Met. My numbers are staying below 110 and in 3 months I hope for my A1C to go way down as my doctor thinks it will.

Question: Without meds, does ones A1c number matter in fasting number control (or even control of your numbers during the day) or it that all based on diet and exercise and the current A1C doesn't effect those numbers? I was just wondering if it is easier for those not on meds with a lower A1C to control their numbers or have lower fasting numbers than those on meds - or is that all dependant on your diet and exercise and what your A1C is doesn't matter.

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Permalink Reply by Judith on May 11, 2010 at 3:49pm

Kimberly---there are so many variables. My feeling is that if you are able to test often and if you know how your meter relates to the lab (my meter runs about 15-18 points under lab tests), then you won't be too surprised by your A1c and it isn't as important in terms of frequency. But that means testing a lot each day so you don't miss the highs and lows that give the A1c average.

I've always thought it dangerous to rely too much on A1cs solely (which my HMO wants to do now for T2s!) because an average doesn't let you catch your first 200 quickly enough, for instance......Judith in Portland

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Permalink Reply by PatientX on April 17, 2010 at 8:40am

I think at your level you are doing great. My thought on aggresive treatment is that it will impact your quality of life. I will tell you from my experience on metformin. Metformin is a train wreck in your stomach. When I first took metformin I would puke all the time on anything that I would eat. The higher the dose the worse it got. At that time my A1C was 6.7 and i wanted it under 6. I was put on Januvia which just made me insane and the stomach problems got even worse. It got bad to the point that I would have to leave work to puke. Then i would be on the toilet when i was not throwing up. I could be in the middle of meetings and I had to go home because the stomach problems got so bad. I then decided to work out like a mad man and that improved my A1C which lowered my metformin doses.

So my suggestion to you if you dont have a strong stomach then I would hold off on the metformin and any pill as long as you can. It got so bad for me that I asked to be put on insulin only but my doc would not do it. That is when I decided to work out and cut out a lot of food. I am on 750 of metformin now which is better on my stomach but I do get problems sometimes. So with metformin I had to pretty much quit eating anything that was good even healthy good even in small portions. Now my diet consists of bland chicken, salad, fruits and occational different food. the different food is when I dont mind having stomach problems. I practially eat almost the same thing every day.

So be happy with your A1C. Its a merathon and not a race so pace yourself and rejoice on your accomplishments for the day

take care

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Permalink Reply by JB King on May 11, 2010 at 7:14am

I was put on meds right away. My A1c number was initially a 9.9 so I was put on Metaformin 500 mg 3 times a day and then a month later got that upped to 5 times a day and Avandia 4 mg a day added to it. Now I'm down to Metformin 2 times a day and no Avandia but my sugars are now under control most of the time.

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Permalink Reply by The Diabetic Welfare Queen on May 11, 2010 at 4:09pm

Well, I was diagnosed in November of 09, with an A1C of 10.5%, and a fasting blood glucose of 235 mg/dL. The doctor wanted to put me on meds right away, but I really pushed to do it myself, with a semi low carb diet... I have good numbers this way, but my A1C is now 5.5%... Yours being at 5.2%, well... You may want to figure out things with your diet, as to see what may not be working as well... or tips on how to get morning numbers down. The meds really lower numbers, and can cause lows, if you're already at such a low A1C... Perhaps adjust carbohydrate portions here and there, and play with that. It can take a lot of fine tuning, and tweaking, sometimes...

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Permalink Reply by Judith on May 11, 2010 at 4:20pm

I've been thinking about your post off and on all day. You are getting great responses that offer you many things to consider. So I'll give you one more----your desire to Know is marvelous and a diabetic's first, best line of defense against complications!

At age 57+, I was diagnosed at 6.5 A1c almost 4 years ago. I was so enraged, I stormed out of my doc's office before she could prescribe anything, throwing out my BP meds and my statin on my way out. I stopped in the pharmacy only long enough to buy a home BP monitor and continued to stomp my way home. I then proceeded to become a sponge for everything to do with diabetes that I could absorb. My A1c dropped steadily through the 5s and 3 months ago was 4.9. So far on diet and exercise only.

But it is difficult and you have to be mildly deranged and stupidly disciplined like me to Maintain it, I think. In the beginning, however, it might be satisfying for you to conquer your number difficulties without meds. I hope you can test frequently---you need to come up with your own system for tracking what everything you eat does to those #s. It's the only way to get control. I use a little notebook with multi-colored pages for easier reference. Lots of you "youngsters" (and savvy oldsters!) use computer notebooks, I know.

And for me---well, I started out on the ADA guidelines and despaired of ever getting control. Then I found Dr. Bernstein's book on low-carb eating for diabetes. We called him Crazy Bernie because at first it seemed impossible. My husband went along for the ride in Solidarity, lost 70 pounds and got off his BP meds. Crazy Bernie is now an icon of Good Info in our home. Do note that some of us, like my friend Nel Peach can tolerate a lot more carbs---that's one of the things frequent testing teaches you.

Now I have also been helped by the careful addition of some vitamins and supplements---for BS specifically Nopal powder, Fenugreek, and Gymnema, but that is probably another discussion. And never underestimate the importance of exercise to the process of bringing a number down---often rather dramatically.....

Enough for now. I'm wishing you well and hope you will keep us posted.....

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Permalink Reply by momto3 on May 11, 2010 at 4:20pm

I am recently diagnosed also. I am slim and my highest number was only 264. The endo did a c peptide on me as well and it was within normal limits. At this point the endo does not want to specify on wether it is type 1 or type 2. I don't really fit either profile. I am not on meds at this point either, I meet with a CDE next week. They said they want to watch my numbers for awhile. I have noticed latley that I am having higher numbers more frequently than I was so just have to wait and see.

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Permalink Reply by Daniel Stamey on May 19, 2010 at 3:28pm

I wouldn't assume that you will need to ever go on meds. I was diagnosed in Oct 2009 with an A1C of 11.1. Normally, the ADA recommendations would mean I should have immediately been put on Insulin (I think they recommend at with an A1C above 9.0). Anyway, my doctor, knowing me and that I would take my diagnosis seriously, told me he was going to give me 3 months to prove to him that I can get my diabetes under control through diet, exercise and supplements. I went from 11.1 to 6.0 in those three months going very low carb (darn near the Dr. B. levels but not quite that low). Now, 8 months later, my A1C is 5.1. I am glad that my doctor gave me the chances to make the necessary changes without immediately putting me on insulin or oral meds. Maybe one day I will need them, but I plan to do whatever it takes to control this without them.

I do take supplements. I take Carlson Nutra-Support Diabetes and Insulow with EPO (evening primrose oil). I also take Metagenics multi-vitamin since I am eating very low carb (probably in the 40-50g a day range). They seem to help me quite a bit.

I have talked with my doctor (family doctor, not an endo) about metformin and Byetta but with the success I am having with the diet/exercise and supplements, he sees no reason to even think about putting me on meds. It is tough but if you can go low carb, you can get control without meds. I have easily adapted to my new diet and actually really enjoy it now. I don't miss breads or pastas or sugar.

So, you can start off with a very high A1C like I did and through just diet/exercise and supplements, get control of your blood sugars. I had a c-peptide of 4.2 which is above average and I assume that is why I was able to do this without meds. I just got another c-peptide test yesterday and hopefully it is back in the average range showing that my pancreas isn't having to work as hard anymore due to the severe limiting of carbs. I plan to stick with my current regimen as long as I can and am open to taking meds if I just can't sustain this regimen. It has only been 8 months so we'll see how long I can do this.

Good luck and remember that this isn't a sprint but a long distance race in which you will need to control this disease for the rest of your life. Make the changes you are able to sustain for as long as possible and it that means needing to add meds, don't be ashamed.

Dan

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Permalink Reply by Judith on May 19, 2010 at 6:47pm

Well done and Me, too. Gymnema, Fenugreek and Nopal powder have also helped me a lot---got me down to a 4.9---at least for the moment. I'm always scared about maintaining it!.....

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Permalink Reply by Daniel Stamey on May 20, 2010 at 12:59pm

I too take Gymnema and Fenugreek. Haven't heard about Nopal powder but I will check it out. I would be jumping up and down if I can get below 5.0 like you have! Congrats!

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Permalink Reply by Bitter-Sweet on May 20, 2010 at 1:11pm

I just ordered the nopal powder. I have heard good things about it, I hope it works for me...My A1c last month was 5.2, but I still have fasting blood sugar above 100 and below 112. Post prandial readings at 2 hours are usually around 135-142..no matter what I do. I eat little carbs and exercise every, jogging or biking...I just hope this nopal powder works...It's very famous in Mexico, I know a lot of people who use it there...I just never paid attention until I was diagnosed not so long ago...Good luck!

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