The a1c that runs at that is successfully stopping the rot is not necessarily for everyone.
For me, once average BG dropped to 155 ( 6.9 a1c) the kidenys stabalized, the excess waqter dropped, the hemorages on eyes dropped etc. I got off excess insulin, dropped the actos and booted the glyburide/starlix.
Getting to sub 6.0 will be dependent upon how well the liver and its fifo operation is working correctly - adding glucose when sub 100 and sbub 70.
If liver can be trusted to do the glucose add operations without adding the full pail, then by goodness, one can go lower on the low glycemic diet and move to lower average BG and a1c.
So far all data is showing that getting average BG to 140 and below stops the rot.
In my case, my doctor had me stop my bg going sub 100 (70) and triggering the liver glucose add operations as it would NOT refrain from adding full pail ( a1c ends up ay 13.3 and all the attendent rot issues)
Data from hospitals, my doctor et all suggest that healing, lower deaths etc happen when average BG is between 140 and 180 and when they try to maintain the "young" regular properly operating body BG numbers; deaths go up and it takes longer to heal.
As usual here in the "dam the torpedo's land and full speed ahead" always seraching for the one unified field theory solution and single silver bullit that kills vampires we end up missing the better overall balanced answer and why settling one answer does not help all.
still an excellent number don't beat yourself up to badly there is always another chance for improvement
Aimee, just remember that every person is different, and the A1c is only ONE indicator of how you're doing with your diabetes control. If you know you're eating well, and exercising to the best of your ability, and you're testing, and correcting in whatever way you do it, and you feel good, then I'd say you're doing a good job, regardless of what the A1c says.
If 7.0 is where you tend to gravitate, so be it. Just do your best and don't stress. OK? :-)
Do you mind sharing what some of the things you are doing to try and get your morning BS lower? I am having the same issue and all my Dr continues to do is want to throw medication at me. It is driving me crazy! Currently I am taking Victoza 1.2 and 500mg Met in the morning and evening. My last A1C was 6.7 A year earlier it had been 5.8 which was right before my diagnosis of Thyroid disease. Since then its been in the crapper. Dr. does say that a high morning BS is a sign of whats going on during the prior day however, my BS readings during the day are great and I eat lower carb and practice yoga.
It is a shame the lack of consistent knwoledge and understanding of the body and type 2 diabetes.
Certainly high morning glucose can be a result of yesterday's meals and last night snacks and delayed digestion.
Bur not always, the liver and its response/lack of response to early moning hormones and the wake up dawn wffect can effect morning BG dramatically as well.
In my case, until I got liver stopped in its tracks with metformin, morning bg was 238 to 248 every dam day. No snacks after dinner at 5:30 pm day before and carefull carbs control eating. Midnight would be 100 and at 3:00 am was 150 and 238 by 6:00 am.
SOmetimes this is a result of low insulin levels and basil insulin in blood at late night and sometimes only metformin at 10:00 pm and 1200 am midnight - for me 500 mg dose at each time - one large dose useless. COntrary to all the pill jockey experts. That approach for me shut down the excess glucose so that midnight number of 130 was 130 at 6:00 am wakeup.
One has to monitor every hour thru midnight 12:00 am to 6:00 am using caveman fingerprick machine to watch liver and monkey shines or by CGMS.
Present midieval/stone age data collection one shot lab tests one a day are usless and unrevealing as Dr McCoy of Startrek 23 third century time might be inclined to say.
Until we put loaner analysis pack that can collect real time data on 24/7 basis on a complex multi organ -multi hormone system, much of what is being done is still experience , guess and by golly and the wand of merlin, incantations etc. There is much more light that needs to be shed on the darkness to get all the claptrap and goof ball theories and misleading idea out of the loop.
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.
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.
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.
Jim... how many nights/weeks do you think it takes before you see a pattern as to what is going on with your BS overnight?
I am ready to kick it DB in its ugly face with my morning highs. I hover anywhere from 119-140 first thing in the morning.
Interesting what you said about figuring it out on your own. My Dr wasn't sure about when was a good time of day for the Metformin and suggested split breakfast/dinner so I wouldn't forget it. I did take it one night together and my BS was HIGHER than usual. Its all a mystery isn't it. I am going to start the testing and tracking and figuring it out on my own (and with help of all you knowledgeable people here)
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 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.