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New and have some Questions - Page 2


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Old 08-24-2018, 18:15   #11
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Interesting case. Time to dive in and put this jigsaw together as a BAU Forensic agent in the show Criminal Minds much like Spencer Reed. I will review this case and have a report for you soon.


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__________________
Diagnosed with Type 1 diabetes Sept 12 1977
Developed Hypoglycemic Unawareness Dec 83
8 grandmal seizures requiring paramedics + ER
Dx heart disease in 2000; triple bypass surgery
2 pancreas organ transplants 2001+2004 at Univ Minn & Univ Calif San Francisco med ctr
Dx with cancer twice 2007 & 2008, stage 2 & 3
Lost 2 transplanted pancreas; 6/2001 & 6/2015
Longtime advocate & member of diabetes & cancer support forums for 15 yrs. A1c 5.0
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Old 08-24-2018, 20:09   #12
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After reading your posts, first let me recite how you got here. I dont want to miss anything or misconstrue your progression of events.

You were dx type 2 in 1961 at age 4. I cant recall knowing a type 2 at such a very early age before. Insulin resistance at 4? Then for next 10 years you were on small does of insulin until age 14 or to mid 1970's when you were taken off.
(why do i see course correction of stopping small does of insulin as a potential risk?)

Did you have years where you had fluctuating weight gain (more than 10 to 20 pounds) other than during pregnancy?

You have had 3 pregnancies at age 22, 24 (early to mid 1980s) and 29 and had gestational diabetes the second time but only needed to treat that with diet. At age 29 or around 1990 around time of most recent pregnancy, while pregnant you were on insulin but afterwards your blood sugars went back to normal.

From mid 1970s to 1989, do you recall or have any visibility on your any glucose values or testing results or A1c levels.? Keep in mind A1c tests were not available until early 1980's

From 1990 thru 2016, were you insulin independent?
Were you on any oral meds during that same span?
Do you remember what your A1c's were or any FBG or 2hr PP references from early 1990's to 2016?

It appears you have been on a low carb and low fat diet for many years so your not likely in a ketosis state even though your carbs are under 30 - 50 as your fat intake is low as well.

As of May 2017 your A1c was 13.5 and a few days ago A1c was 9.0. Metformin 1000mg 2x daily and now glipizide Xl 10mg daily Your values have come down but are up again.

so far so good?

Now lets think outside our world and start looking towards the stars.

1. There are other classes of meds for type 2 treatments and Insulin Resistance and perhaps a change in class of medications will be more effective as they have different mechanisms to target insulin production, glucose reduction and other pathways.

GLP-1 receptor agonists Glucagon-like, peptide-1 agonist incretin mimetic such as Trulicity, Ozempic, Victoza

DPP-4 Inhibitors like Januvia

Sodium-glucose cotransporter 2 (SGLT2) inhibitors like Invokana and Jardiance

**Your already on a Biguanide with meformin and a sulfonylurea with Glipizide


2. Also make sure your glands such as hypothalamus, pituitary gland., thyroid, parathyroids, and adrenal glands are reviewed.

An Example would be a condition called Cushing Syndrome which secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol than normal which certainly would raise glucose levels.

Keep in mind adrenaline and cortisol are stress hormones and they cause the liver to secrete glucose back into the bloodstream. Glucagon also raises glucose levels.

3. Insulin options include fast acting ie: humalog, basal ie: lantus, and
even Tresiba which can last 40 hrs

One more question How sensitive are you to carbs?

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__________________
Diagnosed with Type 1 diabetes Sept 12 1977
Developed Hypoglycemic Unawareness Dec 83
8 grandmal seizures requiring paramedics + ER
Dx heart disease in 2000; triple bypass surgery
2 pancreas organ transplants 2001+2004 at Univ Minn & Univ Calif San Francisco med ctr
Dx with cancer twice 2007 & 2008, stage 2 & 3
Lost 2 transplanted pancreas; 6/2001 & 6/2015
Longtime advocate & member of diabetes & cancer support forums for 15 yrs. A1c 5.0

Last edited by Hearts Jounrey; 08-24-2018 at 20:12.
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Old 08-24-2018, 23:10   #13
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So sorry you're having such difficulties.

Have you ever done a systematic testing of your blood sugar throughout the day to see what happens after you eat and inbetween? A really good way to find out how one's carbohydrate metabolism is working is to test before eating, 1 hour after, and then 2 hours after that. One can see immediately what foods/meals cause BG to rise and which ones allow for more stable BG.

www.bloodsugar101.com covers about every aspect of diabetes, including how to lower BG (found in the "How To Lower Your Blood Sugar" section) which covers the testing method I mentioned above. We call this "Eat to your Meter".

Everyone is different and everyone's body responds differently to meds. Personally, if I was having difficulty with high BG, especially FBG, I would take metformin and skip the other meds (which have some serious side effects) and go straight to insulin. I know it's more bother, but it is more precise than the Gip and other meds, and one can respond correctly and accurately to fluctuations in BG.

I'd also suggest you take another look at your diet. If you are eating low carb and low fat, then you are probably eating more protein than you actually need. Most of us here are eating low carb and high fat, moderate protein. Fat does not affect blood sugar, but some of the excess protein eaten does get converted to glucogen which later gets turned into glucose which can raise BG. I know of some members on insulin who have to factor a percentage of protein into their insulin calculations.

I do hope you can get your BG stabilized soon.

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70 yrs. Dx May 2010
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Old 08-29-2018, 10:13   #14
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Hi Snowynight, welcome to the forum.

I am by no means an expert on DB, but age of diagnosis + little symptoms to now more symptoms leads me to think of some sort of MODY (there are many types of MODY, some of which never need insuline, some only after many years). I would advise discussing this with your doctor as MODY has a genetic component so - if I'm right - it can have been passed on to your children.
Some forms of MODY also benefit from different medication than the standard treatments, another argument to get tested for at least those that benefit from non-standard medication and where the symptoms match yours.

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Old 08-30-2018, 15:43   #15
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Quote:
Originally Posted by Hearts Jounrey View Post
After reading your posts, first let me recite how you got here. I dont want to miss anything or misconstrue your progression of events.

You were dx type 2 in 1961 at age 4. I cant recall knowing a type 2 at such a very early age before. Insulin resistance at 4? Then for next 10 years you were on small does of insulin until age 14 or to mid 1970's when you were taken off.
(why do i see course correction of stopping small does of insulin as a potential risk?)

Did you have years where you had fluctuating weight gain (more than 10 to 20 pounds) other than during pregnancy?

You have had 3 pregnancies at age 22, 24 (early to mid 1980s) and 29 and had gestational diabetes the second time but only needed to treat that with diet. At age 29 or around 1990 around time of most recent pregnancy, while pregnant you were on insulin but afterwards your blood sugars went back to normal.

From mid 1970s to 1989, do you recall or have any visibility on your any glucose values or testing results or A1c levels.? Keep in mind A1c tests were not available until early 1980's

From 1990 thru 2016, were you insulin independent?
Were you on any oral meds during that same span?
Do you remember what your A1c's were or any FBG or 2hr PP references from early 1990's to 2016?

It appears you have been on a low carb and low fat diet for many years so your not likely in a ketosis state even though your carbs are under 30 - 50 as your fat intake is low as well.

As of May 2017 your A1c was 13.5 and a few days ago A1c was 9.0. Metformin 1000mg 2x daily and now glipizide Xl 10mg daily Your values have come down but are up again.

so far so good?

Now lets think outside our world and start looking towards the stars.

1. There are other classes of meds for type 2 treatments and Insulin Resistance and perhaps a change in class of medications will be more effective as they have different mechanisms to target insulin production, glucose reduction and other pathways.

GLP-1 receptor agonists Glucagon-like, peptide-1 agonist incretin mimetic such as Trulicity, Ozempic, Victoza

DPP-4 Inhibitors like Januvia

Sodium-glucose cotransporter 2 (SGLT2) inhibitors like Invokana and Jardiance

**Your already on a Biguanide with meformin and a sulfonylurea with Glipizide


2. Also make sure your glands such as hypothalamus, pituitary gland., thyroid, parathyroids, and adrenal glands are reviewed.

An Example would be a condition called Cushing Syndrome which secretes an excess amount of ACTH, which in turn stimulates the adrenal glands to make more cortisol than normal which certainly would raise glucose levels.

Keep in mind adrenaline and cortisol are stress hormones and they cause the liver to secrete glucose back into the bloodstream. Glucagon also raises glucose levels.

3. Insulin options include fast acting ie: humalog, basal ie: lantus, and
even Tresiba which can last 40 hrs

One more question How sensitive are you to carbs?
Hi Heart, I'm going to try to answer your questions. First off, Once I was taken off of insulin at age 14, I did fine, no weight gains or losses other than small ones when I would PMS. 5 - 7 pounds, give or take.

I was diagnosed in 1965, Don't want to make my self any older LOL.

I was told after my 4th child that my BS was fine. I didn't bother going to the Dr and having it checked. As a matter of fact, the only reason I went in May was because my insurance company made us go so we could get a cheaper premium. Thank goodness they did because who knows what would have happened if I had gone unchecked.

I've never been on any meds outside of pregnancy.

My diet has been off and on. in 1998 I started Atkins, the old Atkins, which i think is better than it is now. I have been off and on Atkins for 20 years. If I'm honest, mostly off in later years. Never low fat, I never believed that worked.

The last 3 days I've been testing one hour and then two hours after each thing I eat. I find my fasting BS are high, I was drinking Atkins shakes and my BS would go up from them so now I have changed my breakfast to CarbmasterYogurt. Today my fast BS was 193. After the yogurt it was 155 There is a thread here, somewhere and when I find it I'll send it to you, It shows my last 3 days of testing and how it's gone.

I also think I have a problem with eating. I just want to munch all the time especially at night while watching TV. The last few nights I've been playing games on my iPad to stop me from eating. I didn't realize it was such a problem until now. So weird!

Thanks for your help, any more questions, let me know.

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Old 08-30-2018, 16:45   #16
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You just found the answer to your passion for munching at night. Become a fulltime game player on you Ipad and your blood sugars will be your best friend.

Determine how much your blood sugar rises for every 10g of carbs you eat by checking 15 min, 30 min and 45 min after you eat. If your blood sugar is 140 before eating then you eat 10g and check in 15 min and its 190 thats 50 pt jump or 5 pts a gram. Then check at 30 min and at 45 min and 1 hr to see when levels begin to fall. For instance each gram of carb raises my blood sugar between 2 and 3 pts within 30 min.

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__________________
Diagnosed with Type 1 diabetes Sept 12 1977
Developed Hypoglycemic Unawareness Dec 83
8 grandmal seizures requiring paramedics + ER
Dx heart disease in 2000; triple bypass surgery
2 pancreas organ transplants 2001+2004 at Univ Minn & Univ Calif San Francisco med ctr
Dx with cancer twice 2007 & 2008, stage 2 & 3
Lost 2 transplanted pancreas; 6/2001 & 6/2015
Longtime advocate & member of diabetes & cancer support forums for 15 yrs. A1c 5.0
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Old 08-30-2018, 18:23   #17
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Quote:
Originally Posted by Hearts Jounrey View Post
You just found the answer to your passion for munching at night. Become a fulltime game player on you Ipad and your blood sugars will be your best friend.

Determine how much your blood sugar rises for every 10g of carbs you eat by checking 15 min, 30 min and 45 min after you eat. If your blood sugar is 140 before eating then you eat 10g and check in 15 min and its 190 thats 50 pt jump or 5 pts a gram. Then check at 30 min and at 45 min and 1 hr to see when levels begin to fall. For instance each gram of carb raises my blood sugar between 2 and 3 pts within 30 min.
That is interesting. I'll try that. I've always wondered if there was some sort of formula to figuring this out. That will help alot!! Thanks!

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Old 10-12-2018, 12:29   #18
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Snowynight, I can't remember if you have been tested for Type 1 antibodies or if you have followed up with some of Hearts Jounrey's thoughts on hormonal/glandular issues as being the cause of high BG. You are already on a sulfonylurea drug that stimulates more insulin production, maybe your pancreas is just not capable. Have you had a c-peptide test run, it measures how much insulin you are actually putting out?

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Think I've had this since 2003. Told I was Type 2 lean on 2/13/12.
a1c 8.8 (8/2011) 5.2 (02/2020)
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