[Nagesh Rao]

Hi all,
I am starting a new thread, as adviced, in order to get maximum feedback.
New here and new to Diabetes type 2, diagnosed two weeks ago. I have been desperately trying to keep the BG under control and I dont think I have quite got the hang of it yet. So any help from you experienced people will help me. My fasting has for some time been at 14 mmol/L [which I think equates to 252 mg/dL]. Yesterday, I decided to take 1 Metformin in the morning with Amaryl 4 mg (glimepride). Blood sugars came down beautifully by 1400 hrs to 8 mmol/L (144) and then slowly started creeping up to 14 (252) by bedtime. I took 2 more Metformin at night and was hoping that my FBG will be normal. But it was 12 this morning (216). I am a bit confused by all this. Nothing so far is succeeding. I have oatmeal porridge for breakfast, a zero-carb high protein lunch and a high protein dinner. I do drink plenty of coffee. And yes, I do aerobic exercise [Lateral Thigh trainer] for half hour every day.
Should I be going on to Insulin? Should I be trying health food supplements? (I do take Omega-3 1000 mg every day) I wonder.
Nagesh

 

[fgummett]

Hi Nagesh and Welcome!

As I mentioned in that other thread, Metformin seems to be a drug that can take several weeks to get up to therapeutic levels so you may need to be patient before you see results and it also does not make much sense to take extra doses or miss a dose to try and make short-term Blood Glucose (BG) adjustments.

Insulin can be a useful tool for managing BG levels (I started on it early myself). There is a recent thread discussing this option... http://www.diabetesforum.com/diabetes-news/2974-starting-insulin-instead-oral-hypoglycemics.html

Many (though not all) find (through home BG meter testing) that our tolerance to Carbohydrates (sugar) varies through the day with breakfast as the time of day when we can least tolerate carbohydrates.

Here is my usual spiel on diet (in this case it simply means "what I eat", as opposed to a drastic short-term weight-loss change)... I apologise if it crosses any religious/cultural dietary taboos...

Real whole food, is the order of the day... preferably local and in-season, grown/reared on nutrient rich land... grass-fed beef and pastured chickens for example. This means eat whole (unprocessed, unpackaged, unadulterated) food, which includes a natural balance of fat, protein and carbohydrates (as well as vitamins, minerals etc...) ...there really is no need to be afraid of natural fat... it's gotten a bad rap.

Those of us with Diabetes need to pay particular attention to the foods which have the most effect on our Blood Glucose (BG) levels. There are obvious things to watch out for like candy, cola, cakes and sweets (these are high in refined/concentrated carbohydrates)... next in line are the "white" foods like bread, pasta, potatoes, rice, breakfast cereal... but even something assumed to be healthy like orange juice has about as much sugar as a cola... fat reduced milk can have an higher proportion of lactose (sugar), especially in low-fat products such as yogurts which may have High Fructose Corn Syrup (HFCS) added to replace the fat... and so it goes on. That does not mean you need to feel deprived or hungry to eat this way, not by any means. You may even find you can work in an occasional family cake... for example. The keyword there being "occasional" as it used to be when our Grandparents baked cakes only for Birthdays etc... not everyday (muffins, donuts, pastries) for breakfast.

You may have heard the phrase "eat to your meter" and this deceptively simple message is very wise... test around your food and figure out what works best for YOU.

Learn to read nutritional labels AND ingredient lists. Be aware of hidden "sugars" -- mostly ending with "ose" -- and starches (such as Maltodextrin) which also quickly break down into sugars.

Some ideas for snacks: nuts, cheese, dark chocolate (70% cocoa or higher), pork rinds/scratchings, cold meats, boiled eggs, peanut butter.

While we are encouraged to eat "so many servings of fruit and veg daily", many of these can spike our BGs so test, test test... for many of us, green leafy vegetables seem to work best... but you may also help reduce/slow the BG spike by mixing foods... for example: instead of eating an apple by itself, try just half the apple in slices with some peanut butter or cheese... or have a few berries with some cream.

I'd suggest that BG control be your primary aim... while minimising the need for insulin which is the major fat storage hormone -- reducing excess fat mass, improving cholesterol/lipids, hypertension etc... all these tend to improve with more normal BGs.

I am not big on setting unrealistic "exercise" goals... flogging yourself at the gym... unless you feel especially motivated to do so. I think you are better off with something sustainable in the long term. There are many health benefits of activity but I'm not convinced that losing weight is a major one. I do believe in building activity into your daily routine (rather than finding excuses for missing the gym)... take the stairs, park further away, get off the bus a stop earlier... go for a walk at lunchtime... take "smoke breaks" at work where you walk around the block instead. Physical activity can help with your BG numbers as it tends to lower Insulin Resistance (IR) , as well as using up glucose but as with food, it is advisable to test and see how it affects you.

 

[Nagesh Rao]

Thanks Frank,
That is very helpful. I guess I am just an impatient guy, which probably goes with my job as a surgeon [looking for quick fixes!!!]. I will print out your reply and work on my diet. Also, maybe I should be less obsessive about the BG levels. I seem to be testing almost every two hours!!!! We live in the countryside surrounded by farmers, who are more than happy to sell us their fresh produce for less than the supermarket rates. I see your point about oatmeal breakfast.
Well I have settled on taking Metformin 1gm twice a day. I will see how it works on my Blood glucose.
Nagesh

 

[onaughmae]

Hi all,
I am starting a new thread, as adviced, in order to get maximum feedback.
New here and new to Diabetes type 2, diagnosed two weeks ago. I have been desperately trying to keep the BG under control and I dont think I have quite got the hang of it yet. So any help from you experienced people will help me. My fasting has for some time been at 14 mmol/L [which I think equates to 252 mg/dL]. Yesterday, I decided to take 1 Metformin in the morning with Amaryl 4 mg (glimepride). Blood sugars came down beautifully by 1400 hrs to 8 mmol/L (144) and then slowly started creeping up to 14 (252) by bedtime. I took 2 more Metformin at night and was hoping that my FBG will be normal. But it was 12 this morning (216). I am a bit confused by all this. Nothing so far is succeeding. I have oatmeal porridge for breakfast, a zero-carb high protein lunch and a high protein dinner. I do drink plenty of coffee. And yes, I do aerobic exercise [Lateral Thigh trainer] for half hour every day.
Should I be going on to Insulin? Should I be trying health food supplements? (I do take Omega-3 1000 mg every day) I wonder.
Nagesh

Hi Nagesh and welcome to the forum!

Congrats on working to get your diabetes under control. I know it can be confusing in the beginning and there is a lot to learn about managing your blood sugar. Perhaps you can tell us what medication your doctor has prescribed and what dose they have told you take it. There are several different kinds of oral medications and they do not all work in the same way. I see you are taking metformin. Metformin is an excellent drug for type 2 diabetics. It does not directly affect the pancreas. Meaning, it does not stimulate the pancreas to produce more insulin. It works by lowering your insulin resistance, allowing your body to properly use the insulin that it does produce. Metformin takes awhile to build up to a therapuetic level in your body. That is why taking an extra dose just because you have a high blood sugar is not an effective way to lower a high you are having now. Metformin should be taken exactly as prescribed, if your blood sugar is not coming down over time, your doctor can increase the dose.

So, what can you do to lower your blood sugar while the metformin is working? It is imperative that you are very conscious of the carbohydrates you are eating. It is not only 'sweet stuff' that will raise your blood sugar. It is carbohydrates that has the most effect. Most foods have carbohydrates. Some have more than others. Proteins, lean meats, and fats have the least amount of carbohydrate. Starchy foods like bread, pasta, cereals, wheat, potatoes and fruits have the highest amount. You are better off eating whole grains, sweet potatoes instead of white potatoes, brown rice instead of white rice, etc. It is important to know the carbohydrate count of what you are eating. The less carbs you consume, the lower your blood sugar will be. If your blood sugar is low, carbs will raise it.

If you have not seen a diabetes educator, or a dietitian to give you instruction on how many carbs a day you should be consuming I highly recommend it. A good recommended place to start is 45-60 grams of carbohydrate for meals and no more than 15grams per snack. This is more than a lot of people can eat and still maintain a good blood sugar, but its a starting point. If you find your results are still too high, start cutting down the number of carbs you are eating. Eliminate snacks if you can. If you must have snacks, lower the amount of carbs you consume at mealtimes.

It is important to test your blood sugar at home. Especially in the beginning while you are figuring out how many carbs you can safely consume. Test before you eat a meal, and if possible test at least 2 hours after you have eaten it. Your blood sugar should be back down to what your premeal blood sugar was in 2 hours. If it is not, then you have eaten too many carbs. Lower the number of carbs you eat and try again. The only way to see how carbohydrates are affecting your blood sugar is to test.

If you do not have a book that tells you carbohydrate contents of foods i recommend you get one. There are also many online places you can go to see the carb content of fooks. I recommend calorieking.com I use it all the time. They also have a nifty little carb counting book that is cheap (only 9 dollars) and I have used mine a lot. If not calorie king, there are many others to choose from that are just as good...that is just the one I use

The most important thing you can do is watch your diet and get regular exercise as you can tolerate it. Sometimes you might be eating what you think should be healthy, but it really isnt good for your diabetes. For instance, oatmeal is very high in carbs. A lot of diabetics just cant eat it, or they can only eat it in small amounts. I have a much better time of it when I eat more protein at breakfast and a smaller number of carbs. Typical breakfast for me is usually more along the lines of eggs, maybe some bacon, low carb toast. I do eat yogurt for breakfast a lot of the time, but in small amounts. The yogurt I eat has only 16 grams of carbs per serving.

Good luck to you and please feel free to ask all the questions you need to ask. There are a lot of great people here and I am sure you are going to get a lot of really advice. Post often and let us know how you are doing! Maybe giving us an idea of what you are eating at meals can help us to help you find any hidden carbs may be consuming.

 

[Nagesh Rao]

Thank you Pam,
You are certainly a lot more experienced at this glucose control than I am. This morning my fasting glucose was down to 9.5 [171], whereas it was 216 yesterday and 252 for a few days before that. I am now on Metformin 1gm twice a day, along with Omega-3 1000mg and various other medications for high cholesterol and triglyceride.
I have noticed a complete lack of appetite with the Metformin. I feel like I have had a ten course meal. I dont feel like eating much and only do so because the food smells nice and as a behavioural response, I eat. Is it normal to have this side effect with Metformin? It is not a very nice feeling.
I will stop Oat meal porridge soon and replace it with a portion of a Spanish Omelette [I have downloaded the recipe].
I notice that you take Milk Thistle twice a day. Does that help for Diabetes? I have been liberally adding Cinnamon on to my food and drinking Lemon juice.
I need your advice on drinking. I know people say that it is ok to drink as long as there is a carbohydrate load before and after the drink. I have not had a drink for about two weeks and feel great. However, I am going on a holiday soon and wondered if I should continue my restriction on alcohol for ever. I am sure, I can enjoy my holiday without the booze, but I could be tempted especially on the flight.
Nagesh

 

[Shanny]

Metformin curbs my appetite too, Nagesh, and can sometimes cause a little gastric upset. Usually the gastric distress subsides in a few days or so. The appetite-suppressant properties seem to endure, however . . . at least for me they have.

 

[onaughmae]

Thank you Pam,
You are certainly a lot more experienced at this glucose control than I am. This morning my fasting glucose was down to 9.5 [171], whereas it was 216 yesterday and 252 for a few days before that. I am now on Metformin 1gm twice a day, along with Omega-3 1000mg and various other medications for high cholesterol and triglyceride.
I have noticed a complete lack of appetite with the Metformin. I feel like I have had a ten course meal. I dont feel like eating much and only do so because the food smells nice and as a behavioural response, I eat. Is it normal to have this side effect with Metformin? It is not a very nice feeling.
I will stop Oat meal porridge soon and replace it with a portion of a Spanish Omelette [I have downloaded the recipe].
I notice that you take Milk Thistle twice a day. Does that help for Diabetes? I have been liberally adding Cinnamon on to my food and drinking Lemon juice.
I need your advice on drinking. I know people say that it is ok to drink as long as there is a carbohydrate load before and after the drink. I have not had a drink for about two weeks and feel great. However, I am going on a holiday soon and wondered if I should continue my restriction on alcohol for ever. I am sure, I can enjoy my holiday without the booze, but I could be tempted especially on the flight.
Nagesh

The side effects do go away after a little while. It did make me feel bloated in the beginning and caused quite a bit of GI upset. Mine didnt last though. I sort of wish at least the appetite suppressant would have stayed

The thing about alcohol is, you need to be careful because it can lower your blood sugar. i think its ok to have a drink occasionally, I love a glass of wine with dinner sometimes. I am just careful to check my blood sugar later because it usually makes me go low.

I actually started taking milk thistle because my liver enzymes were a little off balance. Then I started reading about how it has been shown in some studies to help T2 diabetics stabalize blood sugar. After my liver enzymes were normal again I decided to keep taking it.

 

[Nagesh Rao]

My fasting glucose was slightly lower today at 169.2. Yesterday, we went to a American restaurant [Frankie and Bennys] and all I felt like having was a bowl of soup and chicken salad. Appetite is pretty low. I miss the stomach growling. I have gone off alcohol completely. My specialist tells me that it is good. This T2 DM seems to be effecting a complete change in my diet. I am going for a complete fasting blood checkup tomorrow. I hope my Hb1Ac has come down. It was 8.6% two weeks ago.
With reference to alcohol, I used to love sipping a little Scotch whisky from time to time. I suppose that is out of the window, now.
Nagesh

 

[fgummett]

Is it the Type 2 or the Metformin that is affecting your appetite? If it is the Metformin you might reconsider some insulin and a lower dose of Metformin. I really don't think starving is helpful to the body... we need to feed the machine and that includes more than simply energy... there are many nutrients essential for health.

As Metformin works on the Liver I suspect that it ought not to be mixed with alcohol... at the same time I know some who find a moderate intake (a glass or so most nights) of dry wine or spirits (like an aged single malt ) beneficial in terms of BG control, not to mention lower stress levels.

A1c is a reflection of your average (mean) BG over the last 90 days or so (largely based on the 120 day average life-cycle of red blood cells), weighted to the last 30 days or so (it is not an exact science!)... so don't expect an huge change over 2 weeks of treatment... so long as it is heading downwards, then that is a good sign

 

[onaughmae]

My fasting glucose was slightly lower today at 169.2. Yesterday, we went to a American restaurant [Frankie and Bennys] and all I felt like having was a bowl of soup and chicken salad. Appetite is pretty low. I miss the stomach growling. I have gone off alcohol completely. My specialist tells me that it is good. This T2 DM seems to be effecting a complete change in my diet. I am going for a complete fasting blood checkup tomorrow. I hope my Hb1Ac has come down. It was 8.6% two weeks ago.
With reference to alcohol, I used to love sipping a little Scotch whisky from time to time. I suppose that is out of the window, now.
Nagesh

An Aic is an average of what your blood sugar has been running for the last 3 months. Getting one done after only 2 weeks really isnt going to tell you anything useful. Most people have one repeated every 3-6 months or so.

 

[Nagesh Rao]

I think it is the metformin. My BG has been in the target range today [3.9 to 10 mmol/L]. Although I would like it to be between 3.5 and 5.5. Anorexia continues, despite that. Overall, the trend is for the BG coming down, which is encouraging. Incidentally, I am on the slow release Metformin.
Nagesh

 

[Nagesh Rao]

Thanks for all the very useful advice I have had over the last few days. It has made a great difference to me. For the last two days, my BG has been in the target range - fasting and post prandial. I went to a party this evening and the host gave me the 'usual' which was some neat scotch. I refused, but he said, 'Ah dont worry, I am also on Metformin [three a day]'. I therefore had one measure, which led on to another one as the party rolled on. I only had proteinaceous food like Kebabs, chicken, fish. No carbs. I came home and quickly ate a Chocolate chip muffin to enhance the carb as I was told that alcohol can drop the glucose. The BG now an hour later is only 7.0 mmol/L [126], which is fantastic. I met my diabetologist at the party and he told me to add on Amaryl [Glymepride 4 mg] tomorrow along with my regular Metformin 1000 mg twice a day.
I think, thanks to all of you, I am getting to grips with this Diabetes. By the way, I think Cinnamon is great stuff. I am consuming a teaspoon of crushed cinnamon with breakfast.
Nagesh.

 

[fgummett]

Sounds like a great start Nagesh and a fun party

 

[sanahenk]

That is a good post, and quite helpful too.

 

[Nagesh Rao]

Frank,
I think you were absolutely right about the loss of appetite being due to DM. Today my BM is 5.6 mmol/L [100 mg/dL] and I am feeling hungry and could eat a horse!! I am getting a new CPAP machine end of this week for my presumed sleep apnoea [not proven on testing but good response in the past]. Weight is dropping off steadily, which is great news.
I think adding on Glimepride 4 mg to the Metformin 1g bd has done the trick.
I ordered some Glucobetic which is alternative medicine stuff consisting of herbs whose names I cannot remember. Has anyone had any experience of this. It is not here yet. Apparently with continued use, it brings down the dose of Metformin. Should I try it?
Nagesh

 

[wallycorker]

..........I am going for a complete fasting blood checkup tomorrow. I hope my Hb1Ac has come down. It was 8.6% two weeks ago.........

Hi Nagesh,

What happened with your results - are they posted elsewhere on this forum?

I'm certain that your HbA1c will be on its way down you sound to be making a lot of progress in the right direction.

John

 

[Nagesh Rao]

Hi Nagesh,

What happened with your results - are they posted elsewhere on this forum?

I'm certain that your HbA1c will be on its way down you sound to be making a lot of progress in the right direction.

John

John,
Because I was on high dose steroids for five days and a tapering dose for the next five days [for the Bells palsy, which fortunately is much better], the blood glucose was seriously out of order for ten days or more. So the HbA1c was a high reading and the GP said, it is best not to consider it. I am having it done again towards the end of October.
Interestingly, my cholesterol is down to normal and the HDL cholesterol is up [due to the fish oil capsule that I am on]. Tryglycerides are coming down as well and am feeling much less tired these days. I bet everything was down to the DM that I had.

 

[ColaJim]

fair warning

Glimepride is yet another stressor of the pancreas and some people feel that it would be better to use some insulin instead to give your pancreas a rest and not burn out your beta cells.


Generic Name : Glimepride

Pronunciation : GLYE-me-pye-ride

TradeName : Amaryl, Azulix, betaglim, daoryl, Dialgim, Diapride, Emperide, Euglim, Gepride, Glifix, Glimcom, Glimer, Glimestar, Glimetop, Glimiprex, Glimpid, Glimpil, Glimulin, Glimiz, Gly, Glypride.

Why it is prescribed (Indications) : it is a potent sulphonyl urea with a strong action.it stimulates the insulin secreation from pancreatic
beta cells.


Read more: Glimepride Glimepride

Thanks for all the very useful advice I have had over the last few days. It has made a great difference to me. For the last two days, my BG has been in the target range - fasting and post prandial. I went to a party this evening and the host gave me the 'usual' which was some neat scotch. I refused, but he said, 'Ah dont worry, I am also on Metformin [three a day]'. I therefore had one measure, which led on to another one as the party rolled on. I only had proteinaceous food like Kebabs, chicken, fish. No carbs. I came home and quickly ate a Chocolate chip muffin to enhance the carb as I was told that alcohol can drop the glucose. The BG now an hour later is only 7.0 mmol/L [126], which is fantastic. I met my diabetologist at the party and he told me to add on Amaryl [Glymepride 4 mg] tomorrow along with my regular Metformin 1000 mg twice a day.
I think, thanks to all of you, I am getting to grips with this Diabetes. By the way, I think Cinnamon is great stuff. I am consuming a teaspoon of crushed cinnamon with breakfast.
Nagesh.

 

[wallycorker]

..................Interestingly, my cholesterol is down to normal and the HDL cholesterol is up................Tryglycerides are coming down as well............

That's the way all the numbers go when you are on the right path!

 

[Nagesh Rao]

Glimepride is yet another stressor of the pancreas and some people feel that it would be better to use some insulin instead to give your pancreas a rest and not burn out your beta cells.


Generic Name : Glimepride

Pronunciation : GLYE-me-pye-ride

TradeName : Amaryl, Azulix, betaglim, daoryl, Dialgim, Diapride, Emperide, Euglim, Gepride, Glifix, Glimcom, Glimer, Glimestar, Glimetop, Glimiprex, Glimpid, Glimpil, Glimulin, Glimiz, Gly, Glypride.

Why it is prescribed (Indications) : it is a potent sulphonyl urea with a strong action.it stimulates the insulin secreation from pancreatic
beta cells.


Read more: Glimepride Glimepride

Jim
I am not sure why my specialist started me on both Metformin and Glymepride. I checked with many others and they felt it is not necessary. In fact, four hours after taking Glymepride, my blood sugar drops quite sharpish and I start feeling funny. One of my friends who is an endocrinologist told me to stop the Glymepride and do a week of blood sugar monitoring and suggested some newer drugs which do not have the same side effects.