[BessyBell]

Got some new lab results today.

A1C is 10.4 (was 8.8 in July). Blood glucose was 190 (fasting).

Obviously, the 500mg metformin (twice a day, so 1000mg/day) is not enough.

The lab also said there was protein in my urine.

The doctor also started me on HBP meds (can't remember the name right now).

Her notes said to start me on basal insulin at bedtime.

That got my attention! I don't want to start down that road because I feel like that's not a road you come back from AND I think there are other options (like increasing the metformin!).

What other options do you all think there might be for me?

 

[VeeJay]

What is your daily carb load? Perhaps you could reduce carbs and increase metformin.

But, even so, you should get an antibodies test to be sure you aren't dealing with LADA - late onset Type 1 diabetes.

All that said - don't be afraid of insulin if you need it. Better insulin than high BG that are doing organ damage.

 

[Mary]

Personally, I would definitely cut carbs and increase metformin before starting insulin. If that doesn't work, I would then add insulin. Also, insulin isn't a one-way road. We've had several members go on it for some time and then come off of it.

 

[Shanny]

Looking back through your posts from the beginning, I noticed where you had wondered where you'd be a year or two down the road. Well, here you are.

How have you been managing your diabetes since November of 2011? Clearly your doc has not increased your metformin, and that would be the obvious step to take. If you take the regular version of metformin, the maximum dosage is 2550mg per day, and if your doc doesn't know this, then perhaps you should tell her.

Do you have a meter? Have you given any thought to testing throughout the day? We can't control our blood sugar if we don't even know what it is, so testing is absolutely necessary.

Have you adopted the LCHF way-of-eating? That would be the MOST obvious step to take, since it doesn't require your doctor's permission or prescription. You were prob'ly directed here in the beginning, but it bears repeating, since you really need to get those numbers down NOW.

Are there any other developments since the beginning? Since you've now wakened up to the seriousness of diabetes, I think you'd be wise to buckle down & slash your carb intake. That will work faster than anything else, and it doesn't cost anything. You just don't eat grains or anything made with grain (no bread, pasta, cereal, etc.), no fruit except a few berries, if your meter shows they don't spike you. No milk, unless your meter approves. And only moderate protein, since excess protein is also converted to glucose. You slash carbs and replace them with fats - which means bacon, butter, heavy cream, sour cream, avocados, olives, coconut oil, nuts - all high-fat foods which are wonderfully healthy especially for diabetics. Saturated fat is good for you, say cardiologists.

 

[skb]

I agree with Shanny. You have been going down that road for a long time now. However, do not lose hope. Your thinking that there's no coming back is wrong. It is indeed pretty simple & easy. Dietary adjustments (as have been advised) have a huge impact & pretty fast. I would think that diet should be the first line of therapy for all T2s. Diet is your best option. Try it.

 

[foxl]

Insulin is NOT a bad option though, if you need it. And it does not have to be forever, either. With signs of some renal injury ... I would go with it, until you can do better without it, at least!

 

[BessyBell]

Thanks everyone for your input and advice.

For awhile last summer, things had gotten much better. So much better in fact that my doctor at the time reduced my metformin dosage.

For me, based on meter readings in the past, I don't have a lot of spikes with carbs. But I do need to be aware of them. Everything in moderation, I guess.

I think what worked so well for me last summer was I was getting a lot of daily exercise (different job, LOTS of walking) and practically living on cucumbers (we were growing them in our back yard, lol).

Since then we've moved. I hate my new job, I hate where I live. We've lost our house and I'm facing bankruptcy. In short there is A LOT of stress right now.

I don't know this doc well and I'm not entirely comfortable with her yet. But she seems like one I can work with once I get to know her better.

I went to see her yesterday afternoon. She wanted to start me on a basal insulin at bedtime only. I asked if we could up the metformin a bit, and I'm going to try to increase my exercise and watch what I eat. And test more often. She agreed that we could try this. I see her again in a month for a "status" on my meter readings and then again in three months for a re-check on the A1C. She said that if there is a significant enough reduction that we can continue on that path. If not, she will be more "forceful" with the recommendation of the basal insulin.

If I remember everything she said correctly, she said that newer/more recent protocol indicates that the use of basal insulin is "better" than metformin because it is "stronger" at getting the blood glucose down. If that makes sense. I'm sure you all are already aware of this, but it was news to me.

Anyway, last night we went to a local amusement park and walked around there for two hours. My husband is going to dig out our treadmill and I'm going to get the Wii up an running again (for yoga and other Wii fit stuff). I'm also going to be much more careful of what I eat and how much.

Hopefully I can get back on a track that works for me.

Again, I sincerely thank you all for being patient with me and for still giving me advice and insight. I know I probably seem incredibly hard-headed and stubborn. And I am (lol). But I don't want diabetes to run or ruin my life. I have to make the changes and I have to live with them. It's just much harder than I thought it would be.

 

[Shanny]

Just a word about testing and catching whether foods spike you or not . . . you must test at the one-hour interval after eating. Yes, we recognize that many 'experts' advise two hours, but that is not going to help you catch the spike.

And another word about insulin vs. metformin. Two drugs which treat two different issues: Metformin treats insulin resistance, which you no doubt have. Exogenous insulin treats endogenous insulin deficiency. If both problems are present, then you need both. Your doc shouldn't be making it an 'either/or' equation.

Exercise is good for us, and we should all try to get some, but your way-of-eating is what controls your blood sugar levels - that's an undeniable fact. If you continue to eat carbs, nothing else is going to help much. Even if you go on insulin, the carbs have got to go - insulin can cover a lot, but it also fosters weight gain when you have to use a lot of it, and if you insist on eating carbs, you'll need a lot of it.

Since you've already made the decision that you don't want diabetes to ruin your life, then all you have to do is stick to your guns. Once you're off carbs for a coupla weeks, you'll discover that it gets easier.

 

[VeeJay]

Can you give us an idea of what your diet is? And what "watching my diet" consists of?

As Shanny said, it's the carbs that raise BG. So less carbs, lower BG. It's as simple as that.

It's not a difficult way to eat, and is quite satisfying. But it does take some work to calculate number of carbs with each meal, testing what happens to BG after a meal, and being willing to reduce portions or eliminate some foods altogether. Giving up some favorite foods is really the hard part. But it gets easier as time goes by as one finds low-carb substitutes for old favorites.

BTW - being stubborn is a trait common to members of this forum. We don't have any intention of letting diabetes win.

 

[BessyBell]

VeeJay- for the most part I haven't paid any attention to watching what I eat consistently for awhile now.

Now, however, it's obvious I need to make permanent changes. But it's not going to be easy. One step at a time.

"Watching my diet" for me will involve following the advice here - doing my best to really reduce the carbs. I'm not sure I can completely eliminate them but I can try to make that a goal. Maybe as I start to find alternatives or something it will be easier to let go of the carbs I love.

I don't know. All I can do now is try my best and hope I can get these numbers down.

 

[silvertiger]

You don't have to completely eliminate them, especially at the beginning. This doesn't have to be an all or nothing proposition. Just cut down. Cut out rice and potatoes, they mostly are fillers in a meal anyway. Try to buy fresh vegetables and feel free to put salt and butter on them.

 

[Shanny]

BB? I wish you could know how many of us here were the ultimate carboholics in our previous lives. You think you love carbs? Multiply that by about 10,000 and you'll find all the rest of us who loved/adored/idolized/worshipped carbs. Now you see us having come out the other side and lived to tell about it. It always sounds like a banal cliché to say 'If we can do it, you can do it', but it's the literal truth around here. If you'd ever seen me at a sushi restaurant devouring rice by the bucketful, you'd know from loving carbs. Or even seen me take a loaf of my homemade sourdough bread from the oven and eat the whole loaf in the next hour.

But the nasty thing about carbs is the addiction element - eating carbs creates cravings for more carbs. If you can accept that you are addicted, it becomes a medical issue to be treated - not a personal weakness to be waved off if you get tempted. When you get rid of them for a week, the cravings subside. Of course cheating brings it all right back - just like one drink will do to an alcoholic, or one fix will do for a junkie.

My suggestion would be to eliminate grains first - wheat, corn, rice, oats, barley, etc. - i.e. bread, pasta, sushi, oatmeal, etc. These are the worst offenders, and they often are causing other medical issues besides just exacerbating your diabetes, so you might find improvement in other areas you hadn't realized were related to food.

Then take your time tapering off other starchy foods. Load everything up with butter & other delicious fats so you don't get hungry or lose energy. Being able to eat all the fats we want is what makes ditching carbs a lot easier.

 

[skb]

BB? It always sounds like a banal cliché to say 'If we can do it, you can do it'

How about - IF IT IS TO BE, IT IS UP TO ME

 

[VeeJay]

My suggestion would be to eliminate grains first - wheat, corn, rice, oats, barley, etc. - i.e. bread, pasta, sushi, oatmeal, etc. These are the worst offenders, and they often are causing other medical issues besides just exacerbating your diabetes, so you might find improvement in other areas you hadn't realized were related to food.

Then take your time tapering off other starchy foods. Load everything up with butter & other delicious fats so you don't get hungry or lose energy. Being able to eat all the fats we want is what makes ditching carbs a lot easier.

Shanny has outlined a very good plan.

I think the hardest thing to give up is wheat - it actually contains an opiate that makes one feel good after eating it, and results in a craving for it. It takes from 3days to a week to detox from it. When you know in advance what to expect, it's easier to tough it out for the final outcome. Other foods don't seem to be as hard on the body when eliminated from the diet.

Drinking lots of water and eating more salty foods helps with the withdrawal from carbs. Along with Shanny's suggestion to increase fats so you aren't hungry.

Another excellent strategy is to visit here daily - go ahead and rant and rave while you're going through withdrawal (we will sympathize with you), and report your successes (we will rejoice with you) and any failures (we will commiserate with you and try to encourage you to get back on the wagon).

 

[naynay]

My response to you BB is, do you love your life more than those carbs? Because if you keep eating those carbs, you will cut your life short, or worse, end up with complications and lose a foot, or fingers, or toes, or a leg, or how about your kidney's? I know how brutal that sounds, but it is something we as diabetics have to be aware of constantly.

If you go to the recipes section on this forum you will find many alternative ways to eat things that are tasty and wonderful substitutes for your favorite carby foods. I still eat sushi, but I use shredded cauliflower instead of rice, and if you follow the directions, you would be hard pressed to know the difference! I also eat pasta that has been made with almond flour rather than wheat and it is very satisfying (and I'm Italian so giving up pasta was tough for me). If you really want to improve your health and your numbers, please look over these recipes and make the change in your habits. Once you rid yourself of the toxic carbs, you won't miss them one bit.

 

[Daytona]

Another excellent strategy is to visit here daily - go ahead and rant and rave while you're going through withdrawal (we will sympathize with you), and report your successes (we will rejoice with you) and any failures (we will commiserate with you and try to encourage you to get back on the wagon).

I am not the only one who has noticed that I do best when I am reading this forum every day and commenting. Like others have said, carbs and all the foods that go with it (sugar, wheat) are addictive. This is the only place many of us have to openly discuss what's going on in our lives with people who truly understand. I know you can do this!

 

[Mary]

I am not the only one who has noticed that I do best when I am reading this forum every day and commenting.

I became susceptible to major carb creep several weeks ago, when I was super busy at work and not able to check in every day. Totally agree!

 

[Msfranxie]

I use MyFitnessPal to plan my meals days in advance. Really easy. Most foods, with their nutritional values, are already in it. It has really helped me get my daily carbs down to under 60 grams from over 200 (gee, I wonder why I was sick all the time?) and to spread those carbs evenly through the day. I know that there are many other FREE online programs like it, but it was the first one I found that was easy to use and had a huge database of foods. Good luck!