Quick question about what to do next

[mehdave]

Hi all, diagnosed type 2 recently placed onto metformin 2x500mg a day Then worked upto 4x500mg a day and have been on that for a while now. It isnt really doing anything at all to be honest. I have seen the dietician and am following the advice they gave. Still my bg after fasting 12 hours is about 10-12 in the morning then hitting between 15-19 after every meal.

Stopped all suger since diagnosed. For the last week I tried a really low card diet cutting out bread cereals etc and still on the met, my bg etc all stayed within the same range and at one point spiked to 23 after a meal even with no carbs or suger. I have not had a HbA1c yet they said give it 3 months with the metformin and diet so will be february when I get it. However i have a appointment with the diabetic nurse and have been having constant pain with the metformin and loose movement. I have ibs and also bile absortion issues so makes it even worse. I was wondering if I should possible be asking her about alternatives like BYETTA which would also help with my weight loss, (lard ass lol) or even onto insulin to control it. Do you think im getting ahead of myself and wanting to get the upper hand too quickly? I just feel the tabs are not working and diet has no difference. :|

Edit: Forgot to add from my Nano my 7 day avg this week is 12.6 14day 13.5 30 day 14.1
Sorry for the long post, im still confused and new to all this.

 

[IanD]

I'm surprised they haven't done the HbA1c. They did that to diagnose me.

Sadly the metformin is working, but giving the side effect rather than the control. Those readings may be better than without MF but are still high. If you are low-carbing, then you should get lower results. Their is an alternative MF (glucophage) that has reduced effect on the motions.

I think you should report back to your Dr with your results to date - include the side effects.

You should be responding to the change in diet & tablets & heading in the right direction.

Can you give us an idea of your diet & readings on a typical day?

 

[cugila]

I'm interested to know what was the meal that gave a reading of 23 !

 

[mehdave]

Hi, firstly thanks for the quick response. Yeh they didnt do the Hb1Ac just my fasting test and several other finger tests over 2 days all sky high.

Ian D, Take todays for example,

Got up at 10am, Had not eaten since 6pmish the night before first reading was 13.3 So had breakfast.
Scrambled egg and bacon with fat cut off. Glass of lilt zero
1230. 2 hours after breakfast 13.9

before Lunch reading 12.9 230pm
Lunch is always hard for me as I like so little so had Weight watchers bread 1 sandwhich with cheese. Some lilt zero 2hrs test at 440ish reading 14.7

Tee Time 630pm Reading 12.6
Bacon and sausage grilled and egg, Scrambled, glass of diet pepsi.
830ish reading was 13.2

As you can see there all over the place, during the day to be fair I was sedentary at the pc, but I did scrape the car before tee maybe why it went down a bit more.

The meal I had which gave the reading of 23, was roastbeef and gravy and instead of potatoes I had a few meatballs, I think there might of been hidden carbs somwhere As my mum made it though.

 

[IanD]

That looks satisfactory as a low carb diet. I can't see any significant diet change giving benefit. Keep that going, & get further medical advice.

 

[carolynjw]

good luck - hope you can get it sorted. I am surprised your specialist is happy to leave your sugars so high.

Carolyn x

 

[cugila]

Just reviewed this one. I agree with Ian regarding your diet. Your high fasting levels could simply be down to the Dawn Phenomenon effect. You are not eating for many hours and your Bg levels may have dropped because of this, the body then dumps Glucose into your system in the early hours causing your Bg level to be elevated when waking. A start to the day which is difficult to recover from and then just gets worse as the day goes on.

As regards the Metformin Ian has previously stated that there is an alternative to the standard version, it is called Metformin SR (slow release) or MR (modified release). This is usually better tolerated by those who have trouble with Standard Met. You should ask to go on that. Typically Metformin only reduces Bg levels by around 1.5 mmol/l and that is when on the maximum dosage.

There are several other drugs which can be prescribed as well as the Metformin, they are called Sulphonylureas. One of the more effective ones is Gliclazide. Now, this can cause weight gain, but will help to get those Bg levels down pretty quickly so might be worth getting just to gain control.
Can always be reduced later when you have better numbers. Don't listen to those who allege it 'burns' out the Pancreas. The source for that is suspect. I was on it for years and it has done me no harm, my Pancreas is working fine. there are many who also do well on it, being careful regarding weight.

If Byetta (Exanitide), injected twice daily, was to be considered it is usual that the Patient would have been on maximum doses of the Biguanides Met) and Sulphonylureas and have bad control, plus have a BMI in excess of 35 to be considered. A very effective drug for most people, however it can have side effects mostly nausea. For most people that clears up after a few weeks, not all though. an appetite suppressant as well and good for weight loss.

There is also the new drug, Victoza (Liraglutide), injected once daily, which has similar benefits which may be another option. This too appears to be effective as well. We have threads on the Forum about both in the Diabetes Drugs and Medication area. Take a look for more information.

As for Insulin, yes it is very effective and might be an option. It can however cause weight gains which you may not want. So those are some of your choices. It does appear that you really need some medication as diet alone doesn't seem to be working for you. Discuss all these options with your GP or better still get a referral to a Specialist, an Endocrinologist. The treatment should be far better from an Endo.

I have just noticed your age.....24, is that correct ?

I have lost 2 stone in a month

That from a previous post of yours too ???

Who diagnosed you as a T2 ? I would definitely be asking for a second opinion by an expert, and a proper confirmation of the Type. T1 or T2, that could explain those high numbers despite what appears to be a good diet ! See your GP asap.

 

[mehdave]

Hi firstly thanks to all for the great information again. I was diagnosed by the emrgency doctor of the day back at begining of december. They diagnosed me by taking a urine sample said it didnt have any ketones I think she said that coupled with by BGH readings for fasting and afteer eating of over 14 all the time. As it was an emergency doctor she said take metformin gave me a script and sent me on my way with an appointment to see the diabetic nurse a week later.

Went to see the diabetic nurse, turns out i had a simple 15 min appointment as the doc didnt tell her i was newly diagnosed so she shought she was seeing a patient who had diabetes for years lol. She was aweosme and took as long as she could causing delays to explain the basics etc . She made me a dieticians appointment who I seen end of dec and I have a proper 1 hour or longer session with the nurse again on monday. I have privatehealth care so will ask about the specialist.

I lost 2 stone throughout november I initialy thought this was fantastic but soon realised I wasnt eating very much, peeing insanly and had a constant thirst that was driving me mad. Since diagnosis and eating a bit more I have gained back about 7lb, so still a lardass with a bmi over 35 lol. Will have a look at those medicine threads and keep you all updated after monday. where I will ask for a HBA1C test

 

[mehdave]

Going for full blood test and HBA1C next week. He thinks its worth trying another set of tablets before byetta so has put me on Gliclazide and Actos and will recheck in a few weeks. And take it from there. Need to monitor my wieght and sugers carefully. But he wasnt off the idea of byetta or insulin.

 

[mehdave]

Been on the new tablets for a about 6 days now, so far not noticing too much of a difference and thankfully no side effects to report YAY blood still highish at around 10-12 but not 14 as they where before but does spike higher still allot. Does Gliclizide and actos usually take a while to kick in I forgot to ask the doctor.

Cheers again folks.

 

[cugila]

Been on the new tablets for a about 6 days now, so far not noticing too much of a difference and thankfully no side effects to report YAY blood still highish at around 11-12 but not 14 as they where before. Does Gliclizide and actos usually take a while to kick in I forgot to ask the doctor.

Cheers again folks.

They will take a while to get to the maximum effect. Have you made adjustments to your diet to help the drugs to do their work ?

 

[hanadr]

If a strict low carb diet helped, I'd go with that. However, if Metformin isn't working properly, I'd ask them to check to rule out T1. It can come on very fast and doesn't Always show ketones, although it probably does in most cases.
They tend to try a lot of things before Byetta, beccause it costs so much.
Hana

 

[mehdave]

Im cutting out carbs as before cugila so there down to a minimum and im eating no suger at all sweets biscuits juice etc all cut out since diagnosis.

Hanadr so far they all seem sure im type2 but I think thats why there running the full blood works as he also mentioned something about my last blood test in july for a different issue showing my liver as having a strange reading. Cant remember what but there doing the full panel and the HBA1C so im sure that would show if im actually a t1 :lol:

 

[LittleSue]

That rapid weight loss, along with high readings despite tablets and low carb diet, suggests type 1 definitely needs to be considered.

 

[mspoohbear2]

Hello All!

The doctor had put me on a Sulphonylurea (Amaryl/Glimperide) 1mg to start along with Januvia.
Cugila, I read in a previous post that the sulphonylureas were widely used a decade or so back. Do you know why they fell out of favor? I was also glad to read that the "pancreas burnout" is not as bad as some articles say. You are a wealth of information, thank you.

For those with the metformin side effects, I would like to add that when I was on metformin and had the diarrhea side effects, a bulk fiber supplement worked very well. I had to find something as I am prone to IBS. I found that this bulk fiber works for the IBS as well. Even though I am not taking the metformin anymore, I still take two a day and things are fine, no more of the diarrhea/constipation roller coaster. At first I was skeptical as the Citrucel brand that is sold in the US is sold as a laxative, but it really works. I also found that the Psyllium type only aggravates the problem, methylcellulose I found is the best fiber to use. Anyway, just a possible tip for the metformin ugliness. :lol:

 

[cugila]

Cugila, I read in a previous post that the sulphonylureas were widely used a decade or so back. Do you know why they fell out of favor? I was also glad to read that the "pancreas burnout" is not as bad as some articles say. You are a wealth of information, thank you.

I think that is peculiar to the States, probably because other 'stuff' came along. I have no idea if maybe costs and perhaps side effects came into it ? We certainly have them here as a second stage strategy for continuing treatment. As for the Pancreas 'burnout' that is my personal opinion, however I have yet to find ANY proof of the statement that was made by a person who really was trying to sell a diet and books, so didn't want anybody taking a somewhat effective medication. Everything I have seen so far is only anecdotal. So it really is up to you....who do you believe. I know from my own experience over many years it has done no damage at all....so, I disbelieve the 'burn out' theory. You will have to make your own mind up about that one ! One other thing is that we in the UK always seem to get the 'latest' drugs about 5 years after you in the states !!! Poor relations again. :?

Here in the UK it is pretty much a standard drug treatment for most people, usually treatment starts off diet only, then can progress to Biguanides. Such as Metformin etc.

They lower blood sugar by:
Decreasing the amount of sugar produced by the liver. This is the primary action of these medicines.
Increasing the amount of sugar absorbed by muscle cells and decreasing the body's insulin resistance.
Metformin does not cause the pancreas to produce more insulin. And when taken alone, it should not cause low blood sugar (hypoglycemia) or weight gain. Some people taking metformin may lose weight.

Metformin may lower the amount of fat (triglycerides) in the bloodstream, which may reduce the risk of heart disease. It also has been shown to reduce certain abnormal clotting factors and markers of inflammation that can lead to hardening of the arteries.

If that initial treatment is not successful then the next step here in the UK is Sulphonylureas are added to the mix. So they are definitely NOT out of favour here ! However, some patients miss out the Biguanides and go straight to a Sulphonylurea or evn Insulin. Usually depends on how high the Bg numbers are at the time.

Sulphonylureas are particularly beneficial when combined with agents such as metformin that decrease insulin resistance. Sulphonylureas can also be given with a basal insulin injection to provide enhanced endogenous insulin secretion after meals. Here in the UK Sulphonylureas will continue to be used both primarily and as part of combined therapy for most patients with type 2 diabetes. The diet has to be particularly well controlled as these drugs can sometimes cause weight gain, not ideal. No more than with Insulin though. They are effective though !

Iff all that fails then the natural progression was to Insulin, however we now have other drugs such as Byetta (Exanitide) and the newer Victoza (Liraglutide) which both seem to be very effective providing the Patient can tolerate some of the side effects. For many they are viable alternatives and can significantly help with weight loss. Unlike Insulin which can typically cause weight gain ! I must admit, as a Byetta user myself I had virtually none of the side effects.....however I think I have a cast iron constitution after many (years ago !) pints of 'the black stuff....Guinness. I think my stomach is lead lined..... :lol:

As for the information. Thank You ! I just wish I got paid for it ! (hint)

 

[phoenix]

Possibly slightly off topic (sorry)
Ken

I have yet to find ANY proof of the statement that was made by a person who really was trying to sell a diet and books, so didn't want anybody taking a somewhat effective medication. Everything I have seen so far is only anecdotal. So it really is up to you....who do you believe. I know from my own experience over many years it has done no damage at all....so, I disbelieve the 'burn out' theory.

I don't really know anything about the evidence for sulfs causing pancreas 'burn out' in type 2 but there is evidence that they hasten insulin dependency in those with slowly progressinve type 1, who of cause may well be diagnosed initially as type 2.
http://www.ncbi.nlm.nih.gov/pubmed/12021091?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/14679093?dopt=Abstract
http://www.cochrane.org/reviews/en/ab006165.html

 

[mspoohbear2]

Wow! Thanks for the information. So far have not had any side effects from the new sulfon drug. I also noticed that after the first pill my morning reading was down a small amount so I hope this finally might be the right med.

As to the Guinness, that was my daughter's first drink. She was in Ireland a few years back for a month on a college study abroad trip and emailed me a picture of her drinking a pint on her first evening there. I might have to try some of that for medicinal purposes. :lol:

Again, thanks for the information.

 

[ahsan]

I am in very similar situation, but I have found some interesting fact. My readings comes some time between 20 to 24, but I do the test again on other finger, and its shows below 10, which I should expect after my controlled diet. So its worth a try second go. I don't always trust these monitor to be honest..

 

[PBER57]

I was on saulphonylurea Glimizide and found that I was getting Hypo's on the stuff. It is like taking oral insulin and only is harder to control. If you find you are getting Hypos with it you might explore insulin for your needs. Easier to control and not worry as much with the Hypo. I was always cautious if I was going to drive when I was taking the stuff.

I am writing from the other side of the pond and there is alot of negative on the various diabetes boards over here about it because of beta cell burnout on these drugs. Dont know if that is true but I found I got Hypos too quickly.