Why is my Dr. satisfied with an A1C reading in the 6's?
Sandytoes71
Posts: 463 Member
Hi, im new to diabetes T2. Im 47 yrs old and was diagnosed with this officially about 5 weeks ago. My Dr.(whom I'm not sure I am going to stick with yet, something rubs me the wrong way about him) has me puzzled. He seems to have set an A1C goal for me of anything below a 7.0. I am currently at 8.0. I didnt think that would be a low enough number (in the 6.0 to 6.9 range)?? He put me on a weekly injection called Trulicity as Metformin just killed my tummy. He said glucose readings under 150 were good. Isnt that too high tho? Im just confused.
On another note, I would love to have more friends who are in this same diabetes boat. Thanks for reading ♡
Ginger 😊
On another note, I would love to have more friends who are in this same diabetes boat. Thanks for reading ♡
Ginger 😊
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Replies
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Hi Ginger! This is a subject on which even a lot of doctors are confused.
There's a reason for your doctor's recommendation - that's the guideline recommended by the ADA. However, a lot of people who have been successful at controlling their diabetes disagree with the ADA recommendations, which have been shown to be high enough that they lead to long term damage.
The reasoning behind the ADA guideline is that recent research indicates that trying to tightly control diabetes using certain medications can be more dangerous than poorly controlled diabetes, because of the risk of hypoglycemia. This research has been badly reported and given a lot of doctors the idea that trying for normal blood sugar levels is dangerous. However, that's not what was found - only certain medications were associated with the higher risks. Tightly controlling diabetes through weight loss, diet, and exercise is still a good idea.
I wasn't familiar with Trulicity but I looked it up, and it looks like Trulicity by itself doesn't cause hypoglycemia. From what I'm seeing it works to slow digestion so that blood sugar levels spike less after meals, and to prevent glucagon release. Is that your only med right now?
If you were recently diagnosed you should definitely see what you can do for yourself using lifestyle changes! I was at 11 when I was diagnosed and have now been at 4.7 for over a year, taking only metformin. The doctor said I don't need to take it anymore, but I'm lucky in that it doesn't bother my stomach at all, and it is an appetite suppressant so I asked to stay on it.
If you are obese, that's the first thing you need to tackle - get to a normal weight pronto. Exercise at least thirty minutes daily - three ten minute walks after meals are better than one thirty minute walk. And start counting and logging your carbs, and testing your blood glucose after every meal until you know how different foods affect you and how much you can safely eat. You are correct, 150 is too high and will damage your nerves, eyes, and heart over time. But most doctors think people aren't willing to test their blood regularly, so they make compromises. If your insurance doesn't pay for enough strips, buy your own meter with inexpensive strips - the Bayer Contour next is a good one, and Walmart also makes one with inexpensive strips.
You can do this - just by asking questions you have shown you are not willing to sit back and let this defeat you.6 -
Wow, thank u sooo much for explaining all of that. Makes great sense! I did not realize that about the exercise either. Thank u thank u!!0
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I was diagnosed in 2016. My doctor wanted under 7. The Diabetes Association and metformin was not even getting me BG readings under 200 and I had this vision of adding meds and things not being well controlled. I got a Walmart meter and strips because the OneTouch even with insurance was more expensive. I started paying attention to how I was responding to things I was eating. I discovered that glucose levels for me were mostly a function of carbs consumed. Lower carbs -> lower glucose readings...
I decided that 50 carbs a day was a reasonable limit, and glucose readings were going down. I started looking into this correlation online and found keto and groups like this one. I dropped my carbs per day to 20. I reduced calories and started tracking them to lose some weight
I got my A1C in the mid 5's on metformin, the keto diet and weight loss. The doctor reduced my metformin. The next A1C was even lower. The doctor took me off metformin, and the next A1C was 5.9. The meter is predicting the next A1C will be 5.5.
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I think many doctors end up shooting for an A1C that seems more attainable rather than one that is healthiest. Meds don't not normally bring A1C down below a 6, and I don't think most patients (or doctors) know how to cut carbs to bring BG down further.
I recommend DrBernstein's Diabetes Solution. It is a great book on how to reduce BG and insulin. It helped me a great deal.4 -
I was diagnosed in 2016. My doctor wanted under 7. The Diabetes Association and metformin was not even getting me BG readings under 200 and I had this vision of adding meds and things not being well controlled. I got a Walmart meter and strips because the OneTouch even with insurance was more expensive. I started paying attention to how I was responding to things I was eating. I discovered that glucose levels for me were mostly a function of carbs consumed. Lower carbs -> lower glucose readings...
I decided that 50 carbs a day was a reasonable limit, and glucose readings were going down. I started looking into this correlation online and found keto and groups like this one. I dropped my carbs per day to 20. I reduced calories and started tracking them to lose some weight
I got my A1C in the mid 5's on metformin, the keto diet and weight loss. The doctor reduced my metformin. The next A1C was even lower. The doctor took me off metformin, and the next A1C was 5.9. The meter is predicting the next A1C will be 5.5.
Kudos to u for ur success!! U must be super proud
Thank u for the information! 1 -
I think many doctors end up shooting for an A1C that seems more attainable rather than one that is healthiest. Meds don't not normally bring A1C down below a 6, and I don't think most patients (or doctors) know how to cut carbs to bring BG down further.
I recommend DrBernstein's Diabetes Solution. It is a great book on how to reduce BG and insulin. It helped me a great deal.
Thank u, I will check out that book.0 -
Great suggestions.
A quick note....
Not all Metformin is created equal. I switched to brand name Glucophage XR for a couple years at Dr. Bernstein's (incessant) recommendation, and the theme music of my GI system morphed from "Wellington's Victory" to "Calm Sea and Prosperous Voyage."
Due to coverage issues, I'm now taking generic Metformin made by Oceanside, and it's working pretty well so far.0 -
I was diagnosed T2D almost 2 years ago and decided on my own to go for tight control. I was started on 5mgs of glyburide twice a day and 500mgs of metformin twice a day, and I started working out 5 days a week. I also logged my blood sugars and foods religiously to find out what spiked my sugars and what I could still enjoy in moderation. My starting A1C was just under 8%. By the end of the first 6 months, I had dropped that to 5.6% and was having trouble with hypoglycemia, so we cut the metformin and glyburide in half.
When I say I work out, I mean I started working out hard. I started doing 5ks (and I had not done anything faster than a walk in 30 years), then worked up to a half marathon and a year later, a marathon. I currently training for a triathlon and am doing a few Spartan type races this summer. I also do weights and body weight exercises. In 2 years, I have only lost 10 pounds - but many, many inches.
Tight control means that my numbers are non-diabetic now. I take metformin once a day now and my doc and I will decide if I need to stay on it at my next visit this fall. I work out hard 5 days a week and thanks to the logging, I know what cheat foods I can eat and still maintain my numbers and what I absolutely cannot have. I had to completely change my lifestyle but it is worth it.
This is long, sorry, but I should add - my husband is on Trulicity and made no changes at all, and his doctor is satisfied with how he is doing. Everyone's journey is different. I just wanted to keep a tight control of my diabetes for my own peace of mind.2 -
Congratulations!0
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I was diagnosed in 2016. My doctor wanted under 7. The Diabetes Association and metformin was not even getting me BG readings under 200 and I had this vision of adding meds and things not being well controlled. I got a Walmart meter and strips because the OneTouch even with insurance was more expensive. I started paying attention to how I was responding to things I was eating. I discovered that glucose levels for me were mostly a function of carbs consumed. Lower carbs -> lower glucose readings...
I decided that 50 carbs a day was a reasonable limit, and glucose readings were going down. I started looking into this correlation online and found keto and groups like this one. I dropped my carbs per day to 20. I reduced calories and started tracking them to lose some weight
I got my A1C in the mid 5's on metformin, the keto diet and weight loss. The doctor reduced my metformin. The next A1C was even lower. The doctor took me off metformin, and the next A1C was 5.9. The meter is predicting the next A1C will be 5.5.
I got another A1C yesterday - 5.6.1 -
Nice! Very close guess. 1
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Ginger
My first diagnosis came August of last year with an A1C over 14! Like you, Metformin did a number on my stomach which already felt like crap from my high A1C. He moved me to Januvia and when I started seeing my endocrinologist she moved me to Jardiance and Trulicity. Nothing was wrong with the Januvia, she just felt as though the newer meds would help...plus Trulicity can help with weight loss.
Almost a year later and my A1C is under control (5.5 as of yesterday’s visit) and my BG is fairly good. The fact that your doctor is shooting for that number could be to gauge your commitment to your health. My primary care didn’t want me taking any readings at first but wanted me to go to a diabetic class. I learned there I needed to check my sugar often. My wife was mad though because my doctor said not to but I wasn’t listening to him. It was only when she could see the results did she say I was doing the right thing. If you haven’t had classes yet, I highly encourage you to go to some. Most insurance will cover them with only your copay to be paid.
Drink tons of water, exercise at least 30 a day (my wife and I walk for about an hour) and watch your carbs. I try to keep my carb intake per meal at around 45 grams. I have since lost ove 50 lbs and I plan on losing more! Don’t be discouraged. If you can do the little things then the rest is easy! YOU GOT THIS!4 -
Ginger
My first diagnosis came August of last year with an A1C over 14! Like you, Metformin did a number on my stomach which already felt like crap from my high A1C. He moved me to Januvia and when I started seeing my endocrinologist she moved me to Jardiance and Trulicity. Nothing was wrong with the Januvia, she just felt as though the newer meds would help...plus Trulicity can help with weight loss.
Almost a year later and my A1C is under control (5.5 as of yesterday’s visit) and my BG is fairly good. The fact that your doctor is shooting for that number could be to gauge your commitment to your health. My primary care didn’t want me taking any readings at first but wanted me to go to a diabetic class. I learned there I needed to check my sugar often. My wife was mad though because my doctor said not to but I wasn’t listening to him. It was only when she could see the results did she say I was doing the right thing. If you haven’t had classes yet, I highly encourage you to go to some. Most insurance will cover them with only your copay to be paid.
Drink tons of water, exercise at least 30 a day (my wife and I walk for about an hour) and watch your carbs. I try to keep my carb intake per meal at around 45 grams. I have since lost ove 50 lbs and I plan on losing more! Don’t be discouraged. If you can do the little things then the rest is easy! YOU GOT THIS!
Good job on the A1c! Question, did your doctor say why he didn't want you taking readings? I had the same experience with the doctor who gave me my diagnosis (have since switched doctors) who sent me home on glimeperide and metformin with not even a meter - which is dangerous, and potentially even deadly, since glimeperide causes lows! I learned after I read stuff on the internet and bought a meter myself that I was dropping into the 60s every morning after exercising! I never got to talk to that doctor about his intentions and wondered if yours explained his reasoning.0 -
You've made great progress, my dr told me the same about only taking my bg fasting in the am for 3 months on metformin. It was to see if my bg could be managed on 500mg metformin twice a day. That did not work, so I've been on 1000mg twice a day since July 2017. My A1c was 7.1 and now 5.5 I've lost 24lbs0
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