Is your diabetes management plan working?

russellholtslander1

Many of us are diabetic. We start a plan. Usually pills, then Insulin, exercise, a diet.. all designed to deal with diabetes.

When I ask if it is working, I mean is your A1C below 5.7.

Why do I pick 5.7? Well, that is the top range for a healthy person, and while I AM diabetic, and am on pills, I take those pills to remove the excess glucose, because 5.7 is an average of 117.. and the damage done by diabetes is less, if your blood sugars are under control.

If meds don't drop you to 5.7, then your blood sugars are elevated. You are at prediabetic with a 5.8, and diabetic at 6.5, by most standards. If I am taking meds, eating better, and start exercise.. ALL to deal with my high blood sugar.. shouldn't it actually DO that?

You may still be on meds, have to eat less carbs, and exercise, BUT, the result should be a normal A1C. Over 3 months, you SHOULD average 117 mg/dL, just like a healthy person, or WHY are you doing all of this?

Theoretically, if it is STILL high, you either need to alter diet more, or you need more meds. Why do ALL of this, and still have elevated blood sugars? Less damage is good, but I am 47, and have been diabetic since 28.. minimal damage, for almost 20 years.. hopefully 20-30 more.. maybe 50 years? I bet that adds up.. so if your doctor is excited to see you at 6.4, you are averaging 137.. which is high, and you are higher for significant lengths of time.. how much damage is being done?

So I'm wondering.. how many of us are actually getting the results we need? Normal blood sugars while on the meds, diet & exercise to make that very thing happen.

NYPhotographer2021

I was diagnosed with diabetes about 5 years ago. I was put on Metformin and took my readings every day, and rarely was I at or below 120 mg/dl. Back then I ate a lot of sugary/carby foods. I figured that since I'm on meds, I can eat what I want. Stupid, I know.

I moved to my new area last year at March. Just before Covid hit. I was never able to establish a new medical relationship. None of the clinics were accepting new patients. I still had my prescription and my old doctor kept refilling it. Then he left the practice, and I wasn't able to get my prescriptions refilled. I was also on a blood pressure med and a thyroid med. In March of this year, no more meds. Still could not get in anywhere.

Finally, I was able to get an appointment this past fall. My A1c was 7.1, higher than it was before. Before I think it was around 6.8. My doctor wanted to get me back on the meds right away, but I said no. Let me see what diet will do first. I had started low carb/keto at the end of August. My daily testing of my blood glucose started falling. I was around 110 or below most days. My blood pressure was within the normal ranges most days.

Next week, I go for my annual bloodwork. Then my next doctor's appointment is 2 weeks later. I am hoping my A1c has dropped to a more manageable level, and my blood pressure remains normal as well. He wanted me to lose weight. In August, I started at 214 pounds. When I first saw the doctor, I was at 204. I now weigh 178.

So Russell, in a few weeks I will be able to tell. I really did not improve on the meds. So will diet have improved my health? Time will tell! I'll keep you posted!

russellholtslander1

Sounds like you will be at 5.7 or below, which SHOULD be the goal.. you may still have to be on some meds to remain there, but we know from experience that we either need to lower the number with diet, or medication, but I see a lot of people talking about how they are on lots of meds, even Insulin, and working out, eating what they think is a healthy diet, yet still have elevated blood sugar.

That makes sense if you aren't treating the disease, but I can't think of another disease where the goal isn't to return you to normal. My BP is kept low with some pills, they didn't give me one pill, and say 155/100 is good enough.. they gave me several pills, and mine is 92/62. I have gout. If my Allopurinol, and I think diet, had not prevented a flare-up in the past 9 years, then I would expect to be given a higher dose. No doctor would say.. 300 mg of Allopurinol, knocks you down to 3 flare-ups a year, so that's good enough.

I am not sure most diabetes patients have a goal. When I started, I just wanted my doctor to like my numbers.. it was 2 years before I even knew what was good or bad. I found out, because I would take my BG, and it would be 385, so I would write down 185.. just knock a few hundred points off... and my doctor ran an A1C finally. They had been dealing with my congestive heart failure, so didn't do much about my diabetes until I was more stable 2 years later. It was in the teens. He knew I was lying, and said 185 is still bad.. if you are cheating, at least make the numbers good, and laughed at me. My first BG reading in 2002, was 526 mg/dL.

So he tells me below 120 is good, and to be under 7.0 A1C is optimal. So I tried harder, and got my numbers down, but not to 120.. I was running 150 average, and I was upset, because I was on 2000mg Metformin a day, plus an Actos. I get tested and it is 6.9.. and he praises me. BUT I was not below 120???

The told me what was good, and sent me to diabetes training for 8 hours * which was all b.s ).. but most people do not know what their A1C translates into.. 7.1 is an average of about 157 mg/dL, for example.

So what is 120?? That's a 5.8. So they set me a new goal of 6.5, and I never made that until 2011, when I started low carb.. 7 years later. I was over 10 A1C for most of those years, and was maintaining 360 lbs.

The doctors just looked disappointed, and changed nothing.. I was to blame.. I ate too much of the carby food they told me I should eat, and then i would have 5000 calorie binges several nights a week, for 4th meal. That was the max dose for Metformin, so they had no other ideas.. eat less of the carby food which made me ravenous.. and it would get better. I couldn't ever do that for more than a month or 2. I routinely had 300-500 BG readings.

They probably should have put me on Insulin. I was 28 when diagnosed with T2, so maybe it was my age?? I have a friend who takes 85 units of basal Insulin, and a bunch of fast-acting with her meals. I was on 10, then 15 units of basal Insulin, but since getting back on very low carb, I am off Insulin, and soon to be off pills. I just have to convince the doctors.

One possibility, is that they are afraid to lower BG too much, and want it at 150, so they don't have to worry about LOW BG, and another is that if you follow the diabetic diet they recommended back then ( hopefully changed in 20 years ).. they can't give you enough medication to overcome the end results of eating that way. I imagine it would take a lot of Insulin, to counteract a 500 BG reading.. how much is safe.. pills certainly had upper limits.

That meas a combo of diet and meds at the very least.. I choose a very strict diet, in hopes of reaching 70-110 without ANY diabetes meds eventually, like I did before, BUT I get that most people won't eat that way, so they need to eat BETTER, and take some meds.. but in the end, you want to be under 120 when you take your blood sugare, right?

Otherwise the diet, exercise, and medication is not working, and you need more to get to where you need to be, to be healthy.

I certainly don't want to go to the gym, eat a healthier diet, and take a bunch of medication, and STILL be at an unhealthy BG level.. and both 6.5, and 7.0 are not healthy. You are still doing damage to the body.. just more slowly.. and that's OK, if you are 83, but if you are 53.. how much damage will you do in 30 years?

We hear mostly about people who are struggling. They still have high BG, and no ide how they can lower it, that they haven't been trying to do, and are confused, and upset, and I remember being that way.

What I would LOVE, is for those who are maintaining 5.7 or below.. and regularly getting normal blood sugars, with meds, or without.. meaning they are handling it well, to speak out more. We don't need help, so we usually talk about other health concerns.. for me it is CHF, and of course, weight loss, which is a big one for everyone.

There has to be a lot of diabetic people who are at a normal BG level. I just think once you got it handled, you talk less about it, but I think by sharing, it would help a lot of us know what works, and what doesn't.

kchapmanma

I take both metformin and slow-acting insulin to help manage my diabetes, and my most recent A1C (taken 2 days ago) was 5.9. A year ago it was 9.8, and while I was taking the drugs then too, I obviously wasn't managing it well. What forced me to change was that I have started to experience irreversible nerve damage from having high blood sugar. I can't undo the damage I've done, but I can at least stop from making it worse.

So I started by just cutting down the number of sweets I'd eat. It wasn't like I was eating a lot of sweets, per se. I'd just have like 2 cookies maybe a couple of times a week. So I started just having 1 cookie instead type of thing. I was bad at regularly taking my blood sugar then, so I don't know what impact that had on my blood sugar - but I did end up losing 20 pounds without really trying in 4 months. I liked that, so I decided to get more serious about losing weight too, and started using MFP to track what I was eating and be more mindful about it.

Around the same time, I also got a Dexcom continuous glucose meter. That was a game changer because now I can easily see what my blood sugar is at when I want to eat something, and choose what I eat based off of my current blood sugar number. If I want to have a cookie at night, and my blood sugar is like 110, I go ahead and have the cookie. If it was at like 160, I don't have the cookie. Or, if I was planning on having a slice of pizza for lunch, but my blood sugar is 150, I end up having a salad or something instead (since I know the pizza slice would raise my blood sugar over 200).

Between MFP and the Dexcom, I've managed to get my A1C down to that 5.9. I've also lost about 75 pounds, and halved the amount of insulin I was taking. I'd like to lose another 40 pounds, so I'm not thin either, but I'm working on it. I'm careful about how much I eat, and use the Dexcom to make choices about what to eat when - but I'm not on a diet where I refuse to eat carbs or am particularly strict about what I'm eating. That makes it livable for me.

My take on all of this is that the drugs are a tool to help, but by themselves, they're not a solution. In my experience, you need to do additional work to really manage your diabetes. I encourage everyone with diabetes who isn't managing it much to learn from my mistake, and do that work. The nasty thing about diabetes is that for a long time, you don't necessarily feel it having an impact on you. But having high blood sugar is like having sand paper in your veins, and it's going around damaging things internally. Then one day, you find yourself experiencing those unseen impacts - like a loss of vision or (in my case) a need for a wheelchair because you can't stand for longer than a minute or two (because it caused nerve damage around my heart).

I hope this helps - and good luck to everyone either dealing with diabetes or just trying to lose weight!

Beautyofdreams

I was diagnosed with diabetes in 1989, after turning 26. Was told that I was type 2 and placed on oral meds. I was constantly dieting and exercising and pretty compliant with my meds. Yet my blood sugars were too high. After 7 years of this debacle, I was finally placed on insulin. By 1995, I had developed nerve damage in my feet. It was almost a year before diagnosed. From 2000 to 2004, I had 13 prp surgeries, 2 detached retina surgeries in the left eye and 11 prp surgeries and 2 detached retina surgeries in the right eye. The optic nerve in the right eye died and the eye mummified before it was removed. On September 2005, my kidneys failed and began dialysis. I lost my house, husband, job and horse shortly after. Went to live with my mother on my birthday after being in the hospital 7 times in 6 months and the hospital social worker determining that my husband was a danger to me. Went on dialysis from 2006 to 2009. In that time, I was losing sight in the remaining eye due to a cataract. Was taking Braille living skill courses but too much nerve damage in fingers to read braille and needed someone to dose my insulin. Convinced dr: to check what kind of sight would have if cataract was removed. Fortunately had enough sight to justify removing the cataract. Dr. Could determine my vision behind the cataract. Never was a candidate fot an insulin pump as stomach would not empty and blood sugars would lag way behind when I ate. My internists placed me on the transplant list. Transplant center does not give transplants to type 2 but determined that in reality I was either a type 1 or somewhere between 1 and 2. Was called in 2009 for transplant because of compliancy and good record keeping. Received a kidney/pancreas transplant and monitored blood sugars for 2 years after that before being told to stop. I still have quarterly A1cs drawn in addition to other tests.
Tld: ask your dr.to determine if you are a type 1 or 2. You can be a type 1 at any age due to body aggressively attacking itself.

russellholtslander1

It is important to note I spoke of this topic as a T2 diabetic.. over 90% of diabetics are T2.

T1D is a whole different story, and I apologize for not pointing out that I was talking about T2 diabetics. Although, the few T1 diabetics I know, have a lot better control of their blood sugars.. but they require meds.

I think a lot more can be done for T2 diabetics, and since I posted, I have gotten off my meds completely, and still have 100-115 blood sugars.

I was simply wondering if most diabetics are OK with their doctor asking them to be @ 6.5-7 A1C, which is STILL high.

I had years where 7.0 was laughable, because my doctors presented diabetes as a disease that would have me on pills, then eventually Insulin, and never suggested I could have an A1C, with no meds.. I think if most diabetics knew what they COULD achieve, many would choose to work harder to drop blood sugars to normal, and hopefully get off all meds, if possible. Some would be OK with mildly elevated numbers, and to be on a pill or 2, and eat more of the foods they like.. and simply work on achieving a healthy weight.

I am on a strict diet to reach these goals, which not everyone would do.. BUT, doctors never gave me the option.. they never told me it was possible, so I just ate poorly, and thought, they'll adjust my meds.. but they never got it close to normal. Even when I started eating the way they wanted, I still had 160-200 mg/dL. I'm not sure they can take a person who is eating the diet they recommend, which has " moderate " carbs, and give them enough meds, to keep them below 120 mg/dL. I have a friend who is on a CGM, and takes basal, AND fast-acting Insulin, and she struggles as well.. and routinely has 140-160 blood sugars, despite being able to take Insulin, based on her number.

Maybe she will get better at dosing herself. I am sure she is cautious giving herself Insulin, not wanting LOW blood sugars, but I am fine if I am over 70. If you measure your BG level, and it is 140, you should be able to figure out how to get it below 120, even when you eat.. I think a big part, is that she is aiming for 120, so if she eats an oz. more here or there, she ends up with 5-10 extra grams of carbs, and ends up a little high. If she aimed for 90, she should be below 120, but would probably be worried about going below that.. doctors tend to be leery of going below 120 actually.

I feel good at 70-90. I doubt doctors can, or desire to reach these levels with meds.. it migh not be possible, if the patient is eating poorly ( like it was for me for years ), but they may be hesitant to be aggressive with meds, out of fear of causing low blood sugars. The result is that with meds, few people have the control to feel comfortable at 70-110. Meds change BG levels rapidly.

I think diet is more likely to be able to be tweaked to find a good range.. if you get to 120-140 with meds, eating a normal diet, then eating healthier, SHOULD allow you to get down 30 pts., if you cut a few carbs.

I think most need a combination of dietary change & meds.. change diet more, and you need less meds, and vice versa.. finding what works and can be sustained is best, and is different for each person.

What I think is wrong though, is that many diabetics do not have control, and your doctor should be aiming for below 120... by whatever means you can do... better diet, or more meds.. both fine, as long as they result in normal blood sugars.

Does anyone think that this should NOT be the goal??