6 month diabetes update
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jknops2
Posts: 171 Member
An update after 6 months and since I have all these glucose readings, I thought I analyze them a bit and see if I can learn something of what is happening and changing.
A1c
05/2/2012 5.8
07/6/2012 4.6
10/6/2012 4.6
Medication
5/18/2012 500 metformin
6/01/2012 1000 metformin
6/14/2012 1000 metformin + 25 Januvia
6/21/2012 1000 metformin + 50 Januvia
8/24/2012 2000 metformin + 100 Januvia
I also take 10mg Crestor and 80mg Aspirin daily.
I have been in China, on a 1 year sabbatical since late July. This is a challenge as the Chinese diet is high in carbs like rice, noodles, steamed bunds, dumplings, and whole grains are impossible to find. On a plus, they do include a lot of vegetables and not much meat. I walk on average 1-2 hours a day and bicycle 4-6 hours a week. I measure glucose early morning and 3 times a day 1 hr. (the time when I spike) after each meal. Lately I have 1-2 readings a month above 140; I started in May with 20 reading above 140. My monthly averages are:
Morning After meal Weight A1C
Before 100 129
May 76 109 72.9
June 83 104 71.5
July 90 102 69.8 86
Aug 95 104 68.7
Sept 94 105 68.7
Oct 70.9 86
So looking at this:
Morning glucose went down 25% with metformin and varies much less, before medication it ranged from 80-140, now the range is plus or minus 5 of the average. But morning readings have increased and stabilized at 95 even as I have increased medication. Morning readings, with my diet, do not seem to be influenced by what I eat or, within my weight range (BMI 21.5-22.5), if I am gaining or losing a few pounds. Well I guess diabetes is progressive. Or alternatively the Chinese diet did increase my morning glucose; I guess we will see in 1 year. At this stage, I need medication to keep my morning readings below 100.
I definitely have a dawn phenomenon. When I measure glucose in the middle of the night it is around 10-20 less than in the morning. The A1c, converted to average glucose readings, also shows this dawn effect, as the morning readings are 10 point higher than the average glucose based on the A1c reading. I think my medication has substantially lowered the morning dawn increase. So with my current medication, because the dawn increase is below 100 and it does not increase my average glucose by much, no point worrying about it.
After meals the average is 100-110, but I eat way fewer carbs since June. So I can control my average glucose, and spikes above 140 with diet pretty well, but had to drastically limit carbohydrates to 10-20g per meal. Measuring glucose after meals is the only way to figure out which and how much carbohydrates you can eat. So any time I eat something new I need to measure it for a while.
The oil in Chinese meals and the peanuts/walnuts/almonds that I am eating is catching up on me and I need to start watching calorie intake again.
So overall, I think I have diabetes under control for the time being.
A1c
05/2/2012 5.8
07/6/2012 4.6
10/6/2012 4.6
Medication
5/18/2012 500 metformin
6/01/2012 1000 metformin
6/14/2012 1000 metformin + 25 Januvia
6/21/2012 1000 metformin + 50 Januvia
8/24/2012 2000 metformin + 100 Januvia
I also take 10mg Crestor and 80mg Aspirin daily.
I have been in China, on a 1 year sabbatical since late July. This is a challenge as the Chinese diet is high in carbs like rice, noodles, steamed bunds, dumplings, and whole grains are impossible to find. On a plus, they do include a lot of vegetables and not much meat. I walk on average 1-2 hours a day and bicycle 4-6 hours a week. I measure glucose early morning and 3 times a day 1 hr. (the time when I spike) after each meal. Lately I have 1-2 readings a month above 140; I started in May with 20 reading above 140. My monthly averages are:
Morning After meal Weight A1C
Before 100 129
May 76 109 72.9
June 83 104 71.5
July 90 102 69.8 86
Aug 95 104 68.7
Sept 94 105 68.7
Oct 70.9 86
So looking at this:
Morning glucose went down 25% with metformin and varies much less, before medication it ranged from 80-140, now the range is plus or minus 5 of the average. But morning readings have increased and stabilized at 95 even as I have increased medication. Morning readings, with my diet, do not seem to be influenced by what I eat or, within my weight range (BMI 21.5-22.5), if I am gaining or losing a few pounds. Well I guess diabetes is progressive. Or alternatively the Chinese diet did increase my morning glucose; I guess we will see in 1 year. At this stage, I need medication to keep my morning readings below 100.
I definitely have a dawn phenomenon. When I measure glucose in the middle of the night it is around 10-20 less than in the morning. The A1c, converted to average glucose readings, also shows this dawn effect, as the morning readings are 10 point higher than the average glucose based on the A1c reading. I think my medication has substantially lowered the morning dawn increase. So with my current medication, because the dawn increase is below 100 and it does not increase my average glucose by much, no point worrying about it.
After meals the average is 100-110, but I eat way fewer carbs since June. So I can control my average glucose, and spikes above 140 with diet pretty well, but had to drastically limit carbohydrates to 10-20g per meal. Measuring glucose after meals is the only way to figure out which and how much carbohydrates you can eat. So any time I eat something new I need to measure it for a while.
The oil in Chinese meals and the peanuts/walnuts/almonds that I am eating is catching up on me and I need to start watching calorie intake again.
So overall, I think I have diabetes under control for the time being.
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Replies
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I see some similarities in my not yet 3 months of testing such as the "dawn" effect. I hope you can find some more alternatives for your diet in the land of carbs and wish you well. Thanks for sharing with us
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Great job! your BG is doing great. It is a real challenge when confronted with so many new and starchy foods.0
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Great job keeping your A1C so low.
I'm new to all this so I have a question. Your A1C of 4.6 on 7/6 looks good to me (a newbie) so why did you have your meds increased on between June and August?0 -
I had a similar question about the med increase and what prompted it. Once I got mine under 7, my Dr. took me off my meds completely (tapered, yes, but completely). She also didn't fret about the morning increases, as the liver dump is so normal for diabetics, and told me to call her if my fastings started routinely going above 140, which she acknowledged was high, but felt that as long as my A1C was under 7, the liver dumps in the morning were just getting rid of storage, and not a bad thing.
I don't know that she's "right" and other Dr's are "wrong", I think it's that there's so much information out there, then interpretted by each practitioner and applied to each individual by other factors... weight, gender, other health problems, etc.. It's just wild to see the disparity, and to wonder if someone else's plan might work better for you than your own.
So far though... so good (though I still fantasize about those days when I should have worried about food and sugar, but didn't)...0 -
Ok, medication increase.
I did 3 months of diet with very low carbs before May, but only got the A1C from 6 to 5.7, thus I started medication and Metformin alone was not enough, hence the added Januvia. With medication it dropped to 4.6. Then I still had too many spikes above 140 even with eating almost no carbs. Hence the increase in medication in May and June which bought the number of spikes down. And in August my morning reading kept going up, hence the increase which stabilized it.
And yes, I probably can lower medication, seeing these numbers I cut the Metformin to 1000 and the Januvia to 50 this week.
However, I do not think that keeping the A1C below 7 is enough, spikes above 140 or 160 or 180, depending on what you read, causes vascular damage. The odds of getting diabetic retinopathy is 80% after 10 years of diabetes, and you live, on average, 10 years less with diabetes. Sorry for these depressing numbers. I think that most people do not take diabetes serious enough and that most doctors do not treat diabetes aggressively enough, especially in the early stages and at younger ages. Doctors probably are not aggressive enough, because many diabetic do not make enough lifestyle changes.
However, I eat less than 100g carbs a day, less than 10-20g per meal, lost 40lb, BMI is 22 now, and exercise more than 1 hour per day. Thus, I can’t do anything more through lifestyle. Thus I want medication to bring my glucose down. However, how aggressive you treat diabetes also should be influenced by your age. Vascular damage is progressive, thus the younger you are the more important it is to deal with it. But you can set a higher A1C at older ages and also allow more spikes with fewer consequences during your lifetime. But there aren’t many long term studies examining this.
Anyhow, this is all my opinion, consult with your own physician before you make any decision on what you do.0 -
Thanks for your reply. It sounds like you're doing awesome, and working your tail off, and that you have maxed all you can reasonably do through lifestyle changes. Looks like you're doing awesome!
My weight/BMI is still considerably high, and I think that as it lowers (which it is, though slowly) it'll also affect the rest. I am still hopeful that with constant attention and vigilance, many of the long term effects of diabetes can be slowed or neutralized. I guess in many ways that's what we all hope, and hope that this site, all it's features, and all the support can assist with it.
Keep on pluggin'. You are incredible!0 -
Interesting, many thanks for explaining the meds increase.
And some food for thought too.
Certainly got me thinking about the discussion with my Dr next time round.0 -
Ok, lowered Metformin to 1000 and the Januvia to 50 two weeks ago. Morning glucose increased from around 90 to 126 in 10 days. So lowering medication is nt working for me and I am back on 2000 Metformin and 100 Januvia again.0
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Are you feeling okay about it? That's important... that you're okay with it. Maybe not in this moment, but ultimately. Sounds like your insulin isn't ready or able to work for your body without the help of meds, as from all appearances, you're doing all you can. Good for you accepting the help of meds. Hang in there and keep plugging!0
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I have type 2 diabetes and high blood pressure I sometimes get frustrated taking those medications., I know what you are going through just hang in there and things will get better. I try to exercise 5 days a week and cut down on my carbs, every time I see my doctor he will tell me to keep exercising especially working. Now that it is getting cold I go to the gym and walk as much as I can handle. I hate taking medication but I just can help it. Good Luck and wish you a better health !!!!!!!!! :flowerforyou:0
