How in the world can a person control sugar levels when they constantly bounce up and down without much rhyme or reason? As of now, I carry a diagnosis of glucose intolerance. This is with an A1C of 6.2 and several fasting levels above 170 and a couple randoms as high as 232. The thing is, I can also have readings in the 50's and 60's. Sometimes I can go several days with very normal readings. I take no meds to control the sugar and haven't been given any guidance other than a script for strips to test my glucose levels 4 times a day and told to eat every 2 to 3 hours which is something I've almost always done anyhow cause I'm always hungry. I've been testing since last fall. The doc looks at the logs and says "Oh, looks like these readings are all over the place." Then we move on to the other problems.

I have a very rare thyroid disorder which took 25 years to diagnose and I will be starting specific treatment for that as soon as the special compounded medication arrives. Because of that, I have developed renal tubular acidosis (15 years, undiagnosed and untreated), stage 2 kidney disease and premature osteoporosis. I started treatment for all of these and the intercostal neuropathy that developed last spring within the last 6 months. I take atenolol for the thyroid (been on beta blockers for 17 years for it), am awaiting the dextrothyroxine to arrive, take bicarb, phosphorus, calcium and vitamin d for the kidneys, those plus I will be starting the menostar patch for the osteo and take lyrica and tylenol 4 for the neuropathy.

I'm 48. I'm far from overweight at 5'2" and 104lbs. I've always been small. There is absolutely no history of diabetes in my family. I'm quite active and get plenty of exercise. I eat large quantities for someone my size but I've always tried to eat a healthy, balanced diet.

I've got a feeling I know why I have problems with the glucose levels. Another thing to attribute to the thyroid problem. I've had glucose readings that have been just a little off for the last 17 years. But, over the last year or so, they've become consistently higher and before, I'd never see readings above 200. I've got a feeling it's become a secondary issue like all the others and it's not something that's just going to go away if we ignore it.

What I guess I wanna know is what kind of treatment options are there for something like this? Does it even merit treatment? I've read the contraindications for the various meds and most of them are out cause of allergies and the acidosis. I also wonder if they'd make the low readings even worse. Should I even be concerned since my A1C is below 7? I'm feeling kinda lost. Any advice would be welcome.

Well yes, you should be concerned. But I am not sure you should be over worried.

Is your blood sugar testing regular? Do you test like you should?

6 hours following a meal (normally morning) Considered fasting.
Just prior to eating
1 hour followind a meal
2 hours following a meal
3 hours following a meal

These are the ONLY numbers which tell a medical staff how to precede. All other numbers are mere rubbish. (Besides the A1C, that number is important!)

Do that for a week, and then share the results.

Hugs,
~ Mark

Hi mark, I appreciate your responding. I've been testing for a while. The gp gave me a really nice meter with all kinds of really cool functions back in august. Insurance covers the strips too! I did have to read the instructions to figure out how to do the reports though. ;)

Morning fastings run 91-161
One hour post meals run 57-223
Two hour post meals run 61-232
Don't have many three hour ones but they range 51-191
I normally test at bedtime and they run 80-210

Bouncy, bouncy. :bouncing:

I've been trying to find a pattern. The only thing I can see is it stays high for a while then stays normal for a while and then back again. I don't comprehend the why's of the low readings (this meter is so cool, it asks me if I need a snack :D) but catching em on the meter has explained symptoms that I've had for years. I always thought it was the thyroid hormones breaking thru the beta blockers when I felt like that. Perhaps not???

You ready to put up your dukes? ;) I don't think readings at any other time outside of those parameters are mere rubish. Saying that's not fair to the people who land in the hospital with outrageous readings. Just cause the readings don't fall within certain time frames doesn't make a bit of difference. The problem still needs to be addressed.

But regardless, you're still a sweetheart for responding. :) I just get really frustrated when I don't understand something and don't know what to do about it. :(

Testing is, of course, very important, but you need to correlate it with other things. You need to compare exactly what you ate (and where) with those readings. You also need to add in exercise and emotions can also play a role. I know that for myself when I am depressed or angry, my sugars go up.

So you will have to take detailed notes and see what foods, what restaurants, what emotions, and what exercise affect you. Sorry to make you do more work, but there are many things at play and just recording the numbers doesn't mean anything in isolation. You need the big picture.

Cora

I just wish the gp would stop looking at the log, writing glucose intolerance in the chart and just go ahead and address the issue and give me a little guidance here. He's a really good doctor and I like him a lot and we've dealt with a lot of problems lately. But he also knows I'm going to look it up and sometimes leaves it to me to come up with a solution. He even asks me for my research papers sometimes. He's the only doctor in this isolated area and he doesn't have a whole bunch of time.

I've taken some notes, although not real detailed and not real consistently. I did see a big swing when I got a uri about 2 months ago. But I have found that I can eat a certain food one day and get a high reading and eat the same thing again and don't so there has to be something coming into play. I'm very much a creature of habit and don't change routines very often. Haven't been in a restaurant in about 20 years. We don't have any of those around here. :cool: Perhaps if I pay a little more attention, I can figure out where I'm going wrong. In all honesty, I don't really wanna have to deal with this but I know I've got to.

Had a dog with diabetes years ago. He was easy to take care of. Fed him the exact same thing every day at the exact same time, taught him to pee in a cup every morn when he got up and gave him his insulin once a day at the exact same time. I'll be darned if I wanna go that route. :eek:

As a very "brittle" type 1 diabetic having gone through lots of daily swings over the years, I can sympathise with you and say that I found that swinging blood sugars like you describe can really affect your day to day health, the A1c can be "fine" but you are still very affected. I really hope you find some answers that help soon. The advice here has been good.

First things to my mind. Has your pre diabetes (or "glucose intolerance") been upgraded to diabetes? Because the high figures you have quoted (often above 126 mg/dl) are well into diabetes territory. Get your doctor to revise and rethink accordingly. Strategies or drugs to tackle diabetes may help.

As for the low figures... something is causing you to be hypoglycemic as well. Now, I don't know much about Hypoglycemia (the "condition"), but that seems to be the case - some drugs or underlying condition is causing this.

I guess I'm trying to say that perhaps 2 things are going on here and they need to be treated for themselves, rather than trying to find a condition or explanation that accounts for both of them.

Here's some more ideas. How much are you taking into consideration your carb intake? If I were you I would work out maybe 2 or three low-medium GI, moderate carbohydrate (20-40) meals and snacks to take regularly and take note of when I do. Then see if a pattern occurs around those meals.

With consistent meals and regular tests, see if a pattern occurs around certain times of the day. Perhaps you have a real curve going through the day of resistance/hypoglycemia. For instance I do (minus the hypoglycemia of course) - my basal insulin needs increase by 30% through the morning then drop right back at 4pm, then climb steadily again.

Good luck. Again, getting adequate diagnosis and subsequent help may really help, I really think that glucose intolerance cannot adequately explain those high sugars, and of course not the lows.

Didn't see your previous post. Sounds like you are on the right track questioning or pushing the doctor. You really need to try to get your blood sugars under control, this is something you need to do with or without him. (as in, him OR another doctor... don't do it alone, you need medical assistance)

Also about your old dog... well, that all sounded a bit tiresome, but he probably didn't care. But regardless, you should not let your fear stop you treating your blood sugar problems, you will find many times the freedom in controlling it vs not controlling it. Chances are that peeing in a cup won't be part of it, and as for insulin - well if you do indeed need injections (and the chance is oral meds would be the way) then you may be interested to hear that after the first week or so, during 15 years of injections 4x per day I have found that shaving is by far the more annoying and tiresome activity.

I have something called pituitary resistance to thyroid hormone. I periodically go hyperthyroid and at other times I do pretty well. I have a stack of lab reports dating back 25 years. As expected, the more hyper I'd get, the higher my sugar would go. That's normal for hypers. Never caught it above 185 though. Fructosamine would always come back slightly high too. But it always followed the hyper episodes and would normalize during the quiet times. The hyper episodes can last a couple years. I'm kinda used to bouncing. But I'm also used to quiet times and it ain't happening this time. I still feel like I'm on a rollercoaster, just not as bad.

Last check of the chart, it hadn't been updated from glucose intolerance but I haven't seen the report from the last visit yet. I usually see him about once a month or so and will see him again on the 25th of feb. I don't know why he won't come out and say it. The A1C's circled on the last set of labs with a notation "a little high". We didn't get a chance to discuss it at the last visit. I was too fumed up about the nurses having screwed up every one of my last set of scripts. I've been battling those nurses for over a year with them bumbling almost every test and every order and I finally got fed up and said something. Took in my own set of filled out scripts too, which he signed and faxed off personally. I was without strips at the time (another bumble) so I have no idea what the anger did to my levels.

I do think you're right about 2 things going on. I think it was originally 1 problem and has now split into two separate problems. Right now, my thyroid hormones are under control and been under fairly good control since last may. My sugar isn't.

I have lowered my carb intake. I try and keep it under 45 carbs a meal and never go over 60 anymore. I've also lost a couple pounds since I started being careful. Problem is after the last hyper episode, I have about 10 pounds to make up to get back to what I should weigh.

I shall try your idea though. I gather you're saying look for a daily pattern based on consistency? I guess if the dog could do it, I can do it for a little while.

Almost missed your second post.

I really like my doctor. I've been doctor shopping for 25 years. I found a real gem in this one. He's also local which means no trips up and over the mountain. He's just wickedly busy and overwhelmed with being the only doctor here. I need to pin him down. He's also more than willing to take input which is a rarity these days. I've made a lot of progress under his care.

The dog was perfectly happy with the routine. Funny, but he outlived his expected lifespan for his breed. He did go blind though. That didn't bother him either. Had a toe amputated too.

I think my fear lies more in ignoring the problem than the treatment. I already pee in a cup. Got darn good aim too. Gotta control my acidosis and make sure I'm not concentrating too much. My kidneys don't filter properly. Ph and specific gravity's my game. But cause of that, I do know that I don't pass sugar and only rarely drop ketones. Metformin's out cause of the RTA. I seem to have contraindications to almost all the meds I've read about. It keeps coming down to insulin as about the only option. Is it a viable option and is it something I should talk to the gp about? Or am I off my rocker even considering it at this point?

When I post on my **** I try to include both mg/dL (milligrams per decaliter) and mmol/L (millimoles per liter)[anyone can correct my spelling, there]. So when I see a BG value like 120 I divide by 18 to get a comparison with the system I use (120 = 6.7).

Frankly I'd love to see a value of 6.7 on my meter these days.

.... The only thing I can see is it stays high for a while then stays normal for a while and then back again. I don't comprehend the why's of the low readings ...
It sounds like the extreme variability in your blood sugars is your biggest challenge. The easiest and safest way to deal with that is to go on a low-carb diet. Carbohydrate in your food is primarily responsible for blood glucose going up. Because the effects of this carbo on your blood glucose are inconsistent, injecting insulin and/or using drugs that make your pancrease produce more of the stuff would be problematic. The risk of hypoglycemia would increase. Cutting carb out of your diet, on the other hand, would not do this. It would mean that your blood glucose would not go as high on your insulin resistant days. And because your beta cells aren't being stimulated as much, you wouldn't go as low on your insulin sensitive days.

The Bernstein protocol could work well for you. It involves reducing daily carb intake to 30 grams a day. Many doctors are wary of it because of the notion that fat is bad for you. The jury is still out on that one. But, in my experience, improved stability of blood glucose levels makes it a risk worth taking. I only reduced my carbs to 50-70 grams a day and it has made a huge difference. I have been eating this way for 4 years now, and my health has never been better. While your situation is quite different, I am sure you would get similar benefits.

Good luck with it ;)