A1C = 6.0, Dr. Just Prescribed Insulin

[suzcubfan]

I am completely baffled. I have been Type II for 2 years. I started off with Glucophage (1,500 mg) which I couldn't tolerate. I have lost 70 lbs. My doctor put me on 4mg of Amaryl which he cut in half after I had daily episodes of 60 and lower. When the doctor switched me to 2mg of Amaryl, my A1C was 5.4.

Now, I'm seeing a new doctor (a specialist) as I also have Hashimoto's Thyroiditis. He seems disturbed that my morning readings are running between 140-170. I'm not eating at night before bed. He put me on Glucophage XR (1,000 mg) which again, I couldn't tolerate. Now I'm on 5 mg of glipizide at night (in addition to my 2mg of Amaryl in the morning). If that doesn't bring down my morning readings, he wants me to take 6 units of insulin at night. Does this make any sense? I still have a lot of weight to lose so in addition, he's raised my Synthroid and given me a diuretic as well. I just can't figure out this needing insulin with an A1C of 6.0 yesterday.

[jtu91952]

Hi! i was taking the amaryl for awhile. I also took glucophage but could not tolerate it. I am now taking humalog sliding scale, and lantus 50mgs at nite. I also have thyroid problems (was graves disease but now hypo) and i take levothroid .075mgs.

I also have hbp and was taking hctz. hctz can cause glucose and cholesterol to rise. I went from 5.something to 7.9 . I have stopped the hctz and will retest next month to see if my glucose levels change.

[modert]

Hi Suzcubfan, You mentioned that you are not eating before bed. But you did not mention when you are eating and what you are eating.

My understanding is that eating before bed will help lower your fasting glucose numbers. The goal is to stabilize the glucose levels. When you go for such a long period of time without food (say from 6pm to 8am) your body will naturally produce glucose. By eating small meals and snacks every 3 hours that you are awake you can control your glucose levels and prevent your body from manufacturing it on its own.

Also, what is your diet like? What do eat for dinner and how does that meal compare to the other meals you eat? Every little tiny thing can contribute to loss of control.

Personally I had great difficulties with medications - they all made me VERY ill, so I was determined to find a way to control without the meds.

[suzcubfan]

I do eat three regular meals a day. I check my blood sugar before I eat my All Bran cereal and skim milk in the morning around 7:45 a.m. Then I have lunch at 12:00 or 12:30 and that usually consists of soup or leftovers from the night before. Often I'll have steamed vegetables for lunch. The doctor has now told me more fruit so I have been eating more, but only at lunch. Dinner is around 6:00 and I'll usually have meat, bread and vegetables. Sometimes at night I'll eat something like popcorn.

My diet is not perfect and I'll be the first to admit it. But it was my understanding that I should be striving for 6.0 or less on my A1C's. I've achieved that (as low as 5.4) yet my Endo is so hung up on this morning number. I started taking the glipizide Wednesday night and yesterday morning my blood sugar was 154. This morning I took my blood sugar and at 7:15, while on the train, it was 112. When I got to work, it was 151. I had not eaten between those readings.

I just think that insulin at night is maybe a little drastic given the overall test results. The doctor was upset that I had only lost about 2 lbs this past month but I guess that I look at it as that's a 2 lb loss and it isn't a gain of the 70 I lost before. I've battled my weight since I was a little kid and I am happy even with the small victories. If I consistently lost 2 lbs a month for 5 years, I'd be at my ideal weight. He has upped my thyroid medication to jump start my metabolism and put me on a diuretic in addition to my other blood pressure medication. Is it common for an Endo to start insulin so soon?

[modert]

Originally Posted by suzcubfan

I do eat three regular meals a day. I check my blood sugar before I eat my All Bran cereal and skim milk in the morning around 7:45 a.m. Then I have lunch at 12:00 or 12:30 and that usually consists of soup or leftovers from the night before. Often I'll have steamed vegetables for lunch. The doctor has now told me more fruit so I have been eating more, but only at lunch. Dinner is around 6:00 and I'll usually have meat, bread and vegetables. Sometimes at night I'll eat something like popcorn.

There are a few changes you can make in your diet that will dramatically effect your glucose control. Unfortunately, doctors don't often give great diet advice if at all, so unless you are seeing a dietitian or nutritional counselor you will not know what to do.

If you are only eating 3 meals per day, I strongly recommend that you increase that to 5. You want to have a balanced snack or meal EVERY 3 hours. A common misconception is that avoiding food helps control glucose levels. This is absolutely NOT the case.

Also, based on your post, your daytime meals are extremely carb-heavy. Cereal with milk is not an appropriate breakfast for a diabetic. Cereal and milk are both high carb foods and without an acceptable portion of protein this meal will contribute to increased glucose levels. Same with lunch - eating just vegetables (although healthy and "diet") is 100% carb. You must consume protein with EVERY meal and snack!

I am not sure how many calories you consume each day. I could figure out for you how many you should have, but I need more info from you. It is the calories of your food which will have the greatest impact on weight loss. But it is the balance of macronutrients combined with frequency of meals that will have the greatest impact on glucose control.

In the short term, you MUST add a reasonable portion of protein to every meal and snack. This means 25-30% of total calories should come from protein. As an example, if you eat a 400 calorie meal, at least 100 calories should be protein, which converts to 25 grams of protein. You current breakfast probably only has between 8-12 grams of protein at the most.

Its very important to understand that I am NOT promoting a high-protein/low-carb diet. But I am recommending a better balance. I truly believe that initially making just these two changes will have a dramatic impact on your glucose control.

On another note, I agree with you that the insulin may be a bit extreme right now. I would call your endo and discuss with him the possibility of trying to gain control in more natural ways - diet and excercise. Often, the doctors will give you some time to prove that you can do it, and if you can't, then they will turn back to the meds.