Can someone explain this to me?

[Cookie531]

My husband was diagnosed with type 2 last year. He is now taking whatever the maximum dosage of metformin is (1000 mg?). He tests his blood twice a day in the morning and after dinner. He averages around 140. However, he went to the doctor the other day and his A1C was 8 which I have learned is equal to about a 205. How is this possible? I have control tested the meter which is a one touch ultra and everything seems to be ok there, I even tested myself knowing what I usually average (I don't have diabetes). Could the lab be off?

Also, what medication is usually next in addition to the metformin? When does it become necessary to have insulin injections?

Thanks for your help.

Linda

[SamQKitty]

The couple of tests (fingersticks) that he is doing per day is only a one-second snapshot of his blood sugars. Apparently his sugars are going higher in between the tests.

For post-prandial testing (after meals), there is conflicting advice as to when to test...either 2 or three hours after the meal. Whichever, the timing should be from the BEGINNING of the meal, not the end of the meal.

For the next few weeks, perhaps he should test 4 times a day, AM then at least two post-prandials, and bedtime. Yes, I know it's a pain in the neck, or more accurately the fingers but it's the only way to figure out how his body is responding to various foods. He should keep a detailed log, including what he ate. Armed with this information, his doctor will be better able to tailor medication to his needs.

Also, when you said he averages 140, what are his morning numbers alone? If those are averaging near 140, then he is starting the day off high, and it's more difficult for the body to get regulated from a high no matter how much medication you take. He may need more meds at night.

As for what other medications, they could add another insulin-sensitizing drug such as Avandia, or switch him to Avandamet (which is a combination of Avandia and Metformin), or they could add some sulfonyureas, which will prod the pancreas to produce more insulin. You want to hold off on the sulfonyureas as long as possible as they will hasten the progression towards needing artificial insulin, but if he needs them, he needs them...far better to do that than to let his blood sugars run this high.

Ruth

[blondy2061h]

2 finger sticks a day just isn't enough to show what's really going on. He could be spiking at night, after meals, and any other time of day.

[_mystictiger_]

Hi,

I would test your Husbands blood sugar 2 hours before breakfast, 2 hours after breakfast, 2 hours before meal and 2 hours after meal and 1-2 hours before bed and during the early hours of the morning. Write this all down in a diary and you may notice a pattern when your husband levels are spiking.

Its unlikely your husband will be put on Insulin yet. With my Gran a second medication was given to lower her blood sugar levels and this failed to work, then she had a Heart Attack and was given Insulin. She's been on it ever since.

Every Doctor is different though. But keep a record of your husbands levels.

[Mark1e]

If you want to catch the highs, test about an hour after eating. In addition to seeing just how high your husband's blood glucose is going, it will also show you how he is reacting to different foods.

For example, test an hour after a breakfast of cereal and toast. And do the same thing after a breakfast of eggs and sausages. Also test before and after doing exercise. You will quickly learn how to avoid those highs and bring the average down. An HBA1c of 8% is high and will result in nasty complications if you let it stay up there.

Cheers,

Mark