Diabetic Woes, Need someone to explain
 

After three years of controlling my BG without meds, I noticed the symptomatic thrist/urination about 4 weeks ago. I dug my meter out of the top of the closet and went to radio shack (for new batteries) and my sugar was 375.

Digging around I found my glucaphage 500 (non -XR) that was a bit old, but seemed to work on 1000 mg 2 times a day, and I made my appointment for the doctor. My doctor is a General Practitioner now that I haven't had any diabetic symptoms, although he does treat a good many of us.

Sugars returned to pretty good levels within a couple weeks (110-140). Now I am at a crossroads. I went low on Glucaphage (I am training for a 1/2 marathon next month) at 57 on 1000mg, so I cut back to 500 mg and I went low to 68.

My doctor said to give Actos a try and see because it would not allow me to get low BG, and gave me two weeks worth of samples. He was right, on my 8 miler yesterday, I did not go low.

So, here's my question/problem. What the heck happened? I have never got away from my good low carb habits, I am approximately 45 pounds lighter, anyone got any ideas? He did an HBA1c on 5-28 at 8.6, and the last one was on 2-10 at 6.1.

Also, should I stay on the Glucaphage 500 Xr or the Actos 30mg? I can take either and don't mine telling any doctor where they can go...

I am concerned that something else is going on with my health.

Thanks,
wsgts

Hi wsgts...



First, a gentle chiding: even though your blood sugars are well under control and have been for a while, you should never get out of the practice of checking your blood sugars at least a couple of times per week, both a fasting and a post-prandial reading. I have to admit, I was guilty of doing the exact same thing you did (went about 4 months without checking) and wound up in exactly the same situation...with my blood sugars once again out of control.

Without having some idea of what you average daily menus looked like before you went to the doctor, it's hard to even guess at what may be going on. Do you know what you average level of carb intake has been over the past few months and what the sources of those carbs were?



So somewhere between February and now, your blood sugars got out of control, although 6.1 shows an average blood sugar of almost 110 so you may have been inching in that direction already even then. It could be stress, it could be infection, something could be causing your beta cells to burn out...it could be a lot of things, but I'm sure that your doctor has already asked you a lot of questions about what has happened between then and now.

As for the Actos vs. Glucophage, I don't know enough about the Actos to comment, but if you're going hypo on the Glucophage while excercising and you don't on the Actos, it would seem a good idea to go with the Actos.

Source of carbs
 

My doctor didn't ask too many questions. He just assumed it was some diabetic not taking care of himself. Didn't ask about diet, didn't ask about infections or sickness, just gave me a presription, most of the time, I like it that way.

My diet hasn't changed much over the last three years. I haven't had any sweets in so long I don't remember what is was like.

Breakfast is some sort of meat = bacon or sausage and the quantity varies, sometimes eggs with it, sometimes omelet, but almost always some of the above. Lunch is sometime off the george foreman grill, olives, green salad, cheese, sandwich without bread, something along that line.

I drink the new low carb beer sometimes, but haven't in a while, and a glass of red wine from time to time. Haven't had much lately though, maybe that was an issue?

Later,
wsgts

You're scaring me
 

My dietary habits are very close to what you describe. I get beautiful control. (Blood sugar between 85-100 pretty much around the clock.)

How long have I got?

I wouldn't worry
 

First of all, I should have been checking my sugars every now and then and I would have found this earlier. So, that's lesson #1.

If you aren't on meds, you should have some fresh glucaphage (starts working the same day) available, mine was so old the pharmacist said it probably wouldn't have done much. Lesson #2.

So, I have a fresh supply now, and rigged up a bottle in my blood sugar testing kit so that it is available if I ever get a reading >150 and I am going to make sure that it is fairly fresh.

My biggest problem is that I still weight too much, I have been here for a couple years, and have been happy with it, so I got to get to rest of it off, and I probably will be back to the normal all the time, which were pretty good this morning (130) and last night (117).

So, control is coming back, but I am a bit confused as to why it went away to begin with.

Later,
wsgts

My doctor took me off Glucophage a year ago with a concern that it was affecting my kidneys. I've lost about 40% of my kidney function. My barber, who took no medication other than glucophage, recently died due to kidney failure. He had gained much weight, most of which were fluids.
A new doctor assigned due to an insurance change put me on Actos in August. At that time, I also discovered the effect of carbs on BG and threw away the 20 year ADA recommended diet. My A1C has dropped from 7.5 to 5.4 and has been holding steady there for about 6 months.
I have also gone from 40mg of glipizide/day to 5, and recently came off the Actos completely.
I am now one of those 'born again' LCr's.
The glucophage makes me nervous, however.

Lisa, are you there?
 

Can you give us a primer on some of these drugs? I'm afraid I really don't know what JG is talking about. (Well, I know that Glucophage is a non-sulfonylurea oral hypoglycemic.) What is Actos? And that other one? Glipizide? What the heck is that?

JG, have you read Dr. Bernstein's book? If not, buy it at once. Best price seems to be on his site, diabetes-normalsugars.com.

Hi Jim!

Actos is a new Antidiabetic drug approved by the FDA in 1999. It works by both increasing insulin sensitivity and also by inhibiting glucagon production by the liver. The general precautions that I've read state that those with a history of liver, heart or kidney problems should let their doctors know of that history before taking Actos as the drug may not be suitable for them.

Glipizide is a sulfonylurea drug ( :thdown: ). Sulfonylureas work by stimulating your pancreas to produce more insulin which will eventually contribute to beta cell burnout even if they are effective at controlling blood glucose for a while (personally, I want to keep as many beta cells as I still have and not lose any more than I have to!).

I couldn't find anything about Glucophage causing kidney problems, although there were general warnings for those with existing liver or kidney problems to alert their doctors before taking Glucophage as those with existing liver or kidney problems can develop a very serious (often fatal) problem called lactic acidosis in which dangerous levels of lactic acid build up in the bloodstream and cannot be removed due to the liver and kidneys being unable to handle them in a compromised state.

Sounds like JG has it backwards
 

If I've learned one thing from Dr. B's book and from the forums it's that we should avoid all sulfonylureas completely. Overstimulation of the pancreas is what got us into this mess in the first place.

JG, better you should keep the Actos and ditch the Glipizide, not the other way around.

Actos
 

One thing I will say about Actos is that I have yet to go a too low on it.

Today, 8 miles of running and I measure right when I got back and it was 83. The Glucaphage was getting me in the 50's on 1000mg and 60's on 500 mg.

I have noticed a bit of water weight gain, but nothing serious (4 pounds). My overall measurements (waist) are still going down (39 today) though. so should have that off in a few days.

One other little benefit is that my runs are taking less time now, I shaved 45 secs off my average one mile time. I think this is because the Actos is helping to moving the sugar into the cells. I was also able to do 40 pushups this morning, and I normally do 25. Maybe this 30mg dose is really helping my insulin resistance, might keep this med around for a while (at least till after the race :cool: ).

Later all,
wsgts

My problem with both actos and glucophage was directly related to my existing kidney loss. Most of the contra-indications for actos are liver related, but there is some suggestion that anemia may result. Since my blood tests began to show anemia problems after starting actos, I stopped taking it.
For those of you who suggest that I read Bernstein, thanks. I have, as well as Schwartzbein. Alas, too many years of high blood sugar treated with glucotrol/glipizide have already burned out a large percentage of my Beta cells. My remaining choice has been to begin insulin treatments, which I have strongly resisted.
You know, with people suing McD and Burger King over obesity, who people like me should sue are the ADA and their low fat/high carb diets, as well as the doctors who prescribed them for diabetics.
It's ironic that I discovered what the real problem was after 'getting religion' over deteriorating health and following the ADA diet to the letter. Needless to say, my BG went off the charts, and led to my search for better answers.
My doctors (both GP and specialists) are just beginning to accept that carbohydrate consumption may be 'different for diabetics' than the rest of the population, but its only my vascular surgeon who really believes it!

Why?
 

Why do you resist? Give your pancreas a break!

An irrational but total revulsion to injecting myself with anything.

You're probably not an engineer, then
 

Like Dr. Bernstein, my undergraduate training was in engineering. I actually harbor a secret desire to use insulin. I covet the extra degree of control it would give me.

However, I just took a blood sugar reading - 86. So, I thank God and the Blessed Mother for the normal blood sugars I have, and trudge up to the kitchen to grill some hamburgers. May your blood sugar always be 90 mg/dl!

Jim

No, but my undergrad major was chemistry. I spent my last 20 years in education as a principal in the barrio where needles are not a symbol of comfort. I think I can blame most of my reaction to military medics-in-training though. Their bedside manner with injections did not inspire confidence.