My Morning Numbers Are Scary!

[Ronman]

I was diagnosed with Type 2 about 4 years ago and I worked very hard to get my A1C down to the mid-5's and lost 50 pounds in the process. After my weight plateaued at a higher level than I wanted, I admit, I got a bit discouraged. I gained 12 pounds back but have held pretty steady there. What really concerns me is my fasting BG in the morning. Two years ago, it would typically be around 120- 150. Now, it is always over 200, sometimes in the 250 range. I always check my blood just before I go to bed and and it typically is in the 100-140 range. I have tried eating a piece of cheese and some other remedies that I have heard about but I am getting very frustrated. My doctor, in reaction to these readings and my concern, recently put me on Metformin, but I felt rotten all the time and took myself off it with his approval. Like I said, I am feeling extremely frustrated and when my doctor asked me if I would consider insulin, I nearly accepted. I feel that is the "final" solution however. My recent A1C was 7.1 which I understand is borderline. Any suggestions?

[princesslinda]

Ron, sounds like you definitely need some help with those morning numbers. How long were you on the metformin? Was it the extended-release type? How were your numbers while on it? What problems did it cause you? Has your doctor mentioned other medication options besides insulin?

I think as T2s, many of us look at insulin in the wrong way, thinking that if we take it, it means we are "BAD" diabetics. Maybe we feel this way because we saw someone in our family on it who didn't do well or had other complications and had to start insulin...this is an unfortunate mindset. Insulin is just another medication to help control blood sugar, and that's how we should view it.

I know that my mother, a very non-compliant diabetic, wasn't put on insulin until she was VERY sick and had lots of complications. Had she done what she was supposed to, followed up with her doctor regularly and been willing to start on insulin as recommended, she could have possibly avoided some of the complications she had that were brought on by high blood sugars.

If its the idea of a shot that bothers you, you'll be surprised at how painless the pens are....I take 2 shots of Byetta daily and sticking my finger to test blood sugar is much more painful than the injection in my stomach.

Diabetes is progressive, and most of us will at some point need the help of insulin...no shame in doing what's best for our health. Doesn't mean you're a failure or a "bad diabetic" or that you did anything wrong....just means its time for something different.

Hang in there...do whatever it takes to get the numbers you want.

[Ronman]

I was on the Metformin for three weeks and felt miserable the whole time. At first, my numbers skyrocketed into the 300's! Then they settled down and were, admittedly, lower than the morning readings I am getting now. Usually in the 150-180 range. But I am one of those very lucky people that feel good about 98% of the time. I never get ill and except for the usual aches and pains realized from getting old, I feel pretty darn good. I just couldn't adjust to feeling sick all the time (headaches, upset stomach, heaviness in the chest, etc). He also recommended Actos but I had heard some frightening things about it and declined to try it. It is not the needle aspect of insulin that bothers me. I just feel that resorting to insulin signifies failure on my part to get control of a disease that I once, perhaps foolishly, felt that I had under control.

[xMenace]

I just feel that resorting to insulin signifies failure on my part to get control of a disease that I once, perhaps foolishly, felt that I had under control.

You've done a great job dude! You've done more than your average bear. You have in no way failed. The only thing failing here is your pancreas. You have three choices: help the insulin work, help your pancreas produce insulin, or add insulin.

There are many drugs in these first two broad classes. There are plusses and minuses to all of them. Some of the minuses are cardio risks while some may burn out your insulin producing beta cells quicker. Insulin has few if any physiological risks but has management risks such as hypoglycemia and your existing hyperglycemia.

Finding the right balance with any of these choices is challenging. Just please don't consider any of them failures in effort.

[JadeMonkey]

I'm a Type 1, so I may have a slightly different view of things. I am also not totally up on all of the drugs that are out there for Type 2s. I do know that there are a number of of them out there and that their effectiveness varies from person to person.

I do know a bit about insulin and about how taking it several times a day changes your life, as I only found out I was diabetic back in mid-November of 2007.
It's a little inconvenient having to carry my insulin pen(s) and test kit around all the time.
Occasionally I get an odd look from someone when I'm taking my shot or asking for carb counts in a restaurant.
Some days things just don't work out right and my numbers aren't great.
That's about it for the bad.

Now for the good.
I feel great. Better than I had been feeling for a long time.
I can eat what I want, within reason, as long as I adjust my insulin does to cover for it.
With the newer, predictable, rapid and long acting insulins I use for my multiple daily injections, I don't worry about sleeping in, skipping meals, or the occasional trespass from perfect behavior.
I don't experience the horrible highs/lows I always heard (and still do hear) people talking about.
I have control over my condition since am the one regulating how much insulin is active in my system.

Personally, I think life, for me, is easier as a Type 1 on insulin. I would have a much harder time with the very strict regulation of food and activity I see being necessary for a Type 2 who is not on insulin.

I also don't think I'd see needing to go to insulin for a type 2 as any sort of failure. Maybe other meds just don't work well for you, or don't work well anymore. Perhaps your pancreas finally gave out on you. Don't keep yourself from being as healthy as you can be and risking complications due to pride or fear of a few shots a day. I'd much rather be on insulin and keep my feet, hands, heart, eyes, and ultimately my life as well.

I'm not saying that insulin is the best choice for everyone out there. I know it is not. I didn't have a choice but I am not sure how I would have felt had I been given options. I do know that starting on insulin gave me my life back and right now it is my best chance at having the most "normal" life possible.

What I am saying is that it is a choice you should consider. If you look at all of your options and insulin is the one that might work the best for you don't be afraid to give it a try. It might be the best thing you do for yourself, your health, and those close to you.

I :love: Insulin.

-Jade

[xMenace]

Very nice post :top:

I don't experience the horrible highs/lows I always heard (and still do hear) people talking about.
I have control over my condition since am the one regulating how much insulin is active in my system.

Insulin does come with risks. I tell people there are two types of computer users: those that have lost data and those that will. :stupido: I also believe the same is true for those on insulin. There are those that have experienced nasty hypo events and the rest eventually will. Our bodies change, life changes, and as the saying goes "**** happens!" These changes can and do catch us. I'm not saying you need to live in fear of them. I've been 911'd 9 times in the last 12 years and I'm not bothered in the least. Maybe that's my problem :confused: But we should not let it sway our decisions to take insulin. Even for the worst of us it's a minor bump in the road that we can and should effectively manage - test before driving, carry sugar, learn to recognize the signs, learn our natural patterns, etc.

[susique333]

Hello Ron,

I too battled with the mistaken idea that if I only tried hard enough my blood sugars would go back to normal and I would have "won" the battle with this disease. Can you tell Im a complete control freak? My metformin (taken on a full stomach) was doubled today to 2000mg in hopes to tame those stupid fasting blood sugars. I fully expect at sometime to add a new drug to the Met or eventually be put back on insulin (as I was on it in the past with gestational diabetes).

[Ronman]

Perhaps I should have mentioned that I am already taking Glimepiride (4mg twice a day). I used used to take Avandemet, Tricor and Lipitor as well but once I decided to take control, I managed to lower my A1C and cholesterol to the points that I was taken off those. Now I just feel as though I am slowly sliding backwards. Admittedly, I am not eating as many salads for supper as I used to but I am trying to keep my weight and BG under control by eating smaller portions of "regular" food. It really is just my morning readings that have me very concerned. Generally I am right around 90-115 in the afternoon and 100-140 at bedtime.

[princesslinda]

Ron, have you started eating later at night? I find the later I have dinner, the higher my morning readings are REGARDLESS of how low carb I eat. I work evenings and often can't eat until 8-9 pm....but on weekends when I eat more regularly and get more exercise, my morning #s are down a good 10 points.

[Ronman]

No, not really. I got jobs for two of my sons where I work so I am actually getting home a little earlier and they are both "starving" when we get home so I am cooking earlier and eating an hour or so sooner.

[Lloyd]

Very nice post :top:


There are those that have experienced nasty hypo events and the rest eventually will.

That is likely true for T1's. Much much less so for T2's on insulin. I've been on insulin for about 2 years, and have never been below the 50's. I have read where bad lows are about 20 times as likely for T1's as for T2's, my experience bears that out.

[DonnyC]

I wish I would have been offered insulin
right from the start. I would have saved
alot of suffering from high A1C's over the past 4 years.
I do believe there is a real misconception about
insulin use among the general population of type 2
diabetics. I do believe that a type 2 can be treated
with meds, diet and exercise alone, but when this
does not work, there should be no hesitation to begin
treatment (or should I say enhance your current treatment)
with insulin. It should not be viewed as a final resort
but a new beginning.
For me, it was a new beginning.:) :)

As far as the low's are concerned, Lloyd is correct,
its not that bad for a type 2. Lowest I have seen
is 2.4 ( 43 ). I was still in control of myself.

[Lloyd]

I do believe that a type 2 can be treated with meds, diet and exercise alone, but when this
does not work, there should be no hesitation to begin
treatment (or should I say enhance your current treatment)
with insulin. It should not be viewed as a final resort
but a new beginning.
For me, it was a new beginning.:) :)


What happens with t2's, is the pancreas eventually will no longer produce enough insulin, even with the help of oral medications. This is called beta cell exhaustion. I got by for 12 years before this happened to me.

As a type 2, many things are under your control, how much insulin your pancreas produces, is not one of them. Overall, 27 % of type 2's take insulin (in the USA), a lot more should.

[Jill-O]

I think that type 2's on insulin are much less likely to have a hypo than type 1's.

So far, I've only been on insulin for 10 mos, but I have never gone hypo and my numbers have been so much better and easier to manage.

I take Humalog before meals and Lantus at night. Both are in pens and imo, SO easy and convenient.

Personally, I love having this as my treatment.

[alicat61]

:) Hi Ronman,
You said your glucose levels are ok when you go to bed but are high in the morning. DEo you wake up with a headache or hot and sweaty. Do you have night mares.The reason i ask is that you maybe having low blood glucose levels at night(hypo's) and not relising this. Your liver kicks in and make stored fat into glucose causing your morning levels to be high.I have heard of this and I'm sure it happens to me at times.(I have plenty of fat to convert:D LOL) Do you test during the night. (It's just an idea)
Also don't think of going to different medications as failure just as a new path to follow.I was diagnosed at 21 and put on insulin straight away. (If the meds that are around now where then things may have been different.)
It doesn't mean you are any sicker being on insulin or diet (I often hear they are only diet controlled so it doesn't matter what they eat etc or they are on 4 insulin shots a day they must be REALLY bad) In the big picture we are all the same
we have been given a challenge in life called diabetes and I feel it has made me a better person.
Byetta is also another drug that might be useful I have only been on it 22 days and feel like a new woman.
Just a few things to consider.
Take care from alicat61:)

[Cyborg]

Hi Ronman... Have you ever had a GAD Antibody and/or a C-Peptide test done to help confirm that you really are type 2?

Also, if you are going to bed with a stable bg and waking up high, it's probably because your medication or insulin (if you take it) is wearing off. If it's not that than testing during the night once or twice can help to determine if you are experiencing Dawn Phenomena.

I was both misdiagnosed as a type 2 and I have strong DP, so I can very much relate to what you are going through. Good luck.

[Ronman]

To answer both set of questions....No, I usually wake up feeling fine. In fact, no matter how high my BG has been, I feel fine. I only notice when it gets down in the 40's, which is rare. I can only assume that I am a type 2 as that is what two different doctors have told me. I don't know that I have been given either of the tests that you mention Cyborg. I have also been experimenting with different breakfasts to no avail. The readings are always 220 and up. Not sure if insulin is the answer when I consider that my afternoon and evening readings are around "normal."

[lorelei]

To me, it sounds like a classic case of 'dawn phenomenon'. Not eating for 8-10 hours means your body starts to get hungry. Your liver tries to compensate for this by dumping glucose into your system. This is totally normal, it's supposed to happen so that we don't starve while we're sleeping :). The only problem is that our bodies don't react either fast enough or just don't have the ability to react strongly enough to compensate for the added sugar in our systems.

You're not doing anything wrong, and you most certainly haven't failed to keep control. Your body just isn't quite able to keep up the balance anymore. Thankfully there are some things you can do to help it.

Try eating a high protein snack before bed (and try to make sure it's got some fat in it too). This will help hold you over till morning so your body doesn't dump sugar when it thinks it's hungry. I've heard many type 2's drink a glass of wine before bed with their snack and that seems to help keep them level too.

Unfortunately metformin is the preferred drug to handle this sort of thing, and some people just can't take it. But there are other drugs that will help. I wish I could list them all, but my knowledge of them is limited since metformin doesn't make me ill so we didn't look for a drug to replace it. Also, there are two types of metformin. It seems that the slow release version of it causes fewer problems for people and is much better tolerated, so you might want to give that a try if it wasn't what you were taking before.

And don't look at insulin as failure. Lots of type 2's do. I know I did, to me it felt like I must be lacking in self control, after all if I had just been good enough the disease wouldn't have gotten worse. But that's just not the case. Our bodies were headed down this road a long time ago. We do our best to try and manage things, help our bodies with the balancing act, but in the end there's really only so much we can do. I know it's true that some type 2's can go years and years without any meds at all. But that's not because they are better at control than you are. It just means that their bodies reacted better to the things that they did.

A long acting insulin might be a good idea if your fasting blood sugars don't come down for you. Don't see it as defeat, see it as the freedom to gain control again. (ok, so I know that sounds like an insulin commercial :o but I'm just trying to reassure you that it really can be a good decision to make)

I can't tell you how freeing being able to take insulin was when I finally gave in and started taking it. I would have resisted longer but I was pregnant. And risking my own body was one thing, risking the life of my child was something totally different. But it was still very hard for me to give in and accept what I felt was defeat. I was so wrong.

Suddenly I could eat carbs for breakfast, something that was totally out of the question for me before. Suddenly I could relax a bit and know that my blood sugars weren't controlling my life anymore. Suddenly I wasn't fighting an uphill battle constantly anymore, I didn't feel powerless to the food I was eating (or trying to avoid eating) I had direct control over what was going on, and could make adjustments if I needed to. I honestly wish I had gone on insulin much sooner, I would have been much happier being in control from the start.

And although it's true that hypos are possible for type 2's they are less likely because our balancing act isn't usually quite as delicate as type 1's. So the dangers aren't quite as high for us.

Good luck with what ever you decide to try. Hopefully your body will react well, and you'll have your numbers back to where you want them to be quickly.

[xMenace]

To me, it sounds like a classic case of 'dawn phenomenon'. Not eating for 8-10 hours means your body starts to get hungry. Your liver tries to compensate for this by dumping glucose into your system. This is totally normal, it's supposed to happen so that we don't starve while we're sleeping :). The only problem is that our bodies don't react either fast enough or just don't have the ability to react strongly enough to compensate for the added sugar in our systems.

...

Try eating a high protein snack before bed (and try to make sure it's got some fat in it too). This will help hold you over till morning so your body doesn't dump sugar when it thinks it's hungry. I've heard many type 2's drink a glass of wine before bed with their snack and that seems to help keep them level too.



Our DPs are a little more complex than that. It is not a simple response to fasting but a natural part of our circadian rhythms. It is not so much a release of sugar but rather a sugar and hormone soup: Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These add up to a potentially great increase in insulin resistance.

I have tried many ways to reduce or eliminate it: proteins, fats, large meals, and alcohol, and in every instance it keeps marching forward unchanged. If anything, adding late protein is more likely to send one high. Protein can address the Symogi Effect problem of bottoming out in the night (he's already tried protein anyway), but that's a problem easily diagnosed with some 2am and 3am testing. There are stories of metformin being used late at night to tame it, and this does make sense as it lowers insulin resistance. Like you said not everyone can take it, and endo's don't prescribe it unless you really push hard. It also seems dangerous to mix metformin with insulin. I would think the risk of hypos is greatly increased; though many type 2's do this as they transition over to IDDing. The best way to attack it for IDDs is with an early morning shot of insulin. I start my basal charge at 5am.

[Ronman]

I don't know if this might be that answer or not. I still have some Metformin left as I took myself off it before I ran out. Should I try taking it a couple of hours before I go to bed and perhaps the bad side effects (feeling ill) I was experiencing would take place while I was asleep rather than during the day when I was up. Maybe that would help with my BG spiking overnight.

[lorelei]

I wouldn't begin taking it again unless you talk to your doctor first. It would be a good idea to go have a consult with them about all the options open to you, and then between the two of you try to find a plan that will work best for you. Possibly starting on the other version of metformin and see if that doesn't make you feel as ill. Breaking up the dosage is also an option. I was told when I first stared taking metformin to take half my dose at breakfast, and half at dinner, and to always take it with food. Then work out a backup (or two or three) plan/s for what to do if you can't tolerate the metformin at all.

Checking in the middle of the night, even checking as often as once an hour to see where your spike happens would be a good idea too. At the very least it would be good info to take to your doctor and explain when your BG is spiking, and seeing if they don't have some solutions they think might work.

So far as taking insulin with metformin, it's fairly standard these days for doctors to prescribe insulin in addition to metformin, if it's not covering the spikes. Most type 2's do not have the same risks of hypo that type 1's have. The balancing act that our bodies can still do gives us more of a cushion to fall back on.

There are type 2's who take metformin, Lantus, and Byetta to manage their sugars. Actually there are many combinations that at first they thought would be dangerous and cause hypos that they are now using regularly. That's not to say that some type 2's don't have issues with lows, we do, it's just that the risk isn't as high. It's about finding that combination that will work best to keep the sugars stable.

:) I know it's not quite as simple as I described it. But I also know from experience that fasting at any time, gives me the same reaction. Eventually my BG will begin to climb instead of drop. It's one of those things that's always driven me insane. Why can't I just not eat if my sugars are high? But all not eating does is send my sugars higher. Makes being sick even harder, not only are my BG higher from being sick, but if I don't feel like eating, or forget to eat, it drives them higher, and it takes me longer to recover.

Eating not only a later snack works for many type 2's (me included) to keep the process from spiraling into high morning BG, but sometimes eating dinner later works as well. My numbers change drastically if eat an early dinner and don't eat after 8pm (at least 50 points). But everyone is different, and we all have to find what's right for us.

[princesslinda]

When I took the metformin, I found that if I took it at bedtime (around 10 pm) my morning #s were much better than if I took it with dinner.

Usually it takes about 3 weeks to get full benefit from the metformin. I did have a little gastric "distress" mainly when I ate more "greasy" foods, but this certainly wasn't a daily thing.

If you took the metformin before with the same meds you are currently taking, I wouldn't think it would hurt you to take the metformin again at night in hopes of seeing lower a.m. numbers. Just make sure you have something on your stomach to help alleviate gastric distress. Also, make your last meal of the day lower carb, as generally most of us are more sedentary in the evenings. Remember, you may not see a big change immediately.

When I was on metformin, I asked the doctor to switch me to the extended release and it did help keep my numbers better stabilized throughout the day. Some say it helps with the gastric problems as well. At that time, I took it twice a day, with b/fast and dinner, then changed to b/fast and bedtime. Also, when you go in for your next doctor visit, let him know what you've been doing should you decide to add it back. As with any change, make sure you test more often to see how things are working out.

[MissLynn]

Ron, I started out with insulin due to the stories I have heard about the different pills and worries I have about taking them. Since I've actually been behaving and doing what I needed to my morning numbers look really good. ( 90's yesterday and just slightly over 100 this morning) I take 20 units of Lantus every morning between 4:30am and 7am depending on when I wake up. The rest of the day I adjust the amount of Novolog insulin to keep meals from spiking my BG, now granted since I'm just figuring out how to do this my day time numbers sometimes arent so great but its getting there. Just dont look at insulin like its a failure or its a last resort, insulin for me keeps me from getting sick from pills and puts me in the drivers seat for control. You may find that a small dose of a fast acting insulin will correct the morning numbers, or a small dose of basal insulin will keep them from spiking at all. I dont opt for nightly insulin, too many chances of over doing it and ending up in trouble thus why I use mine day hours only, but the Lantus is 24-36 hour acting and it works rather well, when I behave. Good luck to you..