Sudden Jump of A1c; what possibly happened?

[bigjohnmac]

Last A1c 3 months prior was 6.6. Now it's suddenly up to 7.7 and Doc now considering placing me on insulin. Weight increased 13# during last period as well.
:mad:

Am 84 and A1c has been good for many years.

Presently on 30 mg Actos 1 x/day, Metformin 1000 mg tab twice a day. Furosemide 40 mg 1 x/day.

Stopped using my CPAP about four weeks ago as I was more comfortable not using it at night. Not getting any exercise but prior to my exercise wasn't very much at all. If I still have sleep apnea, I wonder if that might of contributed to the problem?

Because A1c over years had been fairly stable I was not monitoring daily. Now starting to monitor to get more input for my problem. Actos I understand can contribute to weight increase but have been on it since September 2007.

What else could I possibly check that might be contributing to my problem?

[morrisma]

Certainly re-starting the cpap and getting another A1c makes sense.

Normally I'd suggest an end to a honeymoon period but with your history, that doesn't seem likely.

Let us know if the lack of cpap is the culprit.

[derf]

Apnea wakes you up at night, right? If so, you may be experiencing more Dawn Phenomenon spikes as a result.

[xMenace]

John, you are progressing. It's how the disease works. Don't fret too much. There's little you could have done or can do except bump up the meds or move to insulin.

[Hammer]

There's a thread that just started about sleep apnea here (http://www.diabetesforums.com/forum/type-2-diabetes/28109-sleep-apnea-glucose-levels.html)

Sleep apnea has to affect your BG levels simply because not getting a restful sleep puts stress on your body. Stress increases BG levels, so that's probably why your A1C numbers have gone up. You really should use your CPAP machine every night....not just because of the elevated A1C numbers, but not using it and not getting a restful sleep can cause all kinds of other problems.;)

[princesslinda]

John, it may be that over time your meds just aren't doing their job properly and its time to try different ones. Most of us T2s will eventually end up on insulin, as diabetes does progress, even with our best efforts.

I would suggest that you test more frequently, so you can see when your blood sugars are the highest. If you test 2 hrs after your first bite of food, you can see which meals are causing you problems and modify your diet accordingly.

If you're not getting rest due to your sleep apnea, this would put stress on your body...and blood sugars do respond to physical (and mental) stress.

Keep us posted on how you're doing.

[Evermont]

ScienceDaily (Jan. 2, 2008) — Suppression of slow-wave sleep in healthy young adults significantly decreases their ability to regulate blood-sugar levels...

"Since reduced amounts of deep sleep are typical of aging and of common obesity-related sleep disorders, such as obstructive sleep apnea these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type 2 diabetes in populations at risk," said Eve Van Cauter, PhD, professor of medicine at the University of Chicago and senior author of the study...(link) (http://www.sciencedaily.com/releases/2008/01/080101093903.htm)

This study is not exactly equivalent to your condition Big John, but given this newly discovered connection, it doesn't seem like such a stretch that if young healthy subjects are affected by poor sleep then other more challenged folks may suffer as well. Just a thought.

Your higher A1c could reflect the effects of the poor sleep, the weight gain, any colds, flu, stress or all of the above.