Total Confusion, I Think

[mysusie]

Need some opinions on this situation.

Mid April 60 year old husband is having coughing problem. Goes to primary care internist has xrays and sent to have echocardiogram because of fluid around lung and heart. Cardiologist has some non fasting blood work done which shows elevated glucose levels and she says he is suffering from a upper respiratory virus that will take some time to clear. Internist sees elevated glucose levels and orders 2 hour glucose tolerance test results:114 fasting and 245 2 hours later with an A1C of 5.7 %. Diagnosis is Diabetes. We ask for a retest since he was suffering from this virus told by doctor it is not needed. He gives prescription for metformin 500 1x day. Okay so nurse comes in and gives him a meter, a how to, tells us to sign up for nutrition class etc. She says we must work toward a A1C of 7%. I say his is 5.7 already so what does that mean? Now she is puzzled and wonders why Dr. won't retest. Tells us to perhaps not begin metformin but test for three days in the AM before eating. If he is consistently below 120 to give them a call. Well his AM tests have been 102,106 and 108. I am concerned about him taking the medicaton in case it throws him into blood glucose readings that are dangerously low. Does any one else have an opinion on this? I am wondering if he can control this with diet. We don't believe in taking medicaton unless it is really needed. It wouldn't hurt either of us to lose a few pounds so where do you think we stand?
Thanks

[davef]

Okay, just to be clear I'm not a Doctor and I'm still relatively new to Diabetes (diagnosed 6 months ago) that said, here goes.

I am puzzled (like the nurse) as to why the doctor won't do a retest, is it possible that he told you something more information that in the shock of the moment you haven't included.

His numbers of 102, 106 & 108 are slightly elevated and possibly within the pre-diabete range which according to the American Diabetes Association is 100-126 for fasting blood glucose test, however his A1c is good. The metformin will not send him low immediately as it takes about 3-4 weeks for the metformin to take effect and even at that it is unusual for somebody on Metformin to go very low, especially if they are not also eating low carb etc. I'm on twice that dose and the lowest I have ever gone is 57.6 but I'm eating low carb.

I guess the virus could be a factor, when many of here are ill we do see a raise in our blood glucose levels. Anything that causes a stress on our bodies can increase our numbers.

I would suggest two things:

1. Increase the amount of testing (if you have enough strips/can afford to). Test first thing in the morning Fast Blood Glucose (FBG) test. Then if possible test just before each meal and again 2 hours after the first bite of food. This will give you a good record of how his body deals with the food he eats. Diabetics do this so we see how the food we eat effects us. We generally aim to be below 140 two hours after first bite. Do this for a few days and keep a record of the readings and the food he has eaten.

2. Make an appointment with the doctor and discuss the results of the testing, he may then agree to retest.

With the slightly elevated numbers, it would might well be a good idea for your husband to try shed a few pounds, exercise more and eat healthier. If you feel you can lose some too, then it would be great to work together, it's always easier when you do this with somebody working with you.

Please do let us know how you get on. I'm sure some of the more experienced people here will chime in soon.

[kgm0612]

Susie.........Davef gave good advice in his post above.

My advice would be to increase testing, cut back on the carbs and have your husband get in some form of exercise, if he's able to do so. An A1c shows the average of one's blood sugars over a 3 month period. A 5.7% equals a reading of 126. The Metformin will take 3-4 weeks before to start working. If you feel your husband will follow what is being recommended, then you could hold off on the Metformin for a month and then see how his numbers are doing.

Good Luck!

Karen

[xMenace]

It sounds like your husband is being treated as a statistic with no consideration of the circumstances.

He doesn't need the met right now IMO, but it is not dangerous. He won't go too low. He needs exercise and weight loss, and infrequent BG monitoring to make sure he's good. I'd get quarterly A1C's lined up.

[Evermont]

I agree with Dave Karen and John. You people rock!

When I was diagnosed T2 last September my A1c was 8.8 (now 5.7) and my fasting was 156 (now 110). I've never taken any meds for diabetes - just diet and exercise. Even if hubby's numbers were worse it is quite reasonable to think that he could do what I did, or at least try it long enough to find out if it's going to work.

Losing weight (if needed) and eating right is a great idea for anyone with diabetes, pre-diabetes, or no diabetes. Even if you're on meds - it's still a great idea.