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High FBS & Need treatment advice

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#1
afterglow

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I got diagnosed as a pre-diabetic in January 2005. I've managed to lose 25lbs since then (from 240 to 215) and have become more active.

I'm currently located in the Philippines and the treatment options here are quite limited. We don't have extended release Metformin or Byetta or Lantus available locally but there are ways to import it.

My endo started me out with 1000g of Metformin and Actos but I'm now on 2500g of Metformin and have ditched Actos in favor of Acarbose (endo's worried about long-term effects of Actos). I was able to bring my HbA1C down from ~6.5 to a low of 5.6 but it has crept back up again to 6.0. My 2HPP readings have always been good but I'm struggling with my FBS which is usually between 97-110.

We've been playing around with my dosage of Metformin in order to bring the FBS down but haven't been successful. I'm currently taking 1000g before breakfast, 500g before lunch and 1000g before dinner. I tried taking a larger dose before dinner but it didn't have much of an effect. Is there any dosage/medicine change that can give me better FBS results? For instance, my endo suggested that I try 2000g of Fortamet before dinner.

Or am I just making this a bigger deal than it needs to be??

#2
Ronin

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Hi Afterglow!

Reading your post leaves me with the concern that you seem to be more focused on your use of medication. What have you done about diet and exercise? Having been to the Phillipines myself, I realize that avoiding rice and other high carbohydrate food is difficult, but it is not impossible to restrict the amount of carbohydrates in your diet. Also, what are you doing about your activity level (a.k.a., exercise) which also plays a big part in glucose management.

I would recommend more of a focus on the diet and exercise so that you might not need as much of the medications (they do have some nasty side effects).
Be well, do good work, and keep in touch
[Garison Keilor]

Ronin (a.k.a, George N. Wells, CPIM)
Tandemist/Lay Theologian
Enjoying Life and Learning about myself everyday.

Pre-D -- Not on Insulin :D (yet) :eek:
For Cholesterol though:
2500 mg Niacin
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2013 Cycling Miles: 4880 (31 Dec)
2014 Cycling Miles: 3413 (15 Sep)

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HbA1c's:
 
01-May-2014 -- 5.5%
01-Jun-2014 -- 5.7%
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01-Sep-2014 -- 5.5%

#3
afterglow

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Thanks for the concern.

As I mentioned in my post, I've lost 25lbs since being told that I am pre-diabetic. I've revamped my diet so that dinner is the lightest meal of the day (no rice). The only meal with rice is lunch. Breakfast would either be cereal or a sandwich. The only desserts I have are fruit. I play golf once a week (and no 19th tee binging) and walk/jog around 4 miles/week on top of that (not nearly enough, I know). The funny thing is that my HbA1C started going up when I started exercising...but I was losing weight like crazy!! Weird.....and my endo is stumped as well.

#4
princesslinda

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I'd suggest taking your evening metformin dose later. I take mine around 10 pm (but not on an empty stomach, have a piece of cheese or some nuts) and it does help with the lower #s.

A1C of 6.0 is an AVERAGE 90 day reading of 136 (an average, meaning it is sometimes higher than that, sometimes lower). I was told my fasting blood sugar should be 110 or less, so your # there seems to be on target.

Since metformin helps you better use the insulin you produce and decrease your insulin resistance, i'd encourage you get to regular exercise, which will help even more with the insulin resistance. As Ronin mentioned, watching the carbs and regular exercise are both very important in good control.

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#5
Tropo

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Were you diagnosed in the Philippines?

I was in the Philippines when I diagnosed myself as pre-diabetic back in June 2005.

I don't know why you are so stressed about getting your FBS any lower...they're quite low already. Were these medicines recommended by Filipino doctors, or doctors back in your home country?

If the recommendations were given by Filipino doctors I would exercise great caution. You maybe taking far too much medicine already as Filipino doctors are over zealous at prescribing drugs in preference to offering advice on life-style (eating) changes.

I'm pre-diabetic too in terms of my FBS readings but I don't take any medicine at all. It's possible you will be able to control your BG well enough with only exercise and diet changes.

If you explore these threads you will come across some information about what is called the "dawn phenomonom" or DP for short. Some people have this problem of the liver dumping a lot of glucose into the blood first thing in the morning.

There seem to be 2 distinct classes of pre-diabetics. People with impaired fasting glucose (upon waking), and people with impaired glucose tolerance (after eating).

What type of readings were you getting after meals before you started taking medicine? Were you diagnosed on your FBS, or after an OGTT test or a meal?

#6
MJB

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Based on your A1c numbers and the amount of Metformin you are using I would say that you are most likely diabetic not a pre-diabetic. Either way it would seem that you need something other than the oral meds you are taking, be it better diet, more exercise or insulin.
[SIGPIC][/SIGPIC] :thrasher:

#7
afterglow

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I was initially diagnosed in Toronto, confirmed in Connecticut, and re-confirmed in the Philippines. My meds were prescribed by a doctor in the Philippines who got her training at Johns Hopkins. In both Toronto and the Philippines, they did FBS and OGTT for the diagnosis. We started off with 1000g of Metformin but I wasn't responding to it. The numbers only really started to drop when I got to my current dose. She has already said that she is constrained to prescribing whatever meds are available locally. Her feeling is that I would require a far smaller dose of Metformin if other meds were available here.

#8
Tropo

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Ok. I was a little concerned when I saw how much you were taking and Filipino doctors in the same paragraph.

You maybe lucky with your doctor there in PI. I know how frustrating it is when the medicine you want is not available. I went through **** 2 years ago with cholestasis in the Philippines. There was no medicine available to alleviate my pruritus.




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