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A1c 5.4 Should I Still Worry

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#1
sjkurtz

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Ok, I realize that I might be whining here but I feel that I am among friends and all of the conflicting advice is driving me crazy.:confused:

I was diagnosed in September and turned my life upside down to deal with my new friend T2:D

And I did, I followed the great advice here and low carb dieted and exercised and got my A1c down to 5.4

Here is the dilemma, 6 months later and my latest A1c is still 5.4 and everyone is thrilled, except me. The doctor wants to lower my metformin. But I haven't been sticking to the ultra low carb diet consistently. I almost always eat less than 150g a day and often get under 100g.

I occasionally spike up to 180 or more after some meals. It makes me listless and groggy so I know right away I have done bad things. More often though, I am spiking above 140 1 to 2 hours after meals and regularly have morning BG of 130-140.

The question is, do I drive myself nuts, go all out Bernstein and get lower or am I just fine and keep doing what I am doing?

Thanks in advance for the help!
6/04/10 - A1c 5.2
9/7/10 A1c 9.6
12/9/10 A1c 5.4 - It can be done - 176lbs.
6/3/11 A1c 5.4
6/3/12 A1c 5.7 - Back up to 202lbs - Not Good!

Medications
9/20/10 Met 250 x2
9/27/10 Met 500 x2
10/4/10 Met 1000 x2
6/12/11 Met 500 x2
Met w/Endo 7/1/11 back to Met 1000 x2 now ER
6/3/2012 Still Met 1000 x2

#2
princesslinda

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Just my 2 cents worth here, but you have to decide on a management plan that you can maintain over the long haul, as unfortunately, diabetes is going to be a part of your life from here on out. I'll be coming up on my 5 year D-anniv. in August, and the way I manage things now is a bit different from the way I started out. It's a journey, find what works with you and give it your 100%.

Sounds like you've made some great changes, and have that A1C to show for it!

I've went for a few months eating the Bernstein plan, i've eaten 50 or less carbs a day, I've fell off the wagon for awhile and eaten badly, and finally ended up where I am now, eating approx. 100 carbs or less/day. This works for me w/o making me feel deprived.

As for worry, there are days I worry, but worry does nothing constructive, so I try to do this as little as possible. I live my life with diabetes, tweaking it as necessary and as tolerated.

My doc suggested that I get off metformin when my A1C was at 5.2. I stopped it for a few weeks, noticing that my blood sugars did start to increase within the first couple of weeks. Even eating lower carb, I didn't see the same blood sugars as I did with the metformin, so I resumed it and have been on it ever since.

If you wish to try things off the metformin, why now, as you can always resume it should you need to. Congrats to you on all of your successes thus far.

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.


#3
TrickyTreeFrog

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Ok, I realize that I might be whining here but I feel that I am among friends and all of the conflicting advice is driving me crazy.:confused:

I was diagnosed in September and turned my life upside down to deal with my new friend T2:D

And I did, I followed the great advice here and low carb dieted and exercised and got my A1c down to 5.4


Will start with this part lol......CONGRATS on the A1c that is awesome!

I was DX'd in Sept '10 also with a fasting reading of 320....and am very very happy with any A1c reading of 5.5 to 6.2 I don't place the stress on myself and expect a 5.0 every time.....fluxing between 5.5 and 6.2 is just fine with me and if it goes above that one time....oh well...I will just get right back on track ;) no worries no harm done.


Here is the dilemma, 6 months later and my latest A1c is still 5.4 and everyone is thrilled, except me. The doctor wants to lower my metformin. But I haven't been sticking to the ultra low carb diet consistently. I almost always eat less than 150g a day and often get under 100g.


Don't be so hard on yourself......your hard work is showing and nobody said on here it was going to be easy......it will be an on going slow and steady project.


I occasionally spike up to 180 or more after some meals. It makes me listless and groggy so I know right away I have done bad things. More often though, I am spiking above 140 1 to 2 hours after meals and regularly have morning BG of 130-140.


If I am reading this correctly your working hard at it but are you "eating to your meter"? It seems like you need to tweek your carb amounts a bit at meals.....you say that your eating less than 150g carb and often get under 100g but you might need to space them accordingly with each meal (eating to your meter).

Think about it for a bit: what are you eating before bed time?...what time is you last snack?.....how heavy is your last snack?.....have you tried taking your Met right before bed? .....and spiking higher then you wish to be after a meal sounds like brushing up on adjusting carbs vs bg reading before the meal.


The question is, do I drive myself nuts, go all out Bernstein and get lower or am I just fine and keep doing what I am doing?


Your doing just fine and again don't be so hard on yourself just keep doing what your doing and again try "eating to your meter" for a week or two and see how that works.

Good Luck and wooooot!!! your doing awesome relax and just take it one day at a time!!!

Huggles

Da Fwog
Laura

Ability is what you're capable of doing.... Motivation determines what you do.... Attitude determines how well you do it."

“Be the captain of your ship :captain:~ take control"

DX'd Type2 - 9/8/10.......BG Doc's office 320
HB -A1C
Sept '10 - 13.8
Nov '10 - 8.2
Dec '10 - 6.5
Jan '11 - 5.8
GHb - A1C
Mar. '11 - 7.2 (or- a 5.4 HBa1c reading)
HB - A1C
Jun. '12 - 5.9
Metformin 500mg x 2 
LCHF diet and I eat to my meter


#4
samorgan

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I absolutely would not worry about a 5.4. In fact, my last A1C was exactly 5.4. The one before that was 5.1. There is SO little evidence for additional benefit or reduced risk of any further reductions below 5.5 - even 6.0. I would, however, be a little concerned about the spikes you mentioned. Also, if you spike to 180 regularly and your A1C is so low, I wonder if you are having lows.

My personal goal is no spikes above 120 and A1C of less than 6.0 which I have exceeded with no meds or insulin. In your shoes, I'd not only reduce the Met, I'd dump it and see what I could do without it.

Anyway, you are doing great overall. Remember, excessive worrying can affect BG, too!
Salim Morgan, T2
58 Years Old
DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
Diet: Approximately C:10;P:15;F:75 (as % calories)
Ketogenic (Most of the time)
Exercise: 24 minute bike ride 5 days/wk
NO MEDS, No Highs, No Lows
Grandkids: 11
Edited 6/2011: +1 yr of age, less exercise :(, +2 more grandkids :)

#5
Moonpie

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I think you will be fine, without the Met. It is your choice to stop it or not. I think I read once ( not sure) but if Met is the only med you are on, & you eat lower carb, you will only see a rise of about .1 on your A1C.
I agree that you need to find a meal plan you think you can live on, long term.
09/15/2009 DX
A1C Sept 2009 7.7 . March 2012 5.2
A1C Nov 2009 6.4 July 2012 5.4
A1C 01/15/2010 5.6 12/12 5.4
A1c May 2010 5.6
A1c July ( 10 weeks no meds) 5.9
A1c Dec 2010 5.6 no meds since May :)
A1c March 2011 5.7
A1C Aug 2011 5.5
A1C Dec 2011 5.2
came off Metformin 500mg on 05/11/2010 to control with diet & exercise.
Previously 50 to 100 carbs now I try to limit it to under 50 per day.

#6
kchammmy

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I think you are rocking the house at 5.4 and you should relax a bit! I cant wait for my next A1c because at a starting point of 13....well, no place to go but down or grave yard, lol. But seriously...you've got a very good A1C and a doctor thats actually suggesting you LOWER your meds...thats a fine thing.
Kip

Diagnosed Type 2 on April 19, 2011

A1C: 5.2 (10-01-2011)*NEW!
A1C: 6.1 (07-19-2011)
A1C: 13.5 (04-19-2011)

Metformin Twice Daily @ 500 mgs
(Stopped Glimepiride 9/2011) :)
Exercise @ gym 4-5 times per week / low carb diet
Herbal & Vitamin Supplements

#7
jwags

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I think 5.4 is a good number for a D. Mine is 5.3 and I still take 2550 mg of metformin. I have tried to lessen it but then I see BG creep up.
HbA1c 5.3 3/11 , HbA1c 5/12 6.1
metformin 2550 mg
Moderate carb diet 40-75 carbs a day
3 T of Coconut Oil daily

Vit D, CoQ10, Melatonin, Multi vitamin, zinc, B 12
Chia Seeds , Flaxseeds

Exercise- Tennis - 4 hours/week, Power Walking- 2-3 miles most days, Hiking in the summer on trails and in the mountains

diagnosed Feb 2007
Age 63

#8
Breezin

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Congratulations on your 5.4. I will have my follow up A1C in mid July. I would love to see that number! Enjoy!

#9
Lloyd

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I think you will be fine, without the Met. It is your choice to stop it or not. I think I read once ( not sure) but if Met is the only med you are on, & you eat lower carb, you will only see a rise of about .1 on your A1C.
I agree that you need to find a meal plan you think you can live on, long term.


I am on met and insulin. As a test, I stopped the met for 3 weeks. My insulin dose doubled, and was still going up. I decided it was not a good trade off.

The 0.1? Only if you are not insulin resistant. BTW, I eat 80 carbs a day ave.

2014 A1c 5.4 5.6   2013 5.3 4.9 5.2 5.2
2012 5.3 5.2 5.1 5.0
2011 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<---Pump 6.9 (Mix)
2006 (Lantus) 7.8 8.5 8.7 7.1
2005 8.4 6.9 7.4 2004 6.2 5.6 6.4 6.0 (Pills)


#10
Lloyd

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Here is the dilemma, 6 months later and my latest A1c is still 5.4 and everyone is thrilled, except me. The doctor wants to lower my metformin. But I haven't been sticking to the ultra low carb diet consistently. I almost always eat less than 150g a day and often get under 100g.


My target is 4.9 to 5.4. There is little data showing that 5.0 is better than 5.5. Or showing that it is not. There is no money to be made studying well controlled diabetics. There is almost no data at all :(

Try to join a T2 research study, if your A1c is less than 6, you are disqualified.

2014 A1c 5.4 5.6   2013 5.3 4.9 5.2 5.2
2012 5.3 5.2 5.1 5.0
2011 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<---Pump 6.9 (Mix)
2006 (Lantus) 7.8 8.5 8.7 7.1
2005 8.4 6.9 7.4 2004 6.2 5.6 6.4 6.0 (Pills)


#11
Ed B

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My target is 4.9 to 5.4. There is little data showing that 5.0 is better than 5.5. Or showing that it is not. There is no money to be made studying well controlled diabetics. There is almost no data at all :(

Try to join a T2 research study, if your A1c is less than 6, you are disqualified.


Concur.

And add to that the distinct possibility that well controlled diabetics may be a rare bird indeed. That is the impression I got from my last two doctors. They both considered a 6.5 or lower to be very good control compared to vast majority of their diabetic patients. They saw no need for follow-ups for another year with numbers like that. When I was first diagnosed with around 10.x the first doctor was very worried and was seeing me every 3 months.

My own unscientific observations back this assumption up. I am amazed and horrified to see what some fellow diabetics eat on a regular basis. My father works hard at control but the others I know pop a pill (if that) in the morning and eat whatever they want the rest of the day. Just down the hall is a fellow who has a horde of crumpled up burger & fries bags pilling up in his cubicle. We talk about diabetes from time to time and he grudgingly acknowledges that he should probably eat better but he sure likes those Wendy’s Frosties (or whatever they are called) after his burger and fries. It’s sad, really and I really don’t preach or badger him. I just share information and some of my failures or victories.

I think one reason that we hear of many doctors being satisfied with anything < 7.0 is that it is not that common among their patients. To them we appear to be doing great. I wouldn’t be surprised if there is research that says that 7.0 is on the good side of the bell-curve for all T2 diabetics. If that wild assumption is true at all, it doesn’t mean we can’t do much better if we are willing to work at it. It may just mean that most people are not willing to work at it.



Back to the OP (sorry for the hijack), a 5.4 IS doing great! Congrats! Do not worry, just remain diligent and continue what you have been doing.
Old A1Cs: April 2007 A1C: 10.6; Aug 2008 A1C: 6.0; Jan 2009 A1C: 6.5; April 2009 A1C: 5.6 !!! :); June 2010 A1C 6.1;
Bayer A1C Now: May 31 2011 A1C 6.7 ; June 30 2011 A1C 6.2
Latest Official: July 06 2011 A1C 6.1
Bayer A1C Now Dec 1 2011 A1C 5.6
Bayer A1C Now April 20, 2012 A1C 5.8
--------------
Metformin: 1500mg/day
Onglyza 5 mg
Crestor: 10 mg
Quinapril 20 mg


Photoblog http://countryoaksimages.com/

#12
jwags

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Concur.

And add to that the distinct possibility that well controlled diabetics may be a rare bird indeed. That is the impression I got from my last two doctors. They both considered a 6.5 or lower to be very good control compared to vast majority of their diabetic patients. They saw no need for follow-ups for another year with numbers like that. When I was first diagnosed with around 10.x the first doctor was very worried and was seeing me every 3 months.

My own unscientific observations back this assumption up. I am amazed and horrified to see what some fellow diabetics eat on a regular basis. My father works hard at control but the others I know pop a pill (if that) in the morning and eat whatever they want the rest of the day. Just down the hall is a fellow who has a horde of crumpled up burger & fries bags pilling up in his cubicle. We talk about diabetes from time to time and he grudgingly acknowledges that he should probably eat better but he sure likes those Wendy’s Frosties (or whatever they are called) after his burger and fries. It’s sad, really and I really don’t preach or badger him. I just share information and some of my failures or victories.

I think one reason that we hear of many doctors being satisfied with anything < 7.0 is that it is not that common among their patients. To them we appear to be doing great. I wouldn’t be surprised if there is research that says that 7.0 is on the good side of the bell-curve for all T2 diabetics. If that wild assumption is true at all, it doesn’t mean we can’t do much better if we are willing to work at it. It may just mean that most people are not willing to work at it.



Back to the OP (sorry for the hijack), a 5.4 IS doing great! Congrats! Do not worry, just remain diligent and continue what you have been doing.


I agree that most D's don't even want to think about the consequenses of not taking care of their D. I guess Ignorance is bliss. But this shouldn't mean that doctors shouldn't push them to try to get HbA1c lower. My doctor is happy with anything below 6.0. Lowering HbA1c is not easy but it is doable. I don't think I eat a terribly restrictive diet. I eat at least 2000+ calories most days, I just don't eat a lot of processed carbs.
HbA1c 5.3 3/11 , HbA1c 5/12 6.1
metformin 2550 mg
Moderate carb diet 40-75 carbs a day
3 T of Coconut Oil daily

Vit D, CoQ10, Melatonin, Multi vitamin, zinc, B 12
Chia Seeds , Flaxseeds

Exercise- Tennis - 4 hours/week, Power Walking- 2-3 miles most days, Hiking in the summer on trails and in the mountains

diagnosed Feb 2007
Age 63

#13
Caravaggio

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Ok, I realize that I might be whining here but I feel that I am among friends and all of the conflicting advice is driving me crazy.:confused:

I was diagnosed in September and turned my life upside down to deal with my new friend T2:D

And I did, I followed the great advice here and low carb dieted and exercised and got my A1c down to 5.4

Here is the dilemma, 6 months later and my latest A1c is still 5.4 and everyone is thrilled, except me. The doctor wants to lower my metformin. But I haven't been sticking to the ultra low carb diet consistently. I almost always eat less than 150g a day and often get under 100g.

I occasionally spike up to 180 or more after some meals. It makes me listless and groggy so I know right away I have done bad things. More often though, I am spiking above 140 1 to 2 hours after meals and regularly have morning BG of 130-140.

The question is, do I drive myself nuts, go all out Bernstein and get lower or am I just fine and keep doing what I am doing?

Thanks in advance for the help!


Congratulations!

First, regarding your frustrations with your numbers, check what you are eating. Keep a food diary for a while and then see if there's a trend. Start with tweaking your diet and see if it improves your numbers to ones that you can be happy with.

To answer your question, decide on whether you can live with Bernstein's plan for a while (which may be a long while). To help you decide, go all out on Bernstein and see how you do. I've not done Bernstein, but I've reduced my A1c to 4.9 for about 6 months and those were miserable 6 months for me. So I know that doing Bernstein is out of the question for me, regardless of what Bernstein claims his regimen can accomplish.

Diabetes is a condition that will not go away. Since it will be with us until they find a cure or until we croak, how we deal with diabetes may change over time, depending on changes in other areas of our lives. So, experiment and try different approaches until you settle on one that works for you, and then if that stops working later on, try something else. Whatever you do though remember to live your life, not just survive the years.

#14
Larry H.

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Personally like the others I think your number of 5.4 is wonderful. It appears from your other readings that some serious look at the kind of carbs your eating is in order. When I discovered my problem I was at 5.9 (at least a year afterwards I should say). I have never taken medications and still have a 5.9. That may change once I am able to again resume my recent addition of resistance training.

There are a large range of ideas here as to how one should or could proceed. One has to choose for them selves where they feel comfortable. Like Princess Linda I looked at the Bernstein method and quickly dismissed it as far to one end of the possible scale of ways to proceed. I too used to see some 180 reads when I first got diagnosed. But after studying what I was eating and choosing good choices in carbs I am usually able to keep my numbers well below that. Over the four years my numbers have generally improved rather than getting worse. I think that is possible in people whom have gotten their wake up call long before things really got bad. I realize that someone who has little ability to control their situations are almost destined to be reliant on drugs for help. Should I reach that point, I too would do that. However drugs no matter how wonderful have proven to all have downsides somewhere along the line. In the case of many here careful choices of food or carb intakes had worked to maintain a reasonable number. I would try to find your happy balance, not spending your life depriving your self of things you might easily enjoy in moderation. Test some lower carb items and see how you react. Keep them limited but available.

For my self when I read many here say they hadn't had a muffin or a sandwich since diagnoses I was scared to death. Wow, we can't enjoy anything any more! But after looking over bread labels and finding some with as little as 10 carbs for the whole sandwich I couldn't see any reason to deny my self that item. I eat a few low fat chips and fruit with my lunch and nearly always have a couple scoops of low carb (4) ice cream and am perfectly happy with my lunch. Many days it only registers in the 117 range, and once in a while it might jump to 130, but still I feel its well within my comfort level. Almond flour with a good recipe can make some amazing treats at almost no carbs, pie crust, pancakes, muffins, cakes, breads, ect. My goal is to still enjoy eating while taking care of my body at the same time. A good exercise routine is almost a must to help keep ones numbers reasonable and for me it shows real benefits in health and stamina.

I always remember that when I searched the sites for how to proceed from early stages of our disease it nearly always says that diet and exercise is 2 times more successful at slowing the progression than metformin, I take them at their word.

Diet And Exercise Keep Diabetes At Bay Better Than Meds.
Diagnosed: Sept 2007

Fasting then: 128 now: 85

Ac1 5.9

No medications, diet and exercise. Lost 35 pounds.

#15
stevehm

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After resuming metformin did you have to go through the GI issues again? (assuming you went through them when you first started Metformin)

Steve

#16
amiguita

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I just saw my endo yesterday and after major illness and surgery, I'm back at 5.9. I've lost another 4 lbs. and she thinks that if I lose more weight I can start cutting back on the Glucovance and just stay on the Victoza, but then again, she says she's comfortable if I test 2hpp at 120 or 130. I am not. I want to stay under 120 at all times.

I'm not so convinced about reducing. I'm eating less than 50 carbs per day and am certain that if I cut back on the meds those bg numbers would go up.

Personally, I would be thrilled at an A1c of 5.4. The best I've been able to achieve is 5.8. I'd like to be a bit lower because according to my meter, I should have an A1c of 5.1. I must be a high glycator.

Congratulations on the excellent A1c. :D
[SIGPIC][/SIGPIC]
diagnosed in 2/2010, Type 2 then 1.5
HbA1c
05/26/12 6.9 :mad: !!
03/13/12 6.6 :eek:
02/03/12 6.3 :mad:
11/01/11 5.8 :smile:
07/12/11 5.6 :dancing:
02/03/2011 5.8
10/2010 - 7.2 :(
6/10/2010 - 5.8 :)
5/04/10 - 6.5
3/24/2010 - 7.4
2/2010 - 8.5

FBG
05/26/12 190 :eek:
11/01/2011 - 177
07/12/2011 - 110
02/03/2011 - 104 :star:
10/2010 - 235
6/10/2010 - 145
3/24/2010 - 130
2/2010 - 250

Levemir: start 6/12/12. Levemir/Humalog basal/bolus regimen. 2000 mg Metformin ER daily

#17
sjkurtz

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Thank you all so much for the feedback, I can't express how much it means to me.
I truly believe that this place is one of the most important resources for all diabetics.

Well, I have decided to again take everyone's advice and congratulate myself a little on what I have achieved. Be a little proud of myself.

Just to be clear, I rarely ever have postprandial above 160 and when I do, I feel it.
My 1hr and 2hr are almost always below 140.

My primary care's most recent comment is that he almost never sees any of his diabetic patients as low as I am unless they have recently dropped significant weight. It amazes me that so many diabetics do not take this seriously and don't work hard to get under control. Of course the ADA doesn't help by telling everyone that 7.0 is more than good enough.

Thanks again!
6/04/10 - A1c 5.2
9/7/10 A1c 9.6
12/9/10 A1c 5.4 - It can be done - 176lbs.
6/3/11 A1c 5.4
6/3/12 A1c 5.7 - Back up to 202lbs - Not Good!

Medications
9/20/10 Met 250 x2
9/27/10 Met 500 x2
10/4/10 Met 1000 x2
6/12/11 Met 500 x2
Met w/Endo 7/1/11 back to Met 1000 x2 now ER
6/3/2012 Still Met 1000 x2

#18
goldie

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you said your morning bgs are 140s? my doc told me that when my morining bgs are under 100 she wold try taking me off meds. i watch my carbs but i do eat them and i have not been over 130 in a very long time, after a meal (i had srgery last week and with no food all day i got to 198 but it went right back down) my at home a1c was 6.8...just mho..i would wait till i didnt have the spikes to cut the meds..but thats just my opinion:)'
good luck!!!
DX Apr 15, 2011
a1c 11.1
first FBG 290
2 weeks later holding the bgs under 120 most of the time!!
metformin--1000mg BID
50 or less carbs per meal
Live on a ranch in Texas:D

#19
sjkurtz

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Thanks Goldie, it looks like you really took the bull by the horns and have driven down your BG very fast. Congratulations!
I look forward to seeing your next A1c.

The short of the story is that my primary cut my medication down from 1,000 mg of Metformin twice a day to 500 mg of Metformin twice a day.
This put me in the position to have to make some decisions about my care.
Therefore, I have decided to do several things.

1) Get my focus back and start tracking things closer.
2) Get back in to daily exercise.
3) Go see an endocrinologist.

With regard to the third item, I am choosing carefully. I have a friend whose wife is an endocrinologist. She is young, very knowledgeable about diabetes and is really hard on her patients. I need hard, want hard. She has been known to "fire" patients.

My appointment is a week from Monday.

Wish me luck.
6/04/10 - A1c 5.2
9/7/10 A1c 9.6
12/9/10 A1c 5.4 - It can be done - 176lbs.
6/3/11 A1c 5.4
6/3/12 A1c 5.7 - Back up to 202lbs - Not Good!

Medications
9/20/10 Met 250 x2
9/27/10 Met 500 x2
10/4/10 Met 1000 x2
6/12/11 Met 500 x2
Met w/Endo 7/1/11 back to Met 1000 x2 now ER
6/3/2012 Still Met 1000 x2

#20
Ela

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Congratulations Sjkurts! Good job and good luck with your plan!

Keep us posted.




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