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A little backstory:

My doctor decided that I was pre-diabetic a year or so ago. And he put me on Metformin 500 mg per day - taken at breakfast. So I'm not diabetic. And trying never to be.

However, I recently decided I wanted to be drug-free and the Metformin was having unpleasant side-effects. So I quit taking it (also quit taking the statins I was on for cholesterol) about a month and a half ago.

At the same time, I decided I would take matters into my own hands wrt my health and I have begun exercising almost every day. I give myself a day off about once a week (since invariably something comes up that interferes with my schedule anyway and when it does I let that be my day off). More importantly, I've changed my diet to what I describe as "almost vegan".

I've been slowly losing weight.

End of backstory.

Now: I decided that if I really want to know what's what I would get a blood glucose meter and take readings to see how I'm doing.

The meter just arrived a couple of days ago and I've used it twice.
The first time was yesterday afternoon about 2.5 hours after eating lunch. It read: 109

Then, this morning, before breakfast and still fasting, it read: 114.

I'm puzzled at this. Isn't the fasting number usually lower than the after-eating number? And are these numbers ok?

Could someone who knows about this please fill me in on what to expect from these readings?

Thanks so much.


AM
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You are still pre-diabetic.

What you do NOT know is what is the cause of your condition. What is known is you are not making enough insulin quickly enough to meet normal needs. What is NOT known is WHY that happening.

1. Could be the insulin-producing cells are failing. Losing weight means less insulin needed--but that is a no-win situation because you can not lose enough weight forever.

2. Could be a failed blood-reading sensor in your body. So, it THINKS you are ok at 110 when it should be 90.

What you know is the reading--and nothing else. And that is what the doctor knows also. The usual problem is #1--and that would require a "New and Improved !!" source of insulin production.
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So you are saying my readings were not good?
(having a lot of trouble trying to figure out what you are saying.)

AM
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AM -

Best to check with your Dr. to see what your readings should be.

I have had to accept that my morning readings will be higher than my readings before meals - but I am still trying to change that with diet, exercise, and metformin.

The metformin has been very helpful to me: over the past 10 years I have lost more than 40#, most of them soon after I started the metformin.

What side effects have you been having? Where have you checked to see what can be "expected" and what to do about this?

A/L
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Ummm… the medication comes with a list of side-effects. You can also find them on WebMD, I think. I experienced at least one of the more unpleasant ones.

Besides that, I like the idea of being drug-free. I don't think humans were meant to take all those pills. But I would, of course, if I were dying right away without them.

I believe that eating a good diet and exercise should bring me back on the right track.

From what I could learn on the internet, those readings of mine that I posted seemed well within the normal range for normal adults and not for diabetics.

But I was a little confused about why fasting numbers would be higher than those taken a couple of hours after eating a meal. That seemed not quite right to me. But I'm new at this. :)

AM
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So you are saying my readings were not good? (having a lot of trouble trying to figure out what you are saying.)

Have the doctor do a test AND you do your own test using your own meter from the same sample (or take a sample at the same time and get a reading). Then you have TWO meters with two samples taken at the same time and you can compare readings.

Significant different = the meter mfrs have to figure out which is correct and fix the one that is failing. That is what a test solution is supposed to do. The meter should ALWAYS return the same value for the test solution.

If both meters show about the same figure, then the meters are close enough to not make a difference.
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But I was a little confused about why fasting numbers would be higher than those taken a couple of hours after eating a meal.

The food we eat is not the only source of blood sugar. Your liver stores a form of glucose and releases it when needed to keep the body/brain running 24/7. It's supposed to keep you from getting low (hypoglycemic) between meals.

What some refer to as "the dawn phenomenon" is the body's natural process of preparing us to wake up and get active. The liver typically raises our blood glucose levels in the early morning hours (typically 4 to 5 AM) to provide the energy to awaken and get moving.

Some diabetics really struggle with the "dawn phenomenon", with much higher fasting blood glucose levels than at any other point in the day. Sometimes our livers are over zealous, and the resultant "liver dumps" are over-compensating, causing hyperglycemia rather than preventing hypoglycemia.
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Interesting, Rikka.
Thanks.

AM
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First, I do not recommend making changes to your medications (ie stop using them) without consulting your doctor. Stopping mediations can have unintended side-effects just like starting new medications. Second, diabetes affects everybody differently so there are no hard and fast rules. Some people have high fasting blood sugars, others don't. Improving your diet and exercise is important, but don't assume it's enough to prevent diabetes from affecting your future health.

Doctors generally label those whose fasting blood sugars are 99 or below as non-diabetic. Another measure is an A1C blood test index below 6. If it takes mediation to get your readings into the desired ranges, then that is the best thing for you to do. Diabetes is a degenerative disease with no cure yet, which means let unmanaged, it will trend worse. Your mission is to do everything you can do to delay that trend as long as possible.

Fuskie
Who thinks enduring a few side effects in the near term is a small price to pay considering the potential consequences of long term diabetes...
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Fuskie, thanks for your post.
However, i have already stopped taking the metformin and i have no intentions of going back on it. The side effects were unpleasant and too confining. Diarrhea is one of those things that is difficult to live with. You find that you cannot even leave your house with any kind of confidence that you wont embarrass yourself publicly.

Beyond that, i never, but never, want to be in a position where i have to take a second medication to negate damage from the first, and then a third to treat damage from the second, and so forth until i am nothing but a walking prescription. I refuse. And thats the end of that. I will fight my doctor tooth and nail over this if i have to. Ive seen where that leads and its not a place i want to go.

Secondly, as i said earlier, i am not diabetic. The pre-diabetes diagnosis was about two years ago now. Since then i have managed to lose 20 pounds and have recently decided to get serious with diet and exercise to move from the pre-diabetic state back to normal.

Im following a low-fat, vegan diet and im giving myself a workout on my treadmill every day. Note that ive only been doing this for a month so it is very early for real results to show up.

I bought the blood glucose meter on my own. No prescription because my doctor has not felt it necessary to prescribe one. I just decided that i would like to know how im doing so i got the meter.

This morning, the fasting reading was 102. This doesnt seem too far out of normal to me based on information i have been able to glean from searching on the internet. So maybe im making progress.

I was just wondering earlier how yesterdays fasting level could be higher than the post-meal level. I thought someone here could explain that. But it seems to be complicated.

I will keep on with the diet and exercise until i get the levels down inside the normal range. I still want to lose about 40 pounds but i am not on a diet primarily to lose weight. Im changing my eating habits to get healthy. I think the weight loss will be a bonus. :)

AM

Ps.. Please forgive the lack of proper punctuation. I had to turn off auto correct on this ipad to keep it from deciding for me which word to use. Often it would replace what i was typing with some total nonsense. I wish it just had an auto punctuation function only. :)
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Secondly, as i said earlier, i am not diabetic.

Pre-diabetes is a distinction without meaning and a term that I really dislike. It's more like the early stages of type 2 diabetes. And if you don't like the Metformin, then talk to your doctor about changing it to something else. There are many medications out there, and given your diet and exercise changes, he or she may decide it is not necessary at all. The thing is, unless you are a medical professional, you are not in a qualified position to know what your best course of treatment is. If you don't like or feel a level of trust with your doctor, then find another one. But you risk your health when you dismiss a doctor's prescribed treatment without a consultation.

I'm not a medical professional which is why I try to avoid offering medical opinions or advice. But since you seem to be avoiding speaking with your own doctor, I'll try to explain some biology based on my readings. When you go to sleep, your body does not shut down. All your life support systems continue operating to keep your heart pumping, your lungs breathing and your brain dreaming. Think of it as Power Saving mode, but you still require energy. But since you are sleeping, you are not taking in food. So the body pulls glucose stored in the body and uses it to keep the stove fire burning, and uses insulin to keep the amount of glucose under control.

But when you're diabetic, your body isn't producing insulin correctly, or maybe it's just not using it correctly. As I said before, diabetes affects everyone uniquely. If you produce too much insulin while sleeping, then your blood sugar gets too low. If you produce too little, then the body overcharges with energy, pulling more glucose into your blood stream than you really need. For some people, moderate eating stimulates insulin production, which can lead to lower blood sugars a few hours after eating. For others, a light snack before dinner can also improve fasting blood sugar. And it is also possible that different people need different periods of time between meals and different types of foods to adequately process the glucose in your system.

Your medical professional understands all this, which is why it is important for you to remain in contact with them, to tell them your concerns, and to work with them to find a treatment that is tailored to your particular physiology and personal needs. Trying to manage diabetes on yourself armed with nothing but WebMD and a blood-glucose meter is just fooling yourself into thinking you're not really sick with an incurable degenerative disease.

Fuskie
Whose personal initial reaction to being diagnosed as diabetic was denial, but came to understand that the most insidious aspect to the disease is that even under the best self-management and care, it is a slow deterioration with serious potential consequences and that it is important to have medical experts on his side...
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Oy. I will tell my doctor the next time I see her. I'm not going to waste her time with this right now. It's not life and death.

I don't want her to prescribe another medication. I want to be drug-free. To me, that's the ideal situation for the human body.

You say that diabetes in incurable. But several very prominent doctors have said otherwise. They have written that they've seen patients go from diabetic back to normal with the proper diet and exercise.

You sort of make me feel that this is hopeless - a slow deterioration as you put it. And that I should be on drugs - of some sort just because one doctor decided I was pre-diabetic at some point. I don't think it's hopeless. I don't think the human body was meant to be diseased. I think we were meant to grow old and simply wear out. We can't expect to live forever and what time I have left I don't want it spent gobbling down pills. If I'm reading you right you seem to think that everyone is headed for a slow death by diabetes. That is just too dark for me.

I will take all my testing results to my doctor next time I go. I will tell her about my diet and that I stopped taking the medication - and when. I will show her my weight loss. I'll have a serious talk with her about this. I just don't see the need to rush off right this minute and do that. I just can't bring myself to believe that this is hopeless or cannot be reversed.

AM
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several very prominent doctors have said otherwise. They have written that they've seen patients go from diabetic back to normal with the proper diet and exercise.

Diabetes is fatal, a fact that doesn't seem to register as many look at it as a lifestyle related disease. Early treatment can actually return blood glucose levels to the normal range. In fact, you may not develop type 2 diabetes automatically if you have what is called pre-diabetes. But this requires the cooperation between the patient and the doctor. There is no cure to type 1 or 2 diabetes, but you can manage it and delay progression from "pre-diabetes" to type 2 diabetes though a combination of diet, exercise and non-insulin medication.

But slowing it down is not a cure, and while diet and exercise can improve your blood sugars today, there is no guarantee that your blood sugar will remain under control. The worst thing that can happen is that someone thinks they are out of the woods and then they reduce the exercise or return to eating less healthy foods.

You sort of make me feel that this is hopeless
No, it's not hopeless. To the contrary, there is great research being performed for both the management of type 1 and 2 diabetes as well as hopes of a cure in our lifetime. I am not saying you have to take medication. What I am saying is that the decision whether or not to take medications should be made with your doctor. If you are against drugs, you need to tell your doctor and not let them write prescriptions you don't want or won't use.

Here's a couple articles I found from a recent World Diabetes Day event:

http://health.india.com/diseases-conditions/myths-regarding-...

http://health.india.com/diseases-conditions/diagnosed-with-p...

Not everyone who claims they can cure diabetes is a doctor but there are some medically trained doctors who think it can be cured. As someone who has lived with diabetes for over a decade, I think the real answer is that it can be managed but not cured, at least not yet. Most national and international diabetes organizations seem to agree with me. So I take it with a grain of salt when someone claims to have found all natural or organic cures. They said the same thing about Cancer. When the ADA, JDRF, CDC or NIH announce a cure, then I'll be a believer.

That said, there are many examples of people living with type 2 diabetes, starting with Tom Hanks, Randy Jackson, Drew Carey, David Wells, George Lucas, Nick Jonas and Charlie Kimball. Plus, one of my diabetes heroes, BB King (88, living with diabetes and still touring with Lucille).

Fuskie
Who thinks living with diabetes is a matter of life and death, maybe not immediate, but the decisions you make today can impact your days down the road...
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I appreciate your honesty. And I believe you are very sincere.
I also thank you for taking the time to speak with me about this.
I would like to ask you a question though: Do you eat a low-fat vegan diet?

AM
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No, I'm a carnivore.

Fuskie
Who has a paced-meal controlled carb diet which allows him to eat what he wants but in moderation and he doesn't go out of his way to eat unhealthily...
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I don't want her to prescribe another medication. I want to be drug-free. To me, that's the ideal situation for the human body.

The human body is, by definition, a walking drug factory. So your claim is nonsensical. Keep reading.

You say that diabetes in incurable. But several very prominent doctors have said otherwise. They have written that they've seen patients go from diabetic back to normal with the proper diet and exercise.

Special situations that are not repeatable over a large group. One group does it consistently--but you won't like what they did. Bariatric surgery. THAT worked on all of them IMMEDIATELY and ended their diabetes. So think about what that means--and how did it work.

You are still a bit overweight, but not excessively so--and trying to lose more weight. You lost 20 lbs so far--that helps a bit. But your body parts are not getting more efficient or effective. That is the key part. Your pancreas is where insulin is produced--and that is slowly losing the ability to make ENOUGH insulin "on demand". That is what diabetes is--the inability to make enough insulin. So you compensate by losing weight (don't NEED as much insulin)--but the pancreas does NOT decreasing its insulin production capacity. That keeps going down as you get older and older. Eventually you need to add insulin--one way or another.

Metformin comes in two types--fast (regular--500, 850, 1000) and time-release (500, 750, 1000). Ask for the time-release version of metformin and see if that helps. And ALWAYS take metformin with a REAL meal.
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but the pancreas does NOT decreasing its insulin production capacity. That keeps going down as you get older and older. Eventually you need to add insulin--one way or another.



So EVERYONE ends up having to take insulin?


And ALWAYS take metformin with a REAL meal.


What do you mean by a REAL meal?


AM
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So EVERYONE ends up having to take insulin?

No, but the trend is the same. What is not known is how fast the insulin-making ability will go down. That is why you test regularly. The idea is see when the change actually takes place (over a week or two--unless it is very obvious something went ka-blooie!!) so you KNOW you need to see the doctor and have the appropriate changes in medications figured out. You want to rule out random fluctuations and see consistent patterns--and that will not happen in one day.

Keep a log of readings by date and time, but ALSO keep a log of WHAT YOU ATE each meal AND snacks. That way, you can see a "cause and effect" when it happens. Note that "all protein" foods such as steak, chicken, etc are great for low readings--but the potatoes, stuffing, etc are NOT. Modest amounts are ok. But figure out what works for YOU--and when to eat them. Then you know what works now. You will also then know when things start to get worse (insulin production goes down) because eating the same stuff suddenly and consistently yields higher test results every time.
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What do you mean by a REAL meal?

Almost forgot this.

Metformin does two things. First, it lowers glucose production by the liver (less produced = lower test results). Second, it improves (indirectly) how well your cells "take in" sugar--so a second benefit that lowers blood sugar. Less sugar produced AND more sugar absorbed.

Regular metformin is "quick dissolve" in your stomach--so that is why there can be diarrhea problems. Having a "real meal"--reasonable amount of food eaten (i.e. NOT a snack) THEN take the metformin after last bite. Idea is to slow down absorption of metformin. Everyone differs, but some people are more sensitive to the medication. One side effect of metformin is it causes the intestines to create a lot of <I forget which intestinal fluid/chemical--begins with an S, I think> and THAT is what causes the diarrhea. This happens to about 20% of users. The diarrhea is NOT caused or created in the stomach. It is caused when the dissolved metformin moves from your bloodstream into the intestines (this is normal). Hence, an extended-release version of metformin means less being delivered at one time but all of it over an extended time.

Take ONE tablet per day and see when the diarrhea hits--if at all. No problems with one, then move to taking one in AM (breakfast) and a second at dinner (evening meal). If problems, stop the evening pill and see if the problem goes away the next day (with one pill only in AM). Start with 500 in AM, then add 500 in PM if no problems. If problems, try JUST a 750 in the AM (as 500 was ok before). If problems, then you are sensitive and just stick to a 500 once per day (just with a meal, as usual).
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The intestinal chemical I forgot was serotonin. Metformin can cause the intestinal tract to create too much serotonin in some people and that eventually causes diarrhea.
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I know you mean well, but please try to avoid giving medical advice on the boards related to prescription drugs. OP should take the medications as prescribed by the doctor. No one here should counter that advice without a medical examination.

Fuskie
Who just doesn't want anyone making changes to how they follow a prescription without consulting their own physician first...
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please try to avoid giving medical advice on the boards related to prescription drugs.

What was described is how doctors do it. They experiment with various dosages until they hit one that works. Can't get the drugs without a doctor's prescription anyway.
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AM - listen to the Fuskie and Rikka posters. Especially Fuskie. His info is vast and up to date. He continues to educate himself. For what it's worth my blood sugar is ALWAYS higher in the morning than during the day. I can control what I do during the day. I can't control what my liver does while I'm sleeping.
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You give me way too much credit. Google is simply my friend.

Fuskie
Who thinks there are in fact many steps you can take that affect what your body does overnight, from medications to the timing of evening snacks (which can fool the body into making more insulin overnight) to the amount of sleep you give yourself each night...
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You give me way too much credit. Google is simply my friend.

Well yeah. But you still do all the work then post it on the Diabetic Fools Board. So I don't have to do all the work just go to the board and read. And don't think I don't appreciate that even if I don't post much.

(Oh yeah I know all about the care I need to take before going to sleep - especially not forgetting the Metformin which I have a bad habit of doing - but what I meant was I can't check my blood sugar level, jump up, get on the treadmill and "force" my numbers down when I'm snoozing.)

Also AM, I did a lot of internet searching after I was first diagnosed and I got on board with that draconian diet, exercise, multiple testing to see how each and every food affected my blood sugar etc. because I was adamant that I was going to "cure" myself of type 2 diabetes. I was so successful I slacked off checking my numbers every day. Big Mistake.
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