How do you lower your FBG?

[danbrown]

I’m a 65 year old male, and I’ve been a diet-induced, obese T2 for 21 years. Over the years (before I became a low-carber), as I gained weight (up to 375lbs.), I progressively increased my oral meds until at one time I was on 10mg Glyburide b.i.d, 1,000mg Metformin b.i.d, plus starting on Avandia.

About 4 ½ years ago, at my doctor’s suggestion,, I started on Atkins, lost 60 lbs. in the 1st year, and kept it off for 3 years. After gaining back 12lbs., I started on Bernstein last fall and have lost 30 lbs. so far (since October 9th).

Of course, soon after starting Atkins I had to reduce my orals, first eliminating the Avandia, then cutting both the Metformin and Glyburide in half, and then cutting them in half again. After starting on Bernstein, I had to cut the Glyburide in half again, to 2.5mgs once a day (in addition to the 500mg Metformin once a day that I still take).

I’m still on Bernstein and losing weight, eating no more that 30 net carbs (6-8-4-12) per day. I also try to eat 120g. of protein (25-25-10-60) a day, and not more that 1,700 calories. The protein is based on a pretty sedentary lifestyle (therefore: .4x300lbs=120g).

I test my BG 4 times a day. Last week, when I was taking the 2.5mg Glyburide and the 500mg Metformin with breakfast, my BG averages for the week were as follows: Fasting BG 116, 2 hours after 114, before the evening meal 68, and 2 hours after 66. Now, I know those are pretty good, but I’d like to get my fasting BG lower. Any suggestions?

[Lisa N]

Any chance you could move taking your meds to bedtime? Something to discuss with your doctor, at least, with an eye towards getting the fastings down a bit lower, althouth 115 isn't disastrously high.
Your afternoon and evening readings are tending to be a bit on the low side; maybe time to decrease the meds again?
For me, I found that persistance with low carb tended to decrease my fasting readings; the longer I low carbed, the lower my fasting readings got.
Some folks have posted that a few ounces of wine at bedtime provided lower fasting readings, but be careful; Glucophage and alcohol don't always mix well. :Puke: Likewise, some have found that a fat/protein bedtime snack such as an ounce or two of cheese helped.
You'll probably have to tinker a bit to find what works for you and what doesn't, but that's not all bad, is it? :)

[danbrown]

Any chance you could move taking your meds to bedtime? Something to discuss with your doctor, at least, with an eye towards getting the fastings down a bit lower, althouth 115 isn't disastrously high.
Your afternoon and evening readings are tending to be a bit on the low side; maybe time to decrease the meds again?
For me, I found that persistance with low carb tended to decrease my fasting readings; the longer I low carbed, the lower my fasting readings got.
Some folks have posted that a few ounces of wine at bedtime provided lower fasting readings, but be careful; Glucophage and alcohol don't always mix well. :Puke: Likewise, some have found that a fat/protein bedtime snack such as an ounce or two of cheese helped.
You'll probably have to tinker a bit to find what works for you and what doesn't, but that's not all bad, is it? :)

Lisa,
Thanks for "listening" and for your obviously informed opinions. Based on comments on other forums, as soon as my present experiment has run its course, I'm thinking of dropping the one dose (in the morning) of 2.5mg Glyburide altogether and replacing it with 500mg. Metformin. (My current experiment is to move the 500mg of Metformin I am taking from the breakfast meal to the evening meal. It's too early to reprot on that now.)

This should have the effect of eliminating the afternoon lows at the very least and also get me off a drug that several posts have suggested is harmful to the pancreas' ability to produce beta cells, gradually depleting that ability, with the result that I will eventually have to progress to insulin.

Have you heard this as well? As moderator, you would be a good person to ask for a citation in the scientific literature of evidence of this phenomenom. What can you tell me about this risk of Glyburide? Thanks in advance.
Dan
PS: I've also heard about the bedtime wine tip and/or protein tip. Of course, more food is more calories, so it has to result in good value (something gained beside weight.) I am thinking about a "cocktail" composed of a shot (2 oz.) of red wine and a shot of wasabi edamame. The red wine hopefully will also have an effect on my HDL and it is heart healthy (tanins, I guess), and the edamame is loaded with protein (14g) and fiber (7g), with only about 2g carbs for a "serving." The soy beans are dry and hot, so the wine should be ideal for washing them down and cleansing the palate afterwards.
What do you think?

[Lisa N]

Dan, I'll see what I can find about Glyburide and beta cell burnout when I have a bit of time tomorrow or perhaps others can also help.

Busy mom...mid week craziness.....stay tuned.... :D

[danbrown]

Lisa,
Thanks, Lisa, I will. A poster on another Forum addressed the Glyburide question, providing a couple of useful citations in the scientific literature. So, don't trouble yourself, unless you really have the time and want to. Thanks.
Dan

[RobLL]

You might find this advice worth trying. Nothing in it which could be harmful, make up your 200+ calories however you like. I talked with the Medco pharmacist yesterday about a variety of my "pre-diabetic" issues (disclosure I believe that to be accurate just take the pre- off the term), and asked about FBG. His general reasoning is that the body makes a whole variety of adaptions to wake up, and rising blood sugars may even be useful in some circustances. But it is not the best time to be a couch potato. It is the time I like to read two newspapers and a few blogs online.

I have never exercised in the morning, (heavy later in the day), nor liked to eat when I first get up. He suggested at least a small breakfast of 200 calories, it could be a whey protein sports drink, maybe one Dove chocolate (5.5 grams carb).

And 5-10 minutes of exercise, like walking. I am going to try this for the next couple weeks, maybe I can learn to like eating and moving when I first get up.

The question I forgot to answer: When is the best time to check BG if I do this? Today I waited for one hour after completing exercise, and got a comfortably low reading.

by the way, congratulations on the big weight loss!

[danbrown]

I have never exercised in the morning, (heavy later in the day), nor liked to eat when I first get up. He suggested at least a small breakfast of 200 calories, it could be a whey protein sports drink, maybe one Dove chocolate (5.5 grams carb).



Rob,
Thanks for your suggestions. I didn't eat any breakfast (or lunch either -- too busy) for most of my life. A lot of people think that is one of the reasons I gained so much weight, by overcompensatiing at dinner.

I ate a late dinner and I ate too much, I guess. Not a lot of carbs necessarily - I don't particularly like bread and potatoes, although I did eat plenty of rice (with chinese) and pasta. And I wasn't particularly hungry.

I ate as a reward at the end of a long day - 10 or 12 or more hours at the office - and I ate a big meal. For example, a big Caesar salad and a New York strip steak, with vegetables, and a full bottle of red wine. As you can see, I was single and ate dinner out a lot. And slept well.

I could care less about desert, unless it's a good cheese plate, in which case I ate it with french bread with lots of butter, and some fruit on the side. Just thinking about this makes me nostalgic. I still like the cheese plate (when you can get it), but without the bread, butter (nothing to put it on) and fruit. Oh, well.
Dan

[Mary1967]

Sounds like the Dawn phenomonem.. not sure if I spelled that right.. look in Bresteins book for that or google it.

[danbrown]

Mary,
Thanks for your thoughts. I may be "The Dawn Phenomenon", but the question is "how do you lower your FBG?"

Several people have suggested I tweak my meds. I was taking 2.5mg of Glyburide and 500mg of Metformin in the morning. Of course, several people on another Forum suggested I give up the Glyburide altogether, arguing that it would eventually wear out my pancreas, leading me to insulin. As you will see below, I had been on much higher doses of glyburide for many years, so it doesn't seem reasonable that regressive dosing (rather than the usual progressive dosing of most non-LC's), will wear out my pancreas

The fact is I have been a T2 for 21 years and paid no attention to my diet or weight and didn't exercise, for the first 16 years. As my weight increased, and I contiunued to eat lots of carbs (I assume), my meds progressed as well. I started out in 1986 on Micronase (glyburide) because it was the only effective oral on the US market at the time (I think). Then, when Glucophage (metformin) was first sold in the US in 1996 (or 1995), my doctor added that. Later, when high doses of both (10mg bid & 1,000mg bid, respectively) failed to control by BG, he added Avandia. That, and the fact I had to go to the Fulton Fish Market to weigh myself on a commercial scale, was when I decided to lose weight. At the next appointment (for which I weighed in at the FFM at 375 because my doctor's scale only went to 350), he suggested I try Atkins. He had tried it himself and lost 17 lbs.

I started on it and immediately lost weight and more importantly had to immediately start eliminating meds. I gave up the Avandia, cut the glyburide and metformin in half, and then cut them in half again. Over a one-year period I lost 60 lbs. After keeping it off for 3 years, I recently gained back 12, so I restarted a low-carb discipline, this time on Bernstein. Soon after, I cut the glyburide in half again to 2.5. and have lost another 30 lbs. I tried eliminating it altogether because it causes weight gain, but my BG went up too much.

Getting back to the question "how do you lower your BG?": 1) tweak my meds (the easiest course of action), 2)try a bedtime snack of wine and/or protein (calories and carbs, but otherwise an easy 'treatment', and 3) a vigorous program of endurance and strength training. This last is something I have resisted all my life. I just hate the idea of "useless" time spent on those dumb machines, even if they will have a beneficial effect, but I decided, since I have a gym in my building, I would try it, as well as 1) and 2) above.

I am in the middle of a 2-week med change, will try two more 2-week med change trials, and then start the snack idea. I the meantime, I'm walking (~3mph) for half an hour on a treadmill every day and trying to figure out how to use the strength training equipment. I'll keep you and the other readers posted on progress.
Dan

[RobLL]

Dan - the pharmacist from Medco emphasized that the early morning exercise should not be long, and it should be moderate, like walking. Not stenuous, not moderately strenuous. He recommended 5-10 minutes of walking. It seems to make a difference to me. It seems to be noticeable in my 90 minute post breakfast BG. I will summarize my findings after completing two weeks of testing. Of course what works for me may not for someone else.

[danbrown]

For me, I found that persistance with low carb tended to decrease my fasting readings; the longer I low carbed, the lower my fasting readings got.
Some folks have posted that a few ounces of wine at bedtime provided lower fasting readings, but be careful; Glucophage and alcohol don't always mix well. :Puke: Likewise, some have found that a fat/protein bedtime snack such as an ounce or two of cheese helped.


Lisa,
Re your helpful reply last week, here is an interim report: Persistance with LC'ing (even for a few days with no cheating) does lower my FBG. My last 8 FBG's were as follows: 112, 128, 117, 105, 106, 94, 98, 101. To be fair (full disclosure), this also occurred after I moved the 500 Metformin from morning to evening, leaving the 2.5 Glyburide with breakfast.

Point of clarification: Is the anecdotal evidence about fat/protein snack at bedtime lowering FBG for some actually a protein snack, or is fat required?
I'd rather not add in the extra calories and saturated fat if protein alone will do it. I have lots of protein choices. Search your memory database and let me know if you can clarify this. Thanks for your support and help.
Dan

[Lisa N]

Dan, I don't think the fat is required as far as an evening snack is concerned. IIRC, the line of thinking in including it is that the fat would delay stomach emptying a bit so that the protein was having it's effect on the system during the hours when blood sugars typically drop at night.
Why not give it a try with just protein and then with protein/fat to see if there is any major difference for you?

It's amazing what consistency can do for blood glucose readings, isn't it? I've found that just one day of eating off plan can throw off my numbers for several days following.
It appears, from your fasting numbers, that moving the metformin to evening is having a positive impact; your fasting readings are trending downward. :thup: How are your afternoon readings doing?

[danbrown]

It appears, from your fasting numbers, that moving the metformin to evening is having a positive impact; your fasting readings are trending downward. :thup: How are your afternoon readings doing?

Lisa,

Here's a small table of all the readings for the last 8 days.

Day 1 2 3 4 5 6 7 8 Aver.
FastingBG 112 128 117 105 106 94 98 101 108
2 hrs. after na 149 na 121 90 115 122 116 119
Bef. dinner 59 79 72 95 76 73 51 59 71
2 hrs. after na 106 83 109 na 88 80 93 93

Daily Aver. 86 116 91 108 91 93 88 92 98
There is some improvement on the FBG's but the afternoons are still too low. Frankly, I don't understand why I moved the Met to the PM and not the GLY. It's the GLY that has the most glucose lowering effect, isn't it?

Re 'off-LC eating': Ditto for me for days afterwards seeing the impact of even a small carb binge. I guess it's that pesky liver keeping the binge carbs in storage and dishing them up into the blood stream as the readiest form of energy.

PS I fiddled with the excel table but can't get it to format in the forum window. Is there a way to do it?

[dina1957]

There is some improvement on the FBG's but the afternoons are still too low. Frankly, I don't understand why I moved the Met to the PM and not the GLY. It's the GLY that has the most glucose lowering effect, isn't it?


I never was on GLY but Metformin gave me afternoon Bgs in upper 50s - low 60s daily, and I did not even feel the hypos.
HTH

[Lisa N]

Frankly, I don't understand why I moved the Met to the PM and not the GLY. It's the GLY that has the most glucose lowering effect, isn't it?

It can, but the middle of the night when you are sleeping and not aware enough to correct the situation is not when you want to have a hypoglycemic episode and some of your readings are pretty close to that range in the afternoon when the Glyburide is having peak effect.
I did also suggest that you discuss the timing of your meds (AM vs. PM) with your doctor. :idea: I will say, though, that for the 6 or so months that I was taking Metformin, my doc had me take it in the evening after dinner and to a certain extent it makes sense since Metformin works partly by inhibiting gluconeogenesis in the liver which is part of what happens with the Dawn Phenomenon.
Something you may not know is also that when blood glucose gets low in a type 2 during the night, you can get something called the Somogyi effect where the liver kicks into overdrive during the night due to low blood glucose so going low during the night could have the opposite effect than you are looking for by making your morning readings higher again instead of lower.

[danbrown]

Lisa
Thanks for another very early morning post. It's full of help.

Your cautionary point about the risk of low BG's during the night while I'm asleep is well taken and is a good reason not to switch the GLY to dinnertime.

Re: discussing with my doctor, I did ask him in October (before I started Bernstein) when I should be taking (at the time) the 5mg GLY and 500mg MET and his reply was morning for both. I sensed I was squeezing him for advice about which he was not particularly informed, however, so it may have been "textbook" or just his need to sound like he was giving me direction. To be fair, also, he did not have the benefit (nor did I) of any BG readings on which to base his advice.

This "experiment" (2.5 GLY at breakfast and 500 MET with dinner) will be concluded in a few days. At that point I was planning on reversing them (MET in AM & GLY in PM). Instead, adding your advice to that of several people on another forum, I think I will drop the GLY altogether and substitute another 500 MET for it in the AM. (I tried once dropping the morning GLY altogether, but that caused an unacceptible BG rise.)

The new "experimental" regimen (starting Saturday) will then be 500 MET in the AM and 500 MET in the PM. That should allow the afternoon BG's to rise a bit, which is my remaining goal (for now, until lots more pounds come off).

My FBG's continue to stay low/get lower as I continue on the strict VLC regimen (20 net carbs/day). The last 5 FBG's were 94, 98, 101, 97, 93. Now, if I can just get my late afternoon BG's UP to those levels, I will be happy. The last 5 were 76, 73, 51, 59, 57, all without any hypo symptoms. Again, thanks for your ideas and input. You help keep me focused and thinking about these tweaks.

PS: Dropping the 2.5mg Glyburide should also be good for my weight loss efforts, since it does cause weight gain by all accounts.