Well, I’ve now lost 100 lbs. I lost 60 in one year on the Atkins diet, starting a little over 4 ½ years ago. I kept it off for almost 3 years, but then gained back 12. I lost the last 52 on Bernstein since October – and that’s great, but now my bs’s are getting worse.

I’ve been pretty good about the carbs: target 30g. total, 20 net-net, 25 Bernstein-net (subtracting only half the fiber). And I’m also on track on the protein, taking in 90g per day. My plan is 4-6-10 CHO (net-net) and 20-30-40 PRO grams.

Since October, my meds went from 500 MET with 5mg GLY, reduced to 500/2.5, then to 500/1.25, then to 500 MET alone for two weeks. Then, for 2 weeks, I increased the MET to 500 with breakfast and 500 with dinner, which is where I am now. However, since giving up the glyburide, my average bs’s have climbed steadily.

The average bs for the last 3 weeks that I was on 500 MET + 1.25 mg. GLY was 94 (95,87,99). The week after I stopped the GLY the average rose to 110. The 2nd week on just 500 MET was 104. Then, after I added 500 MET at dinner (to the 500 MET at breakfast), my weekly averages went to 112 and this last week 118.

My highest readings (FBG generally) have been in the 130’s, but I haven’t seen any bs below 100 in a couple of weeks, and I used to have 2 or 3 per day. A few days ago, for example, my FBG was 135, 2hrs. post prandial 135, before dinner 108, 2hrs. post prandial 109. The last 2 days FBG’s, however, were back down to 112.

I see my doctor in about 2 weeks, and I want to discuss with him various therapy options:
1. Do nothing. My weight loss continues and my bs’s are higher but still ok.
2. Resume the GLY. at 1.25mg. or lower dose.
3. Double the MET at breakfast and dinner to 1000 each.
4. Add another OHA (Are TZD’s like Actos and Avandia weight neutral?)
5. Add basal insulin
6. Add 5mg. Byetta b.i.d. or before breakfast only

I know this is for my doctor and me to work out, but he’s an internist/cardiologist who’s coasting to retirement so I need some talking points. Besides, I’m in charge of my health, right?! He has given me good advice, and monitored me appropriately; but, this board is a very well informed resource, and you have guided me well too (collectively).

It must be said I subscribe to most of Dr. Bernstein’s precepts, but would not describe myself as an acolyte or even an adherent. What say you I should do?

Okay, Dan, it seems that you're getting off the GLY is what contributed to the rising numbers; if you reintroduce it, and your bg drops back, you'll know for sure that's the deal. I know you've seen me post about Januvia, maybe keep that in mind as an option. Or as you say, look into increasing the metformin.

One question: have you changed test strips? I got a bad batch once, and my numbers bumped up around to the 110-116 range (which freaked me out).

I would not let my blood sugar climb higher than what you're talking about; you're getting into risky territory, and I'd do whatever I need to do to get them back under 100. Good luck, Dan.

This was my problem on VLC plan and no medications. If I dropped carbs too low, my FBG would be in the same range as yours.
The weight loss did not make any difference in my numbers either. I got really tired of being stressed over numbers, tired of eating protein and fat, not being able to eat fruit and variety of food that I like after 5 years of 50g carbs, and not feeling well on this plan.
So, I asked my dr. about januvia, since I have read others had very good results with it, and she gave me 4 months worth supply. My FBG dropped from 135 to 113 next day, and is now 100-110, 2 h pp - upper 75-90 and I am able to eat more carbs. I don't abuse grains, bread, sweets or starches, but I can eat fruit, not count every salad leaf, and the best part- no side effects (like on metformin) and weight gain (like on sulfos), it is once a day pill also.




Byetta is twice a day injection, has nasty side effects, and works by stimulating pancrease as well. You have also keep it cool and wait for 30 minutes to an hour after injection.
Januvia is once a day pill and you can take it any time, with or without food.Why don't you try it, it is different class than glyberide and metformin, it does stimulate pancrease to release insulin and restores Phase I response. it also knows where to stop, so I don't go too low, the lowest I saw was upper 70s in the afternoon, when my Bgs are generally the lowest.
Talk to your doctor, they always have some free samples to try.

I was hang-ho with LC diets and with Dr.B's plan, but it did not work for me, as well as it works for others. I have also realized now why other endos do not force t2 to adapt a VLC plan, it is not al about carbs per se, it is more about ability to utilize insulin, and while carbs makes difference, gluconeogenesis is actually bigger issue for T2 and mostly due to loss of Phase I reponse.
HTH

Dan
Regarding the sulfonylurea drugs,glyburide is
pretty good but glimepiride is better.Glimepiride
is the "mose recentl developed" of the sulfys-
only 10 years old.According to propoganda,
glimepiride doesn't cause weight gain and is
the most potent sulfy.4 mg a day works good
for me but you have to watch out for hypo if
you are doing extreme LC.I had a little weight
gain with glyburide but none with glimepiride.
Incidentlly IMHO Bernstein diet plan is same as Atkins induction.
Good luck
Eddie

Let me get out my nit-picking tool .

Bernstein isn't Atkins induction, though similar. Bernstein calls for 30 grams of carbs, Atkins induction 20, and Bernstein warns you off of some things that Atkins allows, like tomatos.

Atkins is all about glycemic load (i.e. EC) and intitally he limits the choices as well, but still allows tomatoes. Bernstein bans tomatoes, carrots, yellow bell peppers- too high in cabrs compare to red (not sure why, fitday does not make a difference), all fruit, beans, starches and root vegetables, and other yummy and healthy food.
Atkins allows to add carbs after induction, 5 g per week until you stop losing (I never lost a pound even on induction), while on Bernstein plan you are bound to protein, fat and, some leafy greens, cabbage (all kind), radishes, fennel, squash ( summer), and few other very low GI veggies but not yellow bell peppers, and watch out for lemon juice, it has los of sugar as well.
IMO, Atkins new Diet revolution is better plan, but it is constructed for non-diabetics, adn aimed at weight loss. While last book atkins diet for diabetics, has also 20g carbs plan for life.
Kudos to those who can follow VLC plans and feel good, it is a death sentence to me.

JMO

"Kudos to those who can follow VLC plans and feel good, it is a death sentence to me."
Ditto for me,Dina.About 5 years ago,I did
manage to lose 45 pounds following Atkins
diet but I can't VLC anymore.I gained about
15 pounds back due to power weightlifting
but I'd rather have muscle than be real thin.
Bye
Eddie

Hi,

Tell me more about januvia. I will also read up on it.

This isn't one of those drugs that stimulates the pancreas. Or is it?

Dr. B warns against them.

I would appreciate your information on this drug.

I will spend the day researching it.

I am at the point where following 6-12-12 brings me down to 110-120. I am taking 500mg Metformin extended release in the AM and 1500mg metformin Extended Release in the PM. The dawn effect has been eliminated for me so far. But I would like to consistently get my numbers down below 100. Exercise gets it down to 85-95. But then it creeps back up. Maybe I need to exercise multiple times per day; I will experiment with that as well. I go for walks. I will also re-introduce weight lifting. I did a lot of that over the past two years. I am really quite strong.

Thanks.

Ralph

Hi Ralph,
All meds works at certain level by stimulating pancrease (except insulin injections) as so do carbs. But having said this, I must add that Januvia works a bit differently than sulfos. Most T2 lost Phase I insulin reponse, and Januvia helps to restore it by inhibiting DPP-4. Januvia restores Phase I (immediate release) of insulin, that blocks glucogen and diminishes/inhibits gluconeogenesis. Most T2 (even when following low carb diet) have lost Phase I insulin reponse ( either ready to go stored insulin or immediate release of insulin almost as soon as one starts eating).
This delayed insulin release drives glucagonhigher, which triggers liver to release stored glucose, so Bgs continue to rise. Pancrease finally will secrete large amount of insulin ( Phase II response) but this can happen 2-4 hours after a meal, so Bgs stay higher for extended period of time.
Januvia restores Phase I response, so Bgs don't spike high, but it knows where to stop compare to other OHA like sulfos (not all of them BTW too), so you don't get hypoglycemia and huge amount of insulin circulating in your system for hours.


http://www.centerwatch.com/patient/drugs/dru935.html


Januvia also decreases amount of sugar that liver makes after a meal. As much I have read, I now believe that liver is the bigger issue for me than exhausted pancrease, could be I am very IR, or could be other issues (pituitary and adrenals, don't want to go into details now), but apprently, there is no good "communication" between liver and pancrease, so Januvia helsp to makes sure that "message" is delivered. It blocks DPP-4 allowing better communication between liver and pancrease.
So, to answer your question, Yes, it does both: stimulates immediate insulin release and curbs liver "dump" after a meal, when it is not needed.
http://www.januvia.com/sitagliptin_...t/about_how.jsp

I will try to address this without being "grounded". After 5 years of trying to manage diabetes following Dr.B's advice, I came to conclusion that I no longer believe he is 100% right,a nd his plan does not help or suites me. So what, if he is against sulfos, he advocated Rezulin that was taken off market in 2000 and wa linked to many health issues.
With all due respect, I don't do "bernstein sez" anymore, there are other well respected endos. One of them told me: you can probably see OK numbers, if you simply starve yourself on 6-12-12, exercise like a maniac, and be miserable, but you will continue to be stressed out over high FBG. I also see my cholesterol creeping up, last test was 216, compare to 170 when I was on lower fat/lower cabr diet. I also have problems eating fatty meals at this point, and I am sick and tired of protein.
DR.bersntalso advocates insulin therapy for T2, but I have read times and times that aggressively treating T2 with insulin will lead to even less favorable outcome as CHD and cancer. So, if Januvia makes sure that my pancrease releases insulin right away and only as much as needed ( I still watch my carbs), then I will take my chance. I can always add insulin therapy if my pncarease fails, but I doubt that it is in really bad shape, since I did not eat sweets for almost 30 years, never abuse carbs, soft drinks,a nd my H1C never crossed 5.9% even when I did not follow LC diet and did not know I have diabetes.
But I had troubles getting FBG and overngith numbers under control, so Januvia worked from day one. I have tried metformin and did not do anything for me, except horrid side effects. I suspect that part of the problem was: VLC diet, I followed whikle on metformin, I have read it works better when you eat more cabrs. BTW, Januvia seem to work better if I eat 20-30 g carbs per meal, and allows me to have veggies, fruits, legumes, and not feel deprived, lots of energy to workout, and my fasting dropped almost 40 points after 3 weeks. Since VLC makes me ill, and insulin injections can and definetely will get me into hypo, I have decided to try this one. Works fine so far, but this is a very mild medication, as my dr. warned me, and as a monotherapy it works only for those with already good control, combined with diet and exercise.
My other option was Byetta, but Dr.B is against it too, and I don't want carry cooler with me, stick myself with needle twice a day, and then have bouts of nausea and vomit, but it is good for weight loss I have read, since it delays stomach emptying and ppl can eat very little without vomiting.
I have noticed also that januvia reduced my appetite as well, without any side effects whatsoever.
But there are possible side effects, and it is new drug, only one year on the market, but I hope for the best. MY next H1C will tell if I should continue on Januvia. The cost is also high, $5 for a pill, so far I get free samples, and I am not sure if my insurance will be willing to pay, most likely not, bacsed on my H1C results. But it is good to know that this one works without hypos and wait gain.


I have read that metformin ER has more negative effect on liver than regular, so you may want to consider switching.
This is what I ha dproblem with, Bgs drop but then creeping back up, januvia keeps them in mid 80s/low 90s even if I haven't eaten for 6 hours.As for the exercise, and I never see higher than mid 90s after a meal, ecen if I eat more carbs. it almost feels like Janiva works better if i eat more carbs rather than less, if this makes sense.
I do cardio in AM (every morning except sunday, when I go for a long beach walk), alternating elliptical with swimming, before BF, and weights in PM before dinner couple times a week. I am too very muscular and strong, but I see that cardio does more favor to my Bgs control than weights, besides, lifting too heavy puts too much pressure on my LES and I get bad acid reflux. ASMOF, I blame years of heavy lifting my acid reflux, espcially squates, so I do lighter weight now (15-20 pounds), no need to stress my not-so-young body, impact on joints is quite high and I don't recover as fast as I used to.
But exercise is a double sword, too streneous - BGs jump sky high, before Januvia 30-40 minutes of lifting will get me to 180, while same amount of carido will drop my Bgs. Now I can "afford" to workout more, at least, Bgs will stay and don't spike.
I believe that Dr.B.is wrong favoring wegiths over carido, I think cardio is better for weight loss and overall fitness, than weights alone. Another mistake of mine, when I stopped carido sessions and just did weights, carido is great not only for physical and carido health, but also fights depression/anxiety. Giving up cardio was the biggest mistake of my life, and made me re-gain bunhc of weight and feel like I am having coronary every time I walked stairs or SF hills, the chest pain was quite real.
After few months of everyday cardio sessions, I can now run uphill without even getting my heart rate elevated, before i would huff and puff after 10 minutes of swimming, now I swim for an hours non-stop, and feel great.
I hope this information helps, I was told by my friend that Januvia did wonders for her, and also read a lot of good information on the web.
I also read JennyB blogs, she is a T2 as well, and she started using januvia after she got burned out after years of 6-12-12 plan and insulin therapy that got her into hypoglycemic episode. I trust her, she did and still does lots of research on diabetes, and her site has lots of information.
http://www.phlaunt.com/diabetes/
The only drawback, that DPP-4 needed by every cell in our body, since it is supresses cancer, so who knows. OTOH, insulin therapy is also linked to cancer, go figure. Life is always a trade off, and only time will tell is this medication is the way to go.
best regards,
Dina

The phase two insulin response can last 2-3 hours but actually begins much sooner than that; within 60-70 minutes after eating. If it didn't, no T2 would see blood glucose declining at the 2 hour postprandial mark. This can be tested quite readily but taking blood sugar readings at 15 or 30 minute intervals from the time you begin eating to the time that blood sugars begin to decline.

it can be true for T2 with decent % of betta cells left, but in advanced diabetics, it can take much longer, and some will never see Bgs drop after a meal.
I have tested myself, and saw spike about 45 minutes after begining of meal, but I am donw to pre-meal numbers in general in 1.5hour-2 hours depending on amount of carb.
My MIL with poorly controlled T2 even on maninin (european sulfo) has to wait 4-5 for BGs to drop to pre-prandial level. You are correct about Phase II in well controlled T2 should begin after 20-30 minutes, while Phase I is generally 0-20 minutes. But Phase I can be delayed as far as 2 hours after begining of a meal, and even later than this. This can explain Bgs elevated Bgs for 4-5 hours after a carby meal, and even longer than this.
ETA: I need to correct myslef, I meant Phase II can be delayed, not Phase I. Phase one is indeed ready to use or immediately released insulin, and as short as 0-20 minutes, the second insulin release may take as long as 2 hours post-emal, depending on how great IR and how many betta cells remain.

Dina, phase 1 is the stored insulin that is relased in healthy, non-diabetic people within 2 minutes of the ingestion of food. There is no 'delay'; either you have it or you dont. This initial release of insulin is missing in most T2's.
Phase 2, OTOH, does kick in within 60-70 minutes (in healthy people within 30 minutes). The fact that it is not equally effective in all diabetics doesn't mean that it's delayed longer; only indicative of how much insulin that the pancreas is still capable of producing and/or how much insulin resistance is present. If blood glucose does not continue to rise past the 90 minute mark, chances are good that the phase 2 response occurred but was simply inadequate to do more than prevent further rise.



That does indeed indicate poor control. I'm very surprised her doctors were willing to accept elevated readings for 4-5 hours after eating; that would mean that the numbers were barely back into normal range (if they were at all) before the next meal. Readings like that indicate a) way too many carbs in the diet and/or b) a serious degree of undermedication

Dina,

I didn't quote your response. It is fantastic.

I do understand what you are saying about taking only Dr. B's advice and not considering other needs/desires and other experts. That is why we all collaborate on the net and listen and learn from each others real experience. I am fine with that. I too might have a long term issue with low carbs for life. I love fruit !!! One fruit and the 30g per day limit is blown right off the bat. I also did weight watchers and I am a lifetime member, but I haven't seen my goal weight in decades. But low carbs are helping me get the weight off again for now.

Finding anyone that believes you must have numbers under 100 is just about impossible too. I have a terrific Doctor who is willing to work with me and do what I ask with respect to supporting my control of diabetes. He also thougth numbers of 110-120 were fantastic. Well they are compared to 350-400, but certainly not long term. The ADA is certainly lacking in this area.

My Doctor last year said I have a warning for diabetes with a 127 fasting blood sugar and 6.6 A1c. From what I now understand that should have sounded an alarm !!

May I ask what your carb intake per day is?

I gather you are above the very restrictive 30 prescribed by Dr. B.

I do find days that I can do that but other days I am between 30-60 and on other days when I feel like having a fruit I will go all the way up to 100.

But I am definitely not consuming 100s of carbs anymore, which I was clearly doing prior to adjusting my lifestyle to get this diabetes under control.

I like what you say and have experienced with Januvia.

I will get back to you on this. It may be my next step as well. I need that assist. I cannot exercise every time I eat a meal.

I also spread my food over the day. My wife says I am constantly eating. Well, I like to have several small meals and that plays better to controlling diabetes as compared to the three big meals per day.

Also, Dr. B does talk about Januvia (page 204,205 of his new book) and is doing the same as so many to see if it helps after meals. From your experience it sounds like it does.

This may very well be the next drug I add to my protocol.

I will have to look at Metformin again based on what you said. It is interesting that extended release might have an issue with the liver but not the regular version ???



It also sounds like with Jaunuvai I may achieve the additional lowering and leveling of my blood sugar levels. I am doing well. I am happy. But I do believe the target should be mid 80s and from I gather so do you.

thanks,

Ralph

I have been to few Endo, and did lots of reading and search the net non-stop for 2 years upon Dx. At this point I still read about diabetes as much as I can: diet, medications, experience shating, etc. I have came across one interesting article, sort of history of diabets: before and after insulin. Someone said: all new is nothing but well forgotten old..
Low carb (mostly animal protein diet) was known long before, and despite adhering to this diet, many diabetics (probably T1 mostly) were dying like flies.
Diabetes is not very well understood desease, and not only it is linked to abuse of simple sugars and carbs in general, but also to adrenal, putitary and liver functions, and this can't be corrected just by diet alone. OTOH, eating less carbs will definetely minimize insulin and meds requirements.
I LOVE fruit too. I suffer if I can't eat at least 2 pieces a day: an apple is a must and depending on a season, something esle. The only fruit I don't like much is banana.
Life on protein and salad greens is not much fun, and many drs understand it. It has nothing to do with will power or being discipled, some ppl tolerate ketosis better than other, again, very individual. While one can strive on this diet, others (like myself) don't feel well. Not only it makes me deprived, it also affects my social life and family. I feel like outcast, especially when we travel and/or go out, social gathering, etc. I am tired of feeling like a criminal if I eat a piece of cooked carrot, or few cubes of potatoes in my soup, or when I eat fruit. Add to this that I am very good cook, enjoy cooking everything from scratch, and love variety of home cooked food daily. Food is a big part of our lives, and we just can't ignore it. I just got tired of living on protein and greens, eggs and cheese, and even when I was very strict, my BGs were far from perfect, especially FBG.


I have also read many times that fruit is mostly fructose (not the one from HFCS, the concentrated source) or not the same fructose sold as sweetener, but small amount that naturally found in fresh fruit, and has to be converted into glucose and glycogen by liver.Fruit does not upset my BG much, sweets and starches are bigger problem. Small apple is 16 g carbs only, apricot - 5 g each or even less, tomatoe- 5-6 g, etc. But fruit is yummy, especially Grany Smith apples, hairloom tomatoes, peaches, etc. I like berries, but just crave other seasonal fruit.if you eat it as a part of a meal, it is fine. Better than snack on fruit alone.
I think WW is not bad plan, I personally prefer variety over ability to eat high calories/larger meals even low carb.

I believe that normal range of non-diabetics Bgs is 70-120, for random test, and 60-100 for FBG.Enough said. If I would continue to stress seeing Bgs of 95 instead of 85, I will drive myslef to an early grave. Being Dx with diabetes was a huge shock to me, not obese, never a sugar addict, and this alone was enough to cause anxuety/depression, and feeling down. Striving for perfection is not a crime, if you want to dedicate your life to it.
I already said it once: a prostetic leg will never be functional as real one, same goes for having BGs of 83 around the clock. I will say no more.


I self-Dx with diabetes having H1C of 5.7% and FBG of 157, back in 2002. My dr. just shruged, and said: may be you ate something last night, LOL. Most of them don't want to declare me as diabetic, and my insurance refuses to pay for glucose strips, based on my humbers. But FBG 127 combined with H1C 6.6% I believe is consider diabetic. But again, fefw years back it was almost normal to be under 7%, then under 6%, last lab slip was H1C <5.8%... and the trend is towards even lower numbers. pretty soon, 90% of US population will be Dx with T2 diabetes, and consider the cost of strips and medications, it will be only beneficial to physicians and pharmaceutical companies. But it is worth to try to keep it in control, but for what I have heard and understood, it is OK to be under 100 for most of the time, and avoid most complications.


Ralph,
I am the same. Some days I eat less than others, depending on my mood, season (crave more fruits and veggies in summer), exercise level, etc. I think at 60-80 some days more like 100, but never 30 g anymore. I think Life Without Bread by Dr.Lutz, recommends 72 g, and this is allows you to have some fruit, lots of veggies, and feel great overall. I generally stay away from bread, grains, potaotes, and just eat lots of veggies, some fruit, some yugurt, and a little beans/legumes. if you eat small portions, you will stretch your carbs.


Even 100 g carbs a day from good sources is still low carb,LOL, consider that normal ppl eat about 250 g carbs, not to count soft drinks and desserts.


Exactly, why I decided on trying this medication. I just must exercise, and in order to exercise, I need carbs, or I have no energy. But OTOH, I can;t hop on elliptical after each meal, I do it once in the morning, then go for a 45 minutes walk after I eat lunch, and then some days lift weights. This is plenty, and I can't do more.


I am not so sure about it, I prefer 3 smaller meals to snacking. This is what I don't do, I don't snack. Constant eating triggers constant insulin reponse, and this is one thing I agree with Dr.B. I wait 4-5 hours between meals, besides, I am not hungry between meals. I eat very little now compare to when I ate less carbs, I was actually hungry and ate too much protein.


I don't have his latest book, I have the 1st edition, and ordered and read the 2nd edition, which I then sent back. I still think his plan is more taylored for T1, give or take, and I am not willing to toy with insulin at this point, just to get perfect number. I know every medication has side effects, short and long term, so no illusions here. But OTOH, at this point, I want to see better control, and if Januvia will drop my H1C to low 5% (last one was 5.8%), I will be very happy.

ER is slow released verison, coated so it does not get absorbed too quickly, to it cause less side effects. But on the other hand, it stays in the system longer, so as all ER versions of any medication, have bigger impact on liver.
I think metformin is good in terms of reducing inflamation, some recommend it as a longevity drug. I just have hard time to believe that any medication that affects liver function can make one live longer, LOL.

it is great to hear that you are happy, and this is what life should be all about: happiness and self-acceptance, I do think it is better to be in mid 80s, and I do everything in my power to achieve this goal, but if I can't achieve it by diet and exercise alone, I will continue to take medication. Ther are few new on the market, and they very promissing, including byetta, janumet, symlin, and januvia. These and I believe more meds around the corner. Something gotta work!
best regards.
Dina
P.S. Feel free to PM me, I feel like hijacking this forum, LOL.

Lisa,
She is not in US, but back in our home country where insulin is mostly reserved for T1 kids. This and even if avaible, lots of bad quality insulin, exparied, etc. On a top, she is afraid to use it ( I offered to buy here and FedEx it) and I suspect she is not compliant at all, but what can we do long distancez. She listens to her drs, that have the same approach to diabetic diet as ADA, and her FBG is never <200, and some days is even higher - 250-300, imagine how high she spikes after meals. Her H1C is around 11% now, but was as high as 14%. I tried to explain low carb diet, but her dr. said: big NO, it will kill you, your kidneys already leak protein ( which is true), and she can't tolerate sat. fat - it raises her BP. She is a big mess, and still refuses to drop carbs, not much we can do long distance either. I believe she must be on insulin, and not on sulfos, her pancrease is no longer capable of producing much of insulin, even if the dr. tells her than her insulin level is normal.