I think I mentioned on this site that I started to a new Internist who said he would work with me to keep my blood sugars between 80 and 100. He didn't exactly lie, but after three months my BGs are no better than when I was using Regular Insulin on my own, in fact they are worse. I was getting maybe 15 % of my readings in the 80s, more in the 90s. I have only had two readings under 90 in the last 6 weeks, a few more in the 90s. And today he proposed raising my Metformin ER dose to 2000 mgs a day. As I am typically between 98-115 Metformin is not going to do the trick. Nor will 16 units of Lantus Insulin once a day. I think I need 20 units of Lantus, and 3-5 units of Regular Insulin 2-3 times a day.

As I may have mentioned he had me taking 2000mgs of regular Met. and it brought back a raging session with GERD. My BGs were about 5 lower, but I went back to a lower dose Metformin ER from an older Rx I had. He assured me repeatedly today that Metformin cannot cause GERD. I also explained that because I was low carbing, I had to eat higher fat. He repeatedly assured me that this was not so. Am I dealing with someone who faked their medical exam, or is this part of the denial of those who listen to the ADA? My triglycerides are bouncing all over the place, from 300, 95, 300 again this week. He wants me to take niacin, I have no objection but realistically how much will niacin lower them? I think the high doses of Metformin may have lowered my Triglycerides.

I have low tryglycerides.

I never thought about Metformin ER lowering them.

Mine are like 60 from the last test.

I need to read more on that.

I have been thinking of stopping the Januvia and simply moving to a basil insulin as you have done.

My readings were ranging from 85-120 with an average of 110 and a A1C of 5.4 from last test.

But lately, they crept up. I have been lax with carbs going over my 60 carb limit. Well I have been trying to get closer to the 6-12-12 lately and the readings are coming down again. My average had gone all the way up to the 140s and now my running BG average is back down to 125, but it is not 110.

So something has changed. Initially, I thought it was the statins that my Doc put me on. Almost immediately after starting the statins my BG levels all went up. So I stopped the statins. It does take some time for them to completely flush out of your system. So I am watching closely.

But again, having Lantus in my arsenal of meds rather than Januvia may be the right way to go.

This way I can get the whole range of readings to be more consistent in the 80s-90s based on Lantus injection. From what I gather you do the injection once a day in the evening.

But do give the Metformin ER a try. I have had no issues with it.

I am at 2000mg per day, 1000 in the AM and a 1000 in the PM

Ralph

Rob, regular Metformin is well known for causing GI upset with the most common side effect being diarrhea, but gas, nausea, indigestion and stomach pain are part of the GI upset picture as well.
Metformin ER tends to not produce those symptoms as often as the regular. Regular did give me GI upset, but the ER didn't. That's not to say that the ER can't produce GI upset, it's just a lot less likely to.

I don't think your internist is recommending Niacin to you for it's glucose lowering effects but rather for its ability to decrease triglycerides and LDL while increasing HDL. If you do decide to add it, definitely look for the 'no flush' kind or you'll develop a new-found sympathy for what menopausal women go through with hot flashes. Your tri readings are very odd; it's not at all common to see them fluctuate so wildly on a low carb regimen. Other than carbs, alcohol and transfats can have an impact on triglyceride readings.
Also keep an eye on your blood glucose readings because some studies suggest that Niacin may increase blood glucose readings (note I said may, not absolutlely will) so if you notice no change in your readings or an increase, that would be the first thing I'd suspect.

Re low carb and lower fat, I suspect your internist is a fan of Agatson and South Beach which is a lower fat (but higher carb) plan. If you follow Bernstein or Atkins, your percentage of calories coming from fat are going to be higher than South Beach without a doubt. OTOH, that doesn't mean you can't tweak the percentages on what you're currently doing in respect to percentage of calories from protein and fat and see what effect it has on your readings if you're so inclined.

About niacin:
I take it to increase HDL-1000 mg a day of regular
flushface niacin works fine for me.No flush niacin
was worthless for me however everyone is different.
About Januvia:
Studies show minimal improvement on FBG and
A1C.Got that bit of information from www.rxlist.com.
About your doctor:
Remember you are the boss.
Cheers
Eddie

Thank all - your comments are really helpful.

Actually I think my Internist prefers people to follow the ADA recommendations

Well that answers it all.

So A1C of 7.0 or less is fine with him.

As long as he works with you it doesn't matter.

I want to see my A1C get below 5.0.

I need to do my part too and stay low carb and also drop more weight.

My target for 2008 is to drop another 30 pounds as I did in 2007.

Ralph

Rob, I just read what your NEW DR. said about Metformin does not cause Gerd, WRONG, the side effects say it, the trails showed it, and I landed in the Hospital for 5 days 3 yrs ago. I had Lactic Acidosis from the Met. They said very quietly it was most likely the medicine, but we will never know. But to never take it again. It took month's to get better. My colon is Probably never going to be right. I started out with gerd, Diarreha for a month, cramping, then blood, and I colapsed. It was quite scary. He is ADA brain washed! Debbie

Debbie - thanks for the reply. You may have cleared up a mystery. Jenny on her site looked and said there was not peer referrede(sp) study, the extended label probably does have it listed. I think I through my copy away. My optho thinks he has found me a endo who likes very low carb and readings 80-100. Rob

Dr. Davis says the no flush niacin is worthless.
http://heartscanblog.blogspot.com/2...oesnt-work.html

"Dr. Davis says the no flush niacin is worthless."
I agree with a doctor for a change.
If you can tolerate the flush,regular niacin works
wonders.
I like the flush-sort of like an orgasm in the face.
Eddie

Wow.

I think I will try the niacin.

1000mg I believe was mentioned as a good dose per day.

My poor wife suffers from menopause and it has been going on for years. That is the way it is for woman in her family.

I watch her as the sweat just suddenly starts to pour down her face while she is sitting there at the table.

I don't mind being warm though.

So I will try it. At minimum she will get a chuckle out of it if I have induced my own version of menopause.

The cause is good. Higher HDL and lower LDL, but within the LDL what are we lowering? I have read up on it a bit; but not enough. The small LDL particles are the danger. The large LDL particles are benign at the worst.

I wonder is this is why there is such controversy about Zetia that recently showed up in the news last week. Yes it lowers cholesterol and yes it reduces LDL, but the study that was broadcast stated that it did not help reduce the risk of cardio vascular disease and that in fact plaque build-up increased. Perhaps, and I don't know for sure, Zetia is reducing the large particle LDL and not doing anything to small particle LDL resulting in a more dangerous mix of cholesterol components.

Got to snoop around more on this.

Ralph

You crack me up Eddie! Interesting analogy! I for one, did NOT like the feeling of the niacin. One dose and that was it for me...no more! I guess it must be a personal thing!

Had a boss end up in emergency due to niacin... Don't take it without your doctor's advice!

"My poor wife suffers from menopause and it has been going on for years. That is the way it is for woman in her family."
Ralph
Jarrow Estro-G has gone a long way towards getting rid of my wife's menopause symptoms-
started working in a couple of days.
Might be worth a try.
Eddie

I will look into it.

She has tried all kinds of "alternate" treatments, but to no avail.

This sounds familiar, but...

Thanks,

Ralph