3+ Medications Dropped: New Concerns
 

I developed gestational diabetes in 1987, had a heart attack in 1997, started low-carb in 2002, & had medications severely reduced by my (new) endocrinologist last Thursday. My goal has been to get off sulfonylurea & statin drugs & now that I have, my blood sugars have really increased. This morning, instead of my usual 75 or so, my reading was 120, with no changes in diet or exercise yesterday.

My blood pressure numbers remain excellent, but I'm really concerned about the blood sugar number. My A1C was 5.3, down from 8.3 two years ago. I have been on five medications for diabetes, high blood pressure & high cholesterol for nearly two decades & now I'm only on Actos (45 mg) & Tricor (54 mg) (Tricor was reduced by 2/3rds). I really can't believe I am able to drop Lipitor, Glyburid, & Vasotec just like that!

Should I go ahead and take a Glyburid tablet (or half of one) even though I was told to drop them?

120 is very good
 

If you realized how bad most Type II diabetics are in the morning, you wouldn't even bother to ask. Your doctor is worried about you bottoming out, and he/she is probably right. Don't take this stuff unless you got to.

BTW, mine runs about 120 in the morning as well. Other Type II have been happy with anything below 200 in the morning.

As long as you don't start going real high, I would stay away per doctor's orders. Believe me, they wouldn't have taken you off if they didn't think you could handle it. As your weight will continue to come down, you will see those numbers come down as well, which I am sure your doctor told you already.

BTW, great job on the control,

Later,
wsgts

Re: 120 is very good
 

Happy or not, that's way too high. Anybody's who happy with a reading of 200 at any time won't be happy very long unless he/she does something about it.

I raise an eyebrow any time mine is above 100, and I absolutely never have it above 110. Most of the time it's between 85 and 95. When my morning reading begins to be > 105 consistently (it does this now only occaisionally when I eat late at night) we go to Plan B.

Jim

So, Jim, what is your Plan B?

I cannot accept 120 in the morning; that's simply way too high for me to feel comfortable. As I said, I have already had a heart attack & I also have the beginnings of diabetic retinopathy, so tight control is crucial. Do I add an additional 15 minutes of exercise to my 35+ daily minutes? I already keep my carbs at 30 or below. Should I drop them to 20?

My doctor only gave me five minutes (& there were 25 people in the waiting room just for her!) so I didn't get a chance to ask questions. This was only my second visit with her (& the first was even shorter), so I will probably be looking for someone who will give me a little more time. (She billed my insurance company $1,066 for an initial visit & some blood & urine tests.)

My numbers were usually in the 70s in the mornings & to see 113 yesterday morning & 120 this morning really scares me. Did she take me off the sulfonylurea drugs too soon? I guess that is the real question I'm asking.

Don't say anybody
 

Jim I certainly was attempting to say that 200 was a good reading. Did you think I was? You know as well as I do people that frequent this board ask about fasting of 300 at times.

My point, althought ignored, was to give it a bit of time. We all know what dangerous level of BG are, and flucatuations after two days (113 and 120) of removing sulfonylureas are hardly worth adjusting medications without doctor's consultation in my opinion. Besides, if you are watching that meter so closely, you are seeing it move back down the scale.

Now, if it keeps heading up, I think it will be time to take action, and put in a call to the doctor.

Later,
wsgts

First an oral hypoglycemic like metformin. If that doesn't cut it, insulin.

Re: Don't say anybody
 

Yes. It sounded to me like you think it's acceptable. I don't. Ever.

My doctors won't put me on metformin because of my kidney numbers. If those numbers drop after I've been off the blood pressure medicine for a while, then that is definitely a possibility. My eye doctor says that insulin does damage to those with diabetic retinopathy & that I should stay off insulin at all costs, so I guess my only real choices are an even more stringent diet & additional exercise. Sure beats the alternatives. Thanks for the help Jim.

Since you've only been on lowered meds for a few days, you could be seeing some rebound increase as your body adjusts to having to work without the aid of medications.
While 113 and 120 are certainly a lot higher than your usual morning readings, they're not what most would consider "in the danger zone" just yet, especially for a diabetic. Although lower is certainly preferable, a few days of higher readings such as what you're having probably won't cause you any harm.
How do your blood sugars look the rest of the day? Are they staying in an acceptable range? If so, it could also be a bit of dawn phenomenon that was being masked previously by your medications.
Keep a close eye on those blood sugars and definitely let your doctor know if they start climbing higher or don't start decreasing in a week or two once your body should have adjusted to having to do the work itself. It's going to be even more important to be vigilant with what you eat now and adding some morning excercise may help with those higher morning readings since excercise increases insulin sensitivity and most people have decreased insulin sensitivity (to either your own insulin or insulin that you inject) during the morning hours.
Above all, try to relax. Stress and stress hormones can cause havoc with your blood sugars even if you are normally well-controlled. :)

Lisa, can you explain that? Seems counterintuitive to me. I should think it would be of benefit to those with retinopathy.

Jim...I did a brief internet search and couldn't find anything that supports that, but that doesn't mean it's not out there. I agree that it seems counterintuitive unless it's not actually the insulin itself that is doing the damage, but rather poorly controlled blood sugars which have been known for a very long time to contribute to diabetic retinopathy.

Lisa & Jim: I was in such shock last Sept. when my eye doc said that my eyes were showing signs of damage from many years of poor blood sugar control that I didn't ask questions. All he said was that I should get good control and to "stay off insulin." It was so frightening that I started my low-carb diet that day & haven't looked back. When I see him again in Sept. I will ask more questions.

Back to my earlier question: I just about demanded that I be taken off Lipitor (statin drug) & suggested that all my medications be reduced. When I got a 5.3 on my A1C, however, it was the doctor who told me to drop the glyburid. I haven't had a number below 100 since Thursday even though I've been very careful with carbs. So, if I have been AVERAGING 95.4 (that 5.3 x18) while on the glyburid, then obviously my A1C is going to go way up by the next test. Right? It was 6.0 in late February so if it's a 6.0 again I will just be put back on the medication that I want so badly to be off of. That is my fear.

I am probably stressing too much about all this. I've had such poor control all these years & now that I'm finally doing the right thing, I just don't want to lose the progress I've made. I'll give it a week or so before I panic. Thanks Lisa & Jim.

Oh goodness yes. Your numbers are actually *quite*nice! I wish mine were that good!! (Getting better, but still not as good as yours) Plus bear in mind, you could do three BG readings in a row and get 3 slightly different readings (within 10 mg/dl or .3 mmol), but they would still all be considered the 'same' reading. All that reading says is you are seeing 'dawn phenomenon'. Nothing to worry about. All of us have experienced it. Some folks have tried different things to thwart it a bit, such as not eating much for dinner (in case you have gatroparesis) and staying away from any carbs for the last meal of the day--to eating a pat of butter with cinnamon before retiring for the night! (Actually, oddly enough, that last one does seem to work for a number of folks according to posts I've read on this forum as well as some others).
I'd definitely stay away from the sulfonylureas. If you only knew how damaging they can be to your pancreas...
Your blood sugars are definitely not out of control. Yes, trying to keep them below 100 would be IDEAL and I congratulate the person(s) out there who can do it, but these things do take time. Just keep at it and be patient. Your cholesteral numbers will improve, as well as the BP readings too. But give it time. Some folks get nearly immediate improvement and are able to drop ALL medications within just a couple of months, some of us take longer. This is a LIFELONG plan designed to extend your life. So kick back and enjoy!
I was able to drop my sulfonylurea and now am only on glucophage XR. My next goal is to start weaning myself off the glucophage and the blood pressure medications. I told my doc NO on the statins (really scary side effects) and now my cholesteral dropped about 65 points in 9 months. So I know this works...

Not necessarily. The A1C is not an average of blood sugar readings. It's the percentage of red corpuscles which are glycosylated. The HbA1c makes it impossible for spikes and hypoglycemic episodes to fool the doctor (highs and lows may average out to a decent reading yet be doing considerable damage). My last HbA1C was 4.5% and at the time my two week average sugar was 93 mg/dl. I took it three times per day: early morning fasting, two hour postprandial after lunch and two hours after dinner.

It's an excellent measure of the tightness of control in addition to the degree of control.

Hi,

I wanted to address the comments about insulin being bad for those with retinopathy. This is absolutely FALSE. I read reuters health news every morning for news on diabetes. This morning (www.reutershealth.com) there was an article called, "One in four say "no way" to insulin shots: study."

Here is an excerpt.

Hispanics were more likely to believe falsely that taking insulin would cause more complications, with 72 percent reporting that they heard that insulin injections, not the diabetes itself, could cause blindness.

"This is an enormous myth," said Polonsky, who pointed out that it is easy to understand how some might make the association.

It goes on to say that because diabetes is "invisible," problems often emerge after patients start treatments and then they attribute the problems to the treatment rather than the years of poor control. Polonsky = Dr. William Polonsky, who presented the new information here at the American Diabetes Association's 63rd annual meeting.

-Deb