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    Medformin and alpha lipoic acid
    stevewwp posted:
    Hi Dr Dansinger I guess I ought to be alarmed or ashame. My A1C has been between 8 and 10 for the last couple of years. Ironically, I have been spared all the symptoms. My podiatric checks showed perfectly normal responses. My retina scans were normal so much so that the eye specialist commented "for someone with a 10 history of diabetes, you must be controlling your BG very well". Sadly, I don't really make enough effort. My weight has been stable and my BMI (24) is borderline between normal and overweight. I have normal blood pressure. My cholesterol scores are normal for all the indicators. A few years ago, I had tingling sensations in my hands but they stopped after I took some liquid L-carnitine without consulting my doctor. For a 56year old, my skin is wrinkle-free. I am presently on Medformin (850mg) morning & evening and diamicron (80mg) for breakfast & lunch. Now I have started taking alpha lipoic acid which some websites say is good for reversing the bad effects of diabetes. So, the questions are : - is ALA really good for diabetics? - is it true that Medformin has anti-aging side effects? - if my present medications are not effective, what other options should I take short of insulin jabs? I am asking this question here because my doctor seems reluctant to prescribe anything else. Will appreciate yr advice, Steve
    nutrijoy responded:
    My A1C has been between 8 and 10 for the last couple of years. Ironically, I have been spared all the symptoms...

    It really sounds like you have been incredibly lucky but if your A1c levels have been in the 8 to 10 range for the past few years, it is a clear indication that your diabetes is NOT under control. If you continue to wait until symptoms actually develop, it may be much too late to avert the insidious damage that diabetes causes to internal organs including the eyes and blood vessel walls. Nephropathy (kidney damage), for example, is generally NOT reversible and by the time that symptoms are actually noticeable, you could become a candidate for dialysis or a kidney transplant. Most of the damage that diabetes causes is insidious meaning that the damage takes place silently without producing any outward, physical symptoms "026 until it is often too late. The fact that you have been spared from complications thus far only means that you have been incredibly lucky. Nutritional supplements can provide a temporary buffer but are useful only as an adjunct to an overall treatment program. However, your A1c results clearly indicate that your current treatment regimen has been inadequate in controlling your diabetes. A reasonably healthy A1c should be in the <5,9 range and not the 8 to 10 that you have reported.

    You need to check with your doctor for other options than what you are currently using to get your blood sugar levels lower. You need to set a goal of getting your fasting blood glucose readings (upon arising) under 100 and your post-prandial (after meals) readings under 140 (you do test with a meter, don't you?). That should bring your A1c readings into the more desirable <5.9 range and hopefully prevent or at least postpone the dreaded complications of diabetes from developing.

    I can't provide a medical recommendation but can state a personal opinion: if it were me (with elevated A1c results in the >6,0 range), I would be requesting a Rx from my doctor to go on insulin as a means of getting better control over my elevated blood sugar levels; especially if your oral meds have not produced better results than what you have reported. However, that is strictly a personal decision because I know that insulin works, plain and simple. In my own personal situation, I am a type 1.5 (my beta cells produce an insufficient amount of insulin to offset my blood glucose levels and no oral medication is going to change that). By using insulin in combination with major dietary modifications and a fairly active (daily) exercise regimen, my own A1c levels have been in the 5.2 to 5.3 range for the past two years. BTW, I do supplement with alpha lipoic acid as a safeguard against neuropathy and blood vessel damage but it is in addition to and not as a substitute for a successful diabetes treatment program (as previously mentioned, one that includes insulin, dietary changes and exercise).
    auriga1 responded:
    Steve, absolutely agree with Ms. NutriJoy. You need to do something aggresive with that A1C. An A1C of 8-10 means that on average your blood sugars have been running from 180 to 250.

    You're taking risks with your own health. Metformin does not bring your BS down if you eat too many carbs. What it does is help your body utilize the insulin in your body.

    Rather than reverse the bad side effects of the diabetes, it would be best to MANAGE your diabetes so you don't have to worry about such things.

    What has your physician said about your A1C? "I guess I ought to be alarmed or ashamed" is being said because you think it's bad or someone has said something to you? No bones about it, but that is called "uncontrolled" diabetes.

    I can't figure out why you are not concerned enough to help yourself bring it down. Are you eating properly? Do you exercise?

    There are other medications which can be taken in conjunction with metformin to help bring your glucose numbers down. If your doctor can't help, maybe you might think of changing physicians.

    Right now, things may be "fine" with no bad side effects, but this will catch up with you sooner or later with numbers like you have been running.

    Your present medication is not effective. We don't know if you eat properly by watching your carbs and if you exercise.

    Steve, I was started on insulin at diagnosis because I had "uncontrolled" diabetes with an A1C of 13.2. I still have to count my carbs diligently and stay active. Using insulin or any other medication does not give you the opportunity to eat anything and everything you want.

    Would you rather have anti-aging effects or bring your BS numbers under control? Sounds harsh, but that is the last thing that would have ever entered my mind. As an aside, if metformin does have anti-aging effects, it's cheaper than many of the anti-aging creams out on the market.
    Michael Dansinger, MD responded:
    Dear Steve,
    Thank you for your questions about how to treat your diabetes. As you indicated, your A1c in the 8 to 10 range puts you at high risk for complications such as damage to the retina, kidneys, nerves, and arteries. Blindness, kidney dialysis, limb loss and lethal heart attacks often occur in patients who allow their a1c's to remain at those levels for prolonged periods of time. You have been taking metformin and diamicron, but in most cases, doctors would also recommend additional medications such as insulin shots to bring the A1c to 7% if lifestyle changes cannot get you there.

    In patients with type 2 diabetes who are not particularly overweight, we usually find low insulin levels. This indicates that the beta cells of the pancreas are making very little insulin and therefore the treatment of choice is typically insulin shots (or pump). I am not in a position to offer specific medical advice, but your doctor's recommendation of insulin shots certainly fits with what I would expect.

    I am a strong proponent of lifestyle change (ambitious eating and exercise strategy) to push the A1c as low as possible

    Here is a link to my blog post about the role of medications in type 2 diabetes:

    The supplements you mention are not really proven to make a difference. That does not mean they have no role, but we have convincing scientific evidence that pushing your A1c to 7% with prescription drugs including insulin can reduce the risk of complications and possibly increase survival, compared to leaving your A1c where it is.

    Ultimately, it is always best to discuss these issues with your doctor, and if you feel like communication with your current doctor is not so good, then I encourage you to either address that issue or find a doctor with whom you feel comfortable. In my view there is too much at stake to leave your A1c in the high range any longer.

    Thanks again for your important questions.

    Michael Dansinger, MD
    stevewwp replied to Michael Dansinger, MD's response:
    Thank you everyone for your advice.

    Will look into initiating insulin treatment.
    Just for info, since my onset of diabetes 15 years ago, I have
    not experienced more than 3 hypoglycemic condition; lowest ever BGL was 3.8 (68).
    I exercise quite regularly and intensively for about an hour 3-4 times a week without feeling fatigue. These workouts include threadmill for about 30min and weights.

    Could insulin treatment lead to hypoglycemia ?
    Do I have to change my exercise regime, ie,to less intensive?

    Thanks again.
    nutrijoy replied to stevewwp's response:
    Insulin, diet, and exercise are all intertwined in terms of their effect on your blood glucose levels. All three factors have a direct cause-and-effect impact on your BG levels. A higher level of exercise will have a tendency to lower your BGL but instead of changing your exercise regimen, you would simply reduce your insulin dose. It is going to take a lot of trial and error (i.e.experimentation) to get everything just right as each of us is somewhat different in terms of our metabolisms. I would recommend that you adhere to the law of small numbers and simply reduce your insulin dosages preceding the hours prior to your exercise routines. Then test your BGL about an hour after completing your exercise routines. If your BGL is still elevated, you can always add an additional dose of insulin as needed. If they are lower than normal (e.g., <75), you can eat something to raise it back up but it may take a bit of experimenting to determine what and how much carb you will need.

    You will have to determine (via trial and testing) how your own body reacts to insulin. In my body, for example, a single unit of regular insulin will lower my BGL approximately 25 points overall. In contrast, a single gram of glucose (carb) will raise my BGL approximately 5 points. I am able to obtain fairly tight control by balancing my carb intake with my insulin dosage(s). Depending upon your own body ratio/distribution of fat to muscle, your own results will differ and only via multiple or frequent trials and testing (and keeping logs of the results, at least initially) will you eventually determine the best formula for you to follow.

    One word of caution: over-correcting a temporary hypo is very common so be cautious about ingesting too much glucose/carb-containing foods to counter a temporary low. Fruit and fruit juices often result in over correction and may kick your BGL higher than intended so should be avoided. Instead, keep a supply of glucose tablets on hand (e.g., a single 5gm glucose tablet will usually boost my BGL up 25 points and is a quantifiable measurement that I can rely on but the effect on your own BGL could very well be different from mine). Rule of thumb: when starting on insulin, use your meter and test often until you establish a reasonable history of cause and effect. Your doctor or diabetes support team should be able to provide guidance in this area.
    auriga1 replied to stevewwp's response:
    Steve, is your doctor suggesting insulin therapy?

    I do applaud you for your exercise initiative. That's wonderful.

    For me, insulin was the best thing my doctors ever did for me. My current A1C is 5.8. Each diabetic who uses insulin is different in what therapy would be most effective for them.

    Doctors do have a tendency to start out on the conservative side until they see what will actually work for you. You still need to maintain good eating habits and of course, stick with your exercise.

    The main drawback with insulin is the hypoglycemia that often occurs. Each individual has to work out (as NutriJoy says) what will be beneficial for them. It truly is an exercise in mathematics each and every day.

    I take two insulins daily, one is the basal (background) which works for 24 hours. The other is a rapid-acting, which is taken with meals to cover the amount of carbs I eat. If I need a correction factor, those units are included. By correction factor, I mean is if my BS is 121-160 before I eat my meal I need to take an extra unit of insulin along with the units I need to cover the carbs I eat. As I stated previously, everyone is different. I very rarely need to take a correction factor.

    With insulin, diet and exercise you will have to determine how to work with all three. It will depend on what your doctor prescribes for you and the dosage amount.

    I had the same questions as you when I started insulin. My dosages have been lowered when exercise and ingestion of less carbs proved beneficial for me.

    NutriJoy has the right of it. Don't lessen the exercise intensity, just the dosage of insulin.
    stevewwp replied to auriga1's response:
    One other fact I did not disclose. My father was diabetic and passed away at the age of 71 from heart failure.
    My 3 siblings are also diabetic.
    Would genetic factors make it much harder to bring down the A1c ?

    Thanks so far for sharing these valuable insights.
    rfbeta replied to Michael Dansinger, MD's response:
    I do keep a good diet the most i can: no sugar added at all, high quality carbs most of the time and lots of exercise (4 times a week or more).
    But just to make sure, I'm not diabetic and hopefully will never be. My aunt is and she takes good care of herself. My mother is pre-diabetic and also keep it from progressing.

    In my case, i wake up with sugar level just above or just below the top end of the range (100). At one point i did a very extensive analysis trying to figure how bad my condition was. I measure my sugar blood level after a good sample of meals during about a year and put it all in a spreadsheet (i really needed to see how my body was doing).

    I was almost 100% ok before and after every meal with the exception of the fasting blood glucose levels. I also notice that the situation was even worse (higher reading) on mornings after i had a late -8pm or later- and/or heavy dinner.
    Incidentally, 2 or 3 drinks the night before improve my chances of a good morning reading for reasons that now are obvious to me.

    My main question is: I would like to know how directly related are high levels of fasting glucose to ultimately becoming diabetic? and if i should expect the these levels to raise over time even if i keep a good dose of healthy eating and exercising?
    stevewwp replied to Michael Dansinger, MD's response:
    Dear Michael :

    Two months back, I saw another doctor who prescribed 3 x metformin 850mg (one with each meal) and 2xdiamicron MR 30mg at breakfast, but no insulin.

    I am pleased to report that my A1c has gone down to 7.7% from 9% since. A health check also showed no problem with my kidneys or liver. However, my cholesterol is slightly elevated at 5.5 so I am now on statins (1xsimvastatin 10mg daily).

    Is it true that cholesterol and A1c levels are linked, so if one goes up/down so does the other?


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