Hello, I have been a type 2 diabetic since about 2006 and have never gotten the hang of it. My A1C is 7.9 and I really would like to see it at 6.0 or so. I am taking Januvia 100mg and Amaryl 4mg. I have taken the Januvia for about 3 years now and just recently, about a month began the Amaryl. My blood sugar has a tendency to be high about 165-180 fasting and when I eat it spikes up to 250-300. I get really tired during those spikes and can sometimes go into what my family calls a sugar coma where I cannot wake from till my body decides to. It's usually 2-4 hours. And the sleep is not restful at all. i take my meds like I am suppose to. I assume it is the diet and exercise that needs attention. Help and advice would be appreciated. Thanks
Elevated blood sugars cause damage to virtually every cell in your body and it often does the damage without the afflicted person feeling any physical symptoms. The damage is done by a process known as glycation or non-enzymatic glycosylation whereby a sugar molecule bonds to a protein or lipid molecule. The protein can be anything from an RBC to a cell in a blood vessel, nerve, kidney, heart, eye or some other precious body protein (or fat cell). Once glycated, for all intents and purposes, that particular cell is rendered useless to the body. With RBCs, they will die off in 90 to 120 days and be replaced with new ones. In the case of body tissues, the damage is more permanent and it is also cumulative. If you have been uncontrolled for over six years, you could become a candidate for complications that include neuropathy (painful nerve damage), nephropathy (kidney damage/failure), circulatory damage (possibly leading to amputation of a toe or worse), blood vessel wall damage (atherosclerosis and cardiac-related disease), retinal damage (which could lead to impaired vision and/or blindness) and a whole lot of other potential issues.
I am not trying to frighten you; these are established facts but are often ignored or dismissed by too many diabetic patients because they don't "feel" the damage or experience physical symptoms ... until it is too late. Based on your post, you need to make some serious lifestyle changes in your diet and activity levels. For starters, eliminate all processed foods from your diet for a minimum period of 30 days (i.e., anything that comes pre-packaged in a box, can or bag ... except perhaps, for coffee, tea, soup stock and spices). Also eliminate all grains, whole or otherwise, including corn (which is a grain) and all starchy vegetables including anything that grows below ground level. Avoid most fruit during this adjustment period and stick with cruciferous and green leafy vegetables. Fish, poultry, pork and eggs are permitted but avoid most dairy until after you have achieved reasonable balance. Keep your total carb intake to 20 grams or less per meal (maximum of sixty grams per calendar day and that includes the carbs in veggies). You will also need to incorporate at least an hour (60 minutes) of exercise into your daily routine. If you can't manage a full hour in one session, split it up into two or three such as a brisk after-meal twenty minute walk three times a day (every day).
You may want to also consult with your doctor about the possibility of adding insulin to your regimen on a temporary basis until you can bring your blood glucose levels under control. For example, your fasting blood glucose level exceeds my own personal maximum after a meal. My current A1c is 4.9 and I have successfully lowered my finger stick tests (taken four times a day) to an overall average of 82 during the past month. There's lots more to say but I don't want to write you a book. This should do for starters and I'm sure others with chime in with lots of additional tips. Good luck.
Thank you. That is very helpful. Yes I do experience some of those complication to a minimum and am hoping to get this under control before it gets worse. I think I will look more into a specialist in this area and see if with their help I can get things more manageable.
Because of your extremely high (to me) levels, you will need to undergo what knowledgeable dieticians refer to as a period of "carb detox" where ALL refined carbohydrates are removed from your diet for a minimum period of 30 days (some dieticians who are diabetic themselves recommend a period of 60 days). That means during the detox period, you omit all starchy and processed foods from your menu and stick only to veggies, eggs and meat (but not red meats). Some patients have gotten reasonably good results by going with a Paleo diet (if you're not familiar with the term, just type it into your favorite search engine).
Always bear in mind that the damage that elevated blood sugars are doing to your body's precious proteins are cumulative and by the time that more serious symptoms actually manifest themselves, it is often too late. Your "sugar comas" are a waving red flag that you are already on the precipice. Whatever you do, don't procrastinate. The eyesight, kidney or blood vessel walls that you preserve are your own. Do get additional professional help as required but your diet is something that you can start with immediately on your own. One well known maverick endocrinologist told me that 90% of his patients use some form of insulin. Some on a temporary basis, others more permanently and insulin might hold the key for you also. The key focus is to lower your blood sugar levels and get them into balance and that should be below 6.0 (not the 7.0 that the ADA promotes). Continuing with high blood sugar levels over an extended period of time really amounts to what I call "slow-motion suicide" because that will be the bottom line net effect. FYI, I am a veteran of neuropathy anomalies including foot drop syndrome. I corrected them within a six month period, have been 100% free of any complications since, and my A1c levels have been dropping ever so gradually over the past couple of years (currently at 4.9 and projected to go even lower at my next appointment based on finger prick results).
You do need some help because those sugars are too high. You know that. Otherwise you wouldn't have posted here.
My sugars were worse than yours and I understand that tired feeling. So tired, I was falling over, sleeping sitting up, etc.
It took a bit for me to get my A1C down from 13.2 to 5.7. It requires diligence at all times of the day, except for sleeping.
Carbs are needed for fuel by the body, but as diabetics, many of us can't handle a lot at one time. My body can't handle them at all. I need insulin after every meal so my sugars won't spike. I also take a basal insulin in the a.m. because my fastings were always 250 and above. Forget the 2-hr post-prandial. Usually between 300 and 450.
The insulin usage is based on the amount of carbs I eat per meal. I try to keep the carb intake below 35 per meal even though my dietician recommended 35-45. I don't want to eat that many.
If you can, please get active. Just active. Does not entail a gym or any such thing. I have a new part-time job where I am on my feet and moving for three hours straight. When I eat at work, I don't even need my insulin because my activity level keeps my sugar from spiking.
Seriously, the key is to watch that carb intake diligently and keep active every day. You see Dr. Dansinger's column to the right "Featuring Experts?" He proposes 7 1/2 hours of exercise per week to help keep blood sugars within normal range. This goes without saying that you watch your carb intake, too.
Meds won't work unless you watch what you eat. There are many that think they can eat anything and just take their insulin to cover those carbs. It works in lowering their blood sugar, but if those carbs aren't burned off, weight gain is inevitable. No one wants that.
I agree with NurtiJoy; try and get your A1C below 6.0. Good luck to you. If I can do it, certainly anyone can do it.
DISCLAIMER: I am not a Doctor; I am a "Long Term" Type 1 Diabetic. Upon being diagnosed Type 1 at the age of 26, I was told I could expect to see my 35th birthday. I asked my primary care Physician just how aggressively we could treat my condition. This was a conversation when treatment for Type 1 included glass syringes, 25 gage needles, Pork or Beef insulin and a lot of guessing. Until the advent of Humalog and Lispro Insulin, several years after plastic syringes for one-time use became available, and later, home testing equipment, and patience"026I became quite discouraged. However, the treatment went on to include "Sliding Scale" insulin adjustments. What a difference! By the way, I turned 70 near the beginning of 2012.
There are some similarities between Type 1 and Type 2; however, it is my observation that Type 1 is actually easier [now> to control than Type 2. My observation of friends with both types tells me that Type 2 diabetics have fluctuating insulin production by their own pancreas, which makes their blood sugar go out of bounds for no apparent reason.
You mentioned that as a Type 2 Diabetic, "My A1C is 7.9 and I really would like to see it at 6.0 or so" and "My blood sugar has a tendency to be high about 165-180 fasting and when I eat it spikes up to 250-300." You, most likely, understand that treatment for any type of Diabetes is a 3-way balancing act.[br>[br> 1. Diet, your Body Mass Index, and food utilization. 2. Insulin and/or Oral Medication. 3. Exercise.
The criteria for controlling Diabetes should come from your Diabetic Educator, Primary Care Physician, and your personal observations. Make it a team effort. While I cannot tell you perfect control is possible, your diligence will enhance your future lifestyle. Keep working on the balance.
My last A1C was 7.1 and I gradually moved it from 6.0 at my primary care Physicians request. He told me that studies have shown that the move to 7.0 actually enhances general health. It appears that this has made a positive change in my health.
I volunteer Childcare a few hours a week for three groups of Parents. That is what helps make my day brighter, happier and gives me more joy than I can give the children. I have several handicaps including, Diabetes, COPD and Arthritis. The children do not seem to mind at all. I am usually in a rocking chair with one or two children that exhibit separation anxiety, they may want books read to them, or want to make up funny stories with you.
For me, the Childcare helps me balance out the exercise needs. This may not be perfect; however, it is much better than vegetating in front of a TV all day.
One more thing; it will be a great advantage, if you keep a daily Journal and record just before and two hours after meal, and just before going to sleep at night. When your bedtime blood sugar is in the range of your sliding scale, you should use only one-half the recommended additional insulin. This will bring your blood sugar level approximately to normal upon waking in the morning. I know this may seem tedious; however, your results will please you. Once you have made it a part of your lifestyle you will hardly notice the change in your daily routine.
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