[SCRN1]

I was just diagnosed two weeks ago with Type 2. The doctor started me off with Glucophage 1000 mg BID and Diovan 80 mg daily. My BP is fine, but the Diovan is supposed to protect my kidneys. My blood glucose has not come down (mid 200s fasting - almost 500) and was changed to Actoplus Met five days ago. Still no change.

My doctor said they are finding that by the time someone presents symptoms and is diagnosed with Diabetes, they have actually had it for about 7 years. I'm not sure how long my blood glucose has been elevated but I did check out of curiosity within the year and it was normal. I told my doctor this and from what I understood, he explained it could have just been because of fluctuation and I had checked it when it was lower, but the process of changes had already begun taking place.

No matter what I have tried eating and that I've been taking my meds as directed, I still cannot get it within normal range. I am to see the diabetic educator at my doctor's office this Friday and am hoping she will help me with figuring out what I should eat. I've been searching the net to see what I need...how many carbs/meal or day and such, but it is so hard to find anything cut & dry. Does anybody have any suggestions I could use until I see the educator?

I also work 3 12-hr night shifts per week. I'm finding that the nights I work are my better days as far as my blood sugar goes. But I can't work 7 nights/week. Also, I find it harder to work with my blood sugar elevated. I don't feel as focused as I used to and I get blurry vision. The nurses I work with are aware of my new diagnosis and they've been so helpful in checking behind me meds I draw up in syringes and if I'm really blurry, they'll start IVs for me if I need them to.

[Myxel67]

Originally Posted by SCRN1

I was just diagnosed two weeks ago with Type 2. The doctor started me off with Glucophage 1000 mg BID and Diovan 80 mg daily. My BP is fine, but the Diovan is supposed to protect my kidneys. My blood glucose has not come down (mid 200s fasting - almost 500) and was changed to Actoplus Met five days ago. Still no change.

My doctor said they are finding that by the time someone presents symptoms and is diagnosed with Diabetes, they have actually had it for about 7 years. I'm not sure how long my blood glucose has been elevated but I did check out of curiosity within the year and it was normal. I told my doctor this and from what I understood, he explained it could have just been because of fluctuation and I had checked it when it was lower, but the process of changes had already begun taking place.

No matter what I have tried eating and that I've been taking my meds as directed, I still cannot get it within normal range. I am to see the diabetic educator at my doctor's office this Friday and am hoping she will help me with figuring out what I should eat. I've been searching the net to see what I need...how many carbs/meal or day and such, but it is so hard to find anything cut & dry. Does anybody have any suggestions I could use until I see the educator?

I also work 3 12-hr night shifts per week. I'm finding that the nights I work are my better days as far as my blood sugar goes. But I can't work 7 nights/week. Also, I find it harder to work with my blood sugar elevated. I don't feel as focused as I used to and I get blurry vision. The nurses I work with are aware of my new diagnosis and they've been so helpful in checking behind me meds I draw up in syringes and if I'm really blurry, they'll start IVs for me if I need them to.

Find an aggressive endo quick! Oral diabetes meds won't touch the BG levels you have. You need insulin, and the sooner the better. Your Hemoglobin A1C could have been 12% or higher. The goal for good control is 6.5% or lower. PO meds can achieve only about a 2 point drop in the A1C. It takes insulin to get the kind of results you need. Your vision will improve when your BG control improves, so don't go out & get new glasses.

In annual checkups, usually only fasting BG is checked. 126 mg/dl is considered diabetes. A Hemoglobin A1C can tell you how good or bad BG control has been over past 2 to 3 months. Many people will have a good fasting BG, but cannot handle a large amount of carbs at one time. So FBG might be under 100, but if A1C is 6% or higher, this means after-meal BG levels have been high enough to push the A1C into the diabetic range.

Lifestyle changes are important, but without insulin, high BG levels can't usually be controlled. You need a combination of long, slow acting insulin (Lantus, Levemir, or NPH, plus rapid acting mealtime insulin (Novolog, Humalog, or Apidra). This does not necessarily mean that you will need insulin in the long term. Many people are able to switch to PO after good BG control is achieved. Your weight loss was due to your body's use of fat for energy since you were unable to use the carbs in your food for energy. Insulin resistance prevented effective use of your own insulin.

I am an RN and a Certified Diabetes Educator, and I work in a hospital based ADA accredited Diabetes Care Center . I also have type 2 diabetes. I hope that you will be able to find an endcrinologist who will be able to help you achieve good control sooner, rather than later. Most PCP's think they are capable of treating type 2 diabetes, but in my experience, they tend to undertreat and take much longer than necessary get good results. Make sure you go to a Board Certified endo.

Good luck with your education session on Friday. I would love to hear from you to see how you are doing.

[morte]

Originally Posted by jCLNC

I too have joined the ranks. My dad discovered his Type 2 Diabetes at the same age in his life that I have. I'm mirroring his progress, though I don't know that I ever heard him say that he lost the feeling in his feet.

I lost the ability to feel the hot. Still didn't do anything. About 2 or 3 years before that, I noticed the Plastic Wrap feel to the bottoms of my feet as I would get up in the mornings. My fastings were not bad at this time and my Internal Medicine MD is excellent. She was keeping an eye on me. So all told, I've really been a diabetic for about 8 or 9 years, only 3 with treatment. I wonder if I will ever get some of this feeling back in my feet. I've done a little research online, but nothing speaks to that point...it's just that part of it really bothers me.
jen

please check out brain.hastypastry.net/forums go to the peripheral neuropathy forum.....good luck......
p.s. the post prandial bs has been "gold standard" for at least a couple of years......and apparently peripheral neuropathy esp of feet can precede a dx of "frank" diabetes ......good luck
pps research benfotamine/benfotiamine

[suzy253]

Another RN recently diagnosed with Type II as well. I need to lose weight...in a major way! I've been on an emotional roller coaster lately in my personal life that I'm not eating right, certainly not 3 meals/day and not good choices either. Arrrggghhh

[SCRN1]

Originally Posted by Myxel67

Find an aggressive endo quick! Oral diabetes meds won't touch the BG levels you have. You need insulin, and the sooner the better. Your Hemoglobin A1C could have been 12% or higher. The goal for good control is 6.5% or lower. PO meds can achieve only about a 2 point drop in the A1C. It takes insulin to get the kind of results you need. Your vision will improve when your BG control improves, so don't go out & get new glasses.

In annual checkups, usually only fasting BG is checked. 126 mg/dl is considered diabetes. A Hemoglobin A1C can tell you how good or bad BG control has been over past 2 to 3 months. Many people will have a good fasting BG, but cannot handle a large amount of carbs at one time. So FBG might be under 100, but if A1C is 6% or higher, this means after-meal BG levels have been high enough to push the A1C into the diabetic range.

Lifestyle changes are important, but without insulin, high BG levels can't usually be controlled. You need a combination of long, slow acting insulin (Lantus, Levemir, or NPH, plus rapid acting mealtime insulin (Novolog, Humalog, or Apidra). This does not necessarily mean that you will need insulin in the long term. Many people are able to switch to PO after good BG control is achieved. Your weight loss was due to your body's use of fat for energy since you were unable to use the carbs in your food for energy. Insulin resistance prevented effective use of your own insulin.

I am an RN and a Certified Diabetes Educator, and I work in a hospital based ADA accredited Diabetes Care Center . I also have type 2 diabetes. I hope that you will be able to find an endcrinologist who will be able to help you achieve good control sooner, rather than later. Most PCP's think they are capable of treating type 2 diabetes, but in my experience, they tend to undertreat and take much longer than necessary get good results. Make sure you go to a Board Certified endo.

Good luck with your education session on Friday. I would love to hear from you to see how you are doing.

Thank you so much for the information. My visit went pretty well. She broke it down for me in a way it'll be easier to count what I'll need daily to eat and gave me a check off sheet to keep up with it. She also added to the other meds a couple of others. They are Glucotrol XL, Crestor & an aspirin a day. My triglycerides & LDL were high also. I have lost 5 lbs since last week. Yay! I just got back from the book store, where I bought 3 Diabetic cookbooks so I can find some things to eat so I won't get bored eating the same ole thing the same ole way all the time.

One thing that concerns me that neither she nor the doctor could explain is the ketones in my urine. She said that usually happens with Type 1. But she told me to continue testing my urine each day and if it continues through the next time I go back, they'll investigate it further. Got any ideas why?

[Myxel67]

Originally Posted by SCRN1

Thank you so much for the information. My visit went pretty well. She broke it down for me in a way it'll be easier to count what I'll need daily to eat and gave me a check off sheet to keep up with it. She also added to the other meds a couple of others. They are Glucotrol XL, Crestor & an aspirin a day. My triglycerides & LDL were high also. I have lost 5 lbs since last week. Yay! I just got back from the book store, where I bought 3 Diabetic cookbooks so I can find some things to eat so I won't get bored eating the same ole thing the same ole way all the time.

One thing that concerns me that neither she nor the doctor could explain is the ketones in my urine. She said that usually happens with Type 1. But she told me to continue testing my urine each day and if it continues through the next time I go back, they'll investigate it further. Got any ideas why?

I hope this gets through--it[s my third attempt.

You have urine ketones because your body is burning fat for energy. Happens in type 1 at glucose levels as low as 240, but can happen in type 2 at much higher BG levels--400's - 700's. I'm going to try to see if this will post. I wrote long message and did not go

[Myxel67]

Presence of urine ketones and weight loss indicates BG still very high Your body is burning fat because your insulin is not working well enough to allow you to use glucose from food for energy. Ketones are a byproduct of the incomplete burning of fat for energy. This can lead to DKA, even in type 2 DM if BG and ketone levels in blood are high enough. This is one of the reasons I think you need insulin now and that pills are not enough at this time

[Myxel67]

Glucotrol stimulates release of insulin from the pancreas. XL is a long acting form which can be taken once daily at about the same time everyday. However, as I said before, oral DM meds are not effective in cases where the BG is as high as yours.

If a person has an A1C of 6.5 or 7%, diet and exercise are aften sufficient to control BG. Diet and Oral meds work if A1C is 8.5% or so. When A1C is above 9%, insulin is usually needed--at least temporarily.

Diet can make a dramatic difference in AIC if person's diet was very high in carbs, including sweets, fruit juice, regular soda, and other sugary drinks. That person has a lot that can be cut out to reduce A1C. However, if carb intake was more moderate, diet would not produce such a dramatic drop in A1C. Ask your doctor for AIC result. Or have it done if he did not check it.

[Myxel67]

Even people without DM produce ketones if the amount of carbs in diet is severely reduced or eliminated. Since no carbs are available, the body burns fat and produces ketones. If the amt of carbs is too high, insulin production is stimulated & body uses carbs and stops burning fat. The is the basis of the Atkins Diet. Atkins dieters even use ketostix to check for urine ketones to ensure that carb intake is not high enough to stop ketone production. (Purple is good for these dieters). The resulting state of ketosis has been the medical community's chief criticism of the diet. Atkins held that this state of ketosis was not dangerous because BG levels were not high and the ketosis did not progress to DKA. He does recommend 8 glasses of water daily to help eliminate the ketones.

[SCRN1]

I know I said above mine has been ranging from 200 to almost 500 range. There have been several times the past week it was like 470-something to 498, but for the most part, it's been around 360-something a couple of hours after eating and around 302-306 fasting. With the ketones, could this mean that it's in the 400s more often than I realize, but just not catching it at that time since I don't check it right after eating or something? When I was first diagnosed three weeks ago today, my HgbA1C was 10.7.

I knew about the ketones with Atkins. Back in nursing school, I went on that diet and on the 7th day, one of my classmates said something about it to my clinical instructor...who just happened to be the one to do all the GU lectures. She blessed me out in front of the class about all the damage I could be doing to my kidneys and I went off that diet that very day and never did it again.

Over the years, my diet has probably been more carbs than protein. I really have a sweet tooth, especially with chooolate. But since finding out I'm diabetic, I haven't had any of those. It's kinda strange, but I haven't even missed or craved them lately. My drink of choice for years has been Diet Coke or coffee with Sweet 'n Low and skim milk and regular soft drinks are too sweet for me. The past three weeks, I've stuck pretty well with eating what's recommended on the ADA website.

When I go back to the NP next month, if there hasn't been any changes, I will request a referral to an endocrinologist. With our insurance, we have to have a referral or it won't pay for specialists. I know of an excellant endocrinologist who sees patients often at the hospital where I work and if I can ever catch her where she seems to have a few seconds, I might run all this by her and see what she says. I'm just not the type person to ask doctors questions about myself while at work. I'd like to see her as a patient if I get that referral.

Thank you for all your info!