Just diagnosed, using meter, no meds yet

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Valiant Posted: Sun, Nov 1 2009 5:46 PM

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Hi, my name is Val and I am 52, just diagnosed last week. Will be seeing the Doc on Tuesday for med prescription. So for the weekend, I got a meter and have been testing to get used to it. I have only been eating fish and broth, but my numbers are still in the 200-400 levels. I have been on the computer googeling since last Thursday when diagnose. I go from depression to relief and back again. I feel this will put me on a healthier course in my life so in that it is a good thing. I am however, feeling overwhelmed about checking all the time and recording my results all day everyday.

I just wanted to introduce myself to the newly diagnosed board. I live in Denver and have three cats that I love. No children and already 3 years into menopause. 

Hope to meet new friends like me. Type 2 is what I have. My big brother has it and so does my mom. I am too overweight, but lost 25 pounds in the last month. Obviously the diabetes. Now I am hoping to drop the wieght just by my diabetic meal planning. 

Val

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Ron AKA replied on Sun, Nov 1 2009 6:44 PM

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Val, welcome to the forum. The article at the link below is getting a bit dated, but still is one of the best I have found on the various drugs used to treat type 2 diabetes. It is a little on the technical side, so if you want something simpler let me know and I should have something else.

Oral Agents in the Management of Type 2 Diabetes Mellitus

A common first drug for a type 2 especially if overweight is metformin. I believe it is a good drug, but you have to be patient and persistent to get it working properly. The doctor should start you on a low dose (like 500 mg), and have you on it for 2-3 weeks. If that is not enough to get your BG to good levels (140 two hours after meals, and less than 110 or ideally less than 100 before meals and fasting in the AM), then the dose should be increased by 500 mg every two to three weeks until you get there. Maximum dose is 2550 mg per day. If you increase the dose too fast GI upset can be disturbing! Some doctors will not take the time to see you every 2-3 weeks to determine if the dose should be increased. That is why you have to be persistent, and make sure you are seen until the dose is correct.

On eating I found the best source of information on what to eat can be found in a book called The New Glucose Revolution which is now in the 3rd edition. More information at the link below:

The Glycemic Index

The now have an edition specifically for diabetics but I bought a copy of it for a friend, and I think the original is better.

Hope that helps some in getting started. Feel free to ask question here. There are many well informed contributors.

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jen1229 replied on Sun, Nov 1 2009 8:34 PM

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Hi Val

Welocme to our boards.  When you se your doc you should ask for a referral to a nutritionist, preferably one who is a Certified Diabetes Educator (CDE).  This person will have specialized training in nutrition for diabetics.  She/he will help you to work the foods that you like into your meal plan.  For now, you should avoid white foods, like white rice, white bread and potatoes.  Opt instead for brown rice, and whole graisn whenever possible.  Exercise will help to bring those numbers down also, walking is good if you can.  I can't do walking and I belong to the Y so I swim laps and do a water fitness class three days a week. Hope this helps and try not to feel to badly.  Don't be surprised if once you get your Blood Sugar under control that you see some of that weight come back.  Weight loss is a symptom of diabetes as your body tries to rid itself of the excess sugar.

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Valiant replied on Sun, Nov 1 2009 11:02 PM

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I am 150 pounds overweight so after studying the meds out there since my diagnoses, I am going to ask my doc to put me on Janumet....Januvia and metaformin. Neither cause weight gain, and have the least side effects. I also am slated to see the nutritionist, podiatrist, opthamologist, and obgyn. I am usually my best advocate, so these appts I set up already. I go the the Colorado University Hospital, so everything is in the same place...and all of it is on computer so all doctors see what is going on, and what my history is. Very cutting edge care. I thank you guys for your support. I am all alone here, got divorced 4 years ago, and don't have a car anymore to get around. It is hard to make friends that way. sigh. Glad to have found you here.

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Spirit replied on Mon, Nov 2 2009 3:12 PM

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Val:  With the series of appointments you have scheduled, you are very much on top of diabeteic care and WAY ahead of the curve for most newly diagnosed diabetics.  Consider all of these medical resources your team and use them accordingly.  You want to also be sure to mention diabetes to your dentist at your next appointment, so he/she is up to speed as well on your care.  Also, consider your local pharmacist to be part of your team as well.  Pharmacists have a wealth of knowledge about prescription meds and over-the-counter remedies.  Before you buy cough medicine or cold tabs or any other OTC preparation, talk it over with the pharmacist (the RP, not the tech).  I have been given some excellent advice about good/bad effects of routine non-prescrition drugs by the pharmacist.  Most times they are very willing to come around the counter and review all of the choices with me.

I am glad to see you have a nutrionist (a Registered Dietitian, I presume) who will be working with you.  This should get you off to a good, healthy start.  As time goes on and you test frequently, you may refine and tweak parts of your meal plan to get the most benefit. 

And please don't forget that exercise can be a very potent tool in managing blood glucose results.  A brisk walk after my main meals of the day has been my "magic bullet" in shooting down high blood sugar levels. 

Welcome aboard.  Let us know how you are doing and if we can help in any way. 

Spirit

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Ron AKA replied on Mon, Nov 2 2009 6:31 PM

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"I am going to ask my doc to put me on Janumet....Januvia and metformin."

I don't know much about Januvia, but I'm sure others here have tried it. A combination drug is convenient and can have synergistic effects. Before you go to the doctor, you may want to check with the pharmacist about the cost of taking the Januvia and metformin separately. It could give you a little more flexibility to start with the full dose of Januvia (100 mg), and the minimum dose of metformin to avoid the metformin GI upset issue, and then work up from there every 2-3 weeks. You really don't want to get the infamous metformin quick step! 

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kat replied on Tue, Nov 3 2009 9:21 AM

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I don't know anything about Januvia.  Metformin, as I believe Ron mentioned, should be taken in graduated doses.  Aside from the "quick step" he mentions, there's also the sonorous bloat issue.  The ER (extended release) form of metformin seems to cause fewer of those GI issues than the regular version.

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Valiant replied on Tue, Nov 3 2009 11:47 AM

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Just got back from the Doc, she prescribed 1000 mgs XR of metaformin to take in the mornings. We are going to do that for 2 months, then see where we are at.

How does that sound?

Val

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Spirit replied on Tue, Nov 3 2009 12:42 PM

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Sounds excellent.  Metformin has been around for a long, long time and its effects have been well studied.  It is probably the most common first medication prescribed for diabetics.  Some people do experience gastric upset when first put on it, so that is something you should be aware of.  Also, it takes a while for it to show a true effect, so don't expect a radical and sudden change in your glucose numbers.  Keep a record of your food intake and the resultant glucose reading.  What you will be looking for is a trend (hopefully a downward one) rather than an abrupt plummet into lower ranges.  Sometimes people have unrealistic expectations of the effects of Metformin and can become very upset if they see a higher reading or two.  Everyone's glucose readings vary from time to time (even in non-diabetics), so single readings are less significant than overall patterns.  That can be a tough concept to grasp at first. 

Spirit 

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Ron AKA replied on Tue, Nov 3 2009 12:46 PM

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Valiant:

Just got back from the Doc, she prescribed 1000 mgs XR of metaformin to take in the mornings. We are going to do that for 2 months, then see where we are at. How does that sound?

I would agree that starting with the Januvia right away could be premature. Watch for the GI upset issue. It likely won't be an issue as you have the ER version. But if it is, go back for a lower dose. My view would be that you need to keep taking your BG readings. Ideally you want before and 2 hours after each meal and bedtime. You do not have to do that every day, but you should rotate times so that at the end of the week, you have some idea where you are at for each of these times. If after 3 weeks, your BG is not good (100-110 or less before meals and AM fasting, and less than 140 two hours after meals), then you should go back to the doc for an increase in metformin dose. Many make the mistake of just watching BG continue to be higher than it needs to be, instead of asking for an adjustment in dose. Waiting two months is too long in my view. If you eventually get to the max dose of metformin (2550 per day), and still do not have good BG, then ask again about Januvia.

Just my thoughts,

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Nelle replied on Thu, Nov 5 2009 2:05 PM

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Hi Val-

Good luck to you.  It is scary when you're first diagnosed.  My numbers fortunately were much better and I have been able to control with a strict low carb diet.  It's not easy giving up all the food I loved, and I do cheat once in awhile, but on a low-carb diet I easily lost 45 pounds and all my numbers improved.  Please go to this website: www.phlaunt.com  It is so helpful.  You can also google "Blood Sugar 101" to get there.  I wish I had seen this site earlier.  I thought I knew a lot about diabetes but this site really taught me a lot. I think it is extremely important that you read the pages on medications, diet, and self-testing, especially after meals.

Another thing you should do is get Dr. Bernstein's book "Diabetes Solution."  You will probably need to get it online.  Also, Dr. Bernstein has a website- the Bernstein Connection I think it's called.  Dr. Bernstein is a Type 1- one of the longest living type 1s because he stopped following the diet the ADA recommends and he was able to control his diabetes with diet, exercise and less insulin. 

Dr. Bernstein recommends the brand name Glucophage instead of the generic Metformin.  He said it makes a world of difference.  If you can get your insurance company to pay for it, try to get the Glucophage if your Dr. wants to put you on Metformin.  (And you might want to see about using the Glucophage ER- extended release).

If you eat more protein and fat, and less carbs, you will find you are not hungry and you will lose your craving for carbs.

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Nelle replied on Thu, Nov 5 2009 2:06 PM

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CORRECTION on the website- It's:

www.phlaunt.com/diabetes/index.php

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Ron AKA replied on Thu, Nov 5 2009 3:40 PM

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Be careful with Bernstein. Hate to start the low carb wars again, but my personal opinion is that Bernstein is a quack. Certainly the statement that there is a difference between generic metformin and Glucophage is false. There is a fair chance that the generic version comes off the same production line as the name brand. It is a common drug company practice after the patent rights to the drug expire.

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Spirit replied on Thu, Nov 5 2009 3:58 PM

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By law, the active ingredients in generics must be identical to the proprietary drug.  Except in the cases of people with allergies or Celiac disease who might react to the inert fillers, whether you take Metformin or Glucophage you are taking the identical drug.  To claim one is better than the other is nonsense. 

Spirit

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Nelle replied on Thu, Nov 5 2009 4:18 PM

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One might think so, but the results speak for themselves. Not to mention, I was taking a generic statin and even their list of adverse side effects and reported side effects were different from the brand.  So those inert fillers might have more of an effect than we think.  I was just passing along what I've heard from a diabetes expert.  If Metformin doesn't work well for someone, they might want to consider trying Glucophage.