When Doctors Put Type Two Diabetics on Medications

[sweetdebbie628]

My glucose level one hour after dinner was 260.  At two hours after dinner, it was 222 (I know, I know....I shouldn't have had the pizza and popcorn).
My fastings have been recently up to 118.
Should I be on medication?

What levels do most doctors look at when determining to put their patients on medications?

I was dxed via the O.G.T.T. going on 11 years ago (I was not pregnant...it was ordered after a routine physical found my fasting at 113).  Those results were:  fasting 97, 1/2 hr. 220, 1 hr 218, 2 hrs 219, 3 hrs 115.  I've lost 30 pounds and kept them off since then and have experienced normal levels (fastings around 97, and under 140 most of the time, sometimes over 200 depending on what I ate, and most a1c's in the 5's).  Over the past 6 mos, I've had fastings up to 118.  I'll be going in for a new a1c and other bloodwork soon.  My last a1c in July was 6.1%.

Advice would be appreciated.

Thanks,
Debbie

[sweetdebbie628]

Hi All,
Just wanted to give an update.  My appointment went well.  The lab reported the highest fasting it has at 115.  My a1c went slightly down to 5.94%.  My doctor was happy with all & eventhough I told her about that 260 an hour after pizza, she told me I was doing well/not to worry about it.  That the 260 was reminding me that I was diabetic.  She didn't think I needed meds at this time.

I've been eating more protein and fat, but my cholesterol levels were good, too!  Total was 156, my trigs were 83, ldl was 54, and my hdl was 85!  Wow!  It's usually a little low...never been this high!    So all in all, things went well.

But....my doctor gave me the news that she will be leaving the area.  Now I need to find a new doctor.  I wonder if I'll like him/her or if she/he will be a good one.  I'm also hoping my doctor wasn't seeing my glucose levels lightly since she won't be my doctor much longer.  Guess I'll find out if my new doctor has more stringent goals for me.

Thanks for replying to my post.  I'm trying to do more low-carb.  My fastings have gone down some....I was 106 yesterday.

Have a great weekend!

---Deb.

[sweetdebbie628]

Thanks again, Sally.

Below 5  would be "normal?"  Like I asked before, I'd think that would be kind of low?  The labs report 6% as "normal," but I know less than 6% is better for us.

I think I've had too many spikes along the way.  I've heard too many times, well, if it goes up high, as long as it goes back under 140 at two hours, you're doing ok.

I like your fire analogy!  And I know, if my levels warrant the meds, I'll go along with it.  Especially since I've read or heard of stories of people who had more or less normal levels, weren't on meds, then kind of went to their old habits, and ended up with heart attacks. Scarey!

In fact, my aunt was on insulin with type two diabetes.  Kind of like me, she was on diet/exercise for 10 years,  but then she had to have a hysterectomy and her glucose went up and was put on insulin soon afterwards.  Sadly, she died of a heart attack at 65.

Then her daughter, my cousin (who was never over-weight, by the way) began to have some problems with her glucose levels in her 40's.  Her doctor was "watching it."  She had a heart attack at 44, then she was put on Glucophage sometime later, and  unfortunately, 3 or 5 months after starting the meds, she had her second heart attack and died at 46 years of age.

This should help me get out of denial.  But it's easy to tell oneself "it won't happen to me."

I'll have to check out that book "Diabetes Solution."  Thank you for suggesting it.  I did read Gretchen Becker's book "Diabetes, the First Year."  That is a really good book, too.  I've read a few other books and have been looking around the internet for information, too.  I prefer the books, since I can read them at my leisure and make notes here and there and go back and read it again later, if I want to.

Thank you again for writing.  I will see what my appointment on Thursday brings.  I am apprehensive about it, because I have a feeling things are the worst they've been so far.  But I'm pretty sure if the doctor suggests the meds, I'm ready to take them, then also get more serious about controlling it.

Bye for now.

---Debbie

[sweetdebbie628]

WaveRider,
Thanks again for your reply.  
Yes, levels of over 200 aren't good for us.  
Thanks for wishing me well.  I should probably call ahead of time and ask about the results, but I'm chicken.  I am kind of apprehensive about this appointment. I will be glad when Thursday is over with!
---Debbie

[Super_sally888]

Hi,

A1C below 5 is actually normal and what all of us (diabetic or not) should ideally be targetting.

If your blood sugar is high (even spiking high) it will damage your pancreas and make your diabetes worse.  Therefore it is important to manage blood sugar early and agressively to get it down to levels as close to normal as possible.

If you do this, even though you pancreas may not be at full capacity, it will be able to keep working effectively.

Metformin is usually the first line drug for anyone with type 2 diabetes.  It appears to be very safe and effective in long term studies.  Do not be scared of appropriately using meds. It could save you lots of problem in the long run.

think of it as putting out the fire while it is small and before it has spread, rather than trying to put out a bush or wild fire.  

Diabetes managed (and I do beleive you are diabetic from your numbers) well can avoid complications and problems long term.  Diabetes unmanaged is just plain scarey (and painful and poor quality of life, etc).

If you are into reading, i can recommend "diabetes solutions" by Dr. Richard Bernstein. (You can google it and it is easy to find on Amazon) as the best resourse I personally have found for managing diabetes.

[WaveRider]

"You don't think I'm diabetic with my levels after meals around 200 sometimes?"
The definition of 'sometimes' is speculative and can  be interpreted in many ways - once a day, three times a day, once a week, once a month and so on. Your last blood work, whatever they were, will help the doctor make a determination; normal, prediabetes, or diabetes. It is just not a good idea to have levels of >200 mg/dl postprandial. Continued levels this high will kill off your beta cells, the cells which produce insulin in your pancreas.

"I wonder how many carbs are in a personal pan pizza (Pizza Hut---pepperoni, mushrooms and black olives)--it is a small pizza?"
Nutritional values for all pizza's are listed on the Pizza Hut web site. Instead of eating an whole pizza, eat 1/4th with other foods - vegies, poultry, fish etc.

Good luck with dr's appointment.

[sweetdebbie628]

WaveRider,
Thank you for your reply.  You commented "before I become a full-blown diabetic."  You don't think I'm diabetic with my levels after meals around 200 sometimes?  

With the OGTT, I was dxed as diabetic and with my fasting at a routine physical just a week or so before that, can classify me as pre-diabetic.

The way my fastings have been, I am pre-diabetic, but I do experience some over 200 levels after meals.

I wonder how many carbs are in a personal pan pizza (Pizza Hut---pepperoni, mushrooms and black olives)--it is a small pizza?  I was surprised about the 260!  That doesn't happen very often, thank goodness!

I had bloodwork done this week and will go in to see my doctor to  discuss the results on Thursday.  Wish me luck!  I just know I've been experiencing higher fastings lately and also after meal levels, too.  I know I probably can tweak my diet more and hopefully lower them.

Thanks again for writing.

---Deb.

[sweetdebbie628]

Hi Super Sally,

I have a cousin named Sally!  :-)
Thanks for replying to my question and giving your recommendations.
You think our a1c's should be less than 5%? That seems kind of low?
I got my blood work done and will be seeing the doctor on Thursday, so will discuss the results and whether or not I should be on meds.  My doctor suggested I think about being on meds perhaps 5 years ago, but my a1c's were in the 5's and fastings around 97, so we agreed to wait.  I was afraid of the long-term effects of being on meds if it wasn't absolutely necesary yet.  

Thanks for replying.

---Debbie

[WaveRider]

First off, congrats on keeping the excess poundage off. However, I think you know your erratic eating behavior is leading you towards being a full blown type 2 diabetic. Eating a slice of pizza [not 2 or 3 from a large] and a couple handfuls of plain slightly salted popcorn is tolerable. Anymore the carbs in these foods will jack up your glucose levels as you attested to in your post as well mess with your body weight. Aside from avoiding sugary foods avoid eating white foods and foods made with white flour; potatoes, white rice, white breads, crackers, pretzels and so on. Also avoid high carbohydrate foods. Carbs is equivalent to refined sugar. Low carbs means low glucose levels and low body weight.

"What levels do most doctors look at when determining to put their patients on medications?"
This depends on your doctor. Doctors will tell you tight control of your glucose levels can prevent or slow the progress of many complications of diabetes. Tight control means getting as close to a normal [non-diabetic] glucose level as you safely can. Ideally, this means levels between 60/70 to 99 mg/dl before meals [some say as high as 130 mg/dl], and less than 141 mg/dl two hours after a meal [some say as high as 181 mg/dl], an optimum postprandial level of 126 mg/dl. Your last A1c of 6.1% equates to 128 mg/dl, diabetes. An A1C level less than 5% [some go as high as 7%] is ideal.

"I was dxed via the O.G.T.T. going on 11 years ago"
Test results only matter with your current present day health state. You cannot use or go by 11 year old test results, they're useless. Good luck

[Super_sally888]

Hello, your numbers are diabetic.  I beleive you should be on meds.  And you do need to watch your diet as well.

It is very important to get your numbers down to avoid long-term complications.

Ideally your A1C should be < 5.0 if it is to be normal (from literature ideal non-diabetic A1Cs will be in the range of 4.1 - 4.6),  yours is well above this.

Please discuss seriously with your doctor about meds.

Keep up with regular exercise, weight management and diet.

Best wishes