BS up to 548 on meds and diet. Now what?

[Uff Da]

My blood glucose test 10/4/11 was 289.  The doctor then ordered an A1c test; the result was 11.5.   After seeing the results of my blood glucose test, and especially in the past week after buying a blood glucose monitor and seeing just how bad my blood sugar was, I'd been eating very lightly to avoid an emergency from very high blood sugar.  Consequently I've lost eight pounds

I saw my doctor for the first time yesterday since having diabetic symptoms and was diagnosed with diabetes.  (Surprise!  LOL)  She said she wanted to start meds slowly, so put me on 500mg metformin and 100mg Januvia and gave me an 1800 calorie diet.  And she told me that if my blood sugar should end up over 400 and I was feeling really bad, to go to the emergency room.  The idea was that she would gradually increase my metformin, but wouldn't do that until my next appointment in two weeks.  She also chided me for taking so many blood tests, saying to only take them at bedtime and before meals for now.

I took my meds after dinner last night as directed, but forgot to take my BS before bedtime as I typically go to bed shortly after eating dinner.  But by the time I took my BS at 3:30 AM before my middle-of-the-night "snack," it was down to 297.  And my before-breakfast reading at 10:00 AM was 291.  These were readings similar or slightly better than I'd been getting shortly before seeing the doctor but I'd now been eating more food, so while that was far from being under control, at least we were heading in the right direction.

But then I ate breakfast.  The meal plan called for 2 starches, 1 meat, 2 fruit, 1 milk and 1 fat serving.  Most of the foods I ate were the same foods as listed as a menu example, though I did substitute an extra meat serving (some ham in my scrambled egg) for a starch serving (example was 1/2 cup cream of wheat).  I ended up feeling rather poorly after breakfast, but certainly not so poorly I thought I should go to an emergency room.  I did lie down for a few minutes to rest, but I was able to go back to normal activities (even got down on hands and knees to scrub a floor) and by lunch time was feeling pretty normal again.  But then I took by BS before lunch about 2:00 PM.  548!  That would have been about 3.5 hours since finishing breakfast.  

There was no way with a BS like that that I dared to eat the prescribed lunch of 2 starches, 2 meats, 1 vegetable, 1 fruit, and 2 fats!  I ended up having a marinated bean salad over a mostly green salad which I'd interpret as 1 starch, 1 meat, 1 vegetable and 1.5 fat servings. And I'm skipping the afternoon snack of 1 starch and 1 fruit (for which the example was 6 vanilla wafers and 1 small banana.  I'd be in the hospital!)  My doctor isn't in on Fridays, so I couldn't call her and ask anything.

So what would you do?  Follow the diet and resign myself that I'll end up going to the hospital to let them sort it out?  Go back to my former low-calorie diet at which I was losing weight until I can get an appointment with an endocrinologist?  I have no idea how long that would take.  (I'm currently at 120 pounds, what I consider the low end of my ideal weight range.)  Follow my gut on diet until I go back and see my doctor in two weeks and ask to be put on insulin?  Other?

And how bad do I have to feel before it warrants going to emergency?  Some people go to emergency at the drop of a hat, but with high blood sugar, what is true emergency?  What would be the symptoms - besides just a bad reading. (And incidentally, I haven't yet had my monitor checked for accuracy, though presumably most of them are now pretty good.  My doctor said to wait until my next blood test in about a month.)

[Super_sally888]

How are you doing now?  

How are your sugar levels?

[Uff Da]

Thanks for your reply, Super Sally.  After eating the much smaller than recommended lunch, omitting the snack, and taking a 30-minute brisk walk around the house (didn't dare get far from home), my blood glucose reading before dinner was down to 276.  So the high-stress situation has calmed considerably for the time being.  I've eaten dinner, and I'll see how bad the reading will be in two hours. The main part of the meal (homemade chicken-vegetable-soup)  was leftovers from a couple of nights ago and I tested 473 two hours after that.  But that was before I was on any meds. And the rest of the meal could have made things better or worse.  So we'll see.

I'll have to look up ketoacidosis to learn more about that.  I really need to be informed of potential problems.

[Super_sally888]

I typed a longer message, but it got lost due to internet glitch.

Your prescribed diet is t traditional high carb diet.  it is obviously not working for you.  I recommend only 1 serve of carb per meal and none for snacks.  You need to eat more protein and fat to compensate for the low carb.

However, the meds are not working.  With blood sugars this high you need to go to the hospital.  You could develop ketoacidosis which is life threatening.
I suspect that you may be type 1 diabetes instead of type 2 and your pancrease has stopped working.  IN this case oral meds and diet can't work and you need to be on INSULIN.

You cannot affort to wait for 1 months to do something.  Good on you for monitoring closely.

Please go to the emergency room next time you test high.  This really should not be ignored.  Else, eat your recommended diet (one meal) and then go to the emergency room (I am assuming if you test 2 hours after eating you will definitely be over 500).

Do not ignore.  Please go to the ER.  Let me know how you go!

P