Frustrated Readers Unite, Part I
From unruly glucose levels to catching every virus that comes to town.
This month's column is Part I of II in a series that reflects on several readers' questions about frustrating diabetes-related situations and presents possible explanations. Have you faced something similar? If so, what has worked for you? Write to me and let me know.
Bewildering blood glucose readings
1. I've been walking daily for 1.5 miles in the morning and 3 miles in the evening and my levels are still high. Today it was 340. Help!
Congratulations on nailing down a regular activity program. Exercise is a fantastic way to control diabetes, but not the only way. Healthy eating, and oftentimes taking medication, is needed in combination with being active. Type 2 diabetes is progressive, meaning that over the years, the pancreas makes less insulin at the same time the body becomes more resistant to using the insulin that's available. Your body may need a little medicinal help to get those numbers down where they belong. Check with your healthcare provider to find the best plan of attack.
2. I've had controlled type 2 diabetes for 5 years with medications and diet until 3 months ago when I changed jobs. I went from a sedentary job to a very active one. My morning readings have increased to 152 – 236. My small snack before bed has not changed. Plus my cholesterol increased to 273. I am going to see my PCP. Please advise.
Several factors can result in rising glucose levels. These include the pancreas wearing out (as explained above), a resulting need for a medication increase or change, and stress from the new job. Are you tossing and turning at night, worrying about it or are you sleeping soundly? Has your weight changed? What about your food choices throughout the day? With a new job that barely allows for a lunch break, you may be inclined to grab food on the go. Unless you plan for something healthy, you might end up with high-fat entrees. Or maybe that's not your situation at all. Cholesterol is mostly linked to food choices, but genetics play a role as well (some people eat like saints and exercise daily, yet still have high cholesterol). Have your activity patterns outside of work changed? What did your primary care physician suggest for your cholesterol and diabetes? And how's your blood pressure? When numbers start to go up, it's time to refinance — medications that is!
3. I'm taking 1500 mg Glucophage and 30 mg Actos per day for the past 8 months. My fasting blood glucose is still 215-230. What other options do I have?
You are not on the maximum doses for these medications. Plus, your pancreas may need a little nudge in the form of an insulin secretogogue (a pill that forces your pancreas to put out more insulin). Another option is taking a long-acting insulin (once a day injection like Lantus or Levemir that lasts up to 24 hours) which can give you the foundation of lower numbers so the pills can do their job. Many other medication approaches can be discussed with your specialist. You are on the right track because those numbers are too high. How's the exercise department? Need we mention the food department?
4. My fastings are 130 and higher. My A1C is 6.9. I'm on Glucophage and meds for blood pressure and cholesterol. I'm also obese. My CDE wants me to start Byetta to help me lose weight but I'm afraid to do so because I have some gastro issues.
Byetta is an injection that helps drastically curb appetite and has wonderful weight loss side effects, but it is not authorized as a weight loss medication (and many practitioners use it off-label because of its positive results). It can cause severe nausea while starting the therapy. Given your health history, you are wise to be concerned. Your CDE is trying to help you get a jumpstart on the weight loss which will in turn, help your glucose, blood pressure and cholesterol levels. Byetta might be the ticket if you, your CDE and you physician work together to come up with a plan to minimize any gastro issues first.
Getting sick with a cold or the flu every month
I have type 1 diabetes and am well controlled, but I continue to get sick on a monthly basis. I'm always tired or dealing with some new virus. I get the flu shot every year, I eat right, exercise and my numbers are good. What can I do with my doctor to improve my overall health? Any help?
My first concern is your statement about always being tired. Is that because you are having low blood sugars and don't know it? Are you cutting out too many carbs which would make your body not have enough fuel? To make sure these factors aren't at play, and that your diet is nutritionally sound, I'd suggest you ask your doctor for a referral to a friendly registered dietitian who is also a certified diabetes educator. You may also need to have a continuous glucose monitoring system (CGMS) placed to closely track glucose levels for 3 days. Type 1's with ideal numbers and A1Cs may have undetected lows (less than 70 mg/dl, or 3.89 mmol/l) entering into the equation; a CGMS will rule that out.
If that hunch is way off the mark, what about sleep? If you are not getting enough rest, it puts everyone at risk and more susceptible to illness. Other ideas that come to mind: exposure to young children that love to share the wealth of viruses, public transportation (and the need for hand hygiene), allergies and depression. In your email, you also mentioned you had a near fatal hospitalization when you were diagnosed. That takes a huge mental toll. If the mind is not up to par, the body follows in its path. How's your mental state of being? Have you had a chance to process the significant near death experience? If none of this resonates, you may also want to consider seeing an immunologist.
Hopefully these thoughts shed some insights to your questions about strange glucose readings and other perplexing situations. Stay tuned.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...