Yesterday I went to the diabetes clinic for my tri-annual visit. I went there feeling guilty and ready to be scolded for my latest test results, especially my A1c.
When I got there, before checking in with the receptionist, I ran into the nutritionist I was on my way to see.
“I was just going over your blood test results,” she said to me with a smile.
Oh no, I thought to myself.
When I sat down with the diabetes nurse and the nutritionist I said, “I guess you’re going to be giving it to me now.”
The nutritionist said (smiling again), “We only shout at people with an A1c of over 7% and if it’s over 8% we use physical punishment.”
They downloaded the data from my pump and meter and after a look told me that my numbers were great except for the period I had told them about when I had pump troubles.
My next stop was the doctor. She looked at my blood test results and as I expected, asked me about my cholesterol. I told her that after doing some reading I decided to see how I would do without the statins.
“So it didn’t work out so well,” she said. Then we had a serious conversation about it. She explained to me that diet would probably make very little difference and that with numbers like 150 and considering my diabetes she would highly recommend taking the statins.
I told her about my A1c, that I felt like it was too high, but she didn’t seem to be very concerned. Then she asked me if there was anything else. For a while I’ve wanted to try metformin, thinking that maybe it could help me reduce my insulin levels (which aren’t that high – 18 units a day) and thinking that I wouldn’t mind enjoying some of the cancer protection it seems to offer.
So I said, “Can I try metformin?”
“You know, metformin is considered a type 2 diabetes therapy,” she said.
Well, it was worth a try, I thought to myself. I wasn’t very disappointed since I hadn’t expected her to prescribe it for me.
Then the doctor looked at my pump data. “Sixty-two percent of your insulin is basal insulin. That’s very high.”
I tried to explain about my low carb diet but she didn’t seem to be listening. The she said again, “Metformin is listed as a type 2 diabetes medication.”
“Yes,” I said, “But may be it could help me reduce insulin intake.”
“I do sometimes give type 1’s metformin,” the doctor said. “Maybe, if you take it at night it will help you with you morning highs, the dawn phenomenon.”
She explained about the side effects and that it would take about two weeks to really see the effects of the medication.
I couldn’t believe it. I didn’t think I had a chance of getting metformin, but I did, and without a fight.
Now lets see if it does any good….
Michael,
I eat low-carb and think I’m using exactly the right amount of basal insulin at 65-70% of my TDD. I don’t think most doctors are used to looking at basal:bolus ratios of low-carb eaters. If I took less basal insulin I’d have to correct frequently throughout the day… In my opinion that’s not better.
I compared my basal to Gary Scheiners “Think Like a Pancreas..” charts and found that I’m right in the middle of his range for basal, but I’m off the low side of the chart for total insulin. Since you take even less than me, I’d say you are unusual, and shouldn’t expect to have the same insulin ratio/need as others.
I’d be curious to see how Metformin might help you. I’m starting Symilin this week, and it’s going to be an interesting experiment.
Since when is ~60% high for basal? That’s not that far off from the 50/50 split lots of docs recommend–your low carb diet easily makes up the difference.
By the way, have you thought about asking for a cholesterol test outside of the standard lipid panel? An NMR can perhaps give you more information about your LDL to better judge whether it needs treatment. Also, what do the other components of your cholesterol say about your heart disease risk? From the previous link: “combining HDL-C and TG into a ratio (i.e., TG/HDL-C) is probably the single best predictor of cardiac risk you can derive from a standard cholesterol test. The lower the ratio, the lower your chances of having an “adverse cardiac event,” as the medical community describes it (e.g., a heart attack).”
P.S. I mention this in the context of having just gotten an LDL of 133 and preparing to go to my endo tomorrow, with the potential of having a similar conversation.
Hi Jana.
My HDL was 78. down from 82 last time. The doctor told me she wouldn’t mind if my LDL was a little high because of my high HDL but that 150 is just too high.
Mike, I am very excited to hear how the metformin goes. I recently had the chance to try Byetta (it was in a clinical study) and it had a truly dramatic and intriguing effect on my blood sugar — despite the fact that I’m type 1.
I also wanted to empathize with the A1c frustration. Anyone who reads your blog knows how on top of your diabetes you are — you have truly amazing determination and self-control. I find you and Jess both extremely inspiring in the way you take care of your diabetes. It’s very annoying that the number did not reflect the impressive amount of effort you put in.
I’m a type 1, 41 yrs old. Hba1c of 6.7% (yeah could be better but my meds for arthritis and psoriasis screw with my endocrin system) I’ve been taking Metformin for around 8 years as well as injecting insulin 4 times a day (Humalog/Humalin I).
Allows me to reduce my intake of insulin as it improves insulin cell barrier transition and also keep a stable weight, plus it more or less eliminates dawn phenomenom which I was prone too prior to taking it.