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Insulin resistance. Taking metformin, rise and fall in blood glucose. Glucose tolerance test done. Treatment?

Hi. I was rediagnosed last July with Insulin Resistance , I ve been frightened, frustrated and quite alone with this and I really need advice. I ve just had my third glucose tolerance test yesterday morning and I was shocked to see how dramatic the figures have become: Fasting level - 6.3 plus 1/2 hour - 15.2 plus 1/2 hour 17.1 plus 1/2 hour - 15.4 plus 1/2 hour - 5.4 I am still feeling sick and weak after it. On the last test (my second one) the final level was 2.4 and I was also diagnosed as having reactive hypoglycaemia. I am very concerned about the levels from yesterday but my next appointment with my endocrinologist isn t scheduled until October although the phlebotomist said that she would probably call me on receipt of them. But in the meantime and because I m worried, could you tell me if this looks like a diabetic pattern? I m doing everything I can in terms of diet to control blood glucose levels and I’m, only 9st 1/2lb (I m 5 7.5 ) and lost a further 4lbs without trying this last month. I m feeling fairly desperate about this as I can t seem to control anything. Just to say I m taking 2500g metformin per day. It was 2 tablets after breakfast, 1 after lunch and two after dinner but my doc changed it last week as my highest levels of the day were occurring in the morning so she changed it to 3 tablets after breakfast, 1 after lunch and 1 after dinner. What is really bothering me is that I can t seem to control the rise and fall of the blood glucose. This wave pattern, I know, is characteristic of Insulin Resistance but even with strictly controlling my diet and metformin and exercise, it has just started going crazy. My eye sight has worsened in the past few months. I am constantly tired, my head won t work, I have no concentration, am prone to terrible short term forgetfulness and if I try to exert myself even around the home, its as if a plug has been pulled, all power leaves me and my blood sugar levels drop like a stone. There is though a pattern within the absence of pattern in that my blood sugar will rise at the drop of a hat in the morning while I can withstand challenges (in the form of food!) later in the day particularly the evening. To give an example - this morning I ate 2 tbls yogurt, 1 dsp chopped nuts and half a grated apple mixed together with a half slice wholemeal toast and a cup of coffee. Before breakfast my level was 5.7 but afterwards it rose (half an hour later) to 11.4. Curiously, I had chicken stirfry (my own!) last night for dinner. My level before was 6.1 but after my much larger meal it rose only to 7.8! Is this now diabetes?
Asked On : Sat, 28 Jul 2012
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Diabetologist 's  Response
Aug 2012

Sorry to be late to answer this as I am new here!!

To start with, I would say please do not give up. Taking metformin and ready to follow the dietary advice in itself is a very good start. You have pre-diabetes as your sugars checked within 2 hours post glucose challenge tend to be higher than a person with no diabetes would have, and secondly you also show reactive hypoglycemia which happens in many people who are on the verge of developing full blown diabetes. Solution? Please avoid direct sugars as they tend to make you feel terrible by causing more and more episodes of reactive hypoglycemia. Have complex carbohydrates like whole wheat breads, brown rice, whole fruits and protein rich foods cooked in minimal fats- this will take care of both the tendencies of sugars- shooting beyond 10 and coming down below 4...You having carbs from apple, yogurt, wheat bread and coffee certainly is healthy but because you have impaired glucose tolerance, sugars will certainly go high and later hours it will fall down like a stone to make you feel powerless. And when you eat chicken, which mainly contains protein and fat, there are minimum carbs and hence your post meal sugar doesn't rise too much, not it will give any reactive hypoglycemia. But be aware this kind of high fat meal will increase the insulin resistance!
So what to do? one, as I mentioned earlier, take less quantity of carbs at a time and that too never from simple sugars, but from complex sugars. Take these kind of small meals every 3 hourly, so that neither the sugar jumps high nor down. Secondly, continue your exercise and metformin but your physician or diabetologist would certainly like to add something called alpha glucosidase inhibitor in your medications to take care of this problem. Do see any one of them. Take care. Do write back for any further query.
Answered: Fri, 31 Aug 2012
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