HbA1c rising despite increasing meds??

[MischievousKat]

I find it all very confusing. I am diagnosed as T2 but am on a large quantity of pills. My current pills and dosage is: am - 10mg Dapaglifloxin + 80mg gliclicide. pm - 40mg glicazide + 4 x 500mg slow release metformin.
My HbA1c stayed fairly regular when I was diagnosed in 2015 but at the end of 2016 it went insane, shooting up from 47 to 61 and then to73 in 2017. It has been up and down since then and currently at 64. With each read they increase the dosage of medication. Any advice out there please?

 

[Robin]

I find it all very confusing. I am diagnosed as T2 but am on a large quantity of pills. My current pills and dosage is: am - 10mg Dapaglifloxin + 80mg gliclicide. pm - 40mg glicazide + 4 x 500mg slow release metformin.
My HbA1c stayed fairly regular when I was diagnosed in 2015 but at the end of 2016 it went insane, shooting up from 47 to 61 and then to73 in 2017. It has been up and down since then and currently at 64. With each read they increase the dosage of medication. Any advice out there please?

There are a lot of helpful people on the forum, who I am sure will be along with suggestions, if they see your post. I will tag Admin @everydayupsanddowns or a moderator, @Docb who could move your post to a more prominent place on the general message board, I fear it might get lost here, in the rather less frequented Technology sub-forum. (Don’t worry, they are used to shunting stuff around so it gets seen)

 

[rebrascora]

Hi and welcome.
Sorry to hear you are struggling to manage your diabetes well. Can I ask what, if any, dietary changes you have made since diagnosis to help with your diabetes management? I am just wondering if you have perhaps not had the best advice on diet and that has led to your diabetes progressing, despite increasing meds.
Can you give us an idea of a typical day's menu for you ie the sort of things you eat and drink for breakfast, lunch and evening meal and any snacks, to see if we can make some suggestions for adjustments that might improve your levels.
I see you are Gliclazide. Do you test your BG levels at home? If so, when and what sort of readings do you get?
Do you have much/any weight to lose?
Can you tell us about your initial diagnosis? I appreciate it was a while ago now.... Did it come on suddenly with obvious symptoms or was it picked up through a routine blood test.... or perhaps some other means?
Have you lost or gained weight since diagnosis?

Sorry for all the questions, but the more info you can give us, the better we can advise you.

 

[Martin.A]

My HbA1c stayed fairly regular when I was diagnosed in 2015 but at the end of 2016 it went insane, shooting up from 47 to 61 and then to73 in 2017. It has been up and down since then and currently at 64. With each read they increase the dosage of medication. Any advice out there please?

Do you self-test? Reason for asking is that you seem shocked by the changes in your HbA1c over time. I'm in remission but I still test at home so that if things start to go awry I should get an early warning from my readings.

 

[Inka]

Welcome @MischievousKat 🙂 Can you work out what made it “go insane”? Illness, stress, hormones, etc? What kind of thing do you eat on an average day?

 

[childofthesea43]

I find it all very confusing. I am diagnosed as T2 but am on a large quantity of pills. My current pills and dosage is: am - 10mg Dapaglifloxin + 80mg gliclicide. pm - 40mg glicazide + 4 x 500mg slow release metformin.
My HbA1c stayed fairly regular when I was diagnosed in 2015 but at the end of 2016 it went insane, shooting up from 47 to 61 and then to73 in 2017. It has been up and down since then and currently at 64. With each read they increase the dosage of medication. Any advice out there please?

The way you put the question suggests you may have had the expectation that Type-2 medications somehow fix the underlying problem. They don’t, they just try to abate its symptoms. As Dr Fung pointed out, if any actually worked in the fullest sense of the term, why would we have over 500 of them on the market? Generally Type-2s progress towards becoming more like Type-1s which is why nearly half land up on insulin, and a key aspect of that is the damaging of the pancreas from internal fat that one has not cleared away by suitable dietary methods. Your own case may or may not have this rationale but I too would wish to know more of the weight-diet story here to get a sense of why the A1c might have gone awry.

 

[Leadinglights]

The way you put the question suggests you may have had the expectation that Type-2 medications somehow fix the underlying problem. They don’t, they just try to abate its symptoms. As Dr Fung pointed out, if any actually worked in the fullest sense of the term, why would we have over 500 of them on the market? Generally Type-2s progress towards becoming more like Type-1s which is why nearly half land up on insulin, and a key aspect of that is the damaging of the pancreas from internal fat that one has not cleared away by suitable dietary methods. Your own case may or may not have this rationale but I too would wish to know more of the weight-diet story here to get a sense of why the A1c might have gone awry.

I like Dr Fung's analogy of an overflowing sink (high blood glucose) which you can bail out the water (taking medication) but the sink will still overflow (still high blood glucose) unless you turn off the tap (stop eating too many carbs).
Of course for some people even that doesn't work but there never seems to be a good explanation why other than misdiagnosis.

 

[childofthesea43]

I like Dr Fung's analogy of an overflowing sink (high blood glucose) which you can bail out the water (taking medication) but the sink will still overflow (still high blood glucose) unless you turn off the tap (stop eating too many carbs).
Of course for some people even that doesn't work but there never seems to be a good explanation why other than misdiagnosis.

I think there is potentially a multi-layered explanation for most such cases: (a) the lowering of carbs was insufficient to promote weight loss, or (b) there was weight loss but not enough to clear pancreatic fat, or (c) that fat was cleared but was done too far down the road so that insulin secretion had become irreversibly impaired. But, more research is needed to get a really clear analysis. I do believe that if all newly-diagnosed T2s fully bit the bullet straightaway, slimmed down entirely by any method and kept their new profile then the T2 crisis would be largely mitigated. For most of us it is within our own hands and minds and is not a medical matter.

 

[Drummer]

I think there is potentially a multi-layered explanation for most such cases: (a) the lowering of carbs was insufficient to promote weight loss, or (b) there was weight loss but not enough to clear pancreatic fat, or (c) that fat was cleared but was done too far down the road so that insulin secretion had become irreversibly impaired. But, more research is needed to get a really clear analysis. I do believe that if all newly-diagnosed T2s fully bit the bullet straightaway, slimmed down entirely by any method and kept their new profile then the T2 crisis would be largely mitigated. For most of us it is within our own hands and minds and is not a medical matter.

When diagnosed - or rather when told that I had high glucose levels, it was ten years after a test indicated there was a problem. For some reason my GP did not think it appropriate to let me know, just went on insisting that I stick to a diet low in fat and high in starchy foods.
I got down to the top if normal levels quite quickly but can't seem to go lower even when eating fewer carbs.
I cannot understand why HCPs think it appropriate to keep things secret from their patients like it is some sort of twisted game they are playing.
When I was actually diagnosed the GP had phoned to make an appointment 10 days earlier and told me it was a routine follow up - I had a thyroid check and thought it was something to do with that, then get 'you are a very bad diabetic'. Like when I was first told my thyroid was defunct - the GP started off by saying 'there is something very wrong'.
Very twisted people.

 

[childofthesea43]

Mmm - maybe you were just unlucky with your GP(s), I’ve not observed most people regarding their GP as very twisted. Very exhausted perhaps …

 

[harbottle]

There is a category (Phenotype) of people with T2 that don’t have visceral fat, but do have beta cell dysfunction. This normally starts earlier than ‘classic’ T2, and might be genetic or linked to lifestyle. I know someone who fits this category.