What next?

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OhJoy

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Relationship to Diabetes
Type 2
I was diagnosed in October with an Hb1Ac 118. With help and advice from the forum I have lost weight, over a stone and sill dropping, BMI now 22, cut down to very low carbs, increased excercise to at least an hour a day of walking/cycling and kept taking the tablets. This has resulted in my next Hb1Ac being down to 49.
Obviously, I am really pleased and proud of myself and want to thank everyone for their help and taking the time to answer rookie question.
My question now is what next? My BS hovers around 8 each morning and drops to around 6/7 after dinner in the evenings. I know that’s OK but I would like to get it just a little lower and hopefully get into remission/reversal/whatever term you prefer and come off the Metformin.
Can anyone suggest the next step for the final push?
 
You have done amazingly well and really it is actually not very long in the scheme of things since diagnosis.
Clearly what you have been doing is working and allowing time for your body to adjust is better and kinder on nerves and eyes. I would just be patient and keep on with what you are doing, If you don't want to lose more weight then up your intake of protein and healthy fats.
Morning readings can be the last to come down and can depend on when you test as if you are one of the people who get Foot on the Floor Phenomenon where the liver releases glucose in preparation for the activities of the day so testing in bed can reflect better your fasting level.
 
That's excellent progress in such a short time.

Morning levels are sometimes higher for two reason: Dawn Phenomenon or so called 'Foot on the floor syndrome.'

DP is a slow rise that starts in the early hours, triggered by hormones, usually starting around 3am, FOTF is a rise when we get up and start getting active. In both cases for T2s the pre-existing insulin resistance and/or beta cell dysfunction means we can't handle it properly.

If you do a test before you get up and it's 8, then it's DP. If it starts at the normal fasting levels (<6.1 in the UK, USA seems to have a lower one!) and goes up when you get up, before breakfast, then it's FOTF. The body releases hormones during the night that make us more insulin resistant, which doesn't help.

There's been very little research done on DP, but Metformin possibly doesn't prevent it from happening - even with a night time dose that reaches peak concentration in the early hours when DP starts.

There is also another thing called 'adaptive glucose sparing' which some people report - this happens to people in low carb diets and sees slightly elevated fasting levels, perhaps due to insulin resistance that is brought on to prioritise certain organs (Brain) getting the glucose.

Not sure what you can do other than keep doing what are you doing!
 
Thank you both, that is helpful and reassuring. I will try testing before getting out of bed just out of curiosity but generally just keep going and see where it gets me.
 
Well done @OhJoy - that’s a brilliant result. Good for you! 🙂
 
Well done on your great progress so far @OhJoy

You‘ve done amazingly in just a few short months (and with Christmas in the middle!).

I think if you maintain the effort you’ve been putting in and aim for consolidation you’ll see a gradual gentle improvement in your levels.

In time you may decide you’re interested in seeing what happens if you reduce or drop the Metformin, and can have a chat to your GP or nurse about that - but there‘s no hurry really. Diabetes is a marathon not a sprint 🙂
 
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