From Rhode Island, USA:
The last time I went to an endocrinologist, she suggested the addition of metformin 500 mg for week one (after dinner only); 1000 mg for week two; 1500 mg for week three; and 2000 mg for week four and thereafter taking half after breakfast and half after dinner. Is this typical dosing with Glipizide, 10 mg twice a day, and Avandia, 8 mg?
My typical fasting blood sugar is 225 to 250 mg/dl [12.5 to 13.9 mmol/L]. Also, she wanted me to test four times a day. I feel a little unsure on when I should test. What would be optimal times to test? I addressed this to the covering doctor and he was no help, saying it depends on how I feel and things like that. I feel fine and have no signs of highs or lows. I really just want to understand when I should be keeping track of my sugar levels to best help my regular endocrinologist.
Metformin can cause loose stools, nausea, and gas when it is initiated. Your physician escalated the dose over time to allow you to get use to the medication. At the same time, she was trying to titrate the dose up to the maximum effective dose. In addition, metformin does come in a sustained release formulation. The advantage to this medication form is that the medication can be given all at one time. Otherwise, metformin is usually given as a split dose, twice a day. This would be the case whether you were using other oral agents or not.
The matter of when to monitor your blood sugars is a philosophical matter. The goal for the treatment of type 2 diabetes is normalization of the glucose levels and normalization of the A1c. Your monitoring is to help you get there. A reasonable way to start is to begin monitoring before meals and bedtime with a goal in mind of blood sugars between 70 to 140 mg/dl [3.9 to 7.8 mmol/L]. Once you have gotten to this level of control, you may want to do additional testing two hours after meal as an even more intensive measure of your level of control with good sugars, less than 140 mg/dl [7.8 mmol/L] after meals.
In general, complications and diabetes-related outcomes have been geared to the A1c so you need to continue to use this as the best gauge of your control. This may require you and your physician to set new goals for your monitoring over time. Finally, I have made it a point with my patients to have them monitor more frequently because this allows them to determine the effect of lifestyle choices on their blood sugars. This will allow them to stay in tune with the decisions they make and they can anticipate what effects this may have on their blood sugars.
Last Updated: Tuesday April 06, 2010 15:09:59
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