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a1c, metformin, diet change

Answered on August 27, 2013
Created April 21, 2013 at 10:21 PM

Last November I started gaining weight with no changes in my diet or exercise routine. I went to the doctor and had some blood work done and was diagnosed as pre-diabetic with an a1c of 5.7. I had been eating an ovo-lacto vegetarian diet with occasional fish for about a year. Very strict vegan for 10 years before that, and ovo-lacto for 15 years before that. I ate very little processed food but was heavy on the grains and legumes. The doctor I was working with looked at my diet and said it was "pretty good" and shouldn't have lead me towards diabetes as it had and prescribed low dose metformin to level out my blood sugar. At the same time I started the metformin I decided to go paleo (I'd been considering it after reading Gary Taubes, Lierre Keith, William Davis etc). What a mindfuck going from vegan to paleo was but that's a whole other story. Anyhow, after just over three months of metformin 500mg twice a day and a paleo diet I had my a1c re-tested and it came back at 5.6. I have not cheated on the paleo side of things - years of a vegan diet and I have self control down pat.

I'm mostly just surprised that with both the metformin and the diet change there wasn't more of a drop in a1c. I don't really have a concept of how much change I should have expected and have since lost health coverage so am not in the care of a doctor I can talk to about this. I made the fallacy of changing two variables at once but I'm wondering if I should even stay on the metformin (though after reading Robb Wolf's article about it it sounds like there's no reason not to).

FWIW, the weight I had gained and was worried about has disappeared since making the changes. I've also since switched from a cardio heavy exercise regime to CrossFit 3x week and swimming/long walks 2x week.

Long story short, should I have seen more a drop in a1c? Should I stay on the metformin?

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on May 18, 2013
at 02:32 AM

As for Metformin, it is helpful if you're an overweight T2 or prediabetic. If you've lost weight, much of the benefit is gone but some people still take it because it supposedly is protective against cancer and other diseases. Its primary benefit is insulin sensitivity for those who're overweight and with fatty liver.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on May 18, 2013
at 02:30 AM

115 is not a spike. I suggest getting your fructosamine tested. Check your hemoglobin and RBC numbers to see if they're low or high. You seem completely normal and your A1c should be 5.0 or lower, not 5.6, based on those readings. 5.6 is equivalent to an average blood glucose of 115, yet your spike is 115.

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on May 17, 2013
at 09:06 PM

I finally got around to getting a BG monitor. Wow. I've been monitoring for 3 days, 1 day on metforim and 2 days off. My blood sugar has not been higher than 115 at any point, even after eating some ice cream. The 115 spike was from 6oz red wine on an empty stomach. The lowest it has been has been 77. The average is 91.8, doing readings hourly. Since the only diagnostic tool for determining my "pre-diabates" was the a1c, I think I fall into the "not an accurate indicator" group. I am going to stay off the met for a few weeks and do another curve to make sure everything is still good.

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on April 22, 2013
at 07:22 PM

I would prefer my levels to be more towards the mid range rather than the high end. The lab where my bw was done had 5.6% as the "normal range" top end threshold.

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on April 22, 2013
at 07:20 PM

I have been meaning to get a BG monitor. I will try tracking throughout the day and see how that looks. Thanks for the reminder. That's a great link, as well.

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5 Answers

0
3013d1b44fd7f65b4c8412f229d1d00e

on August 27, 2013
at 07:28 AM

Put on more muscle via serious lifting and you will most likely see a good drop in yr blood glucose. Also, protein isn't a problem if you're lifting--unless you're slamming way more than you need AND chomping mega-carbs on your rest days.

0
B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on May 17, 2013
at 09:11 PM

I finally got around to getting a BG monitor. Wow. I've been monitoring for 3 days, 1 day on metforim and 2 days off. My blood sugar has not been higher than 115 at any point, even after eating some ice cream (though my FBG was 90 this morning, probably as a result of that). The 115 spike was from 1/3 GT's "green" kombucha & 6oz red wine (not together - ew) on an empty stomach. The lowest it has been has been 77. The average is 91.8, doing readings hourly (I've been a bit obsessive). Since the only diagnostic tool for determining my "pre-diabates" was the a1c, I think I fall into the "not an accurate indicator" group. I am going to stay off the met for a few weeks and do another curve to make sure everything is still good.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on May 18, 2013
at 02:32 AM

As for Metformin, it is helpful if you're an overweight T2 or prediabetic. If you've lost weight, much of the benefit is gone but some people still take it because it supposedly is protective against cancer and other diseases. Its primary benefit is insulin sensitivity for those who're overweight and with fatty liver.

D33a8d5f095a8532ddf7a0d6c27bfe63

(578)

on May 18, 2013
at 02:30 AM

115 is not a spike. I suggest getting your fructosamine tested. Check your hemoglobin and RBC numbers to see if they're low or high. You seem completely normal and your A1c should be 5.0 or lower, not 5.6, based on those readings. 5.6 is equivalent to an average blood glucose of 115, yet your spike is 115.

0
874ff271ca3379984344d5f9f760fec3

on April 22, 2013
at 06:56 PM

Keep in mind, protein is timed release sugar after about 25 grams per meal. I had to cut back on the steaks and cheese a bit before my fasting glucose would come down.

0
13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on April 22, 2013
at 12:39 PM

The A1c isn't a perfect test, iron status can throw it off and some people "glycate" more than others. I don't know that talking to a doc would be much help, because you're out of the problem zone, but you may see further improvement as you go on with the exercise. Blood Sugar wise, gaining muscle and anaerobic exercise are very helpful short and long term and .

Pre and Post prandial meal checks are the best way to determine how your blood sugar is doing. You can get the details at BloodSugar101. If you find you need more info, the Bernstein Diabetes Forum is a good resource.

Studies show that heart attack risk rises after an A1c of 5.5, so you're clearly in better shape but may want to invest a bit more time into research. It is very possible that your prandial #'s won't quite support the A1c #, in that case, your records are more accurate.

This will help you decide if you need to find a doc to renew the metformin Rx.

This Bloodsugar 101 article is a good place to start - How Blood Sugar Control works - and how it stops working: http://www.phlaunt.com/diabetes/14046621.php

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on April 22, 2013
at 07:20 PM

I have been meaning to get a BG monitor. I will try tracking throughout the day and see how that looks. Thanks for the reminder. That's a great link, as well.

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on May 17, 2013
at 09:06 PM

I finally got around to getting a BG monitor. Wow. I've been monitoring for 3 days, 1 day on metforim and 2 days off. My blood sugar has not been higher than 115 at any point, even after eating some ice cream. The 115 spike was from 6oz red wine on an empty stomach. The lowest it has been has been 77. The average is 91.8, doing readings hourly. Since the only diagnostic tool for determining my "pre-diabates" was the a1c, I think I fall into the "not an accurate indicator" group. I am going to stay off the met for a few weeks and do another curve to make sure everything is still good.

0
Cc3ce03985eac5ebcbb95fc2329f13b0

on April 21, 2013
at 10:54 PM

It's been awhile for me, but your glucose levels are completely normal

What are you thinking they should be at? I don't see the problem, and don't think you are prediabetic, but if there really is some problem, get a testing kit and test yourself throughout the day for a week or two, first on the metformin then off. See if it's actually helping you. It also might help determine if specific foods are a problem.

Maybe the measurements are different wherever you are.

B77077b10dae8aacdd01ac61cb5bcfc3

(55)

on April 22, 2013
at 07:22 PM

I would prefer my levels to be more towards the mid range rather than the high end. The lab where my bw was done had 5.6% as the "normal range" top end threshold.

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