It's Saturday and this is the day I evaluate my progress. It is also a full week (8 days actually) on a 50% in metformin. I figured I should be seeing the impact of taking less medicine to control my blood sugar.
So, before I get into the numbers, let me explain what numbers I track and how I track them...and maybe a bit about why I track them. The "how" piece is actually important, and I think a bit interesting - feel free to disagree.
Every morning when I get up (and the time does vary by a few hours some days) I check my fasting blood sugar and my weight. The fluctuate from day to day so trends are not always clear. I try to check my blood sugar before lunch and dinner and 2 hours after eating as well as before I go to bed. My blood sugar meter automatically calculates 14 and 30 day averages for all of the readings I collect. The fact is I have 3 meters and only one of them does the averaging. One meter is at work and the other is near where I eat.
My fasting blood sugar and three or four other readings are generally taken on the averaging meter. My methodology is not terribly consistent and therefore may not be scientifically reproducible but the trend line for both the 14 day and the 30 day readings has been steadily down. The 14 day and 30 day averages were 178 and 165 respectively in late March. They were 122 and 125 this morning. Considering I'm off Actos and only using half the metformin I once was using, this seems like real progress.
Like I said, the daily weight and fasting blood sugar levels fluctuate some and make trends hard to follow. I have "fixed" this by collecting the daily readings and paying attention but not worrying about them. What I "worry" about are the actual trends and these I can find by averaging every weeks data. For instance, my starting weight was 161.5 pounds and every week since the end of March I have lost between 1.5 and 3.4 pounds and have averaged a loss of 2.3 pounds per week. My goal was 2 pounds per week. The daily weight readings may fluctuate but the weekly average really does reveal what's going on.
In terms of weekly average blood sugar readings, a chart shows the trend more clearly. I seem to be dropping my fasting blood sugar readings by about 4 points per week. The most I have dropped in a week is 7 points and for the four weeks after stopping the Actos the trend went up a few points. I think the averages missed the peak of about 15 points. For the past three weeks I have been down 4, 4, and 3 points respectively. Exercise may have helped restore this trend. It is hard to say.
I am not rushing to stop taking metformin. Since I passed my Class 3 flight physical I don't need to be re-examined for another year (or close to it, actually) to keep flying. This gives me the flexibility to go off the metformin whenever I want to prior to my next physical. My first goal is my health and flying is a secondary (but important) goal. My estimated A1c based on both my monitoring and past tests is 6.0 to 6.5. These meet AACE recommendations and exceed ADA recommendations. My goal is to get it to 5.5 or less.
So what I am trying now is to keep the blood sugar coming down. If the 4 points per week decrease continues (on average) I should have a weekly average fasting blood sugar of under 100 in five weeks. At that point I should be another 10 pounds lighter, more or less and I may either quit metformin or cut it to 500 mg/d. I'm inclined to do the latter. It seems that the effect of metformin on blood sugar is related to how over-weight you are. The more over-weight the greater the effect. If this effect applies to me (each person is a rule unto themselves), then it's possible I will be able to quit the last 500 mg of metformin with little or no effect, if I wait until I'm under 200 pounds, which I am estimating will occur sometime in October.
Alternatively, if I see as little effect in reducing my daily dose from 500 mg 2 times per day to 1 time per day as I did with I decreased the dose form 1000 mg 2 times per day to 500 mg 2 time per day, which is to say there was no perceptible change, I may go off the metformin sooner.
My ultimate goal is to have my fasting blood sugars under 89 mg/dl consistently. That is roughly 28 more points to loose and to do it without taking any medicines. By my estimation I have dropped my blood sugar by between 80 and 100 mg/dl, if I had not reduced the drugs I was taking. I am not quite halfway to my weight goal and if the second half of my weight loss/improved nutrition and exercise program holds even one-third the promise of the first half of the program, I should be readily diet controlled, if not "cured" of my diabetes.
Time will tell.
No comments:
Post a Comment