Re: sulfonylureas

[Guest guest]

Hi, (the other) Vicki...insulin may be a good choice for you...excellent

control is definitely obtainable with insulin. (It does take some trial and

error, however, to find your correct dose). As far as fear of needles...we

all start out that way, I guess, but pretty fast it becomes just something

you do. Considering the alternatives of diabetic complications due to

prolonged high BGs (and you know what they are, smile) a little needle prick

is well worth it. Pretty soon giving yourself insulin shots becomes second

nature. Trust me. Vicki in Portland, Or.

In a message dated 04/06/2002 10:31:17 AM US Mountain Standard Time,

vmossman2@... writes:

> Woudl insulin be a better choice for

> me (much as I fear needles?) My primary goal is to have excellent control

> with no more complications than I have currently!

>

[Guest guest]

Dawn wrote:

<< I take Glipizide. This drug falls into the Sulfonylureas category, in

fact it is second generation. Are all oral meds in this family, or is the

only alternative to inject insulin? >>

Sulfonylureas are the " old medicines " - the only thing type 2's had until

about five years ago. I am totally opposed to them. There are many dangers

.... elevated insulin levels, increased risk of heart attack and stroke, the

risk of potentially-fatal hypos, weight gain (from the hypos they induce,

with resulting eating binges), etc. There are modern drugs, including

Metformin/Glucophage, as well as the " glitazones " . Type 2's don't have to

resort to insulin, unless they have been on sulfonylureas so many years that

they have lost their pancreas function. (However, some type 2's choose to

use insulin for improved control, while allowing themselves more eating

choices.)

I have a sister who has been on sulfunylureas for much more than six years.

Despite her very low carbohydrate intake, weight loss and exercise regimen,

she is going to have to move to insulin. She spent too many years on

sulfonylureas such as Glyburide and Glucotrol. It may make a diabetic and

his/her doctor happy to see these low HbA1c's of 4.5-6.0, but if you are

doing it by destroying your pancreas function, this approach needs some

rethinking.

Susie

[Guest guest]

Dawn wrote:

<< I take Glipizide. This drug falls into the Sulfonylureas category, in

fact it is second generation. Are all oral meds in this family, or is the

only alternative to inject insulin? >>

Sulfonylureas are the " old medicines " - the only thing type 2's had until

about five years ago. I am totally opposed to them. There are many dangers

.... elevated insulin levels, increased risk of heart attack and stroke, the

risk of potentially-fatal hypos, weight gain (from the hypos they induce,

with resulting eating binges), etc. There are modern drugs, including

Metformin/Glucophage, as well as the " glitazones " . Type 2's don't have to

resort to insulin, unless they have been on sulfonylureas so many years that

they have lost their pancreas function. (However, some type 2's choose to

use insulin for improved control, while allowing themselves more eating

choices.)

I have a sister who has been on sulfunylureas for much more than six years.

Despite her very low carbohydrate intake, weight loss and exercise regimen,

she is going to have to move to insulin. She spent too many years on

sulfonylureas such as Glyburide and Glucotrol. It may make a diabetic and

his/her doctor happy to see these low HbA1c's of 4.5-6.0, but if you are

doing it by destroying your pancreas function, this approach needs some

rethinking.

Susie

[Guest guest]

Dawn wrote:

<< I take Glipizide. This drug falls into the Sulfonylureas category, in

fact it is second generation. Are all oral meds in this family, or is the

only alternative to inject insulin? >>

Sulfonylureas are the " old medicines " - the only thing type 2's had until

about five years ago. I am totally opposed to them. There are many dangers

.... elevated insulin levels, increased risk of heart attack and stroke, the

risk of potentially-fatal hypos, weight gain (from the hypos they induce,

with resulting eating binges), etc. There are modern drugs, including

Metformin/Glucophage, as well as the " glitazones " . Type 2's don't have to

resort to insulin, unless they have been on sulfonylureas so many years that

they have lost their pancreas function. (However, some type 2's choose to

use insulin for improved control, while allowing themselves more eating

choices.)

I have a sister who has been on sulfunylureas for much more than six years.

Despite her very low carbohydrate intake, weight loss and exercise regimen,

she is going to have to move to insulin. She spent too many years on

sulfonylureas such as Glyburide and Glucotrol. It may make a diabetic and

his/her doctor happy to see these low HbA1c's of 4.5-6.0, but if you are

doing it by destroying your pancreas function, this approach needs some

rethinking.

Susie

[Guest guest]

OK - all this talk about sulfonylureas has got me concerned for sure!

I have been on 1000 mg Glucophage 2 x day, 5 mg Glyburide 2 x day for

several years. (Actually it was 2.5 mg of Glyburide 2 x a day for several

years, and it was increased to 5 mg twice a day about 6 months ago). After

an A1c of 8 a few months ago, my doctor had me add Avandia 4 mg once a day.

His intention was for me to take the Glucophage and Avandia and be able to

stop the Glyburide.

I also began eating low carb the end of January. My bg's came down nicely,

and I began to lose some weight (I've lost 22 since the end of January).

By mid-Feb. my bg's were generally under 140 at all times of the day. I

stopped the Glyburide completely. During March, my bg's remained under 140

no matter what time of day I tested.

I thought, ok, I'm doing so well, I'll stop the Avandia also. (I have

concerns about being on Avandia after reading it's similarities to Rezulin).

I stopped the Avandia on March 21 (was only taking the Glucophage at that

point). I immediately saw an increase in my bgs...and fastings were as high

as 153, with most bg's at 130 or higher throughout the day. I then started

the Avandia again on March 26. I saw little, if any change in my bgs for

the better.

So, April 2, I began taking 2.5 mg Glyburide twice a day and stopped the

Avandia again. Immediately,my bgs are back down to 70-120 range no matter

the time of day. Currently I am taking 1000 mg Glucophage twice a day and

the 2.5 mg Glyburide twice a day, with wonderful bgs.

I'd prefer not to take the Avandia because of my concerns about liver

problems. I thought the Glucophage/Glyburide combination was going to be

the 'answer' until perhaps I could get more weight off and maybe get off the

Glyburide for good. Now I read the concerns about taking this type of med!!

I've also recently gotten a Nordiac Track recumbant bicycle and am riding

1-4 miles a day. First 'real' exercise I've done in a very long time.

I'm confused and not sure what to do. Woudl insulin be a better choice for

me (much as I fear needles?) My primary goal is to have excellent control

with no more complications than I have currently!

BTW, my physician is an internal medicine doctor; I like him very much, but

not sure of his expertise in diabetes care. I'm on an HMO and require

referral to see any other doctor. Also, the town I live in doesn't even

have an endo!

ANY advice and assistance you can give me would be greatly appreciated!

Vicki in CO

[Guest guest]

<< Pretty soon giving yourself insulin shots becomes second

nature. >>

I am getting so use to it I do it in a hurry now. I don't even think about

it anymore cause if I do I don't want to do it. My daughter wants to learn

how to give me a shot. YIKES they want to stick me with needles.

Kathy

[Guest guest]

How do you figure out which type of insulin to use and what dosage to use?

I'm beginning to think I should discuss the possibility with my doctor at my

next visit this month.

Also, how does the cost of insulin and syringes compare with Glucophage

and/or Glyburide?

Thanks for everyone's comments!

Vicki in CO

-- Re: sulfonylureas

Vicki Mossman wrote:

> OK - all this talk about sulfonylureas has got me concerned for sure!

>

> I'm confused and not sure what to do. Woudl insulin be a better

> choice for me (much as I fear needles?) My primary goal is to have

> excellent control with no more complications than I have currently!

Rick said....

to argue with her. Instead, she suggested Insulin - Lantus at bedtime

and Humalog before each meal. Since taking exogenous Insulin would

preserve my own beta cells, I decided to try Insulin, even though I

dreaded the needle. Well - long story short - I seldom even feel the

shot (poking my finger hurts FAR more - even at the light settings), my

BG's began to come down nicely. ...

Rick

[Guest guest]

How do you figure out which type of insulin to use and what dosage to use?

I'm beginning to think I should discuss the possibility with my doctor at my

next visit this month.

Also, how does the cost of insulin and syringes compare with Glucophage

and/or Glyburide?

Thanks for everyone's comments!

Vicki in CO

-- Re: sulfonylureas

Vicki Mossman wrote:

> OK - all this talk about sulfonylureas has got me concerned for sure!

>

> I'm confused and not sure what to do. Woudl insulin be a better

> choice for me (much as I fear needles?) My primary goal is to have

> excellent control with no more complications than I have currently!

Rick said....

to argue with her. Instead, she suggested Insulin - Lantus at bedtime

and Humalog before each meal. Since taking exogenous Insulin would

preserve my own beta cells, I decided to try Insulin, even though I

dreaded the needle. Well - long story short - I seldom even feel the

shot (poking my finger hurts FAR more - even at the light settings), my

BG's began to come down nicely. ...

Rick

[Guest guest]

How do you figure out which type of insulin to use and what dosage to use?

I'm beginning to think I should discuss the possibility with my doctor at my

next visit this month.

Also, how does the cost of insulin and syringes compare with Glucophage

and/or Glyburide?

Thanks for everyone's comments!

Vicki in CO

-- Re: sulfonylureas

Vicki Mossman wrote:

> OK - all this talk about sulfonylureas has got me concerned for sure!

>

> I'm confused and not sure what to do. Woudl insulin be a better

> choice for me (much as I fear needles?) My primary goal is to have

> excellent control with no more complications than I have currently!

Rick said....

to argue with her. Instead, she suggested Insulin - Lantus at bedtime

and Humalog before each meal. Since taking exogenous Insulin would

preserve my own beta cells, I decided to try Insulin, even though I

dreaded the needle. Well - long story short - I seldom even feel the

shot (poking my finger hurts FAR more - even at the light settings), my

BG's began to come down nicely. ...

Rick

[Guest guest]

Vicki Mossman wrote:

> How do you figure out which type of insulin to use and what dosage to

> use? I'm beginning to think I should discuss the possibility with my

> doctor at my next visit this month.

Hi Vicki,

As Phyllis W. mentioned, your Doctor would set an initial dosage

schedule for you. Since the advent of Humalog, more and more doctors are

prescribing it for the daytime mealtime Insulin needs, although there

are still plenty of occasions when a different regimen is called for.

Humalog is fast acting and does not last as long as other types of

Insulin (thinking R & N here). In many people, that is exactly what they

need. Others, especially those with diabetic digestion problems (help me

folks - my mind is going blank on the condition), food is digested and

absorbed more slowly and a longer acting Insulin is sometimes needed in

those cases. He may also recommend a " basal " insulin such as Ultra Lente

(UL) or Lantus. This insulin would cover the background insulin needs

(if required). Dosages of either or both would be adjusted over a period

of time. The docs are not anxious to give anyone a hypoglycemic event,

so they'll make changes slowly over a period of time. Once you've been

at it for a while, you'll eventually learn how insulin affects you as an

individual and it will be easier for you to make minor tweaks as the

need arises.

>

> Also, how does the cost of insulin and syringes compare with

> Glucophage and/or Glyburide?

>

In my case, everything is $10.00 per prescription fill. I am able to

make the insulin last longer than any oral meds, so for me it is

cheaper. This is an insurance YMMV issue though.

>

> Thanks for everyone's comments!

You're welcome. My input on this particular subject is only meant to

say, don't be afraid of Insulin. Everyone's situation is different, but

I truly believe that it's a great drug and when used properly, can boost

your enjoyment of life. We can't get this diabetes " monkey " off our

backs, but sometimes we can knock it unconscious for a while!

Rick

[Guest guest]

I prefer using Ultralente for background twice a day as it's virtually

peakless. And I use fast-acting Humalog, dose matched to carbs eaten at that

meal. This works really good for me. Vicki

In a message dated 04/06/2002 4:56:55 PM US Mountain Standard Time,

vmossman2@... writes:

>

> How do you figure out which type of insulin to use and what dosage to use?

> I'm beginning to think I should discuss the possibility with my doctor at

> my

> next visit this month.

>

>

[Guest guest]

I prefer using Ultralente for background twice a day as it's virtually

peakless. And I use fast-acting Humalog, dose matched to carbs eaten at that

meal. This works really good for me. Vicki

In a message dated 04/06/2002 4:56:55 PM US Mountain Standard Time,

vmossman2@... writes:

>

> How do you figure out which type of insulin to use and what dosage to use?

> I'm beginning to think I should discuss the possibility with my doctor at

> my

> next visit this month.

>

>

[Guest guest]

In a

message dated 4/6/02 10:31:16 AM Pacific Daylight Time, vmossman2@...

writes:

> I'm confused and not sure what to do. Woudl insulin be a better choice for

> me (much as I fear needles?) My primary goal is to have excellent control

> with no more complications than I have currently!

> BTW, my physician is an internal medicine doctor; I like him very much, but

> not sure of his expertise in diabetes care. I'm on an HMO and require

> referral to see any other doctor. Also, the town I live in doesn't even

> have an endo!

> ANY advice and assistance you can give me would be greatly appreciated!

> Vicki in CO

Vicki,

Glyburide of one of the oldest of the oral diabetic meds. That doesn't make

it bad.

It works by forcing the pancreas to secrete insulin into the blood (needed or

not, so always carries the risk of hypo's). Past experience has led Drs to

see a progression from these type drugs to insulin because of failure of the

pancreas after taking them for an extended period of time. That experience is

well documented. Many patients did have to go on insulin.

Now, however, recent evidence has shown that pancreas beta cells will fatigue

and die when operating in the presence of high glucose levels, but will

continue to work if glucose levels are normal.

Since so many diabetics (90% or more) control very poorly and virtually never

maintain normal levels, then the damage to the pancreas when forced by a drug

like Glyburide is likely, leading to failure, hence the progression to

insulin.

The good news is that if bg's are maintained in " normal " ranges, then the

pancreas should do just fine even when stimulated by the Glyburide.

If you are still uncomfortable using it, there are a number of other choices

other than Avandia. Ask your Dr.

, T2

Oregon

[Guest guest]

In a

message dated 4/6/02 10:31:16 AM Pacific Daylight Time, vmossman2@...

writes:

> I'm confused and not sure what to do. Woudl insulin be a better choice for

> me (much as I fear needles?) My primary goal is to have excellent control

> with no more complications than I have currently!

> BTW, my physician is an internal medicine doctor; I like him very much, but

> not sure of his expertise in diabetes care. I'm on an HMO and require

> referral to see any other doctor. Also, the town I live in doesn't even

> have an endo!

> ANY advice and assistance you can give me would be greatly appreciated!

> Vicki in CO

Vicki,

Glyburide of one of the oldest of the oral diabetic meds. That doesn't make

it bad.

It works by forcing the pancreas to secrete insulin into the blood (needed or

not, so always carries the risk of hypo's). Past experience has led Drs to

see a progression from these type drugs to insulin because of failure of the

pancreas after taking them for an extended period of time. That experience is

well documented. Many patients did have to go on insulin.

Now, however, recent evidence has shown that pancreas beta cells will fatigue

and die when operating in the presence of high glucose levels, but will

continue to work if glucose levels are normal.

Since so many diabetics (90% or more) control very poorly and virtually never

maintain normal levels, then the damage to the pancreas when forced by a drug

like Glyburide is likely, leading to failure, hence the progression to

insulin.

The good news is that if bg's are maintained in " normal " ranges, then the

pancreas should do just fine even when stimulated by the Glyburide.

If you are still uncomfortable using it, there are a number of other choices

other than Avandia. Ask your Dr.

, T2

Oregon

[Guest guest]

Phyllis N. wrote:

<< I guess Amaryl is one of these, even though it is fairly new. Is this

correct? I wonder if my problems are linked to this. >>

Yes, Amaryl is one of those drugs, dear.

Susie

[Guest guest]

Phyllis...have you considered starting insulin? All those pills seem to give

you problems and you're still not getting good control. With insulin, good

control is definitely doable; it just takes a little bit of experimentation

to get the correct dose. Vicki

In a message dated 05/12/2002 6:33:10 AM US Mountain Standard Time,

pnorwood1@... writes:

>

> Now, I am just upset and feel that no one can help me get better. Does

> anyone know of any new medication or can anyone give me any advice on the

> Amaryl?

>

>

[Guest guest]

Phyllis...have you considered starting insulin? All those pills seem to give

you problems and you're still not getting good control. With insulin, good

control is definitely doable; it just takes a little bit of experimentation

to get the correct dose. Vicki

In a message dated 05/12/2002 6:33:10 AM US Mountain Standard Time,

pnorwood1@... writes:

>

> Now, I am just upset and feel that no one can help me get better. Does

> anyone know of any new medication or can anyone give me any advice on the

> Amaryl?

>

>

[Guest guest]

Kathy wrote:

<< A while back there was someone that said about Glyburide type of drug

will wear out your pancreas. My Aunt is on Glipizide and I think that is

similar to glyburide and I had said something about it wearing out your

pancreas and she is frightened now and what I was wondering is there any

sites I can direct her to? >>

Studies say that within six years of commencing use, 60 percent of type 2's

on sulfonylureas will lose pancreas function. It goes about treating

diabetes in the wrong way ... pummeling the pancreas to churn out even more

insulin, when what is needed is an approach to improve insulin resistance,

so that the pancreas beta cells don't have to work so hard. That is

accomplished by lowering carbohydrate intake, weight lifting, weight loss,

and regular exercise.

Because of the long history of sulfonylurea use, this notion that type 2

diabetes is inevitably " progressive " has developed. Doctors feed their

patients sulfonylureas; they see their patients' pancreases fail; they

eventually move them on to injected insulin; complications develop. Never do

the doctors recognize their own role in prescribing wrong medications!

Susie

[Guest guest]

This is very concerning to me. I took glucotrol for 8 years, then they

switch me to Amaryl about 2 years ago.

1/2 of an Amaryl will bring my blood sugar down more than all other drugs

combine. I used to take Avandia, glucophage and amaryl and my blood sugars

were never good. Then I took 2000mg of glucophage a day and my levels were

still not that good. Then I say not good, I am talking about 190 in the

morning and 135 in the afternoon. I have never had the blood sugar levels

that people on this list talk about, even on Atkins. They were always about

the same as above.

Now I am taking only 1/2 of an Amaryl, eating about 100 carbs a day and my

blood sugar is 150 in the morning and 100 at night. It has never been

better. I had a C-peptide test about 6 months ago and my insulin production

was normal.

Now I am just confused. Which is more important to take the Amaryl and have

good blood sugars or protect my pancreas?

The glucophage makes my legs hurt really bad, after good use of it for 8

years??????????????? So I have recently stopped it. I tried over 15 times

stopping and starting it over the last two months to see if I could tolerate

it. I would stop for 2 days - leg pain gone away. Then I would take only

500mg a day just to see, hoping my legs had gotten better, in 24 hours, my

legs would ache so bad, I could barely walk.

Also, when I take Actos, my heart races like it is coming out of my chest,

so I stopped it after 2 days of use. I repeated this 4 times in 2 years

hoping something else had effected my heart, with the same results.

The Avandia - which I have only tried once for about 3 months, made my

ankles swell up like watermelons, every night, so I stopped it.

Now, I am just upset and feel that no one can help me get better. Does

anyone know of any new medication or can anyone give me any advice on the

Amaryl?

Last A1C was 6.5

Thanks,

Phyllis N

<<Studies say that within six years of commencing use, 60 percent of type

2's

on sulfonylureas will lose pancreas function. It goes about treating

diabetes in the wrong way ... pummeling the pancreas to churn out even more

insulin, when what is needed is an approach to improve insulin resistance,

so that the pancreas beta cells don't have to work so hard. That is

accomplished by lowering carbohydrate intake, weight lifting, weight loss,

and regular exercise.>>

_________________________________________________________________

Join the world’s largest e-mail service with MSN Hotmail.

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[Guest guest]

Phyllis Norwood wrote:

<< Does anyone know of any new medication or can anyone give me any advice

on the Amaryl? >>

Dear Phyllis, in eight paragraphs you never mentioned approaches other than

medicines to treat your diabetes. Do you still have weight to lose? Are you

exercising regularly? Are you lifting weights? These are all safe, sound

approaches to lowering insulin resistance. Even a loss of 15 pounds can make

a big difference in our insulin resistance.

Susie

[Guest guest]

Phyllis Norwood wrote:

<< Does anyone know of any new medication or can anyone give me any advice

on the Amaryl? >>

Dear Phyllis, in eight paragraphs you never mentioned approaches other than

medicines to treat your diabetes. Do you still have weight to lose? Are you

exercising regularly? Are you lifting weights? These are all safe, sound

approaches to lowering insulin resistance. Even a loss of 15 pounds can make

a big difference in our insulin resistance.

Susie

[Guest guest]

It will be the last resort. I won't reject it and I know I could eat more,

but what about the weight gain. That scares the hell out of me.

Phyllis

>

>Phyllis...have you considered starting insulin? All those pills seem to

>give

>you problems and you're still not getting good control. With insulin, good

>control is definitely doable; it just takes a little bit of experimentation

>to get the correct dose. Vicki

>

>In a message dated 05/12/2002 6:33:10 AM US Mountain Standard Time,

>pnorwood1@... writes:

>

>

> >

> > Now, I am just upset and feel that no one can help me get better. Does

> > anyone know of any new medication or can anyone give me any advice on

>the

> > Amaryl?

> >

> >

>

>

>

>

[Guest guest]

It will be the last resort. I won't reject it and I know I could eat more,

but what about the weight gain. That scares the hell out of me.

Phyllis

>

>Phyllis...have you considered starting insulin? All those pills seem to

>give

>you problems and you're still not getting good control. With insulin, good

>control is definitely doable; it just takes a little bit of experimentation

>to get the correct dose. Vicki

>

>In a message dated 05/12/2002 6:33:10 AM US Mountain Standard Time,

>pnorwood1@... writes:

>

>

> >

> > Now, I am just upset and feel that no one can help me get better. Does

> > anyone know of any new medication or can anyone give me any advice on

>the

> > Amaryl?

> >

> >

>

>

>

>

[Guest guest]

Phyllis N. wrote:

<< Well this scared the hell out of me. The position I am now in that eating

less than 20 carbs per day leaves me with blood sugars of 185 in the morning

and 130 at night. If I take the glucophage, my legs hurt very bad, the

Avandia makes my ankles swell like watermelons, the Amaryl I guess is going

to give me another heart attack. The actos makes me shake and makes my heart

rate go up.

so what is left. What would you do Susie? Would you go on Insulin? I also

can do low carb 99% of the time, but on holidays it is nice to be able to

eat something else.

I am so disgusted with the drug situation. I have began believe that the

drugs may kill us faster than the diabetes, if you can keep the blood sugars

under 200. My last A1C was 6.5, so I guess that is not too bad with

basically no meds. I have been using the Amaryl when I eat carbs. I value

your opinion. >>

Dear Phyllis,

I left your whole post in, because I think it is so important. So often, we

are left between a rock and a hard spot. My choices would be: try

everything to lose weight (and by this, I mean going to your doctor and

doing not only a TSH but a Free T3 and a Free T4 to check your thyroid level

.... in short, consider getting on thyroid meds even if your numbers do not

entirely qualify you for it). Another course is to look into a beta blocker

such as metoprolol. You may be developing LVH (left ventricular

hypertrophy).

I personally believe it is okay for us to cheat one percent of the time, so

I just wouldn't design my approach to deal with those very seldom

excursions. Your A1c looks pretty darn good to me. Your morning highs could

be from an overly-frisky liver, which the Glucophage/Metformin would likely

take care of. I don't understand the leg pains associated with the

Glucophage ... wish I could be more help there. Have you read up on

everything at http://www.rxlist.com? I'm sorry I'm not more help, but I

believe you are doing better than you think you are ... It's important not

to kill one organ (liver) in order to preserve another organ (pancreas).

It's just a tough call for people who aren't able to take the typical

diabetes drugs.

Susie

[Guest guest]

Phyllis N. wrote:

<< Well this scared the hell out of me. The position I am now in that eating

less than 20 carbs per day leaves me with blood sugars of 185 in the morning

and 130 at night. If I take the glucophage, my legs hurt very bad, the

Avandia makes my ankles swell like watermelons, the Amaryl I guess is going

to give me another heart attack. The actos makes me shake and makes my heart

rate go up.

so what is left. What would you do Susie? Would you go on Insulin? I also

can do low carb 99% of the time, but on holidays it is nice to be able to

eat something else.

I am so disgusted with the drug situation. I have began believe that the

drugs may kill us faster than the diabetes, if you can keep the blood sugars

under 200. My last A1C was 6.5, so I guess that is not too bad with

basically no meds. I have been using the Amaryl when I eat carbs. I value

your opinion. >>

Dear Phyllis,

I left your whole post in, because I think it is so important. So often, we

are left between a rock and a hard spot. My choices would be: try

everything to lose weight (and by this, I mean going to your doctor and

doing not only a TSH but a Free T3 and a Free T4 to check your thyroid level

.... in short, consider getting on thyroid meds even if your numbers do not

entirely qualify you for it). Another course is to look into a beta blocker

such as metoprolol. You may be developing LVH (left ventricular

hypertrophy).

I personally believe it is okay for us to cheat one percent of the time, so

I just wouldn't design my approach to deal with those very seldom

excursions. Your A1c looks pretty darn good to me. Your morning highs could

be from an overly-frisky liver, which the Glucophage/Metformin would likely

take care of. I don't understand the leg pains associated with the

Glucophage ... wish I could be more help there. Have you read up on

everything at http://www.rxlist.com? I'm sorry I'm not more help, but I

believe you are doing better than you think you are ... It's important not

to kill one organ (liver) in order to preserve another organ (pancreas).

It's just a tough call for people who aren't able to take the typical

diabetes drugs.

Susie