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Medical Forum / Diseases and Disorders / Diabetes / April 2006

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Actos plus Metformin

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Janice Upton - 07 Apr 2006 18:33 GMT
Hi. I have been reading posts for a long while but this is my first time to
send a post. I am a Type 2 diagnosed in July, 2004. I initially started on
Metformin, advanced to Fortamet which is an extended release Metformin 2000
mg at night, then my doctor added 2mg Amaryl but I still have not done as
well as I should. My A1c this morning was 7 compared to the usual 6.5 I've
been having. I'm tested for that every 3 months. My fasting bg have been
running in the 160's and lately I have been going over 200 in the postmeal
testing. I have to be honest and say that I am overweight and don't always
eat right. I went to doctor this morning and he has switched me from the
Fortamet to taking Actos Plus Met twice a day, 15mg Actos and 850mg
Metformin each pill. He suggested trying Byetta but I am reluctant to take
shots since I have a real fear of shots/needles. I have samples of the Actos
to take before filling the prescription. My brother in law who is also
diabetic could not take Actos because of fluid retention. I'm just wondering
if anyone else here has successfully taken the Actos without significant
weight gain or fluid retention. I've started walking 1 mile a day and hope
to increase that as I get used to it. I'm very out of shape.
Susan - 07 Apr 2006 18:37 GMT
> Hi. I have been reading posts for a long while but this is my first time to
> send a post. I am a Type 2 diagnosed in July, 2004. I initially started on
[quoted text clipped - 13 lines]
> weight gain or fluid retention. I've started walking 1 mile a day and hope
> to increase that as I get used to it. I'm very out of shape.

Hi, Janice.  Good idea getting some physical activity and becoming more
fit. 1 mile daily is a great beginning!

If you've been reading here for a while, you may have noticed that folks
with the best control are paying very careful attention to diet as the
primary means to control, and medication as secondary.  There are a lot
of good reasons for doing so.

Would you like to post a typical day of meals so folks here can make
some suggestions?  When do you test, and how often?

Susan
Janice Upton - 07 Apr 2006 19:09 GMT
I've been testing in the morning when I get up and two hours after dinner at
night. Sometimes I will test before lunch at work but not very often. Right
at first I tested more but my prescription was written for two strips a day
and the insurance wouldn't pay for the strips when I needed more before the
time had passed. I did buy them myself a couple of times but it was running
around $50.00 so now I limit myself to twice a day. I'm not a big breakfast
eater but usually banana, boiled egg on work days or crackers and peanut
butter and sometimes I drive through and get plain cake donut- I know, I
know - bad! Lunch was usually fast food- fried chicken, french fries, etc.
but now I'm trying to bring lunch to work- fix salad
night before, with cheese piece of ham or turkey. My husband died in 2004
and I live with my 84 year old mother now- so we kind of eat a variety at
night according to what she wants- we are eating less white potatoes which
was a big part of our diets before now eating more sweet potatoes instead.
My biggest downfall is that I was still drinking regular soft drinks like
Sprite. Hate the taste of diet drinks but will try to stick to water,
unsweet tea. Also when get stressed or depressed eat more. I really never
was a sweet eater until my husband died and then started. It was three
months after that I was diagnosed. I'm sure I was already diabetic- just
didn't know it.
Susan - 07 Apr 2006 19:34 GMT
> I've been testing in the morning when I get up and two hours after dinner at
> night. Sometimes I will test before lunch at work but not very often. Right
> at first I tested more but my prescription was written for two strips a day
> and the insurance wouldn't pay for the strips when I needed more before the
> time had passed. I did buy them myself a couple of times but it was running
> around $50.00 so now I limit myself to twice a day.

Janice, it's hard to get a handle on what spikes you without testing
more often at first, til you know what to avoid and what to include.
Do you have insurance that'll pay more if your doctor orders more
strips?  I have to have rxs written a particular way, and I can get
quantities I need.

Here's the best advice for getting under control you're likely to find
anywhere:

http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm

 I'm not a big breakfast
> eater but usually banana, boiled egg on work days or crackers and peanut
> butter and sometimes I drive through and get plain cake donut- I know, I
> know - bad!

Really, really bad, maybe not just the doughnut, which is out of this
world bad.  Bananas usually don't work well for us, either, though
boiled eggs on half a high fiber, lite english muffin or diet toast
might be fine.  If the crackers are high fiber, like Wasa multigrain or
fiber rye, that PB and cracker could fit your plan.  But you need to put
your meter to work figuring this out.

 Lunch was usually fast food- fried chicken, french fries, etc.
> but now I'm trying to bring lunch to work- fix salad
> night before, with cheese piece of ham or turkey.

Great lunch idea!

 My husband died in 2004
> and I live with my 84 year old mother now- so we kind of eat a variety at
> night according to what she wants- we are eating less white potatoes which
> was a big part of our diets before now eating more sweet potatoes instead.

I'm sorry about your loss.  Other folks may differ, but more than a 1/4
of a medium sweet potato spikes me.  For the most part, starches are the
thing to avoid, along with other concentrated sources of sugars.

> My biggest downfall is that I was still drinking regular soft drinks like
> Sprite. Hate the taste of diet drinks but will try to stick to water,
> unsweet tea.

I've been drinking citrus flavored seltzer for years now (used to love
Fresca) and now I can't stand the sweetness of diet soda. Some folks
like diet Crystal Lite.  I don't like artificial sweeteners as a rule.
Water with lemon or lime (I keep frozen slices in the freezer in a
ziplock) or seltzer, or unsweetened ice teas can substitute.

> Also when get stressed or depressed eat more. I really never
> was a sweet eater until my husband died and then started. It was three
> months after that I was diagnosed. I'm sure I was already diabetic- just
> didn't know it.

You're probably right.  I'm sure it's been a painful couple of years for
you.  Is there something else you can do instead of eating when
stressed?  A walk outside for 10 minutes, a treadmill, folding laundry
(hey, it relaxes me!)?  You get the idea.  Maybe come here and post
about what's bugging you?

Susan
W. Baker - 07 Apr 2006 20:50 GMT
Janice Upton <jrupton@cox.net> wrote: : I've been testing in the morning
when I get up and two hours after dinner at : night. Sometimes I will test
before lunch at work but not very often. Right : at first I tested more
but my prescription was written for two strips a day : and the insurance
wouldn't pay for the strips when I needed more before the : time had
passed. I did buy them myself a couple of times but it was running :
around $50.00 so now I limit myself to twice a day.

If you are limited to 2 strips a day at this time, swithe yur meals that
you test for.  One day 2 hors after breakfast, next day 2 hours after
lunch and next day 2 hours after dinner.  See what times of dy are hard
for you and that meals cause you the most BG srief(highs).  It takes
longer to learn with teh fewer strips, butyu can learn from this way.  I
know alan will say test a one hour after meals, but start this way and
then, if you can get ore strips from the insurance with a doctor's
prescription, add the 1 hor to our pattern.

I'm not a big breakfast : eater but usually banana, boiled egg on work
days or crackers and peanut : butter and sometimes I drive through and get
plain cake donut- I know, I : know - bad!

this is not a moral exercise, but a way of finding what yu can eat.  The
banana, articularly in teh morning is very hard for most of us to deal
with in bg terms.  Try the egg adn 2 wasa crackers with soem pb or cream
cheese or lower fat cream cheese for the greakfast and no banana.  You
could try my favorite, which doesn't spike me.  abotu 1/3-1/2 C of low fat
cottage cheese, small amount of 3 diferent fruits like half a clementine
orange, 3-4 strawberries, sliced, a handfu of other berries, (blue,black,
rasp, etc) 5 or 6 cherries, 1/5 of an apple, 15 ov a mango, 1 apricot, 1/2
peach, etc.. Notice, no bananas.  top this with a big dollop of low fat
plain yogurt and enjoy!  A similar dish, but a bit larger quantities,
could be used for a lunch too.  Perhaps with some raw veggies to go along
with it.  


Lunch was usually fast food- fried chicken, french fries, etc.
: but now I'm trying to bring lunch to work- fix salad
: night before, with cheese piece of ham or turkey.

This lunch looks great!

My husband died in 2004 : and I live with my 84 year old mother now- so we
kind of eat a variety at : night according to what she wants- we are
eating less white potatoes which : was a big part of our diets before now
eating more sweet potatoes instead.

I can't handle sweet otatoes in any quantity worth eating.  Try winter
squash instead.  It is about half teh carbs s the sweet potato.  No reason
nt to give yur Mom a nice baked sweet potato and you just skip it or take,
maybe a quarter of one.  

: My biggest downfall is that I was still drinking regular soft drinks like
: Sprite. Hate the taste of diet drinks but will try to stick to water,
: unsweet tea.

Oof!  That soda can really kill al your efforts!  many of us find that ,
over time, we get used to the diet soda and no longer either hate, resent,
of even dislike it.   iced tea is great, particularly with lemon in it.  
Yu can use an artificial sweetener if you like.  

Also when get stressed or depressed eat more. I really never : was a sweet
eater until my husband died and then started. It was three : months after
that I was diagnosed. I'm sure I was already diabetic- just : didn't know
it.

Depression can make it harder.  Try to find activities, particularly out
of the house and involving other people, that ou like to do.  Join a club,
religious organization, political club, spports group, help at a soup
kitchen, etc.  Try to get yurself involved in the world socially.  If you
Mom is up to it (like my 84 er old husband) bring her along too.  I
wouldn't be surprised that your diagnosis, so soon after your husband's
early death, gave yu a double whammy and the sweets eting to compensate
for his oss made your diabetes show up.  Sugar does not cause diabetes,
but a change in the number of carbs yu are eating will make it worse, so
it shows u i tests mre easily.

Keep not only reading, but sting to this group and i can beome a
sublimation for you for teh sweets adan wll give you a new friendly group
that can help you.  Just reading is not enough.  You should be an active
participant and it will halp you come out of yourself.

Good Luck and post often.

Wendy
Susan Adair - 07 Apr 2006 20:51 GMT
H, Janice.  Your walks are a great idea; you will get stronger as you
persist.  I can now move at a good clip but at first I kept it slow but
steady.  Taking your lunch to work is also a fine idea; it saves money
and gets you better food.

Your dinners sound like they are still a problem; it's hard to get good
diabetic foods when they are chosen by someone else.  You might try
letting your mother have her potatoes; you insist on broccoli, or green
beans, or cauliflower, as well, and you eat that instead of the
potatoes.   If some potatos get wasted so be it.  Green salads are
good, too.  Yogurt makes a nice inclusion - it can be a sauce on the
veg if you like that, and add to your calcium consumption.

You do need to test as much as you can, and make the tests count.  You
might try using your two strips for a different meal every day, and
save the fasting test for once a week.  If you test at one and two
hours after dinner every day for 5 days, and keep track of what you
eat, you can begin to develop a list of safe foods and foods to avoid.
Starches are the big problem for most of us as Susan says - flour,
rice, potatoes, any baked goods.  Wasa fiber rye crisp bread works for
me as a replacement for crackers and instead of bread with peanut
butter.

I find keeping a food diary helps keep my eating honest.  I force
myself to write down even my evening nibbles most of the time, even if
I don't test after every eating session.  This might help you be aware
of what you eat even if you can't test the effects every time.  One
thing that helps me a lot is eating pretty much the same thing for
breakfast every day.  I don't have to make a decision in the morning,
and I know what to buy in the store.  I take very similar lunches to
work every day as well.  I  also drink a lot of hot tea in the
evenings, particularly when I'm tempted to eat something I should not.
If you do any craft work - knitting, sewing, painting, this can keep
your hands busy and your mouth empty.

Susan Adair
Janice Upton - 07 Apr 2006 21:30 GMT
thanks for the support and suggestions. I believe that my posting today has
been a big step in the right direction. Instead of lurking around reading,
putting myself out there kind of forces me now to make the changes that I
need to.
Susan - 07 Apr 2006 21:40 GMT
> thanks for the support and suggestions. I believe that my posting today has
> been a big step in the right direction. Instead of lurking around reading,
> putting myself out there kind of forces me now to make the changes that I
> need to.

Great outlook, Janice! Stick around, read a lot, ask a lot of questions.

Susan
Alan S - 08 Apr 2006 01:37 GMT
Hi Janice

Just some further comments to add to the other answers,
interleaved.

>I've been testing in the morning when I get up and two hours after dinner at
>night. Sometimes I will test before lunch at work but not very often. Right
>at first I tested more but my prescription was written for two strips a day
>and the insurance wouldn't pay for the strips when I needed more before the
>time had passed. I did buy them myself a couple of times but it was running
>around $50.00 so now I limit myself to twice a day.

See some ideas at the foot of this message on how to get the
best out of two tests a day.

>I'm not a big breakfast
>eater but usually banana, boiled egg on work days or crackers and peanut
>butter and sometimes I drive through and get plain cake donut- I know, I
>know - bad!

Not bad. Suicidal.

Cut the banana and the crackers. Keep the boiled egg, or egg
in any form, add some meat or fish and/or some veges. And
consider doughnuts to be little poisoned wheels that other
people eat to commit oral suicide.

>Lunch was usually fast food- fried chicken, french fries, etc.
>but now I'm trying to bring lunch to work- fix salad
>night before, with cheese piece of ham or turkey.

Great idea! Now do it:-)
And if you miss - then buy salad at the fast food place, not
fries or fried things. My limit for fries, on special
occasions, is three per serve. My carb limit for lunch is
less than 15 gms. YMMV

> My husband died in 2004
>and I live with my 84 year old mother now- so we kind of eat a variety at
>night according to what she wants- we are eating less white potatoes which
>was a big part of our diets before now eating more sweet potatoes instead.

Sorry to hear of your loss.
Changing to sweet potatoes may or may not be good - your
meter will tell you.

>My biggest downfall is that I was still drinking regular soft drinks like
>Sprite. Hate the taste of diet drinks but will try to stick to water,
>unsweet tea.

Again, consider sugared soft drinks as poisonous. On diet
drinks, it's amazing what you can learn to like once you
finally accept that your life depends on it. And it does.
Worse, as far as I am concerned, so does my sight.

You can sweeten drinks with artificial sweeteners;
experiment with the different types. Ignore any alarms you
read about harmful artificial sweeteners - it's just
nonsense.

>Also when get stressed or depressed eat more.

Keep a salad in the fridge to snack on in small portions
whenever the urge hits you. NOT a potato salad or one
slathered in mayo or dressing.

>I really never
>was a sweet eater until my husband died and then started. It was three
>months after that I was diagnosed. I'm sure I was already diabetic- just
>didn't know it.

I'm sure too. But that's history. Let's try to give you a
future.

OK. How to gain control on two tests a day.

First - only test fasting every second day. That's enough to
let your doc know where you're at; even twice weekly would
be enough in your position. You see, in your position when
strips are limited, you want to learn from every test and
not just test to see a number that re-confirmms the same
fasting as yesterday.

Second - target one meal for a week at a time. Start with
breakfast. Tomorrow, test fasting, then one hour and two
hours after breakfast. Yes, I know, that was three. Wait:-)

Review what you ate and change the highest carb item the
next day to protein or fat (as in good fat - like olive oil,
or avocados or salmon etc). For example, cut out the banana
and add an extra egg. On day two, don't test fasting, but
repeat the one hour and two-hour tests.

On day three, continue the modification of the menu to keep
improving the numbers - but only test at 90 minutes after
eating.

On day four, test fasting, but by now you should have some
idea of whether your highest is going to occur at 60, 90 or
120 minutes. Test at that time.

Then repeat the cycle. Once you have discovered a consistent
peak time (mine is 60 minutes, YMMV), just test at that time
plus a couple of fastings per week. Once you have a good
"safe" breakfast, try others to give yourself variety.

Then repeat the process for lunch, then dinner, then snacks
over time.

Finally, as the numbers improve, come back here for
suggestions on how to improve fibre and other nutrients in
the mix.

Oh - and keep doing this: "I've started walking 1 mile a day
and hope to increase that as I get used to it."

If you have any doubts about anything I've said, check with
your doctor.

Good luck,

Cheers Alan, T2, Australia.
d&e, metformin 2x500mg

I have no medical qualifications beyond my own experience.
Choose your advisers carefully, because experience can be
an expensive teacher.

Everything in Moderation - Except Laughter.
Janice Upton - 08 Apr 2006 03:29 GMT
Thanks, Alan. I never thought about the fact that I was just testing the
same thing over and over which usually did just confirm the previous day's
bgs. I printed out your suggestions for testing (sometimes I seem to have
"swiss cheese holes" in my brain!) and expect that I will learn a lot more
doing it that way.
Alan S - 08 Apr 2006 04:33 GMT
>Thanks, Alan. I never thought about the fact that I was just testing the
>same thing over and over which usually did just confirm the previous day's
>bgs. I printed out your suggestions for testing (sometimes I seem to have
>"swiss cheese holes" in my brain!) and expect that I will learn a lot more
>doing it that way.

You'll make it - just don't give up!

Keep in touch, ask lots of questions. Of your docs, of us,
never wonder about this without asking someone who knows
from training or experience.

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg
Signature

Everything in Moderation - Except Laughter.

Nicky - 08 Apr 2006 15:13 GMT
> Thanks, Alan. I never thought about the fact that I was just testing the
> same thing over and over which usually did just confirm the previous day's
> bgs. I printed out your suggestions for testing (sometimes I seem to have
> "swiss cheese holes" in my brain!) and expect that I will learn a lot more
> doing it that way.

Alan did exactly the same thing for me when I started - just rethinking
about WHY I was testing gave me the nudge I needed to make better food
choices.

Nicky.

Signature

A1c 10.5/5.4/<6  T2 DX 05/2004
1g Metformin, 100ug Thyroxine
95/74/72Kg

hilbert - 08 Apr 2006 16:52 GMT
Janice:

I want to just shout out a word of encouragement.  I am also a newbie
at this and am learning - so I can't really advice (others are good for
that).

I have found that just exercise is seldom enough to get my bg numbers
under control. I have to restrict the carbs as well. Use your meter to
guide you
- that's what I have been doing and you will notice that some of the
results
may surprise you.

Depression can make things worse (I know), but moderate exercise
is something that can help both depression and diabetes.

H
 
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