Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars by Richard K. Bernstein

Author:Richard K. Bernstein [Bernstein, Richard K.]
Language: eng
Format: mobi, epub
Tags: HEA039050
ISBN: 9780316191739
Publisher: Little, Brown and Company
Published: 2011-10-31T16:00:00+00:00

GETTING STARTED: SOME TYPICAL PROTOCOLS

Let’s say you’re a type 2 diabetic and through weight loss, exercise, and diet, you pretty much have your blood sugars within your target range. Still, your blood sugar profiles show a regular elevation in the mornings after a low-carbohydrate breakfast, probably due in part to the dawn phenomenon (see here).

My first attempt to resolve the dawn phenomenon would be to try a small dose (500 mg) of Glucophage XR before you go to bed. This will achieve its peak blood level after about 7 hours. If this still doesn’t get your blood sugars into target range, then you could increase the dose gradually, perhaps by one more tablet at bedtime for a week and so on, until you reach a maximum of 4 tablets a night or you hit your target. I always recommend the least possible dosage—partly due to the Laws of Small Numbers, but also because of the reduction of likelihood for potential side effects. With metformin, if you build up your dosage slowly, it lessens the possibility of gastrointestinal discomfort that about one-third of users of the older, more-rapid-acting version experience.

Another option would be to use Actos at bedtime either instead of Glucophage XR or in addition to it, if necessary. We could start with 15 mg and increase the dose to a maximum of 45 mg.

In some cases, blood sugar levels either increase overnight or increase during the first 2 hours after you arise. The latter situation is most likely due to the dawn phenomenon. Either situation may respond to the above treatment.

Another possibility that would warrant oral medication would be if your blood sugar levels increased after lunch or dinner. Some potential solutions include taking rapid-acting Glucophage 1–2 hours before eating or rapid-acting insulin 0–30 minutes before eating if the Glucophage is inadequate.

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