Going back on metformin

My hemoglobin A1c is up to 7.9 -- which is no surprise. I know I've been out of control for a long while. There are a number of reasons, including my knee making exercising non-sustainable, major slippage on our carb control (which I find hard to keep up alone), higher stress levels, and not testing reliably enough.

Getting started again, as I've written before, is very problematic. I'll get myself a head of steam to start again and I'll pick a day and say "starting on that day I'm back to doing everything I should", and I do, and then a day comes when I'm too busy or too tired or I have a cold or something, and it'll be easier to blow it off and break my streak because... I've already stopped before and started again, so what's the big deal about stopping and starting again? The date of starting was arbitrary, after all. And of course I know how stupid and self-defeating that is, but it still happens.

So here's the new plan, step by step.

1. I'm going back onto metformin. This is a very easy drug to go on, as its only side effect is that some people have gas and diarrhea for a few weeks while they acclimate to it. I already went through that once, so I might not have to go through it again, but even if I do, no big deal. Metformin doesn't do bad things to your body even if taken forever -- in fact, it's been proven to help with heart conditions unrelated to diabetes so it's taken by people who aren't diabetic. I always figured, when I went off it, that I'd be back on it someday (and that one day I'd probably be on insulin, too, unless medical science advances quick enough), so it's no big deal to be back on it. The idea here is that, if my control is so bad, it's hard to get encouraged because the little things I do barely make a dent in how bad my numbers are. Metformin can give me a kickstart so my control gets going again without me having to do everything all at once on the first day.
   
   
2. Then I start testing and recording my glucose every day and before and after most meals. I'm just recording, not judging. I have to be very careful not to look at each reading as a condemnation, not wincing at them.
   
   
3. Next I start recording carbs on every meal. Again, trying not to judge myself too much, just trying to record things. Eventually this is meant to get me to be more conscious of it and get out of the habit of splurging so often that it's not splurging anymore. (Key element in this is avoiding all the tasty, cheap high-carb snacky things we buy at Big Lots, which is hard for me when everyone else around me is having them.) But not to be so discouraged immediately that I react by stopping the recording.
   
   
4. Then I start very slowly at exercising. I avoid the treadmill since the knee pain thing was a complete showstopper. Instead, I'm trying out using a stationary bike at work. If it works out as it has in past tests, giving me the exercise without straining my knee to the point of pain, and (more importantly, and not yet tested adequately) it brings my glucose down appropriately (in combination with metformin and diet changes), I will buy one for home. (And someday a non-stationary bike too, for summer! Yay!)
   
   
5. Then the diet changes work their way in, little by little, not all at once. There are already some systemic changes in terms of using substitutions I'm still doing from before -- low carb bread and pasta, for instance. A few other things I've cut out already -- the reduced, but still too high, carb apple juice, for instance. The big challenge here will be the overabundant plethora of inexpensive carby snacks and sweets. The substitutes for these are all things that take a lot of effort and time to make, and in some cases, skills I lack. If you could buy Splenda-sweetened panna cotta and cheescake at the supermarket, I'd be golden, but you can't, you have to make it yourself. Not that it's hard, but when you're in the middle of something and just want to snack, a trip to the pantry is one thing, stopping what you're doing to cook is another.