I've been MDI (Lantus and Humalog) for 3 years, daily dose about 20 units. Well controlled (A1C 5.7), GAD negative, low c-pep, thin and moderately active. My endo has asked me to experiment with Amaryl on the off chance that I have MODY. He said that, since I test often, I'll know within 3 days if it's right for me. Does anybody have any thoughts? Do we know the long term impact of Amaryl?
I think this would be a big mistake. For context, I'm a T2 who voluntarily treats with insulin, rather than pills.
Insulin is natural to your body. Even the analogs, while not "natural", are treated by the body as identical.
Taking insulin when your pancreas can't make enough relieves the pressure on your pancreas to manage your BG. The organ is likely to stay healthier, and your beta cells keep working. This is important, as it makes managing your BG much easier if you have some beta cell response. Your risk of DKA is diminished enormously with a functioning -- but crippled -- pancreas.
In contrast, all the non-insulin pharmacological treatments stress the already struggling pancreas. What they do, in one way or another, is turn the volume up on your remaining beta cells, putting them into insulin production overdrive, and wearing them out. There's a growing body of research supporting this theory.
So, by taking Amaryl, Byetta, glipizide, etc. -- drugs that in the end supercharge your beta cells, you may realize an easier regimen for managing your D for a while, but you risk pushing yourself further into full-blown T1 land where the management gets harder, more critical, and the ever-present boogeyman of DKA is hanging over your head.
LADA, MODY, Type 2 -- many of us believe treating with insulin from the start and preserving existing beta cell function as long as possible is the best way to go.
Thanks, Dave. Exactly my concern. I've found plenty to support that Metformin would be a mistake but, little about Amaryl.
I'd agree with Dave, based on what I understand, at least. I also wouldn't rule out type 1 with you if you have low c-peptide? Because not all type 1's test GAD positive. I mean sure you COULD be someone with MODY , but even then I wouldn't risk it when you're already having tests that say you have low c-peptide. Meaning if you stress your pancreas out with drugs like that, it might make a turn for the worse. I'd say stick to the insulin, it's probably your best route of treatment EVEN IF you're not a type 1. I wouldn't ditch my insulin for anything. If my endo (who's been in my shoes before so I don't see this happening) told me to try something and stop insulin I'd be like lol no bye and never go to him again or at least I'd try to talk it out with him and have further testing (such as genetic testing or further antibody tests) to find out before doing anything with my insulin treatment.
On a side note I'm someone diagnosed type 1, take around 14-20 units of novolog and lantus every day and have an a1c of 5.5% . I will be starting an insulin pump this month, so who knows how that'll change things but I'm hoping for the better on the convenience and fine tuning front .
Also is this the same endo from a previous post that told you were too good and to ease up your doses of insulin? Because you sound like you need a new endo really bad if this is the case , I'm just saying. I test quite frequently and get very meticulous about my results. I freak out if I get highs or lows too. It's not abnormal, you are normal for that. My endo and cde praise me for keeping records like I do and being concerned about both highs and lows and hope I continue this kind of thing for the rest of my life so I stay healthier. I probably will because it makes me feel good.
Thank you so much. I think I was willing to explore the MODY route (vs. the type 1 or LADA as I've assumed) because of the implication for my kids. I have no issues with the shots or tight management, etc. but, the notion that it might be genetically linked sent up a red flag.
Sensorium, get back to us after you've been on the pump for a while. It'd be nice to see how someone with a low A1C does when they go on a pump.
I understand that part of it, just don't make them change your treatment if it works for you, you know?
We will see. I'm hoping to stay in the 6-7% range though I don't mind going up a bit as long as I don't go too high for too long. I really don't mind going up from 5.5% though so going in thinking that might be better thank thinking I"ll stay at 5.5% lol.
Aimee, rather than Amaryl, have you thought about a CGM and pump (or just a pump)?
The Omnipod was very liberating for me!
I've thought about both. A lot. My control has been great with MDI as well as frequent testing and I don't hate managing this way. I did not ask my endo for a change, he suggested it. And he was honest about "experimenting".
If you don't have to change I wouldn't. I take amaryl. I worry about my beta cells. I'm GAD negative, low c-peptide, in normal weight range, and pretty active. I have been told that I'm T2 and can't have insulin. I would be afraid to stop taking it since someone might get it in their head that I don't need it then you will be trapped on a drug that really isn't a good thing in the long run.
Have you had the full antibody panel done yet. A lot of adult onset T1/LADAs are GAD negative but are positive for other antibodies. I'm ICA positive and GAD negative, had to twist some arms to get the full panel done. It was well worth it.