Can your beta cells just quit?

I have D for thirty years.Up until about 4 weeks ago my BG was pretty much under control. I was on metformin and Glucotrol. I had to come off the Met because of bowel issues. I have been put on Lantus about 4 days now. My # are off the wall. Eating next to no carbs. I’m worried because I have retinopathy I don’t want another bleed Can anyone tell me how long it takes for the Lantus to work?
And if your beta cells have quit. What does that actually mean. Does it mean the lantus will not be enough to get me in normal ranges and that I might need a fast acting insulin? I miss my metformin.

Hi Vikki,

Maybe your body is adjusting to being off Metformin and starting on Lantus? I would think Lantus would give you good control but maybe your dose isn't right and you probably do need fast acting as well. Have you asked your endo about this? I would do that right away.

Hi Meee I speak to him monday. He most likely will up my dose.Im on 10 units now. Eating very little carbs. The CDN told me to eat 45_60 carbs a meal. I would be in the 400s. If I did. So until I speak to him no carbs 4 me. Thanks 4 the reply.

Metformin works by reducing the amount of glucose output by your liver. So even though you are eating few/no carbs, your liver is making your BG go high.
Lantus works right away, so if your BGs are high, it means your own insulin production (plus lantus) is not enough to keep up with additional glucose from liver.

Many who switch to insulin are started at a low, conservative dose, to prevent low BGs.

When you see your doctor, see if they can give you a plan of increasing the insulin dosage every 2-3 days by 'x' units, until your numbers come down.

If you are noticing higher BGs after meals, even with no carbs, then adding fast acting insulin may also be needed. If your morning/fasting BG is higher than before bed, you may need to split the lantus dose (and take twice/day), or change the timing of it. Some people have 'liver dump' in the early morning hours.

Have you considered a reduction of the metformin, instead of total elimination ?

My FBG has came down from 275
120. So the Lantus is working in the fasting. Is not cutting it during the day meals. I am sure the Dr. Will tell me to increase the dose. Hoping that will take care of the meal numbers. I will not be to happy if I have to take additional shots. Just getting past Injecting once a day. Every time I inject I have blood not sure if that’s ok? As far as adding the met again it’s not an option. Even dropping the dose to half a 500 I could not leave the house. The sad part is it worked so well. I am going to ask about splitting the dose of Lantus. Thank u for ur input. If there is anything else u can suggest I would appreciate it.

As my a1c climbed to an 8 the doctor kept moving up the metformin doses for me. They had me on 2000 a day and added glimepiride. My stomach was killing me. So I would ask the doc to add some insulin instead. So finally switched docs. I went down to 500 mg of metformin to deal with the insulin insensitivity. And got 10 units of lantus a day. So that combination helped to bring me to better numbers. So maybe you could lower the metformin dose and keep the lantus the same to see if that combination works. That has helped me a lot with the stomach issues and the higher numbers.

Uhhh . . . metformin's action is passive. It does not lower BG, it simply suppresses liver dumps so that BG rises less than it otherwise would.

But you were also taking Glucotrol (glipizide), a sulfonylurea. That drug actively lowers BG, e.g., it can cope with post-meal spikes. But Lantus and Levemir are basal insulins, they're not designed to do that. When you eat a meal, Lantus will not help much with a post prandial rise. Its purpose is rather to keep you on an even keel when you're not eating.

So, unless I misunderstand, you used to be on a medication for dealing with post prandial BGs and now you're not. In a scenario like that, I would expect spikes galore. So, bottom line, you may very well need to consider a fast acting bolus insulin to get things back where they belong. You need to have this conversation with your doctor, and pull no punches. You need good control and it doesn't sound as though the present regime is delivering it.

I used to be on metformin only and would experience a lot of lows at one point. I would go from 270 down to 50 when I worked out. It seem that it would suppress the dumping of glucose and would not let my numbers back up. I experienced this for 3 years. For some reason the onboard insulin my body was producing would kick in full tilt when I worked out. I would leave the house and be low 20 minutes later after a hard workout. So It may cause lows by suppressing glucose release and normal insulin working as expected under certain condition. I met another person in this forum a while back with the same issue. So the combination of metformin for suppression and the body working could cause lows. I even got a cgm put on cause the doc did not believe me. the data proved my point.

I will talk to my Dr. About this. So I may still need the fast acting insulin to control meal spikes? Will I have to take the Glucotrol also? Is there an insulin that handles both in one injection?

The thought of doing the injections has me stressed but I am managing. When I inject I get some blood. Is this ok? I guess I will get better at it as time goes by. Thanks for the info. This site is a God send. The members are amazing.

What is a cgm?

There are mixed insulins that you can use but they are not the best way to go. I'm sure your doctor has started you on a low dose. My instructions were to raise the amount by 2 units every three days until my numbers got better. Before long I was using 80 units a day and was splitting it into 2 daily injections.

I guess what I'm trying to say is that if you have insulin resistance like most T2's do then large amounts of insulin can be needed. I ask my doctor how much was too much and he said insulin is not toxic the only side effect from too much is low blood glucose. If a person is not going low then they aren't taking too much and should not worry about the amount.

I suspect that once you get more experience the bleeding will be reduced, it might be a good idea to ask a nurse or a diabetes educator to give you help with your technique.

I realize that injections are stressing you out but don't worry it will be just a short time till they are part of you regular routine and you will wonder why you stressed so much. As unpleasant as they are they are still better than the metformin trots.

An occasional drop of blood is normal, it happens to just about everyone. If it's happening every single time, however, that is not normal. It's possible that you may not be performing your injections correctly. You should get some training from a nurse or CDE (Certified Diabetes Educator) if you haven't already done so.

And, CGM stands for "Continuous Glucose Monitor". It's a device you wear 24 hours a day to monitor your BG level. It samples every 5 minutes and tells you what the current trend is (up or down), and can sound an audible alarm if you go too high or too low.

To answer your other question, insulin is enormously more effective at controlling blood glucose than any pill yet invented. If you're using a bolus insulin, Glucotrol would be completely redundant. I can't imagine a doctor prescribing both. One or the other, yes; both, no.

Yes Gary they r better then the trots. My pre meal was 112 and 2 hr was 124. Getting there. The tread mill helped I think. Do u have to be as low as 80 to be considered controlled?

Were would u purchase the cgm. I have not been sleeping well setting alarm to check my readings. I have a fear of lows. I am on the glucotrol also. The night readings have been good. This morning I had a 114 fasting. I know I see folks talking about 70s. And 80s. FBG I don’t want to be that low. Do u have to be that low? This is very new to me and still a little scary till I see how my readings run. I’m sure I will figure it out and be just part of my routine.
Also is it usual to start Lantus and continue with 20 mil of Glucotrol? Can’t u just start with lantus alone?
Thanks for the info.

If you're not using a bolus insulin at mealtimes, then it makes sense to keep using the Glucotrol; as mentioned earlier, Lantus is not designed to cope with meals.

CGMs are expensive; people don't usually get them unless they are covered by insurance. There are a number available; the one that appears to be the most popular and highly regarded just now is the G4 from Dexcom. You can check the Dexcom web site for more information. Also, a CGM is a prescription item; a doctor's scrip is required in order to get one.

The question of what constitutes an "ideal" fasting number is a source of lively and ongoing debate. Different doctors have different preferred levels. Generally speaking, fasting readings for non-diabetic, non-obese, non-pregnant people tend to cluster in the middle 80s. But many doctors do not like their patients to go that low because of the risk of hypoglycemia; this is particularly true of those on insulin. It's one of those questions (like so many relating to diabetes) for which there is no single agreed-upon answer. You really need to work with your doctor on this.

Dave Thanks so much for replying. I do so really appreciate it. I have so may questions I don’t know what I would do with out the group. Drs. do not get into everything. And I believe that people really know first hand about their own experiences. Thanks 4 Sharing. I will be looking for u again That’s if u don’t mind. Nite Dave

NP, you're most welcome. That's why this community is here.

You're discovering what we all eventually learn: you have to become your own expert. No one else can manage your diabetes for the simple reason that no one knows your body like you do and no one else is there 24x7 to do it. Doctors (a) only see you for a few minutes out of the year, (b) have their own opinions and biases just like everyone else, and (c) frequently -- not always, but 'way too often -- tend to apply one-size-fits-all rules that may or may not fit your unique physiology.

TuDiabetes is a community of 35,000 people who have been there ahead of you and are eager to share. You've come to the right place -- welcome to the family.


Glad to be to be.Hoping I will get to the right numbers soon. It’s great being able to vent with people who have been there. Makes things so much better to handle. Talk soon. Vikki