Experiences with oral vs insulin

I have been taking 1000mg of metformin for 1 1/2 years now. Three weeks ago, the doctor added glipizide (sulfanylurea) to the mix. Since taking it, I have had to double my carb intake because on my normal diet I go very low and I’m gaining weight too fast… I would like to acheive an A1c of <6%. Currently, my A1c is 7% and climbing. I am willing to try insulin as a basal/bolus combination . I have read insulin will cause weight gain, but it stops when you reach the optimal dose and the lows are less intense.
Can anyone help?


Hi Danny,
I am sure that other type 2’s will be able to help you much better than I can, but I have a couple of questions. I was first diagnosed as a type 2, but am now correctly dagnosed as a type 1.5 and am on insulin. Why did the doctor add glipizide to the metformin? Were your blood sugars too high? What level do you consider a low? Do you have symptoms when you reach a level that you feel is too low? You said that since starting the glipizide you have had to double your carb intake over what you normally eat. How many carbs do you eat per meal? Do you count your carbs each meal or each day? And how often do you check your blood sugar? I realize there are a lot of questions here, but all of these are important.
Insulin is very good to control your blood sugars, but you have to control your intake as well and you shoot insulin according to the amount of carbs you take in. You don’t increase carbs to cover the meds you take. You can gain weight on the insulin too. You have to control your intake to lose weight and of course you would have to lower the amount if insulin as you lower the amount of food. The lows on insulin can be pretty bad, but you learn how to judge the amount of insulin you need and lower your dose if you frerquently get lows.
The reason to use insulin is if the metformin and glipizide are not lowering your blood sugars. I would talk to the doctor about this and discuss all your options. Good luck and come back to let us know how you are doing.

Thanks for your reply. any feedback I get keeps me focused on the problem.
I was diagnosed type 2 in Feb. last year. After trying diet, the doc added metformn 1000 mg twice per day and it did a pretty good job of lowering glucose. My A1C went down to 6.4 and my spikes rarely went over 150. My last A1C was 7.2. So, doc added a low dose of glipizide. She wants to reduce BS into the 5% range and from all I’ve read, so do I.
I used glipizide for almost a month and started keeping a closer eye on carbohydrare intake when my glucose dropped into the 70’s. That is when I discovered a cup of oatmeal for breakfast, a sandwich for lunch, and a supper of 60 - 80 carbs was not enough to avoid feeling low. Also, I am a carpenter and the glipizide increased my sensitivity to the sun. I simply can’t afford to risk a sunburn that would keep me away from work for 3 - 5 days. Also, a pregnant woman can take insulin but not glopizide, so I assume insulin is safer. Plus, on glipizide, I drank my occasional Dr. Pepper and my blood sugar went into the low 400’s and stayed over 200 for 4 hours. Made me sick as a dog and scared me. don’t misunderstand, the soda is an indulgence i allow myself once or twice a month in the summer.
I talked to the doctor and she started me on NPH thursday. The first shot was difficult. I had to overcome a lifelong fear of needles. It has been easier to do with each successive injection. So, far my experiences confirm what I had heard about it. It seems to be easier on my system and I am not having the raging hungries. My diet has almost returned to what it was on just metformin (I’m sitll taking it). Once doc has my basal adjusted, I guess she will add a bolus to control post prandial glucose.

A little history. My mother was a very bad type 2 and diagnosed in her30’s. Eventually, her doctor wanted to put her on insulin, but she refused and in her 60’s, she had to go on dialysis. she lived 1 year and 3 days and suffered every day in that year before she died. I do not want to suffer like that.

So, how did your doctors decide you were a 1.5?


Hi Danny,
Thanks for the information. I am glad you have started the NPH. Your doctor may decide to keep you on the metformn also, just as you have been. The thing you may want to adjust is your diet. If you really want to keep the oatmeal then do so. But it is not very high in protein and the protein will keep you on an even blood sugar better. The oatmeal has more carbs than anything else Has anyone helped you with your diet? A lot of us, but not even nearly all of us use a low carb diet. I personally use the low carb diet and use some meat, a lot of cheese, eggs, nuts, a lot of vegetables and some fruit. I rarely eat bread, but if i do it is always a 12 grain bread, high in fiber., I don’t eat potatoes, pasta or rice. But remember this is a choice. I like to keep my blood sugars down around 100 and lower. I feel better and my kidneys work better in this range… Fats are very important in helping control your appetite. They are very satisfying and make you feel fuller. It is the starchs and carbs that give us a harder time with our blood sugars.

I was first dfiagnosed as a type 2, but the pills did not work for me. They did not bring down my blood sugars. We tried the injectable Byetta. It was okay for a about a week, but didn’t really bring me down much and my kidneys got worse. I was in kidney trouble for a number of years before getting my diagnosis. Then the doctor said we would try the insulin. He started me on Lantus 10 units at night and Novolog 10 units before each meal. Well, that wasn’t the correct combination, but it sure brought down my blood sugars. Now we leave it up to me to take the amount I need fior each meal and have switched to Humalog. I don’t eat a lot at each meal and need less insulin than that. For my basal, we have switched me to morning and night and i use anywhere from 18 to 23 units each time depending on my readings at those times and what I ran the day before. I like the Lantus for my basal, but others use that or Levimir. When the pills and Byetta did not work for me my doctor ran other tests and found my GAD antibiodies were positive. He then told me I wasn’t correctly a type 2, but a type 1.5

I think you will do well with the insulin and it is true that it gets easier to shoot each time you do it. It may never be comfortable, but you will feel better with your blood sugars lower. We don’t all have to have complications and you can be quite healthy living with diabetes. We have over 4000 people here in our family and a number of them are older and doing well. I think our oldest one is Richard Vaughan, He has been diabetic for 68 years and is doing great,. He would be a great one to talk to if you can find his site. Just take it one day at a time and hang in there. Please keep us posted as to how you are doing. We all care about each other and love to give support.

Hello Danny

I am a Type 1.5 wasn’t mis diagnosed, I started taking glipizide (.5mg qd)…2 yrs ago I was placed on metformin (bid 500 mg) along with 2 (.5mg) of glipizide bid. My bg’s were out of control…not because of what I ate but because my honeymoon phase was over, anitbodies were terrible…maybe worse than when I first was DX because the Endo didn’t place me on insulin at all.

I was placed on insulin in Jan 08 and I don’t mind it at all…once you get use to it and the changes that occur…too me it’s a little better than the meds only for 1 reason…I am in MORE control than I have ever been w/ my diabetes.

Hey, Saundra

My doctor is cautious when she dispenses medicine. And i appreciate it. so far, the low dose of NPH has had no adverse affects on me. No lows, no outrageous hunger, but only a minimal affect on my Blood sugar. I actually watched the injection last nigh, so i’m ready to move on to the next phase. :slight_smile:

I’ve done a lot of reading during the past 3 weeks and I have found references to a low carbohydrate diet, so visited the dietitian who classified the low carb diet a fad diet. I try to avoid just accepting a medical persons judgement on just faith. And in nutrition, I have noticed when my carb intake increases my LDL increase and my HDL decrease. So, I am interested in learning more about this nutritional program. Is there a book, or program you can direct me toward?

I really appreciate the input everyone has given me.

Thank you all i hpe to shareing with you


Dr. Bernstein’s Diabetes Solution is the most comprehensive explanation of why it is a good idea to limit carbs. He has been a Type 1 for more than 50 years, and has kept healthy by keeping his blood sugar in the normal range through a very strict low carb diet. I don’t think his is the only way, and I am not sure that you need to eat such a restrictive diet in order to get the benefits. Dr. Bernstein recommends only 6g for breakfast, 12g for lunch and 12g for dinner with maybe a couple of 6g snacks in between, so around 40g total. Many of us here do 60-100g a day and find that we can achieve normal BG. My last A1C was 5.3. I eat about 20-25g per meal all natural carbs, mostly from fruits and vegetables. I eat no pasta, rice or bread. A great recipe book is “500 Low-Carb Recipes: 500 Recipes from Snacks to Dessert, That the Whole Family Will Love” by Dana Carpender.

I got to tell you, when I was first diagnosed as a T1 I though wow, great, I won’t have to restrict my food. Well, it didn’t take me long to realize that by reducing my carb intake it is MUCH easier to control my BG levels. I say try eating lower carb for a week and you will probably see the same results everyone else does.

Hi Danny,
I’m glad to find someone who is Type 2 and taking insulin; so we can share info. I’m on 24 units of NPH @ bedtime, max. dose of glipizide, and max. dose of metformin. Nurse educator, when she receives 10 days of BG numbers, readjusts orals, and insulin. I’m very frustrated because I keep on waking up to highs (160 - 210) in the morning, and having lows (60-80) in the afternoon. She called yesterday and I suggested a bolus of fast acting insulin and she told me there wasn’t such a thing. My A1C was 6.9 and she told me that was a great A1C. Correct me if I’m wrong but isn’t that an average of 168 BG? She said the reason for the highs in the morning is that I need to eat some protein. She suggested 2 tablespoons of peanut butter on toast and some cottage cheese. She also said I have to eat at the same time each day. Which I have a hard time with because of my activities and sometimes I just don’t feel like eating. I’m so depressed, and tired about all of this. I read a book on insulin and either I’m not understanding or she is giving out wrong info. Any suggestions?

Your Nurse educator is giving you wrong information. It is hard to believe that she doesn’t know about fast acting insulin: novolog and humalog both start to work within 30 minutes and last just a few hours so are good to take with meals. NPH has a peak which might be causing your afternoon lows. Some people split their dose to make it more effective, others take a different kind of long acting insulin. (Levemir and Lantus are two others.) Since you are getting highs in the morning, you might want to take a closer look at your diet. Are you eating the high carb diet recommended by the ADA? If so, you will have difficulty getting your BG down to normal numbers. Can you find a different practitioner who is more knowledgeable? A1C of 6.9 is under ADA guidelines but still high enough to cause complications. As close to normal as possible is the best: preferably under 6. I’m sure others will give you advice. Good luck.

Hi, Barbara,

Yup, it is nice to meet a Type 2 on insulin. I have been fortuneate. My primary care physician is as interested as I am to reduce my A1C under 6%. It is currently 7.2%, and climbing. Last month, she added glipizide to my concoction, but it did nothing for my glucose readings and it seemed to make me even more sensitive to glucose. Foods that used to send me into the 200’s would double my glucose after using glipizide. worst of all, it made me ravenously hungry! Now, I am taking 1000 mg of metformin, twice a day, and I started NPH last week. The difference has been astonishing. I have more energy, and my between meal sugars are more stable. I am still spiking pretty good after meals I’m confident that problem will come into line as my insulin is adjusted…in due course.

Now, I’m not a doctor, so i can only tell you how I was affected by glipizide. You have to judge for yourself. Glipizide made me go low too often. Usually in the afternoon, if i could not eat enough carbs and 3 - 4 times per day to boot. The side affects are weight gain among many. I also found out glipizide decreases a hormone (don’t remember its name) that regulates hunger, so I was fighting outrageous hunger and hypoglycemia simultaneously. The day I decided to dump glipizide I made the mistake of eating just a hand full of Captain crunch cereal. I flat could not stop once I started and didn’t stop until I had found the bottom of the box. I was still starving, too. I checked my BS and it was 478 and stayed over 200 the remainder of the the day, and it made me sick and weak.

When I first started NPH, I was also having some high morning numbers. What worked for me is a slice of cheese and about 8 crackers at bed time. It takes about 6 hours to digest cheese which is about the time for NPH to peak. Since I started the cheese/cracker at bed time my morning glucose has been within 5 points of my bedtime sugar.

Peanut butter cookies keep well in my truck, so when I’m out and about I’ve got something the munch. Four of them will send my glucose into the 200’s, but much better than going low, because it seems when I do go low I feel bad the remainder of the day.

I’m still new to the insulin, but I’ll be delighted to share info/experiences with you. I look forward to figuring all this out with someone with a stake in it lol

hey, diabeticizme

I know what you mean. I feel so much better and have better control with the insulin. I guess doctors are reluctant to prescribe it because of the injections. I’m still getting used to it. the first time was the hardest and a week later, I still have the bruise to prove it. I was really a comedy. the first 10 attempts I encountered a mysterious repulsive force that pushed the needle away from me. But since that first one I have become more confident and faster.