Go straight to insulin?

I second everything that has been said here except the criticism of Humulin (I assume we are talking about Humulin R). It may not be the flashiest and newest thing around, but it definitely has its valid uses. I haven't found anything else that handles high-protein meals anywhere near as well. To each his own. Not saying everyone should use it, only that just because it doesn't fit one person's particular profile, that doesn't mean it has no place.

I agree with Zoe about looking for a new endo. You have a right to treat your "mild" case of diabetes aggressively/appropriately. That means getting a correct diagnosis and if you go on insulin having access to modern basal and rapid insulins. A fixed dose of regular (Humilin) hasn't been state of the art since the 1980s and may not have been considered good treatment even then.

Maurie

I agree with Zoe. You are in the SF Bay Area, you should be able to get better care. Yes, it does matter what type of diabetes you have--getting a correct diagnosis is part of good medical care and treatment. Of course, the most important thing is to get proper treatment, which you thankfully are now on insulin. Is it Humulin R or N? Let us know how using insulin goes. Are you stopping the Glipizide? Probably others have given you advice on books, but I always recommend "Think Like A Pancreas" by Gary Scheiner.

Humulin R may have a role as a supporting player or even as a primary insulin if cost is the issue but it is being prescribed for use before bed rather than before meals. How much protein is it going to get to cover over in this situation?

Oh I agree, this particular use doesn't seem to make any sense. I was just responding to the implied subtext that it is obsolete and not worth using, period.

In fact, taking any fast acting insulin right before bed sounds kind of fishy to me.

It is Humilin N. I have Kaiser Permanente. Not sure if you guys are familiar with it. Here's some info: http://en.wikipedia.org/wiki/Kaiser_Permanente. It's an HMO and they have their own hospitals and doctors. I had to get a referral from my primary doctor who I am not particularly fond of either. Maybe I can switch to another primary and ask her for a referral at a different facility. She told me to stop the Glipizide but after I left I realized we didn't discuss the Metformin. Maybe I should send her an email and ask why she prescribed that insulin vs. a newer one.

Humulin N makes more sense, particularly if you and your doctor are concerned about overnight highs.. Thanks for clarifying!

Humilin N is what people used with less than satisfactory results before Lantus was developed. It's other name NPH has been said to really mean "not particularly helpful". If you are T2, going on basal insulin may be a very good strategy but I would ask for either Lantus or Levimir which have much less erratic results and are less likely to have you go low in the middle of the night.

Maurie

Since NPH is the first insulin to be tried according the Shawnmarie's research make sure that you report each and every overnight low to your Endo. If NPH works well you're lucky but if it doesn't, make sure they know it so they can follow their protocols and prescribe something better - even if it crimps their profits.

Maurie

Using NPH as the first response is a bit . . . well, let's be charitable and call it "behind the times".

[Added a few minutes later] Eeek. That protocol is a joke in too many ways to count. Predetermined fixed doses of insulin regardless of current reading or meal contents, and so on and on . . . . OUCH

Every time I hear one of these stories -- and by now they are too numerous to count -- it just drives home even more fully the realization that you must learn everything you can and take control of your own management. You just have to. It would be lovely if there were a nice shortcut but there just -- isn't.

When I got my pump, I went right from NPH to pumping. During the "installation" (a couple hours...) either the doc or maybe the pump SalesNurse mentioned that NPH has only a 53% chance of "peaking" when it's supposed to. This immediately clarified a lot of problems I'd seen both tactically, "why am I low now..." and strategically, "how should I make changes to fix ____" as sometimes a high might be followed by the onset of the med or an early peak by a high later. I think that Lantus/ Levemir are supposed to be much less peaky which, in turn, makes it easier to figure stuff out, without random events clobbering you all the time.


The NPH "peak" is shown here but, if you think of rolling a die so you get a 6 hour range of where it might peak (I'd guess mine was from around 10:00 AM until 2 or 3 pm, but I didn't write anything down...totally unscientific...) and putting the peak where the die tells you...oh wait, except you don't know where it'll hit. That being said, I've used it both times my pump blew up and it worked out ok.

Well, I'm new to Levemir (just a matter of days) but I like it already. Steady as a rock, so far.

Hi Ckurpiewski: I have Kaiser insurance and I see an endo in Walnut Creek named Pamela Kershner. She is great, and really treats me with respect and is there to help me. Humulin N is NPH and I used it before I switched to an insulin pump. NPH is simply awful, IMO! You should be on Levemir or Lantus (I have a prescription for Lantus in case my pump fails when I am traveling in remote regions of the world). And perhaps a fast acting insulin, which in Kaiser's case is Humulog. Maybe someone in TuD's SF Bay Area group can recommend an endo, or maybe you could come up to Walnut Creek to see Dr. Kershner? Really, really, you need the best care for yourself.

"Lantus/ Levemir are supposed to be much less peaky which, in turn, makes it easier to figure stuff out, without random events clobbering you all the time."

HI!

I've been using Lantus+NovoRapid in pens for about a year or two or three - I suppose that I ought to check - and can confirm that, at least for me, the usual Lantus curve in real-world use is perfectly flat. On the other hand, from what I've read, Lantus might be particularly prone to sudden, random, and dramatic lows, especially a random number of hours after exercise. I did find, though, that these become much less common after a while.

YMMV.

Speaking of which, I find that idea that there is one regimen or behavior pattern right for everybody odd. I have had my GP prescribe certain older drugs for me because he felt more comfortable with them, and I can understand that point of view, even if my evaluation of the pros and cons might be different. I have been in situations where a patently pathological laboratory result is still the least evil of all available possibilities.

As Bismarck never said: Life is the art of the possible.

My two cents. Don't ask for change.
M.

Thanks for all your information and research! Doesn't surprise me either that Kaiser uses the cheapest insulin! I have an insulin class today and will try the insulin tonight and will report back on how it goes. I am kind of scared! Never had an overnight low! How would I know? Does it wake you? She started me on a very low dose she said so hopefully I will be ok. I did my lab work this morning and will hopefully get the results tomorrow. Depending on how things go I may switch to my husbands insurance although mine is completely covered by my employer.

I can't agree more with the the advice you're getting on this thread;

1. Your endo needs to be fired. Your A1c is not "mild" and her insulin recommendation is troubling. Going from zero to six units right before bed sounds pretty risky.
2. Your concerns about right diagnosis is extremely valid. It is critical in determining the correct treatment.
3. Avoiding drugs with hotly debated side effects is a wise strategy. Why take the risk? Regular Human insulin, fast acting analogs (Humalog and Novolog) and Levemir (long lasting) all most closely mimic the insulin a body produces. The only difference is how quickly and how long they act. There is some debate around the safety of Lantus. Who knows if it's true, but by virtue of the fact that there is debate, I avoid it. Metformin is a tried and true drug derived from nature that's been shown to have secondary benefits outside of Diabetes treatment in reducing the risk of some cancers. Net - you can effectively manage diabetes with the options above "naturally" without worrying about potentially longer term side effects from newer, more exotic and more expensive drugs.
4. Getting your blood sugars under control to levels that most closely approach a healthy pancreas will provide you with a long and complication-free life.
5. Get on insulin now. It will improve your BG control dramatically and can potentially extend the life of your remaining beta cells.

I got my test results last night. Negative for antibodies and my C-peptide level is 1.2 (said it was in the standard range). I am kind of bummed for some reason. I think it's because everything would just make so much more sense if I had LADA. Now I am as frustrated as ever! I don't understand why I have this! I am 33 years, thin and I have no family history! It is also frustrating to see people twice my age that have had this disease 2-3 times longer and take less medication than me have better A1c's with poor diets. Why is mine progressing so quickly!

The Humilin N seems to be working my fasting this morning was 125 and 113 yesterday. My lunch and dinner are still high so I am going to ask the Endo about some short acting for meals.

Oops! I meant fast acting!

Some people don't show antibodies at all and some don't show antibodies until later. 1.2 i think is the lower of the range though. Just be happy that you've been at least started on insulin. The type 1/lada diagnosis doesn't really matter unless you want a pump or cgm to be covered under insurance. Some type 2s I believe CAN get pumps and cgm's covered if your doctor proves you need it.