Going for insulin

First, thanks to those people who took the time to educate me on oral meds and insulin. I've done some additional homework, and found there is a new drug that is working almost as successfully as Metformin and Janumet. So I am going in to the doc's office with the idea that I will get off the Amaryl that was my first medication for my diabetes 13 years ago, and asking for Metformin and insulin. I am prepped and ready with reasons and results. I guess I am looking for a place to start the conversation, without it sounding combative. Any ideas. Remembering that I don't have a large source of medical people to draw from....in our area and I do work well with this person, except on this area. I have the time and experience with diabetes, my own, where she has many patients with many illnesses to know everything about. But I am looking for a way to make it happen. Suggestions,

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I think it is best to just approach it from the standpoint of being proactive in your care. Not every doctor will appreciate that but for the ones that don't too bad. I am a strong proponent of your approach and have been fortunate enough to have a doc who not only listens but also shares the same opinion. When it was obvious that Met by itself wasn't enough our discussion of the next step lasted all of maybe ten minutes. Started with just Lantus but had to add Novolog about a year later.

Stick to your guns. IMO the path you are taking is the next logical progression of treatment after diet, exercise and metformin fail.

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You are almost precisely where I was a little over a year ago. The way I approached my doc was simply to lay out the facts, that although my control wasn't terrible, it wasn't great either, and I had gone as far as I could with the current therapy and wanted better control. I also stressed the point that I wanted to give whatever beta cells I still had some help, so they could rest and recuperate instead of constantly being driven ever harder, and burned out that much sooner. I worked on making my reasons as logical and unemotional as possible and to his credit, he was very receptive.

Hope that helps! :)

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30 plus years as T2; I am on metformin and Insulin.

Metformin for me and the science I see is used to stop excess glucose release from the liver. The other new hormones out there Junavia and such do interesting things but in my mind there is too much focus on one drug does it all. They all do various different tasks and tuning. Insulin use has also saved my islets and allowed much better management of the glucose control versus diet.

I was on actos and one keeps seeing more and more reports about bladder cancer and kidney issues. I am glad I am off that stuff.

Yes insulin is natural. Meformin is from a plant originally and is not really metabalized by body. It gets dissolved and placed in blood stream causing signalling in the liver and then gets expelled out in same form it came.

As a drug goes; the current version out there has had a long and successful application without serious issues like avandia/actos and others.

My only comment is that I wish I had gone to insulin many moons ago. I do not like the long acting (10-12 hour) mixes like 75/25 and 70/30 as I find them tricky and a nusiance to manage. The humalog lispro I use for meal bolus works 4 hours and is easy to manage. I used to use lantus - slow acting insulin for basil support but currently find I do not need. It works well.

If you have excess liver glucose release; I would hang onto my metformin.
I do not like nor use starlix,glyburide, glimperide et all anymore.

The big issue with insulin is learning to use and identify by experiment what size doses one has to use for your body. Everybody is different and one dose size does not work for everyone. doc usually starts you off at best guess and you need to carefully adjust up and/or down to find how to make it work best for you.

the other trick is to identfy which insulin needs adjusting - basil or meal bolus and/or both. For some their basil insulin is reliably low and increasing that using lantus or equivalent may be all one needs. If that is ok, maybe meal bolus is running a little low and a meal bolus like humalog lispro or equivalent is needed to assist on the meal digestion release.

The other gremilin that sneaks into the picture messing this up can be the dawn effect excess liver glucose release whereby extra basil insulin and or metformin are needed to arrest liver monkyshines.

In any event, best wishes, good health and good luck Sdkate!

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Hello everyone today is a big day for me. I am 48 and I have been fighting and trying to control my blood sugar levels now for about five years. I have not been successful because everything i have tried eventually seems to stop working. I must admit though I myself have not shown the proper discilpine to exercise frequently, I work a rotating shift, and i find myself socially wanting to have alcoholic drinks just as much as everyone without diabetes(type2). So today I received the 75/25 insulin pen to help with my control of my blood sugar levels. However I find myself aprehensive about starting the shots. I'm struggling with all the people around me who say dont start taking shots. I'm confused someone give me some focus.

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Hi Slugger

Insulin can change your life. People who haven't done the shots don't have all the information. They don't know that the idea or a shot is much scarier than the reality, and that the effects of not controlling your blood glucose can lead to things like blindness, kidney failure and amputation. Sometimes life gets in the way of the ideal diabetic diet and exercise program, and then you work with the best tools you have. Insulin is the best tool you have to take care of yourself. Once you get used to it it's really not that scary.

Go for it Slugger! If you need more support we're here for you!

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I spent years trying to control my blood sugar with diet, exercise, and pills. The best results I ever achieved after all that effort were mediocre at best. I finally figured out that I just wasn't going to get the control I wanted without insulin, so I asked the doc to prescribe it and he readily agreed.

Nowadays my test results are the best they have ever been, by a wide margin. Instead of the diabetes controlling me, I now control it. I wouldn't go back for anything.

A while back I saw the results of a very interesting survey. Some researchers interviewed both doctors and patients about attitudes towards insulin. Something like 65% of the doctors said they hesitated to prescribe insulin because their patients were afraid of shots. But only about 30% of the patients in the same survey said they were afraid of shots! So it is often the doctor's (incorrect) perception of patient attitudes that stands in the way of patients getting the treatment that can improve and prolong their lives. Go figure.

Here's one more clue: the world renowned Joslin Diabetes Center now starts every newly diagnosed Type 2 on insulin right away. I think there's a pretty clear message there.

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Thanks Megan and I believe what you just said because everyone who is telling me not to. They don't have very good reasoning why not. It's like you said the scarieness of taking shots. However for me the reality is my quality of life is suffering. I agree with you the alternatives are far worst.

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Wow! thanks David that is interesting because I have alway thought why can't i just take a little insulin to balance me out on my bad times along with my pills. I think it has something to do with people thinking I don't want to be Type 1 and have to take shots. However everything I read about people taking insulin appears to suggest that they are living a hapiier and more productive life. Thanks Man!!

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I am much like David. I struggled with diet, exercise and all kinds of medication to get the control I wanted. And it just didn't work. I don't care what people around me think, it is my health. And the idea that maybe I will just "get better?" I don't think so, I have diabetes and I just have to accept it is with me forever now. So I actually started asking my doctors to switch to insulin. I spent two years asking multiple doctors. Eventually I had to force the issue and started insulin. I skipped the whole mix stage and just started taking what is sometimes called intensive insulin therapy. Three months after starting my A1c got below 6% and where it has stayed there for over two years. Insulin has made my life a lot easier, finally I can actually do something about high blood sugars. So I'm quite happy using insulin as a T2. It doesn't mean I "failed." My body failed and insulin helped me "conquer" my diabetes.

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Don't know exactly how to say thank you enough for your comments. They are right on what I am thinking, and saying to the medical team I have. I am NOT afraid of shots, can't be was a migraine sufferer for too many years, AND use humalog when I get cortison injections for my knees, that doesn't scare me. What does worry me, is the amount, and my determination to work through it. But knowing my tenacity and stubborness, I know I will do it,
As I have always said, from day 1, who knows their diabetes better than the person living with it. You have once again proven that!

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Thank you for all of us who responded for you deep respective comments.
wishing you all the best moving forward and that you find the mix of adjustments that help resolve your issues.

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I know very little about the disease even though I was diagnosed during a pregnancy over 25yrs ago. But, one thing I do KNOW is that anyone taking januvia,janumet should research the drug fully. My husband is very sick, and probably going to die from that "miracle" drug. It really does control blood sugar, but it kills your pancreas while it does it. Read all the reports and news about it if you decide to use it. I wish with all my heart that we had just gone directly to insulin instead of ever letting him ingest that at all. Of course YMMV, but I can just speak from our personal experience.
OTOH, metformin, is a great drug in our experience.

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I am so sorry Mekamom, we have a habit of believing our docs have our best interests at heart, and really they have only the information given to them by drug reps. I am hoping and praying that they can find something that will keep him with you. In the meantime, it might be good for you and your health to read up on all that you can about diabetes. Mine started as gestational diabetes when I was preg with my second son 25 years ago....a msg that I should have taken seriously at that time. I will keep your family in my prayers.

Wow, what great information. I, too, will start insulin this week. I am also not afraid of needles. I watch them draw blood from me at least 4 times a year for my HA1c. I was put on glimpiride in April; the pharmacist and I adjusted the once a day dosage from 1mg to 8mg (the max) over a couple months. As many of you have experienced with this drug, I was hypo by mid-morning, alright through the day and evening, then high (150-220) in the morning again. I am also on the max dosage of metformin. The pharmacist suggested that I switch to bedtime insulin and I agreed. When I met with my doctor he thought that taking 4mg of glimepiride with breakfast, and 4 mg with dinner would help since my A1c dropped from 7.5 to 6.6. Well, after a few weeks on the split dose, I still feel like I am feeding the pills; I fluxuate from dangerously low (low 60s) to regular highs (250+). I feel like crap most of the time. So I told him that and he asked me if I wanted to go on bedtime NPH insulin and drop the glimpiride - I agreed. I am not sure if it is the right insulin but it is someplace to start. I also do not feel like I failed even though he acts like I have. I just started my 9th year since Dx, and I think I know more about my diabetes than he does. Wish me luck!

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Here is what Bernstein says about sulfonylureas, of which Glimepride is one:

. . . they provoke the pancreas to produce more insulin . . . forcing an already overworked pancreas to produce yet more insulin can lead to the impairment of remaining beta cells. These products also facilitate beta cell destruction by increasing levels of a toxic substance called amyloid. Finally, it has been repeatedly shown in experiments — and I have seen it in my own patients — that controlling diabetes through blood sugar normalization can help restore weakened or damaged beta cells. It makes absolutely no sense to prescribe or recommend agents that will cause them renewed damage. In a nutshell, pancreas-provoking drugs are counterproductive and no longer have any place in the sensible treatment of diabetes.

Richard K. Bernstein, Dr. Bernstein's Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011), p. 249

To paraphrase, he is simply suggesting that it is ridiculous to drive your remaining beta cells even harder and thereby burn them out that much faster. The sensible alternative, in his view, is to give them a rest. Insulin is one of the more effective ways to do that.

In my own case, I can testify that his advice has been a bull's eye. After years of diet, exercise, and pills, my A1c was 7.1. After a year on insulin, it's 5.6. I wouldn't go back for anything.

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David, I've got to say THAT makes better sense to me, than working those cells that are already few and those that are damaged to do something they aren't capable of doing for much longer. The reprecusions of such actions is worse than doing nothing at all. Will gather Berstein's book up before my appt and see if we can come to an agreeable solution...insulin!

In addition; there is more and more work showing that lowering the caloric input, stop the excess liver glucose release, exercise and getting the glucose oxidative stress off the pancreas/islets will see the islets recover function.

I was on that other stuff, got off of it ,dropped diet to 1200 calories and got heavy exercise and in 6 months suddenly in week flat was removing 26 units of 75/25; starlix et all and saw my meal bolus on cgms come back and was put on humalog lispro initially at 10 units for meal bolus and now down to 1 to 2 units. That is after 26 years on the other stuff. I still need the metformin to shut down liver monkyshines.

there is a lot of real science out there on work done to examine islets in cadavers type2 and normal looking for the damage/changes between good and type 2 and finding none. Once type 2 islets put back into normal conditions; they make insulin. go figure.

Also is latest paper from Dr. Roy Taylor University of Newcastle who has been using MRI spectography to look at bariatric patients and his extreme 600 calorie diet and watching pancreas come back on job fast as excess fat in liver and pancreas gets absorbed fast well before any other weight/fat loss. Attached.

1592-Type2Diabetes_R_Taylor_u_of_newcastle.doc (463 KB) 1593-NewcastleMagneticResonanceCentre.doc (46.5 KB)

Thanks for the information. I guess I have to be honest, and have no clue as to what you are talking about....it's one of those things that I will have to study and think about. I'm like that with big medical things and testing that comes out. But I will give it a look-see-study. Do you think, for the sake of myself, you could put it into layman's (woman's) terms? Thanks, and sorry for being so anal.


Apologies for all the science and complexity.

Cutting to chase: cut the carbs/calories, get exercise and use insulin to assist to save wearing out the islets. They tend to do a rip van winkle act under excessive glucose stress and being hammered to produce more insulin from the starlix,glyburide, glimpiride et all.

It seems if you can do insulin and other comments you may find things get better not worse.

Best wishes and apologies throwing the science stuff at you.