Help, please

I went to endo today. she wants me to increase insulin to 52 units twice a day, 1000 metformin in am and 1500 evening, symelin 120 at each meal, and byetta 10 mcgs in am and 10mcgs in evening and she’s adding Actose 15mg per day, my A1C is 7.9. What do you all think? Is this excessive? Are any of you on this type treatment?
Please respond ASAP. Thank you, Carolyn

You sound just like me!!! I take Glyburide/Metformin 3 x a day 1000 mg, Novolog on a sliding scale before a meal depending on my numbers when I test before I eat and if I need to, I use it as a correction injection if I’m too high after a meal. I also take Leemir 55 units in the morning and 70 units at night. I am going to talk tomy endo about going back on Byetta. I still have a few pounds to lose. Does Symelin help witth weight loss? Hang in there.

None of us know your particular situation, but there are some things that are a bit confusing. Is your insulin long-acting only, or do you also have a fast-acting insulin (e.g. Novolog, Apidra) for mealtimes and correcting highs? I’m also a bit surprised at having both Byetta and Symlin at the same time; I’ve not seen that before. (Then again I’m not a doctor.) Normally a second oral would be added before insulin, but once insulin’s been started, one usually keeps adjusting the insulin dosage. The only thing I can think of is if you have really high postprandial numbers… which begs the question, how often do you test your blood glucose?

My insulin is novalog, It just seems to me that this is an awful lot of medication. My sugars are never low, they’re always in the 200’s and once in awhile 332 or so.

yes, symelin does help with the weight loss. insulin causes weight gain so between the byetta and symlin it helps to keep it at least stable and not to gain. i haven’t seen any significent weight loss.

Are you taking the Novolog when you eat meals?

If your numbers have been above 200, then you do need a change of treatment. But i don’t know enough about all the meds. It seems strange to me that you are on both Byetta and Symlin. I thought people were usually on one or the other.

Hope that you get more answers!

WHAT DO YOU THINK WOULD HAPPEN IF I STOPPED NOVALOG. no insulin at all. I’ve only been on it for 4 weeks.

Have you had antibody testing to ensure that you are actually T2 and not a T1.5 (LADA)? Those numbers seem awfully high for all the medications you are on and many adult T1.5 are initially misdiagnosed as being T2

Yes that is what kind of meds I was on before the pump. None was working either. I was taking Byetta, metformin, 320 a day of Lantus split in two of course. I was taking novolog also. So my whole day revolved around injections and pills. And did no good at all. Thank goodness for my pump.

Scott, I have never heard of the types you’re talking about. Also, what is the name of the antibody test? Thanks for your input.

T1 - Type 1
T2 - Type 2
T1.5 - LADA (Latent Autoimmune Diabetes in Adults)

LADA or T1.5 is basically Type 1 starting when you are an adult as opposed to being a child.

It seems in LADA that the beta cells in your pancreas are destroyed at a slower rate than they are when diagnosed as a child. This can contribute to the Type 2 medications (and it looks like you are on about all of them) actually being effective for a period of time, but they will eventually stop working as your body will no longer be producing any insulin at all. Those medications all work with insulin not instead of it.

I believe the test is called the GAD antibody test, your endo should know what you mean when you mention it.

Dear Carolyn.

Wow that a lpt of stuff. If you are taking 52 units of insulin twice a day you will gain weight, a lot of weight. You seem maxed out on medication and this with a not good A1c. Yes there is another treatment is is no or very low carb diet. You can keep the metformin at the maximum dose as it does help with extreme insulin resistance. Insulin is a must in your case but more than 0.25 unit per lb of body weight per day is excessive and will make you gain weight. The other drugs are not available in Canada so you wonder about their safety or it could be just our bureaucracy is slow.

Don’t know why you’d want to stop taking Novolog. Without it, your BG would be even higher. If your doctor hasn’t told you about using Novolog to correct highs, you should speak with him/her about this.

Novolog is typically taken before eating (not twice a day), usually 15 minutes before meals. 52 units is a lot of Novolog to take at once. The best way to take rapid acting insulin is according to the number of carbs being eaten based on an insulin:carb ratio. It’s also dosed according to weight & how active you are. Novolog is also used to correct highs to bring BG down to a target number.

Basal insulin (Lantus or Levemir) is taken once or twice a day to keep BG level between meals & overnight.