I am back to where I was last year around this time

Yet again, I am at that point where my morning bg does not want to go down past 150… ugh. And of course I am practically starving myself (which never works - in theory you would THINK it works but no not in diabetes).

So I got frustrated and I was at 10 units in my Lantus and BG was 250ish when I go to sleep last night so I gave myself 15 units and I get a nice 115 this morning. :smiley:

I am on the same meds as last year Metaformin 1000mg twice a day and Januvia 50 mg once a day.

I just started the Lantus last year. My c-peptide was half past the middle mark.

Does this mean my c-peptide is going down more again? Am I on my way to being Type 1?

I am not scheduled to see endo again until April. I will message her though.

I am getting to the point that I don’t care anymore - no more starving myself - it is exhausting. I was eating more before because of adding insulin and now I am stuck again. When that number doesn’t go down my first thought is that I am scared to eat anything because it will get worse…

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@KimKat – Starving yourself is not a good option. You need adequate nutrition to be healthy. It seems to me that your insulin needs have simply changed. Ten units Lantus used to work but now doesn’t. It’s probably that simple.

Are you afraid to make insulin changes without your endo’s permission? Don’t worry about that. Just insure that you closely monitor your blood glucose when you make insulin changes and always have safety glucose nearby. If it would make you feel more comfortable, call the doctor’s office and let them know what you are doing and indicate a willingness to change your current appointment to an earlier one. That way you can also change your Metformin doses, if needed.

If you have a correctly-diagnosed case of type II diabetes now, you will never become a type I. You may, however, need more insulin. There’s nothing wrong with that. You need what you need.

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Don’t you think you are being hard on yourself. You didn’t do this to yourself. And your blood sugars may just be getting worse on their own and it is very unlikely that starving yourself even more will do anything. And 10 or 15 units is not really that much insulin for someone with T2. I adjust my insulin all the time. You took 15 units and had a great result. Things go up and down and for many of us the long-term path of T2 is that we lose insulin production. So maybe now you need 15 units of Lantus now. That is ok. And you will be ok.

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The advice from Terry and Brian is excellent—all of it. Physiology, even without diabetes in the picture, is a constantly moving target. Bodies change all the time as we age, change life situations, have more or less stress, etc. Like Brian, I find myself adjusting my insulin dosage frequently to adapt to changing circumstances. It’s normal—truly. And also as he said, the amount of insulin you’re using isn’t really a lot. Take a deep breath! :relieved:

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Thanks all! Yes I know it isn’t my fault…obviously. I am skinny and I have always been so I don’t fit Type 2 and I don’t fit Type 1 either (I had all the tests) . I still need to check into the MODY tests but if I get that and it is negative then what I am I?

Here is what I don’t get or maybe I am not understanding this incorrectly or I am misunderstanding how insulin works. If I need to take more insulin than before and my eating habits haven’t really changed, doesn’t that mean that my body is making less insulin?

Shouldn’t insulin be able to bring numbers down whether those high numbers are caused by food or stress (or is there another reason)? Isn’t Lantus to replace what your pancreas doesn’t make?

So one day I may be at zero insulin-making because I have used mine up and then wouldn’t that make me a Type 1 if I need insulin all the time to keep numbers down. Meaning c-petide at 0.

Technically I am not really Type 2 but my endo bills me as one because I do not fit Type 1. I be type weird. :wink:

Yes, I am hard on myself but as you all know - when the endo downloading your numbers and sees the high ones they always ask something like “Did you go to a party that night?” Translation : " What did you eat to have high number like that?" And what if you did nothing different - and you eat almost no carbs/sugars and not much food in general - than what? What is the reason? How do you explain the high numbers if it isn’t something you ate? What if you ate practically nothing that day and very low carb?

I guess that part just doesn’t make sense to me…

The less carbs and sugar you add to your body with food the less insulin you should need right?

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[quote=“KimKat, post:5, topic:50359, full:true”]

Here is what I don’t get or maybe I am not understanding this incorrectly or I am misunderstanding how insulin works. If I need to take more insulin than before and my eating habits haven’t really changed, doesn’t that mean that my body is making less insulin? [/quote]

This doesn’t necessarily mean that your body is making less insulin. It could mean that you are becoming more insulin-resistant.

Yes, insulin brings numbers down whether they are caused by food or stress. If insulin isn’t bringing your numbers down enough, you need a higher dose.

Unless an autoimmune reaction occurred that killed your beta cells, you will never be a Type 1 and you will always produce some endogenous insulin.

Why do you say that you are “not really Type 2.” In other words, what about you does not fit the definition of Type 2?

[quote=“KimKat, post:5, topic:50359, full:true”]
And what if you did nothing different - and you eat almost no carbs/sugars and not much food in general - than what? What is the reason? How do you explain the high numbers if it isn’t something you ate? What if you ate practically nothing that day and very low carb?

I guess that part just doesn’t make sense to me…

The less carbs and sugar you add to your body with food the less insulin you should need right? [/quote]

Not if you are becoming more insulin resistant.

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Many possible variables - maybe less insulin production our maybe something that causes insulin resistance such as an infection. Don’t be scared to eat. That it what insulin is for. Ultimately it doesn’t matter what type you are (1, 2, Mody, our wierd), only that you have the tools you need and can control your sugar well.

I guess I would just tell the doc, “I have diabetes and live in the real world for gosh sakes!” Blood glucose spikes happen when people have diabetes. The amount of actual control we have with so-called modern tools is still quite crude when compared to the sensitive and elegant system that Mother Nature uses.

You could also throw in, “when you say that, doctor, it makes me feel shame, an unhealthy, unnecessary, and inappropriate emotion in this situation. I am doing the best I can with the bad cards life has dealt me.”

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Here’s the thing about “types”. At the end of the day, I don’t care whether I am Type 1, Type 2, or Type 56½. What matters is achieving normal blood sugar levels (or as close as humanly possible). That means you do what works. Whatever that is. Having a particular label assigned doesn’t make you healthy. What you do about your condition, does.

None of this is to say that it isn’t important to know exactly what you’re dealing with, e.g., what type of diabetes you have. Of course, it is. But you have to deal with today’s reality TODAY. As the endo of a good friend once said, “if you can figure out what’s causing your spike in ten seconds or less, great! Otherwise, correct it and move on.”

As others have mentioned, there are lots of possible reasons why your insulin requirements could have changed; less endogenous production, greater insulin resistance, etc., etc. The reason “why” is worth knowing, but not at the expense of taking action to fix what’s happening.

I sense a possible misunderstanding here. If I have misconstrued your question, I apologize. Anyway—

Lantus is a basal insulin. Simply put, that means it is a very slow acting insulin whose purpose is to keep your BG stable in between meals. Fundamentally it has nothing to do with food, and it is incapable of counteracting the rise in blood sugar that occurs when you eat. For that you need a bolus insulin such as R, Humalog, Novolog, etc.

When dealing with abnormally high blood sugar levels, the policy really should be “shoot first and ask questions later”.

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I think you wanted to type bolus here instead of basal.

Quite so, and I have corrected it. Good catch.

Thanks for all the helpful advice! You made me feel better. I wish there was a way I could find out the real reason why this stuff happens but there seems like there isn’t a way too. I guess I don’t do very well with grey areas.

The insulin resistance makes sense but than again it doesn’t - if I was insulin resistant at 10 units why would adding an extra 5 make a difference? Meaning what is special about that 5 units that is different from the first 10? Or is it that I am just insulin resistant to my own insulin that I produce? Or is the insulin I produce just crappy and defective?

Is the Basal insulin to replace the c-peptide?

My endo explained Lantus to me as “background insulin” to be “dripping” throughout the 24 hours “in case” I need it to bring numbers down. She didn’t say it was just in between meals. If it is, how does the Lantus know when I eat and when I don’t?

Sorry I have so many questions.

I am not all that dissimilar than you @KimKat - other than the fact that I could not tolerate any of the oral meds my doctor had me try, so I take insulin only. Initially, my BG responded reasonably well to the orals, but other side effects stopped me from taking them. I was not overweight and I was quite active; however, I tested negative for antibodies, so despite a fairly low c-peptide (meaning I make relatively little insulin of my own), I was diagnosed as Type 2. Still, even without orals, I started on fairly low doses of insulin at the beginning. Over the past few years, though, I had to increase the doses to what I’m taking now. If I eat very low carb, I can use less insulin - but ONLY less bolus insulin (pre-meal insulin) – I still need the same basal insulin whether I eat a lot or a little - or nothing at all. The only thing that reduces that need is periods of more intense activity (For example, I’ll halve my basal insulin for an all-day bike ride).

As for why more injected insulin helps – I read about recent research that indicates that apart from “insulin resistance” (as in, cells needing more insulin present to absorb glucose), there’s a factor of “glucose sensitivity” (though I don’t think they called it that). Meaning, that it’s possible that even though your pancreas (and, perhaps, mine) doesn’t make enough insulin to support your basic needs, it can and does produce a lot more insulin when there is a LARGE amount of glucose present. That might explain why many Type 2’s - myself included - clearly need to take insulin for normal daily requirements and meals; however, when those REALLY BAD days happen - days when I go overboard with crab-consumption, like holidays, the highest numbers are still low compared to what a Type 1 might see, I have never seen higher than 340, for example. In part, because I try and avoid high BGs, but I’m not sure that this is the only reason. I haven’t done an experiment in a while, but a couple years ago, I took three days off of taking insulin and the highest my BG went to was 280. I did not low-carb it those days, either (though also didn’t go crazy). Could be that as my BG approach 300, my pancreas finally “notices” and makes more insulin. I suppose I should go get a c-peptide test with my BG high one of these days to see what it shows.

By the way C-peptide is a product of insulin production. The betas cells produce something called 'proinsulin" that splits and becomes insulin and c-peptide. It’s unreliable to test for insulin levels, as insulin tends to get used/depleted very quickly once it enters the blood stream. C-peptide does not get used up the same way and instead gets eliminated eventually from the the blood, so, since it remains a bit longer, it is a more reliable way to test for the level and efficiency of insulin production.

Ask all the questions! We ALL have too many questions :smile:

Our bodies need glucose to survive. When we eat, our meal is turned into glucose. But what about those times when we aren’t eating, like during the night? Our brain absolutely needs glucose all the time. How can people fast and still have enough glucose to survive? The answer is that the liver stores and releases a form of glucose called glycogen. The liver does this around the clock but can also release a burst of glycogen for emergencies, like when it feels adrenaline and other hormones.

The short answer is that basal insulin, also known as background insulin, needs to be present to metabolize the slow release of glucose from the liver. Bolus insulin works for meals. The goal of basal insulin dosing is to counteract the liver, nothing more, nothing less. It’s all about the balance.

As Terry says. Perhaps I stated it confusingly by using the phrase “between meals”. Basal insulin is needed all the time, 24x7, for precisely the reason Terry says. Your endo’s description of it as a “background” mechanism is pretty accurate. Bolus insulin’s purpose, on the other hand, is to deal with meals (or to perform a one-time emergency correction).

Thanks so much Thas for your story. I was tested for the Type 1 stuff too and was negative.

I have trouble with the pills - Metaformin and Januvia - although mostly the Metformin - I can’t swallow it any more - it is too big. I choke on it most of the time - so I now grind it up and put in a little bit of unsweetened applesauce. The Januvia I can swallow - but some days I have a hard time swallowing any pills. My endo wanted me to go up to 100 Januvia but then I can’t use the $5 on the site and the pills are very expensive even with insurance and honestly I am not even sure if they do anything. They worked OK for the first three months when I first started taking them and then I was sort of back where I started but I am still taking them - that was like three years ago.

Since I seem to be changing, I tested before I ate something for dinner - I was at 142 and than I tested before bed before I took my Lantus and I was at 333 (that was about 2 and a half hours after I ate) - my Contour USB flags that as a high number… ugh - the lantus only brought me back back down (but everyone is saying Lantus doesn’t deal with food numbers so what brought it down?) to 162 this morning but I am starving so I got to eat… (and trudge through all the snow that fell last night to get to the train). I am starting to wonder if I need bolus insulin. Is it expensive?

To me, it sounds like you really should speak with your doctor about the numbers you’re seeing. Even the 142 before dinner seems too high for before a meal. Over 300 at bedtime is high. As others have said, your basal insulin may need further adjustment - though you should make such changes slowly and wait 2-3 days between adjustments to see how the changes affect you – again, with teh advice of your doctor. Even though you take a small dose, could also be that Lantus isn’t quite lasting the full 24 hours for you - I had to split Lantus into two injections to cover the whole day, when I was taking it.

Basal insulin may, in fact be needed, and yes, it can be expensive, depending on your insurance. (Check the vendor web sites, there are co-pay assistance cards, at least in the US, though, they don’t work with Medicare/Medicaid.)

We all change, plus Type 2 is progressive, so it is expected to change over time. Needing more medication or different medication, or having to move to full basal/bolus insulin therapy is certainly a strong likelihood for many of us – it’s just the nature of the condition – Contact your doctor.

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+1

300, regardless of how it happens, is just not acceptable. It’s a clear signal that something needs fixing. If bolus insulin is the answer, then that’s what you need. The bottom line here is, you need to do what’s necessary to get your blood sugar under proper control, whatever that is. If it’s dancing under the full moon during the summer solstice, then that’s what you do. (I chose that silly example to make the point—whatever tool or combination of tools is available to fix the problem, that’s what you use. And insulin is the most powerful tool we have.)

Most likely your body’s own insulin. If you are Type 2, you still have some. Your c-peptide reading tends to confirm that. Type 2s, especially in the early stages, usually have substantial insulin available. It’s either just not enough, or it’s not fully effective due to insulin resistance, or a combination of both.

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I couldn’t swallow Diabex XR, my dr. wanted me to take all 4 huge tablets at night. Someone said they used Diaformin because you can break those in half and also they are not an extended release pill so I am now on 3 a day, morning, lunchtime and evening. I can’t take straight Metformin, it upsets my stomach.

That is a good point. You can split or break up Diabex (metformin) pills. But you should not split or break up Diabex XR (metformin XR) because the pill itself has a the framework or coating that creates the extended action. Some people taking metformin XR you may notice what looks like a whole pill coming out the other end and that is in fact the framework. Unfortunately that also means that generic versions of metformin XR can significantly vary and nobody seems to care. Since the amount of active ingredient is the same the FDA just approves it. But the choice of framework and coating can make a big difference in how the metformin gets released and hence the efficacy and tolerance. So for some it can make a big difference on which generic you get.