I'm New To This Site With a Question

Type 2
1

First - something about me.

I've had type 2 for about 15 years. About 4 years ago my Dr. put me on Lantus to get my A1C down. It worked and I've been running between 6.7 & 7.1 since then. Since I'm overweight and find it very hard loosing weight primarily because exercixe is not something I can do a lot of as I have 2 bad knees and it's rough walking or riding a fixed bike. I'm 67 and not active. About 1 1/2 months ago my Dr. took me off Lantus and Actos and put me on Victoza. Known to help lose weight, the Victoza appears to be working as advertised, I've lost about 10 lbs. so far. However, since Victoza is not insulin, my A1C has gone up to 7.8 and I'm getting nervous. I do have some increased tingling in my feet.

Here's my question.

Does anyone know if Victoza can be taken with Lantus? My Dr. says NO, because insulin has a tendency to increase weight and one counteracts the other. Any thoughts on this or has anyone heard anything about this issue?

2

Well, it depends. The first GLP-1, Byetta has been studied with Lantus and been found to not only be safe, but effective when used in combination. The FDA has approved Byetta for use with Lantus.

But it hasn't been studied with Levemir and Victoza has not been studied with any basal insulin. That doesn't mean it isn't safe or effective, only that studies have not been done and the FDA has not approved is as a valid use. But this doesn't mean that doctors can't prescribe Victoza in combination, in fact they can, it is called "off label" use. And in this case, it is a reasonable decision. If your doctor refuses to budge, then ask him for Byetta with Lantus. You really don't care about the extra injection do you?

Do what you have to in order to get good control. You deserve it.

3

Blood sugar control is more important than weight loss. Some doctors see weight loss as more important; that is a dangerous bias.
If your doctors is not an endo, ask for a referral to one. If he is one, switch endos.

As far as exercise goes... can you swim? That lowers my blood sugar pretty effectively

4

If you are not producing enough insulin anymore to keep your blood sugar regulated you need insulin. End of story. Anything else such as Victoza to control weight is secondary. You are right to be nervous if your A1C is up to 7.8 and you need to see an endo who will help you control your blood sugar.

5

Are you seeing an Endo? My Endo has me on both Lantus and Victoza +met. I haven't gained any weight while being on both. My BG's have come down from being just awful to outstanding(at least for me) <120 fasting, with lot's of <100 and between 120-140 or lower non fasting, and I test 4-6x's a day. I do still do have some blips that go beyond but thus far, along with being so much more energetic and exercising and cutting carbs I am very pleased with this approach. I don't see why the two can't be used in harmony.

6

I was on byetta and lantus and it worked, I would think you need to see an endo at this point if your doc will not go that course.

7

Yes that vis what i do . i am not sure why your doctor didnt do that with your a1c levels

8

I know nothing about Victoza, in fact am going to talk to my PA about it this appt. BUT what I wanted to suggest is about exercise. I have two horrible knees that should be replaced, but can't afford it even with insurance. I can ride a recumbant bike, but can't afford one. So here's my saving grace for exercise.....if you have or can get a script from your doc for water therapy....it's great. If you don't have a regular indoor pool therapy place, ask for land therapy PT and then do those exercises in the water. Much better on your joints, especially knees, and gives you the work out you need too. Although most PT places will have a recumbant bike, where you sit and ride....add the water therapy to loosen up your knees and hips, and it's more exercise. I can only do about 5 minutes on the bike, but that with the exercises in the pool.....help a lot both the knees and weight. Also, if you go online and check out sittin exercises for older people, there are many that have information with pics on sitting exercises in front of the TV....that are excellent. Not that we are old ---- but I'll be old if it gets me what I want. Good luck with the meds, let us know what he says

9

<OPINION>

Doctors put T2's on basal insulin first because it's easy for the patient (one shot a day), when the optimal first insulin treatment for T2s would be bolus insulin with the training to count carbs and make corrections.

</OPINION>

If you feel you can handle estimating carb content of what you eat, and doing a simple division calculation to determine an insulin dose, discuss dropping all oral meds and other injectibles except metformin, and starting a bolus insulin regimen with a fast-acting like Humalog, Novolog, or Apidra.

If you're willing to be an early user of a new insulin drug, Afrezza, that would be ideal (see several discussion here on TuD about it).

With your numbers and current treatment, it's near-certain that your pancreas can handle your basal needs on its own. So, in fact, you don't really need a basal insulin -- that was just an "easy" way to get extra insulin into your system so that between meals your BG would eventually drop to normal before you ate again.

However, with this approach you always risk hypoglycemia if you skip a meal, exercise and then eat too late, etc. This is an indication that the "basal" insulin you're taking is doing more than just covering your basal needs.

It's a bigger, more active commitment than the approach your doctor is taking, but it can make your control MUCH better, resulting in you feeling better, having more energy and being more active.

As far as the weight issue goes, while insulin does bias the body to convert carbs to fatty acids, it's really a second-order effect... Weight issues are first and foremost a caloric issue. It really is as simple as burn more than you take in each day, and you'll lose weight. However, like anything, data is king: If you carefully account for nutritional quantities and calories in all the food you eat, and manage your diet based on this, you will lose weight -- regardless of what you eat, and what insulin you put into your body.

So, all that said: Switching to a bolus insulin regimen (administration at mealtime, and during fasting when BG is too high and needs to be brought down), metformin (assuming healthy liver), and a suitable moderate/low carb diet with appropriate calorie content (calories are from carb, protein, and fat), and you can make this work.

Exercise: How about swimming?

10

AFAIK if you want to reduce weight, you cut the carbs and replace the lost energy with healthy fats
it’s a long page and a few good video’s
http://www.dietdoctor.com/lchf
For me, the more carbs we eat the more carbs we want. they don’t give up easy
http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm

"Dr Eric C. Westman, MD and president elect of the American Society of Bariatric Physicians, has 15 years of experience helping patients lose weight and improve their health using low carb. He has also helped do several high-quality scientific studies on low carb."

https://www.youtube.com/watch?v=NImxgj2I4_M&feature=player_embedded

11

Jack, I couldn't agree with you more. My experience fully backs the low carb high fat (LCHF) method to lose weight. I adopted LCHF as a way to restore blood sugar control and was rewarded with a quick and surprising weight loss.

Here's a January 2015 paper that gives a comprehensive review of using LCHF as the preferable first response to type II diabetes.

12

I’m not sure if the question is still relevant sine it was asked several years ago but perhaps it can helpful to others.
I disagree with some of the other responses.
It is acceptable medical practice after trials of which I partipatedin to combine a glp1 like Brett’s or victors with a basal insulin like lantus or levimir. I have used this combination for years effectively . Levimir might be better for weight loss but my experience is you have to take about 20% more than lantus. The combination of levimir and the more powerful glp1 victoza should result in weight loss plus more with exercise.stay tuned for better basal insulin other than lantus and levimir being tested now.
Victoza reduces your appetite even with lantus, which is what I take now.
I think it is correct to have type two use basal insulin. The combination I use has brought my a1c down from way over eight to consistently between 5.1 and 5.9 probably the variance has to do with the amount of exercise. I do take quite a bit of lantus… 60 to 70 grams per day. I prefer dividing into 2 shots per day because studies show it really is only effective 18 or so hours per day. The newer basal insulin in trials now will last longer

13

Since this post was originally made in 2012 the FDA has subsequently approved the use of Victoza with a basal insulin. This is evident in the prescribing information. The use of Victoza with a bolus insulin is not yet FDA approved and the PI says "the concurrent use of Victoza® and prandial insulin has not been studied." So doctors can prescribe Victoza with a basal, but Victoza with a bolus is still "off-label."

ps. And Victoza is still not indicated for patients with T1 although apparently many T1 patients do quite well on it.