Insulin and Warfarin

Type 1 and LADA
#1

I'm wondering if there is anyone else here is who is on insulin who is also on warfarin? I am getting so sick of my inr going down which happened again this week. The dietary restrictions, and all of it in addition to dealing with the diabetes is starting to drive me nutso. Warfarin also upsets my stomach and was giving me severe reflux 3-4 wks ago, but I seem to have that under control at the moment. But my dose was raised again, so that may be a problem again soon.

I'm thinking of stopping it and going back to lovenox shots even though I hate them. At least there are no dietary restrictions with that and I'm not sure about the inr checks but I think there aren't as many.

If you're on warfarin and insulin or just warfarin, how do you manage all of this?

#2

I am not on any blood thinners, but thought I'd comment on your lovenox vs warfarin comment. They acheive the same job but work on different clotting factors to do it. That is why you need an INR done for warfarin. Lovenox works differently and you should never need an INR done to make sure its in a therapeutic range, it will not affect your INR value. That being said, typically, lovenox is used as a short term anti clotting agent (either for post op or in combination with warfarin until INR becomes therapeutic, then stopped) There are others out there, ask your doctor about Plavix, its used commonly as well and doesn't require INR. But warfarin is the most effective at reducing risk of heart attack and stroke, so be cautious weighing pros/cons. Good Luck with it all.

#3

I am a warfarin for life user. I don't have issues with the warfarin upsetting my stomach or causing reflux or having any affect on my insulin or bgs. I do however have constant dose changes and can't offer an explanation. The dietary restrictions are the worst part of the deal for me...All I want is some broccoli! My INR constantly changes and I follow a pretty strict regime which includes diet, activity, etc. This is why testing is so important, I get my INR tested every month and sometimes more when the result is wonky. It sucks!

#4

Thanks Jen,

I know the basics about the clotting factors etc. but for some reason I couldn't remember if lovenox had an inr check or not... I was given that in the er and then 2x per day in the hospital until warfarin became therapeutic, like you said.

warfarin is very difficult to maintain at therapeutic or safe levels, everything affects it, while lovenox is completely stable apparently.

The problem is you have to inject it 1 or 2x per day and I have trouble with that. I did have to do it myself for 4 days one of the times when my inr went down and I seemed to be getting more clots, but they were already there from my first visit most likely.

On warfarin I have already been to the er twice with more dvt/clot symptoms in my early treatment after the initial dvt and my inr has gone down at least 3 x to sub therapeutic.

I'm ready to pull my hair out and I don't feel it is good for me with everything else that happened to have all of these dietary and vitamin/ medication restrictions.

Plavix isn't safe because there is no way to deactivate it if you have an emergency with bleeding etc. so that is not an option for me.

#5

thanks karen,

I hate warfarin! I have been getting my inr tested every week to 10 days since I got out of the hospital- I was back again for dvt in my leg after dka. I follow everything they tell me and it still goes down. I just can't take all these dietary restrictions etc.

I am allowed to eat greens 3x per week, but there are sooo many restrictions it's crazy. Everytime I take a new med I have to check if it's ok. I think lovenox would be a better option for me, but I'm going to be on this for 3 more months at least and that will mean that big needle 1x per day probably.

Plus I'm not sure how much my insurance will cover for lovenox, but maybe they will since I have reflux problems with warfarin as well as problems keeping it therapeutic. I just don't know if I can do that injection everyday for the next three months. I was talking to someone who did this recently though and she said it was much better.

Then there is the question of getting off warfarin, my inr nurse said that has to be done slowly or it can be dangerous. I'm worried I will start to have more clots again. I do feel lovenox works better as my symptoms are better on it. When my inr goes down I can tell because I have more symptoms again.

my father is a lifer too for a fib and his inr is always changing- once they tested it 3x in one setting and got 3 different results.

#6

do they restrict your activity due to warfarin? I've never heard of that before.

btw I also haven't noticed any effects on my bg etc. on warfarin, but I did read somewhere it can elevate your bg levels.

#7

no, they don't restrict anything, they just remind me that ANY change can have an affect and they ask what might be the cause for the number out of range. I never can answer...as said in first post. I just remind them that I'm a person and not a machine and my metabolism sometimes kicks up or slows down for no reason. If I could explain it I'd have much less hassle in my life. It's hard enough to manage diabetes. Warfarin is just as hard and far more dangerous. It has never elevated my bg levels thank goodness. It is not uncommon to have INR go up and down, this is why the testing is so necessary. My goal is a home meter!

If you can change to the lovenox and do that for three months then go for it...I would if I had the choice. I don't remember the needle being "big" really, but it would be a total bummer. May I ask how they know if your clotting issue is okay without testing??

#8

My activity is restricted to only walking for now due to the dvt, but I didn't know that activity levels would affect warfarin levels also. I know what you mean- I have no idea what is causing this although sometimes it does seem to be diet. At least with insulin we don't have to worry about bleeding and clots, lol.

My father was thinking about a home meter too, but then he found out that they force you to test once per week and medicare is charged a lot for that. If you don't test once per week they take the meter back as it's sort of a rental. It seems to be a money making scam for the company that makes them and for insurances.

I'm not sure about how they know you are ok on lovenox. I have read several articles about it and there are tests to see if the way it acts is working or not, but no one does them apparently. I found this which says they are supposed to check platelets before you start, and they can test ACT and APTT also to see if it is working. Someone here also said you should also be checked weekly cbcp to check for thrombocytopenia/low blood platelets which can cause bleeding.

http://www.nhlbi.nih.gov/health/health-topics/topics/thcp/

that was one of my other concerns about switching to lovenox, I'm wondering how safe it is compared to warfarin. I know if you're pregnant, you can't take warfarin and they put you on lovenox instead, so it must be safer for some reason.

The needle is not huge I guess but it is a lot bigger than an insulin needle and it is harder for me to do. But it was less painful usually when I did it myself overall, so maybe I should switch.

#9

An update- I checked with my vascular surgeon and he said it would be ok to do the lovenox instead- he said I will be affected by the dvt forever essentially now- whenever I have any surgery or immobilization I will need to be anti- coagulated and if I fly I should do lovenox shots before. My inr nurse thinks we can work to control the inr and she bought me some b vitamins which are ok with warfarin, which was so nice. Unfortunately they turn my urine yellow and I seem to get irritated by that so I'm still searching for a multi b that will work. I have some patches I think I will just go back to those for now. she doesn't want me to do lovenox because it can cause kidney damage if you do it longterm. So I'm going to stick with warfarin for now as I should be finished by December hopefully. I think I will ask my hematologist about all of this also and see what his take on it is.

My inr went back up to 1.9 from 1.6 so that is good, and I'm brusing again with my insulin injections- a sure sign my inr is up :)

#10

I have been on warfarin since age 18 and I am now 68. New to insulin injections(4/3). Test INR at home. Inr has been variable, as you have experienced. It is a concern of mine too. Have increased warfarin dose and it went up then dropped drastically to barely thereputic today. A bit of a problem since biggest fear is any more PE's. I have over 40 of them. Blood sugars are now normal ranges of 70-100, with rise to 120 2 hrs after a meal. Hope is metformin only will help and get off the insulin injections at 1x per night.

#11

Hi Greg,

Thanks for your reply. I'm off warfarin now as my dvt was reabsorbed at about the 6 month mark. It is very difficult to keep it stable for sure. I guess you have clotting factors, 18 is very young to start on warfarin. I'm sorry about your PE. I am also afraid of that and I carry lovenox with me just in case. I still get symptoms sometimes. I'm glad your bg is in good control and I hope you can get off insulin eventually.