Insulin Question

I have been diabetic for 15 years, gestational diabetic 30 years ago and have tried many of the new meds...Byetta, Victoza, Januvia. I was given Lantus a few years ago but didn't take it regularly. I have done a lot of searching online and found that insulin causes weight gain. I take 2000 a day of Metformin and Glyburide 4 a day. But I don't take the insulin. I am 5 ft 2in and weight 240lbs. The endo (whom I don't like)said I needed to take this and gave me Novolog Mix 70/30 to inject 25 to 30 units before breakfast and dinner. My A1C was 10 last time and I am addicted to carbs. I have all the prescribed meds, but I guess I think I know more than she does. I know she is getting tired of my non compliance. She is this tiny, thin, East Indian who has the book learning but doesn't really know how I feel. You all do.....What should I be doing for my health? If I take the insulin and keeping being addicted to carbs and sugar I know I will gain weight. If I continue on the road I am going I might be dead soon...Please advise....I am 67 years sold.....Respectfully

A1c of 10 is bad. Super bad! That's even worse than mine when it was at it's worse. Perhaps you could find a doc you like better? If insulin is needed to control your bg's better, than maybe you should take it. I don't gain weight from being on insulin--I gain it from eating the wrong things. I've spent a year recently being at my ideal weight. It had nothing to do with insulin. It had to do with my resolve to eat properly. My exercise level didn't change much from usual. You need to get your A1c below 7. If you don't, before you die you may likely go blind, lose kidney functions, get neuropathy, all sorts of bad things. Get that A1c down!!

Thanks for the response.

Sure. I hope you get your control issues resolved, but PLEASE, heed this following warning: do NOT drop your A1c super fast by drastically and immediately getting your average glucose level down to normal levels, as it can cause bleeds in your eyes. It may seem counterintuitive, but that is what can happen. A deliberate and steady drop in A1c is safer. Speak with your endo about that.

I don't have a comforting response for you, but I know your struggle.

Problem is, you are diabetic. Seriously, very, diabetic.

At 67, you have to weigh the impact getting control of your blood sugar has against the risks of serious complications.

The latter is generally a factor of how long you've had diabetes, your age, the quality of your BG control, and the presence and degree of any complications you are already experiencing. In other words, "it's complicated".

However, an a1c of 10 you're averaging BG around 250mg/dl! That's the beginning of risking Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) if you stay there all the time.

Regardless, you're not going to feel well at those levels. You probably feel like you have no energy all the time, feel a little sickly constantly. Apetite problems likely. Foggy headed. Difficult recall.

At a1c of 10, symptoms like these are not simply age-related. They're definitely diabetes effects.

First and foremost, you need to get your blood sugar in line, and your a1c down under 7%. It's quite possible to do, but in your situation only insulin can make it happen. Also, you'll have to learn how to estimate carbs and dose insulin proportionally. Again, not too hard, but something you have to learn.

Once you have tamed your BG, then its time to take a hard look at the weight, diet, etc. While external (exogenous) insulin biases your metabolism to putting excess calories on as fat, the insulin is not the key here -- the excess calories are.

People in your situation start gaining weight when they start insulin not because insulin is the problem, but because they are not properly processing all the carbs they're eating. Just like a non-diabetic eating and processing all those carbs would gain weight too.

Unfortunately, the "free lunch" (pun intended) you've been having has been extremely damaging to your kidneys... You've been peeing out all those extra carbs, round the clock, given your average BG. And that glucose is quite damaging to the kidneys because of the way it's excreted.

So, the tough news is, there is no way to continue on the way you are and feel/be as healthy as you can. Further, barreling on ahead like that will probably result in some side effects in the next decade, maybe even something very serious. Even without serious side-effects, you're like to lose some years off your life.

In contrast, get the sugars under control and your chances to live longer, feeling better, and having more ability to engage in enjoyable life activities definitely goes up.

Bottom line: You need to get insulin, learn how to use it and use it well, then make sure you're covering whatever you eat -- no matter how many carbs -- with enough insulin to process it. Deal with the other problems once you have a handle on that.

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This is the first I've heard of this, and it is counter to other information I've read over the years that say the only "risk" of rapidly bringing BG down is false hypo, which is unpleasant but benign.

Do you have any pointers or reference about the eye bleed issue? I'd like to learn more...

Gee, Dave, I've known about it for so long, I can't remember where I first heard it. I suggest talking to a KNOWLEDGEABLE ophthalmologist or retinal specialist. They aren't created equal, I can tell you that! My wife works with eye docs and believe you me, some are great and some are not so great. :)

google is our friend. I already found a comment referencing someone's doctors comments:

Dave, thank you so much. I will heed your advice. I am tired all the time and I do pee like a race horse (all the time). I still work as a 3rd grade teacher and sometimes I just dread getting up to go to work. I gave up regular coke on Sept 8 which shows me I can do the giving up on the bad carbs. After years in Overeaters Anonymous I do the 3 meals a day thing pretty is just the snacking of carby things in between. Thanks again..

Oh Pat, I know first-hand how you feel. It's awful.

Here's the great news: The day you start insulin you will feel absolutely incredible. Just getting your BG down under 200, to around 150 will make you feel like a million bucks! Energetic; clear-headed; an appetite you forgot you had (I'm not talking about voraciousness, rather just that you will want to eat a regular meal, an it will be satisfying, rather than feeling like you had to choke it down); the thirst and the peeing will stop on a dime -- really!

And you will have an overall, entire-body feeling of "good" instead of "sick".

However, work closely with your doctor in bringing your BG down. Print out this discussion and take it with you so your doctor knows where your coming from. Follow his/her advice, not mine -- I know you only to the extent that we've interacted here.

I can guarantee, though, you will kick yourself for not doing this ages ago.

I did.

My a1c was 13.5 and I had bleeding in my eyes already. The retina specialist told me get it down fast. When I got it to 9.5 and with one laser treatment, retinopathy was controlled and my eyes didn't start bleeding again. Bringing a1c down fast was the best thing i did for macular edema.

I would maybe find another doc/endo who is more compassionate. Then get on a regimin that works for you, everyone is different in what carb levels they can manage but I think you can definitely reduce a lot of what you normally eat without suffering too much. Levemir is better for not gaining weight. You may be able to do a combo of met and insulin that will work to help you manage your situation. I also recommend not to drop too quickly if you don't already have issues with your eyes because I have heard it can cause retinopathy in some people, someone else posted about that here. I think this means don't try to do this in a matter of 2 wks to a month. I was at 13% at diagnosis and it took about 4 months to get down to the 5's for me even though I went low carb pretty quickly. It's a stress on your body overall to come down too fast.

I also recommend one of the fast acting such as novolog, humalog or apidra for meals and corrections not the 70/30% mix- most people find this much harder to manage.

Actually, it was the originator of the thread posting hear-say about what her doctor told her.

Later in the discussion another person relates the exact opposite from her doctor.

Even more pertinent to me, however, is that after searching with Google for six different ways to phrase, "lowering a1c too fast causes eye damage" the only reference I could find directly connecting lowering a1c too fast and damaging eyes was -- that one post on the ADA website.

So, I'm gonna file this one in the "interesting" category, but wait for something more substantive than a posting by someone pharaphrasing her doctor.

Please understand I'm not calling you a liar or anything. I don't know you any better than that person you referenced, so this by itself just isn't enough, when googling turns up nothing else.

I happen to know several KNOWLEDGEABLE ophthalmologists. I'll ask.

For anyone who is "used" to very high bg's, a normal bg may feel scary--you may feel hypo. Same thing with dropping too fast. If you are in the 300's and take insulin for example, and you start dropping, you may feel hypo well above 100--way above, in fact. it all depends on the rate of drop, the length of time one has been hypoglycemic, and the feeling varies person to person.

I see no reason to discount what that person related from her doctor. Secondly, we aren't in a court of law, so I am not armed with a ton of cites. Ya'll believe what your doctors tell you--don't listen to me.

No need to get testy. You see no reason to discount what that person related from her doctor, and that's just fine -- for you.

I more skeptical. I place little value in a hear-say statement from a single person I do not know posting to the internet. I need more than that.

I seen people make stuff up on the internet many, many, many times. Even here on TuD.

BTW, I most definitely listened to you, and haven't dismissed what you claimed out of hand... indeed, it's on the radar, and I'll be looking for more about it. I haven't been able to find anything searching, and that fact is troubling.

The internet isn't the end all and be all of all facts. I have searched for many things online that I'd expect to be readily available, yet nothing turns up during exhaustive searches.

It happened to me. I brought my A1C down about 3 or 4 points, and was diagnosed with pretty severe retinopathy soon after. Obviously, I probably already had some risk factors, and I was long term diabetic, but my Retinal Specialist doctor agreed that the quick drop could bring on retinopathy.
I suffered several bleeds in both eyes, but I've been doing well for several years now.