I’ll be the first to admit, I know nothing about insulin and diabetes. So bear with my ignorance, please.
My friend, started on insulin once a day last week, Lantus? Don’t ask how much, I have no clue. She is taking her metformin 1000 mg / day also. She now has higher BS’s than when she was on metformin only…is this an adjustment period for her. She is feeling physically as if she isn’t doing anything for her diabetes, tired, thirsty, hungry, weak, etc. Her BS’s have been in the high 200’s. She got little or no education on insulin and diabetes when she started a week ago…NOTHING. Well, I guess they did show her how to give herself in injection…that’s it! Share with me, so I can share with her about insulin reactions, what if they are too high, what does she do? What are the basic important things she needs to know? Can she eat anything she wants as long as she injects herself…see I told you I was ignorant about insulin.
Are you kidding, that ain’t going to happen. She is the gal that doesn’t care, and thinks that taking insulin is going to solve all the problems. Talk to her doc…nope, won’t happen.
You’re talking about insulin in regard to someone who has Type 2. The issues surrounding blood sugar/insulin/etc are a lot different from those for people with Type 1.
I’m curious – and not trying to start a fight – why do you think that this discussion belongs in the Type 1 forum?
Type 1 and Type 2 are radically different conditions that have one thing in common: elevated blood sugar. Sometimes I think that they should have radically different names, too, to help get that point across.
I don’t mean to patronize you so please forgive me if I’m telling you things you already know. Type 1 is an autoimmune disorder where the body attacks the pancreas, eventually destroying its ability to produce insulin. Type 1 diabetics are completely dependent upon insulin. We’d die without it because we have no way to produce it ourselves. Insulin is life support for us. Type 2, on the other hand, involves insulin resistance. The pancreas produces insulin but the body can’t use it properly. Drugs like metformin help stop that insulin resistance and allow the body to process insulin the way it should. In contrast, people with Type 1 are not insulin resistant. One confusing part is that people with Type 2 often do need extra insulin such as Lantus.
So . . . that’s why your questions probably would be answered better by people with Type 2.
With metformin and Lantus she could be going hypoglycemic & her liver giving her this result. This can happen when the BS goes down considerably: what you see is high BS. But what you don’t see, unless you test an hour after the injection, is how low it went before it went up.
Get Using Insulin by Walsh.
Get Blood Sugar 101 by Ruhl.
If she only got injection information, she does not really know about changing insulin doses in relation to carb grams intake. I’m sure they want her to keep in close touch.
Your best encouragement is to give her a little notebook in which to record her tests, what she ate (in grams of carbs), and the time of everything, including the metformin and Lantus dose.
Best wishes! Let us know how you and she resolve this!!!
And eating anything as long as she injects Lantus depends on her own body’s reactions to metformin and Lantus. High carb foods are seldom fully covered by insulin in some people - and fully covered well in other people (not many). But don’t become the food police! SHE has to see how things happen and she needs to ask her questions. Hopefully you’ll see her do so.
Cathy, Your friend needs Diabetes Education. No matter what your friend takes, metformin, insulin she needs to understand how to manage her diabetes. Help your friend seek out a Endo with a Certified Diabetes Educator. there are many factors in managing your diabetes i.e. diet, medication self mangement. If the Dr is telling your friend “go take some insulin” without educating her, it could be serious. Your friend could find herself Hypo (low blood sugar). It is also important for your friend to realize what she eats needs to be calculated according to what ever medication she may be taking. You seem to be a close caring friend.
P.S. Many times when a person with diabetes attends the education class they are encouraged to bring a family member or friend to help better understand the managment info. After your friend has attended the class encourge him or her to come online to a great site as “TuDiabetes” and many more. Diabetes Education never stops
Lantus is a basal insulin. Type 1s & some Type 2s on MDIs (multiple daily injections, as opposed to pumps) take basal insulin (one or two injections daily) & rapid acting for meals. Type 1s can’t eat whatever they want simply because they’re taking insulin.
Lantus acts as background insulin to keep BG stable between meals & to help morning fasting BG. Lantus doesn’t help with spikes caused from food. Well, if she took massive doses of Lantus it might cover food, but that’s a prescription for disaster.
If she’s testing regularly daily to know she’s not having lows & experiencing reactive high BG, as Leona mentioned, it’s not Lantus causing highs. She’s either eating more under the mistaken idea that she can, exercising less than before or getting ill (infection causes high BG). Hormones & stress are also factors in higher BG.
For high BG (other than increasing meds & injections, or going on insulin for meals):
Eat less carbs
Lose weight (if she needs to)
Exercise more
She needs to do all three.
Since she won’t talk to her doctor, her BG probably isn’t going to get lower on its own. It’s up to her to take charge of her health & it’s awful how little education she received. That seems to be the status quo.
I think the dicussion got off track. Cathy posted that her friend was put on insulin , things are not working out for the friend, help me understand what insulin is all about. Her friend does not understand diabetes. I suggested to Cathy to help her friend seek diabetes education.
I realize that there is a differance betweek Type 1 and Type 2. But now Drs. are increasingly prescribing insulin along with diabetes drugs to Type 2’s to help maintain better control. A Type 2 family member of mine was recently put on 70/30 and I get many questions about “how do I know that my blood sugar is low?” “What happens if I forget my insulin”.
I feel that Drs must role out a better training program for there patients that they put on insulin instead assuming that there patient truely understand insulin.
Hi, Cathy. Yes, your friend (and you) will have a lot of questions regarding insulin usage. As type 1s, we need insulin every hour of every day or our bodies starve and our blood sugars rise to levels far above 200s. So, like others have said, we’re not the folks to answer questions on how a type 2 on metformin should handle her Lantus. Lantus is a long-acting background insulin that, as type 1s, we use only to handle our most basic metabolic function needs for insulin (like breathing). We also have little to no experience with oral drugs like metformin because they do nothing for us.
If you were to move this conversation into the type 2 forum, we have about 4,000 type 2s here on TuDiabetes.org who use combination therapies like insulin+pills+diet to maximize their blood sugar control who could answer you better about the specifics. We type 1s don’t have insulin reactions from Lantus alone generally, but rather from our faster acting insulins. And we do not have the metformin regulating our livers/fasting blood glucose levels either.
I agree that she needs to find a specialized nurse called a “certified diabetes educator” (CDE) or sign up for diabetes education classes at the local hospital.
Nice summary of T1 vs. T2. Sometimes I think we should adopt a completely different name for T1 diabetes. The confusion and misinformation because of the common name will always be with us.
All of us T1s would do well to adopt your patient attitude and concise explanation.
Leona, thanks for the support. She isn’t doing well, and was in ER last night for this problem. I could shoot whomever didn’t give her the information she needed. And that is all she got, here’s the needle, this is where you put it in…good luck. No call back, no info, no nothing. AND boy was the ER doc angry with the same clinic people.
I am hoping that our support of her situation and her going to our clinic for some education will help her out. Thankfully, that’s what the ER doc told her to do, head over to our clinic with the diabetes educator and find out what is what. I told her I would go with her, for the first visits, cause it never hurts for me to hear the info again too.
Dave, I’m not being stubborn, I totally understand the difference between T1 and T2 and T3 and gestational diabetes, this isn’t my first time around the block either. My questions are about insulin…why would I go to the T2 site, when usually T1’s are the “experts”. it’s not a question about metformin.
But I guess I have given the wrong impression, and please, don’t bother yourself with the question…as with all things dealing with diabetes, we teach ourselves and get our information from those who want to help us. I have always had the impression that whether you are a T1 or 2 or whatever, information about all diabetes is a good thing to have. Guess I’ve been wrong. Sorry.
Dargirl, please read my just previous answer. We will be going to some education at my clinic, rather than hers.
We have an excellent program and grants for just this kind of thing. In South Dakota we have a high Native population that is seeing a rise in the number of people with diabetes. Seeing as though my clinic serves many Natives, and others, they are the prime place to get this info, have CDE’s and dieticians and their whole staff is well versed in all aspects of diabetic care. I was happy to hear that the ER doc told her specifically to go to the Urban Indian Health Clinic, because they are the best we have to offer. That helped me to know that I am in the right place.
She won’t come here, YET, because she doesn’t like sites that are blogs or discussion…but I am sure she will get here eventually. It’s all very new to her, taking care of herself, advocating for herself, etc. And if not, here, then a site that she can get info, questions answered, and not have to have me to it for her. As we were all in the beginning, a little hesitant to ask, and terribly afraid and nervous.
Hi Janet - There are many similarities - and many differences. It’s not as simple as “people with Type 2 often do need extra insulin such as Lantus.”
There needs to be some recognition that there are insulin-dependent T2s, ok? I inject both basal and bolus insulin. Often, this comes about after years of living with T2, or years of taking awful beta-cell burnout drugs given to T2s. I also think we have yet to “discover” certain other classifications of D (I have autoimmune hypothyroid, diabetes 1 & 2 is all through both sides of my family, none of us are overweight).
Still, I am an insulin-dependent T2. I have no beta cells left. That doesn’t make me a T1, that makes me an insulin-dependent T2. I find my issues are similar to T1s, but my reactions and my challenges are much less “extreme,” for lack of a better term.
Cathy - While your question is regarding insulin - it is specific to a T2 PWD (T1s for example, don’t take metformin) and how T1s take and how they react to insulin is usually somewhat-to-very different from a T2. I believe that Dave was trying to be helpful - sorry it struck you the wrong way. It’s misleading to declare that T1s are the “experts” when it comes to insulin - especially as it relates to T2s. Let’s do all we can to keep the T1 - T2 “wars” to a minimum, ok?
Did they cut her metformin dose my feeling is that it is an all or nothing drug. If they did not there is no way that adding Lantus would increase BG except if: She feels cured and said great now I can eat carbs. Her insulin resistance has got a lot worst because of illness or stress or hundreds of other factors.
Adding Lantus a very slow insulin does not permit you to eat carbs. Even adding a fast acting insulin does not permit you to eat carbs if you are insulin resistant.
And of course adding insulin does not permit you to cut exercise.
Spliting the insulin does in two one at night and one as you get out of bed is somewhat better than one dose at bedtime. If this does not help she should increase the Lantus a few units each day until the BG are fine.
Hi Cathy,
I hope that your friend is doing better. My Husband is a Type 2 Diabetic and takes Lantus at night and several Diabetic drugs. IT has taken us YEARS to get everything right. And for once his numbers are falling in a normal range. I hate to think of the damage that has been done, but finally we have found a Dr. that cares and tests for everything! Even when he thinks we are wrong. Your friend sounds like she is on the right track now thanks to the ER Dr. . Shame on anyone who would give someone insulin without giving Diabetic training. (CDE) I think everyone who is diabetic, be it Type 1, Type2 or LADA shoudl see one. Its very important to learn how to eat and how to take care of your self. Even if you are only on pills.
Please keep us posted on your friends progess. It does sometimes take people a long time to seek out a community. My hubby still will not come here. That’s ok, it is his choice. I am glad that he has found the Dr. that he has, and is getting the support he needs.
Christina
– why do you think that this discussion belongs in the Type 1 forum?