Invokana for Type 2...questions

Type 2
1

Hi..I am 60 and have had Type 2 for 20 years. Over the past year or so, my blood sugar has been raging despite a pretty complete drug regimen that includes 65 units of Levemir at night, 25 units of Novolog with meals and 1500 mg of Metformin daily.

With my blood sugar acting up so badly, my doctor said I really need a boost and prescribed Invokana for me, saying it should greatly improve my A1C (last two have been a mess). If I recall, he told me something about possibly becoming resistant to my insulins.

Anyone out there taking Invokana have any good/bad/indifferent feelings about it?

Thanks
Mike

2

By the way, thanks to a battle with my insurer I do not have the Invokana yet...so I have not begun taking it.

3

Well, your TDD implies a significant degree of insulin resistance. So in view of what Invokana does (flushes sugar from the bloodstream via the kidneys), logic suggests that it might make a real difference for you. If your doctor approves, it's probably something that really should be tried.

And -- sorry -- I have heard no substantive reports from users, but it's early days. Invokana has only been on the market a very short time.

4

thanks for the response. My doc has been good about being up on this stuff, which is a good thing. Can’t wait to start it once my insurer starts playing nice.

5

Fingers crossed for you; hope your insurer plays ball, and sooner rather than later.

One other thing -- since there isn't much real world feedback to track (yet), please stay in touch and let the community know how this works out for you.

:)

6

Thanks…promise I will! Example of what state I am in…with all those meds, my typical fasting is in the 250 range

7

I really have to ask, why are you taking just a partial dose of metformin? And are you eating a low carb diet? Why are you using a fixed dose of novolog with meals, it seems pretty high. Are you able to restore your blood sugars down to normal (70-140 mg/dl) after meals?

I have to tell you, doctors love the "latest" drugs like Invokana. But insurance doesn't want to cover paying $100/month for them when existing drugs are effective. I doubt Invokana will be a magic bullet. It would seem to be better to explore a better diet, metformin and insulin regime.

8

That was an estimated average dose re the Novolog. No, my sugars won't go down that much, no matter how closely i follow a diet regime. I have shifted my exercise (four days a week) to swimming; my knees will no longer tolerate running, which i did for years.

9

Thanks, I didn't mean to criticize you, I know you are struggling. Usually your insulin doses will be split about 50/50 between basal and bolus, but for a low carb diet I have found (at least in myself) that my dosing is more like 70/30 or 80/20. I use much more basal than bolus. That is why I commented about the high bolus for meals. I actually suspect you will need to increase your insulin in order to regain normal blood sugars.

I do think that you should work closely with your doctor to consider a maximum dose of metformin and adjusting your insulin dosing aggressively to normalize your blood sugar. When your blood sugars go high and stay high your body becomes insulin resistant. It is a natural response of your cells trying to block the harmful effects of high glucose. Often normalizing your blood sugars can do wonders.

So what is aggressive? I mean working with your doctor and diabetes team to employ multiple daily "corrections" and adjustments to your basal insulin (i.e. raising it) until you get your blood sugars down to a normal levels. This would typically be done over a period of weeks, starting with a modest goal, perhaps getting your fastings (before meal) down to < 200, then < 150 and then trying to get closer to 100 as an end goal. I think it would also be good to really become more of an expert. Some books I would recommend are "Diabetes Solution" by Bernstein for general advice and a low carb diet, "Using Insulin" by Walsh and "Think Like a Pancreas" by Scheiner for insulin regimes.

And you should also try to examine your health in a broader review to see if there are things that causing constant high blood sugars. Typical things that can do that include ongoing infections or inflammations (like periodontal disease) or Sleep Apnea. If your doctor and medical team won't help you normalize your blood sugars, then they have failed you and you should seek other help.

As to Invokana, it may well "help," but I suspect not by much. As David mentioned, Invokana works by lowering the point at which your body starts to dump glucose into your urine. Normally the point at which this dumping starts (the renal threshold) is 160-180 mg/dl. You are already well past this point, so you will just have "more" excretion. And the average improvement in patients using Invokana was an A1c decrease of 1%, this would correspond to dropping your average blood sugar from 250 mg/dl to 220 mg/dl. Invokana isn't going to just fix this.

I hope that is helpful.

10

Brian has analyzed this correctly. If your BG is regularly running in the 200s than Invokana may slightly increase what your body is already doing anyway, but the impact is bound to be slight.

11

Staring at the discussion here is reminiscent of my prior problems. My glucose numbers were at 238 at wakeup and dropped to 180 mostly till it was discovered I had a nasty dawn phen in am that the liver was throwing the full buffer at my body every am and ocassionly do liver dumps and throw the blood glucose up to 500 and slide back to 278 to 315 as heart pumped the glucose around body diluting it.

With my Doctors help; I found that if I walked 2 miles exercise in morning; this would burn off the excess glucose in am and numbers would drop to 140 and under.

Furthermore, this load of glucose was saturating the muscles and causing extreme insulin resistance. So much that 26 units of 75/25 humalog acted like water and sat circulating in my body till I burned off the excess glucose. I got a Dexcom 7 at the time and was a godsend enabling my Doctor to get a picture of what was going on.

Metformin turned out to be the magic bullet that help get the liver's excess blood glucose release arrested and restore sanity.

Contrary to the idiot science out there; with the cgms one could see my liver leaking all the time dumping in excess glucose hammering my numbers.

In the end, I ended up with a diet of 1200 calories low carb - mediteranean and 2 miles a day walking and metformin and regular humalog lispro U-100.
Metformin doses were structured in 500mg doses aith one dose 1 hour before each meal and then 1 dose at 10:00pm and one at 12:00am midnight that effectively shut off excess liver glucose release.

I had also used lantus but did not find that helpful. It worked but not enough to really stop the mess.

In the end, once the liver's excess glucose escapade on dawn phen and liver dumps was arrested by the metformin, then diet and exercise did the trick to putt the world working properly.

There is this utter stubborn resistance to consider the fact that if the liver buffer is big enough ; that it can swamp and overwhealm the muscles and shoot the insulin resistance through the roof. The amount of glucose the muscles can store is finite and when the skeletal muscles swamped the dam glucose backs up in the main blood system with horrendous numbers.

Until my Doctor got the metformin doses and timing good on cgms, diet alone was tried but found insufficient to arrest this mess. The next step was the walking two miles in 1/4 mile loops and watch the glucose readings and after 8 loops, the blood sugar would drop dramatically and then run normally till the next morning when dawn phen shot it back up to 238 and I walked it off again!. Lastly, meformin proved instrumental in arresting this mess.

Which in my case using cgms could see the timing and cutoff by metformin on my liver each time a dose came up to sufficient strngth in my blood stream. The liver stopped leaking and flattened out rather than continuously climbing!

12

I wanted to add as well that in cases like this metformin is extremely useful
as it works irregardless of insulin resistance. Second it is cutting off the excess glucose generation at source in liver.

When insulin is being used, the assumption is the muscles have additional room to store more glucose on insulin command. Secondly this job is unfinished until said muscles are exercised to burn off the extra glucose so loaded. With metformin, this is a single step of cutting liver off - finito - done!

13

Mike,
I have been taking it since October and I love it.
I haven't had a problem with side effects such as yeast infections.
The one thing is that your urine has a strong chemical smell.
Invokana works by pulling the sugar from your cells and
eliminating it through the kidneys.
I have found a lower carb, moderate fat and protein diet has helped me get my fastings in the 80-90 range and my 2 hr pps are under 120.

I am 61 and have had diabetes for almost 16 years.

14

I had a battle with getting it filled also. I talked to a rep from the prescription administrator and he helped me get a waver. My endo was great with supplying them information on my medical allergies and why I couldn't use any of the "widely prescribed diabetic drugs".

15

My understanding is slightly different in that:

Yes the invokana can help exhaust excess glucose in blood stream. As for ant glucose loaded into skeletal muscle cells, the trip is one way in. Only exercise can burn off excess glucose stored in muscles.

16

These responses are all very interesting. One thing that has tripped me up is a deep vein thrombosis in my left leg that has made exercising very, very painful. Clot is cleared up, but I now have vein problems in the leg. (As you can see, this has not exactly been my year.)

Incredibly, I am still awaiting approval for Invokana and intend to try it. You all have given me very interesting questions for my doctor.

17

Mike:

Bless you. You make excellent comments. Walking may not be the right answer for you and I respect that. I also have the dam varicose viens on both legs
I did manage even after stroke to walk but after stroke I was out on a walker for many moons till I got to point I could walk better.

Nothing is easy with this dang diabetes and only offer that hopefully you can find some exercise approach that works for you.

Thank you for sharing and blessings and best wishes fighting this dam pestilence that is NOT YOUR fault.

Thank you for sharing and writing to us.

18

Mike,
If you get approved be sure to register for a savings card at this link.

https://www.invokanacarepath.com/?utm_source=referrer&utm_medium=wwwinvokanacom&utm_content=Saving%20Card%20Page%20Invokana%20Carepath%20Get%20Card%20Now%20Link&utm_campaign=ConsumerSitetoCarepath#

I got the first month free and after that I only pay $5/month copay for a whole year.

Have you called your insurance company to see what the holdup is?

19

Hi,all…I finally received my approval and got my first month’s supply today. And re the savings, the pharmacist actually gave me the card and the number so that it would be free.

I am very curious to see how it works. The things I have read are both encouraging and alarming. Thanks for your input, and I promise to keep you posted.

20

I've been on Invokana for 1 month and it has lowered my glucose numbers by an average of 40 points. My highest used to be over 220 and my lowest fasting was 130. Now my highest reading has been 135 and my fasting is between 90 and 100. I've also lost 25 pounds so far and am feeling great. I do need to pee more to get rid of the glucose.
I can tell if I've eaten more carbs at a meal than I should because I need to go more ofter.