Hi everyone, I am new to this helpful site .Since November year I had been on lantus solo star, started with 14 units increased to 18 units in January 09 as the levels after dinner were still high. I think the levels are still high as 2 hours after dinner I had readings as high as 18.7. My specialist already told me that if May’s 3 monthly blood test my levels are not under 8. preferably under 7.5 he will change the once daily lantus to another twice daily insulin. I have never liked the idea of being on insulin so I am still getting used to once daily insulin, the idea of being on twice daily is something I would like to avoid if possible, can you please tell me of ways that I can help bring the levels down after dinner. Does lantus take a long time to be effected? At night I am on 4 diabex 500g XR slow release. Thanks for any replies.
Still getting used to insulin.
Dear N.B.
A reading of 18.7 mmol/L 2 hours after dinner is horrible the normal range is 4 to 6 mmol/L and diabetics should be close to that. the yanks use other units so you must multiply ours BG measurements by 18 to get it in milligrams per deciliter that they use. Also a HA1c of 8% is not great nor is 7.5 % it should definitely be below 6.5%.
Lantus works immediately. In your case you may not be taking enough.
Not sure what diabex is we do not have that name brand in Canada.
You must go on a low carbohydrate diet: meat, fish, fat, oils, vegetables. No bread, patatoes, rice, cereals, donuts, etc at all.
You probably need a rapid acting insulin to cover meals and most likely a higher dosage of Lantus to cover what is called the basal needs.
HI Anthony Holgo,
Thanks so very much for the reply. Diabex is another word for metformin, I live in Australia so the more common name for metformin is diabex. I phoned my diabetes educator a week ago and told her I am concerned but she said as long as the highs do not happen every day and that they go down by the next morning when I check before brekky, it is an indication that I have to be extra careful what I eat and what to delete from my diet. Pasta is a no no for me or else really a real very small portion.I made an appointment with my own doctor to discuss this but I cannot see her until the 14th of April.She is fully booked and doubled booked I am told. So I will try to keep an eye of what I eat and if it still high I wll phone the specialist before my appointment with him in May. I really appreciate your reply thanks again.Have a nice day.
Dear N.B.
There is nothing wrong with metformin. I personally I cannot tolerate the drug for more than 3 weeks and it does not do anything much for my blood sugar which appears to be the same for you. You are probably a diabetic with insulin resistance and a dying pancreas. a very unhappy situation. I would get on a proper daily regime of a fast acting insulin to cover meals and correct highs and a slow acting one for your basal needs to bring your BG near if not into the normal range. And I would do this as soon as possible. Waiting longer will kill your pancreas completely. Then if you have insulin resistance the diabetes will become your worst nightmare.
Actually, Lantus does not work immediately, it is a long-acting basal or “background” insulin and has no effect on after-meal bs numbers. I use Lantus and take Meformin, along with a low carb diet.
I don’t understand your numbers (different than what we Yanks use), but I can tell you that if your problem is after meal highs, you either need to go on a very low carb diet (as Anthony suggested), and/or ask your doctor about fast-acting insulin. What are your fasting numbers?
I understand your feelings about insulin - it’s a common issue - but I would rather be on insulin (something our body makes and needs) than some of the awful oral drugs with terrible side effects.
You probably also need some tests - C-peptides & GAD Antibodies - to discover what “flavor” of T2 you are at this point.
Cheers,
Cheri
Just to reinforce what Cheri said you need a fast acting insulin not sure what are the popular brands in Australia to cover your meals and a slow acting one like the Lantus you have. Stay away from the oral drugs they may be useless or harmful in you case. With the possible exception of metformin. You must end up with 3 months test below 6.5% not 8%.
18.7 mmol/L is sky high and should never occur. your 2 hours after meal should be below 7 mmol/L. Get the two types of insulin fast you still may be able to save a part of your pancreas, the longer you wait the more it will be destroyed.
There are 2 books you should get probably available on Amazon Dr. R. Bernstein “Diabetes solutions” and “using insulin”
HI Sheri and Anthony
Thanks so very much for your answers and suggestions. I saved all the info I am getting from this forum as I cannot stress enough how helpful the members all have been with their replies and I thank all of you.I have to phone the diabetes dietician tomorrow and tell her how have the levels been these last two days as yesterday she said to also check for these two days the very last before bed , so to test four times instead of 3 times… She said she will tell me tomorrow whether she thinks I must speak with the specialist . From visits I had with her she really believes he will put me on a rapid insulin either the nova mix or the rapid one in May to help with the after dinner. It is only a matter of deciding if I need to talk to him now. Thanks again for you help. Really appreciated…
Hi Anthony and Cheri,
Thanks so very much for your answers and suggestions. I saved all the info I am getting from this forum as I cannot stress enough how helpful the members all have been with their replies and I thank all of you.I have to phone the diabetes dietician of the Diabetes resource centre tomorrow and tell her how have the levels been these last two days as yesterday she said to also check for these two days the very last before bed . She said she will tell me tomorrow whether she thinks I must speak with the specialist . From visits I had with her she really believes he will put me on a rapid insulin either the nova mix or the rapid one in may to help with the after dinner. It is only a matter of deciding if I need to talk to him now. Thanks again for you help. Really appreciated…
Good advice from Anthony! (Hi Anthony). I would also suggest exploring this site - http://www.phlaunt.com/diabetes/
Please do call your doctor - not your dietician - about your high numbers! Also, don’t expect the dietician (and often doctors as well) to understand about a low carb diet and so much more…go to the site I mentioned above and you’ll learn what I’m talking about.
Take good care of yourself.
Cheri
HI Cheri,
Thanks very much for your concern. To tell you the truth I am considering calling my specialist by Friday. I know he is in his office every Friday to look at the results, scans etc and for patients to phone him personally, like I was doing on his suggestion to phone him every second Friday and read him the levels from evry forthnight from November till February 08 when I saw him and he increased the lantus as he does not see patients on that day. I know he will be in his clinic tomorrow so I might not even wait till Friday maybe I can speak to him. So whatever the dietician say as she is clling me in the afternoon before she leaves for the day, I will call him tomorrow and ask to speak with him if I cannot speak with him tomorrow as it is a very busy practice, I leave him a msg to talk to him personally on Friday like I had done in the past… Whenever I called him on a Friday he always took time to speak at length with me as no patients were waiting for their turn. I will check the site you mentioned Cheri and the books you mentioned Anthony, thanks to both of you.
Natalie
Also as Cheri has said do not argue a low carb diet with the dietician they must toe the party line and here in America (includes canada) the party line is very high carbs which is bad news for most diabetics the more so if you are a begginer on insulin as it will make control dificult. Do not argue say yes yes and then don’t eat the carbs. Veggies ok: broccoli, cauliflower, lettuce, cucumber, tomatoes, avocado,olives, nuts very diabetic friendly. Bread, rice, patatoes, cereals, cakes, pastry forget they exist.
The book “using insulin” will tell you how to set up the basal and bolus insulins you need. The Doctor or nurse cannot predict how much insulin you need it must be found by trial and error. Hopefully not too much error. If you see lights with closed eyes, hands tremble a bit, cold sweat you are low; dont panic pop a few 4 or 5 gram glucose pills. and reassess the situation. You should shoot in the first try a fasting BG of less than 8 mmol/L in the morning and 2 hours after meals. Once you master that you should try for 7 mmol/L and then 6.5 if you can do that you will live ok for a long time.
Hi Natalie -
Please let us know what your Doc says and how you’re doing.
Cheri
I have always (for years) taken metformin in morning and at bedtime. I have never read or heard anything that it must be taken in conjunction with meals. It does say to take with food, but that is to avoid stomach upsets. Metformin is not like mealtime insulin.
Hi N.B.
It sounds like you have a lot of work to do! When i was diagnosed, 4 months ago, my fasting BG was 19.1. I am currently taking 3x500g metformin, no insulin. My fasting BG is now in the 6.2 to 7.2 range and my average BG (testing about 6 times a day) is 6.1. Although the metformin certainly helps, most of this improvement is due to low carb diet-under 50 grams/day and daily exercise. If I had listened to my dietician I would certainly be on insulin. My doctor, whom I like, has provided very little guidance, but is positive about the results. If you want to avoid insulin you must take responsibility for your health, not wait for someone else to approve a change. If you do not want to try this approach, which of course may not work for you, you can probably get excellent results by taking both kinds of insulin. Good luck!!
Avoiding insulin is not necessary a victory. Consider this. Adding a very small amount of insulin to help your pancreas stay alive somewhat possibly for the rest of your life would be a real victory. Diet and metformin does not assure that. Believe me once your pancreas dies totally the diabetes goes from a manageable disease to your worst nightmare the more so if you become insulin resistant.
This happened to me I was able to get the BG down to the levels that you are at now but over time the pancreas still died because it was under too much stress with some external insulin.
Further in line with Cheri’s comment, here is a video I did a while back, which deals with LADA (or type 1.5 diabetes). This was my personal case, but I have found many other members to be in a similar situation.
Definitely ask your doctor to be tested for C-Peptide levels and GAD antibodies. You may actually have LADA, not type 2: