I have been diagnosed for 13 years now, under tight control for about three years on Metformin and Amaryl. I also have lost over 80 lbs, have about 24 left to go. I swim and bike five times a week for abaout 90 mins each time. So I am doing things correctly according to my plan. But there is a rub in the center of this that has me totally puzzled. I get lows at times when normally, I should be fine, like after meals and snacks. I run about 118 on average, and so a low of 56 or less is quite alarming to me. My CDE has said that sometimes that happens when you use too many carbs on one meal. For example, tonight we had beef brats, no buns for me, 1 small ear of corn, no butter, 1/2 cup beans (I think there were 37/cup as far as carbs were concerned) But within an hour of eating, I recorded a 56 / 54/ 58 blood sugars. I found some juice and drank that, and am now feeling competent and safe enough to go on with the evening. But this has been happening more and more. Do you suppose with the weight loss, my doc needs to look at lessening my doseages? Maybe they are too large for my body weight now? Anyone else have any insight in to this, it's totally messing with my brain.....and when I am alone, cause hubby has to work nights, I really get freaked out.
Amaryl is a sulfonylurea and is known to cause lows between meals. You should work with your doctor to reduce the dose so that you don't experience lows between meals. Or even better, skip the sulfonylurea which is believed to burn out your beta cells and move to a basal insulin. In either case, you need to reduce to level of sulfonylurea or basal to keep your blood sugar normalized between meals and then use medication and/or insulin to deal with meals.
We have been going back and forth on that one for months now. Since I use a sliding scale when I get cortison injections for another problem, she is very hesitant to drop the amaryl totally. I would be much happier and I think feel easier on the insulin...but I have to be able to prove that. It's wonderful when people have endos, and lots of docs to rely on, but here there are limited opportunities to get a doc as good as this one is...on most thing. I think our ratio is up to 1 doc per 1500 people....not good. But thanks, Brian for reminding me it's time to bring up that subject again,
My question is how much beef brats. Protein can slow the digestion of your carbs. Is it possible that the absorption of carbs has been delayed by the protein causing you to go low. Like Brian says Amaryl is a sulfonylurea which can cause lows.
I also agree with Brian about insulin. You say you sometimes take insulin on a sliding scale. If you are comfortable with insulin I would suggest you try to dump the Amaryl.
I would like nothing better than to do the insulin full time, maybe keep the Met; but here is my quandry and question for you all, do you just go on insulin without informing your medical team? Do you decide on your own that the insulin in the best thing for you just go ahead and start it....then what do you do when you need it refilled? In the state that I live in we can't just refill our own meds, we need approval from our docs. I will need approval even more so, because my ins needs to see that the doc ordered it? How do you handle that situation? I could be put on insulin full time with docs orders IF I can show readings of 150 more than 1/2 of the time.....do I lie and do that? There are other questions that sometimes don't have simple answers of "just do it",
I agree, I think the dosage is too high, we should drop the Amaryl completely., This is the first drug I got 13 years ago when I was diagnosed and weighed in at 252, now I am 88 lbs less and think I am taking too much, I am sure we will talk about this again with my team, but no one knows diabetes better than diabetics in my opinion,
I'm in the switch from the Amaryl to something else camp.
Is your metformin ER? Shortly before my T1 diagnosis when I was taking non-ER metformin, it would trigger lows (4-5 hrs) and high BG (6-8 hrs) as it reached maximum potency and then went out of my system. I'd have lows of 50s and highs of 200s that were out of my control. So if you aren't on ER metformin, spread it throughout the day and see if that changes things. For me breaking the pills in half and taking 1/2 pill 4 times a day was a quick fix, but it didn't resolve the underlying issue that I was type 1.
Sorry, mine is ER or long lasting....I take 1000 mg twice a day....that is working fine.
Not that I'm saying you should just change stuff without talking to your dr but maybe reduce your dose of amaryl? Depending on what your dose is maybe even stop it and see what happens? If your BG goes up too much then you can adjust. Just make sure you check BG often. I forgot my dose of amaryl and met one morning. I work far enough away that it wasn't feasible to go home and get it. I tested a lot and found that I spent the whole day at around 200. Obviously, I need to take my drugs.
As indicated amaryl, starlic, glimperide all drive one nuts as one has to eat to prevent the lows. Dieting - good luck there.
Liquid insulin dose gives you freedom from that.
Metformin helps arrest too much liver excess glucose release. Insulin helps with absorbing the glucose genersted from food/meal. For me both work well.
If your liver is not leaking much/alot; insulin alone may be enough. For me I have a bad boy liver needing to be strangled by the metformin.
Beauty of met is that it is stoppinge excess glucose release at source and not saturate your muscles/fat cells. Insulin does have a bottom line in that it gets the excess stuff in blood stream moved to muscles/fat cells. Now one has to exercise extra to burn off that extra glucose.
No free lunch!