After 10 years its seems I now need to take insulin to keep in control. Anyone out there ever discontinue their oral meds once they hit that point? If you can keep yourself in control on insulin alone and you have to take it anyway, why tax your liver and kidneys with the pills?
Welcome. I was diagnosed T2 in 2005. I tried a whole range of medications. In the end I was on triple combinations. Even with my strict diet and exercise, it was not enough. So I started insulin a year ago last december. I immediately stopped all the other medications except metformin. The metformin continues to provide benefit for me by helping me be more insulin sensitive. But I stopped everything else.
All the other diabetes drugs, I stopped. And with insulin, I've been able to control my blood sugars far better than I ever did in my years on oral medications. I don't worry too much about my liver or kidneys. I get my enzymes and all tested regularly.
My brother is T2 and he is 5'11" and weighs about 145lbs...scarey skinny. He was never able to achieve
any of his Doctors recommendations and took every (all) oral meds in maximum doses for 7 years. During
this past Christmas / New year holiday we had a family intervention while on a trip to Cozumel I gave
him his first injection of Levemir®and the next morning he called me from his room, it had been years since
any of us had heard him say anything positive and he was so happy you would have thought he had just
won the Lotto. His morning BG was 86mg/dL he had not seen a normal BG rreading in over 4 years.
It has been about a month now and he looks great no more bags under his eyes and he has gained about
10 pounds but still needs to put on about 10 lbs more. Today he is going to see a Endo so they can start him
on Novolog®. The Levemir® has fixed his fasting BG but has had little effect on his post-prandial blood sugar
it still spiks to over 200mg/dL after most of his meals, especially breakfast which is double trouble for many
PWD's.
Hi John,
Thanks for your reply , my experience was similar.
I wanted to avoid insulin at all costs like it was the end all, now I find its really my preferred method. I take the levemir and all is great in the morning but later in the day I can be back up to 150 to 200 even with taking Metformin and Januvia in the morning. I did find taking another dose of levemir helps but Novolog 70/30 may be a better choice The idea is to find an Endo that listens to you and tries to help you find the right mix as opposed to pushing their ideas on you. Many people take 2 doses of Levemir but the doctors will insist it is a once a day drug.
My experience was that my basal (NPH first, now Levemir) did wonders for getting my fasting numbers down. I was always high in the morning. But even with a low carb diet, a basal insulin like Levemir may not be enough to keep your blood sugar in control after meals. In my case, I just moved right away to using a rapid insulin with my meals and it has worked out very well.
I think it can often be difficult finding a doctor who really listens and works with you. It was my experience that many doctors fear prescribing insulin for T2s and will only do so when their patients get really, really, really bad off.
After 30 years, 26 years on those dam useless oral meds - glyburide/starlix - they are like taking sledge hammer to fleas.
Once one is trying to bslance energy and loose weight, the oral crap needs feeding.
I am now on liquid insulin humalog lispro, lantus and metformin.
The liquid shots give the highest flexibility and control.
I wish I never got that on the other oral crap for so long.
My brother is still taking 1000mg of Met (in the am) and also takes Januvia but it does not stop the
spike when he eats. I hope they give him some Novolog to day.
I'm like jims I've done every oral medication availiable at some point over the last 20 years usually multiple med at a time. This also included the injectable drugs Byetta and Victroza along with the oral med. I would at times achieve a degree of control with each new med for a short while then be back to square one. But when I started Insulin I was able to have a lasting level of control I had never had before. I've was taken off all oral meds except Metformin. I wish I had started Insulin much earlier.
Most people, I think, would be much better off on an insulin regime but they fear and avoid it because of the injections and the perception that that it indicates a much worse level of the disease. Actually a T2 on insulin is not a sicker person but rather is a person whose disease is much better controlled. That to me is a healther person.
I agree why tax your liver and thing I you don't have to.
Gary S
I started insulin in May 1994, when, after 5 months, it became apparent that Glucotrol (a sulfonylurea) wasn't doing a bloody thing. About 6 months after that, metformin came on the market, but I was doing so well on insulin alone, I couldn't see any reason to try anything else.
The lesson I took away from that is do what works. Each of us is different, and even among T1's there are some that benefit from metformin. IMHO, all the others are too new to know whether the risks are worth the benefits, except if nothing else works. You should talk to your doc and CDE if possible and think it through for yourself.
I use both Insulin and metformin.
Metformin's role in my mind is needed if ones liver is leaking - throwing back excess glucose when it should be fasting.
If that is not issue, then metformin may not have large benefit.
In my case Metformin is the heavy hitter and the liquid insulin is the boost item on pancreas effort.
I hate the oral pills as they simply cause the pancreas to slam in extra insulin willy nilly and one better eat enough or suffer the lows.
Stemwinder has captured it well. In Europe, Doctors go to liquid insulin quickly and do not prefer the oral stuff.
If ones Pancreas is still working, the liquid insulin is variable, controllable and can complement pancrease effort nicely without blasting the body.
AFtre 30 years , I see no value to the oral crap and wish I had gone on liquid insulin sooner. In the end, for T2's; I do not see the sense and use of the oral stuff except to wear out the pancreas sooner.
I agree, bsc. If my gut would have tolerated metformin, I'd probably be on it today along with the insulin. It increases your insulin sensitivity, so you (theoretically) need less insulin while taking metformin. Although I hang out with my T1 buddies (and love them to pieces) I try to remind myself on a regular basis, "T2 is not a disease of 'lack of insulin' -- it's a disease of insulin RESISTANCE." Anything we can do to increase our insulin sensitivity is our first line of defense: exercise, stress reduction, healthier lower-carb diet (more micronutrients, less processed garbage), enough good-quality sleep, nutritional supplements, drugs like metformin. After we handle doing our utmost to increase our insulin sensitivity, injecting insulin takes up the slack and helps to protect our beta function. Some T2s eventually lose beta function, but for us, diabetes starts with insulin resistance.
I agree Gary, there are many, many T2's out there tolerating numbers in the 200's and 300's because their doctors are not willing to face the music: they need insulin. I think once a T2 is on MDI (not just basal) they should be migrated to the pump if they want it, too. Every minute we spend in the normal range is one less minute of damage to our eyes, nerves, kidneys, etc. We need excellent control.
I hate to rain on anybody's parade BUT: the hemorages on my eyes eliminated and kidneys stopped deterioating and got off actos when Aic sub 7.0 and average Bg was 155 and lower.
Abover that, the veins and arteries go soft and rubbery on the high average levels of glucose like natural rubber hose rots out carrying gasoline in a car.
My insulin usage does not yet warrant pump yet but point well made.
I was dx'd in October and started taking insulin after Christmas, at my own request. My post-prandial BG numbers were high and often stayed elevated for hours. I was grateful that my endocrinologist doesn't like sulfonylureas and so I didn't have to deal with that. I'd read a lot about those drugs and the endo told me that he's convinced they burn out beta cells prematurely and may actually damage pancreases more than the body will without their help.
I take Humalog with meals. It's been a struggle to figure out dosages, particularly in terms of calculating my needs at breakfast or anytime I eat a meal that has very little or no carbohydrates. Protein raises my BG slowly. Humalog is a fast-acting insulin that peaks, for me, at about 90 minutes post-injection and seems to be out of my system in about three or three and a half hours. Figuring out how much insulin to take, when to take it and whether to divide doses is an ongoing puzzle, in some ways, but I think I'm getting the hang of it at last.
I'm delighted to be using insulin because it's not the scary thing I thought it was before I was diagnosed and because I can see the results within an hour or two. I have a reasonable idea of why my BG goes up and down in response to what I eat or my activity level and I have a way to correct it if it goes too high. I've continued to follow a low-carb way of eating, with about 20 grams of carb per day and I haven't gained any weight. I'm also taking 2000 mg of the extended release form of Metformin. It does help with dawn phenomenon, but doesn't prevent it entirely.
I'm the kind of person that finds information comforting. Insulin seems to be giving me a great degree of control and that helps reduce my anxiety. I believe that I will be able to manage my diabetes well, be healthy and live a good, long life. It may be that I will be able to stop taking Metformin and insulin at some point. That would be great, but I'm not worrying about it right now. I'm celebrating how good I feel!
I'm still on oral meds after 5 years but with carb restriction and exercise I keep pretty much normal bgs close to 100. I prefer never to spike over 120. I am trying to stay away from insulin basically because my high deductible insurance won't cover the cost until we hit an unbelievable $11,000 per year. I have 4 years until Medicare and then I will re-assess the situation. My husband has been D for 15 years and is still on oral meds and can keep HbA1c in the 5's. I don't think anyone should let their bgs go above 140, ever. But lots of time adjusting diet should be the first thing you try. If that doesn't work then consider insulin. I do think Insulin does add another set of side effects and complications. I hear lots of stories of people on insulin who still aren't well controlled because they haven't addressed the diet issue.
Jeannie, I commend you and your husband for all your hard work! You've set yourself high standards, and I think it's impressive that you, and especially your husband have done so well for so long! :-)
Of course, in T2, there are many different possible disorders, so depending on the individual, the course and treatment needs will be different, but I think the message is that you do your absolute best with the cards you've been dealt.
I think the most important treatment modality is a good attitude, and boy, you folks have really got it! :-)
I would be interested to know if those of you who are taking insulin received training and/or monitoring or if you had to figure it out yourself?
My only training was one shot of saline several months before I went on insulin. It was during a class I went to whose goal at the time was to get me off the oral med I had just started by diet and exercise (didn't work), but they had everyone give themselves a shot of saline, just so people could experience what an injection felt like.
When I actually went on insulin, the doc just wrote me a prescription, and that was it. However, there are/were instructions in the package, and I had seen and read enough that I actually did know how to do it. It WAS nerve-wracking to take my first shot of real insulin, but ultimately entirely worth it! LOL!
My oncologist was the one who started me on insulin. They sent a visiting nurse to my home to teach me how to give myself injections, even though I'd already done it with another med. The instruction took a minute or two, then we had a cup of coffee and a nice conversation.
I was started on a sliding scale (*shudder*) and told to call if I went over 400. I woke up a bunch of on-call oncologists a bunch of times ;)
What exactly is the sliding scale? Sounds like it's not a good idea? Do they still put people on a sliding scale?