Peetie, I found this wonderful (partial explanation) on wikipedia: What physicians typically refer to as sliding-scale insulin is fast- or rapid-acting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold, usually 10 mmol/L. No basal insulin is given, usually resulting in an elevated blood glucose each morning, which is then chased throughout the day, with the cycle repeated the next day.
Basically, you do a fingeretick and give a fixed amount of a -log insulin depending on the results before meals. My opinion - it's useful for docs who don't know what they're doing (like oncologists) but know they need to do something. Sure didn't work for me!
Raising hand to say "Me, too!" ANYONE who is on insulin at all, and many people who usually take orals, should, if hospitalized, AT the very LEAST be given coverage for meals (some people's bodies can handle their basal needs themselves). Basals and corrections if needed, and and frequent BG checks at appropriate times to SEE if basals and corrections are needed. Having diabetes (either type) in a hospital or nursing home is DANGEROUS!!
My training was pretty much the same a Natalie's. I was given a script for Levemir with instructions to increase dose until I reached a suitable BS level. When it was clear that Levemir alone was not doing the job I was given a script for Novolog with instruction to take before meals and again increase dose until I reached a suitable level. I never really recieved training just instructions. Things have worked out well but I think a little training would have helped.
Most of my training has come from here. Without this group I would have been lost.
I had been misdiagnosed Type 2 and after 15 months doing ok on oral meds my numbers started to rise...and rise. My doctor knew I needed insulin though he had no better idea than I did why. He put me on a starting dose probably similar to his other type 2 patients of Lantus 25 units and I crashed low before each meal; he kept lowering it. Finally I came on here and figured out I was Type 1. By the time I saw an endo she verified my diagnosis and told me to take "1 to 3 units of Apidra before meals". Again I came on here and learned how to determine I:C, though at that time the 1 to 3 units was pretty close to what I actually needed. I already knew how to give injections.
Diagnosed feb 2010, on insulin until jan. 1 2012, set my goal to be off insulin and meds, I did stop taking insulin, and cut other meds in half!!! as a result of tight control, weight loss, and working out. here is a similar link for a question that I posted. https://forum.tudiabetes.org/topics/have-you-adjusted-your-meds-without
Too many are misdiagnosed as Type 2s and put on oral meds, when they are actually Type 1 or LADA. It's appalling the neglectful treatment adults receive just because of their age. The same symptoms in a patient decades younger result in much better treatment and support. Dystopian.
Same experience here. Diagnosed 6 years ago with T2 and initially on oral meds. My system unfortunately just could not cope with Metformin and eventually I was put onto insulin - best thing ever!!!!! Levemir at night and Novorapid with meals - best control over BG levels ever and none of the side effects of oral meds. I look better and feel better because I've stopped all oral meds and the insulin gives me perfect contol - weight gain was minimal - only about 5kg's (10 pounds.
I have been diagnosed for 10 years [I'm a genetic T2, 4th in a direct line] and am still using only Metformin 500. I usually take one with breakfast and one with evening meal. I have never needed to increase medication. I eat very low carb and exercise about 8 hours per week, plus I WALK. It's my main means of getting about. I can easily clock up 35 miles in a week. I'm married to a T1 and wouldn't go onto insulin unless there was absolutely NO other choice. I've dealt with so many hypos during the 40 years of our marriage. I know it looks like a convenient way to deal with T2, but it carries a sting in its tail, which is hypo risk and weight gain. I know there's no option for T1, but I'm NOT going there.
Hana
P.S. my A1c is consistently in the 5% range and fasting is usually about 4.1 [74] to 4.7 [85]
My doctor originally diagnosed me with T2 at age 39 and tried to treat with all oral meds which was Ok if I wasn't doing anything active. Once I started working out and running, though, the ups and downs of sugar control were brutal...now that I am on a strictly insulin regimen, I have much better sugar control- I prefer the pens to the pills, and it forces me to check my blood more often, too!
You're right that weight gain is an issue for many people. But it remains true that weight gain results from too much food for both people with and without diabetes. So it seems to me that the REAL issue is hunger. And that's not so easy, because you can't deny hunger pangs forever.
According to the lectures I attended at the AADE last August, there are a couple of ways of combatting hunger. One is to make sure you have enough protein, and not too many carbs. That is because protein stimulates the gut to send hormonal signals to the brain that create feelings of satiety (being full). Carbs, on the other hand stretch out your stomach, but don't leave you feeling full for very long, which results in more trips to the refrigerator.
The other tip that really made sense to me was to eat the protein first, because it takes about 20 minutes for the signal to get to the brain. Restaurants get it all wrong, because they serve bread first, then salad, then the entree, whereas if you ate the entree first, by the time you got around to the vegetables and salad, and left the bread for last, you would already be starting to feel full, and wouldn't eat so many carbs. You'd be filling yourself up with nutritious stuff, not empty bread calories.
Controlling portion size is important, but I think it's even more important to feel comfortably full, and concentrating on nutritious foods like protein and vegetables seems to me the way to do it.
That sounds like a great mix. I went for my A1C yesterday and it was 6.3..down from 10.5 three months ago. The Levemir works great (from night till morning). Once the day starts my BS starts to rise. I also thought about the Novolog 70/30 in the morning. I see my Endo tomorrow. I'm still taking the metformin but would love to ax that too. Im afraid to go off it and see what happens because it took me close to 4 months for my stomach to get used to the drug.
Having studied Bernstein and corresponded often with David Mendosa, I'm convinced that increasing medication can be controlled by avoiding excess carbs, however many that may be for you personally. for me it's pretty much a carb free life, because if I eat any, especially after midday, i gain weight and my Bg goes up Hana
PS I'm not suffering any deficiencies.
Giselle you need the best possible control for your baby, but that's not to say you can't go back after he/she is safely born
Good luck to both of you!
Hana
Giselle, don't be unhappy about being on insulin! I KNOW that the most important thing for you is to have a healthy baby -- and if insulin will help you do that, it's the best thing that ever happened to you diabetically! Plus insulin doesn't make you throw up or be sick on the toilet! You may find that you don't want to go back to metformin after you get used to being on insulin! :-)
After doing the full 9 yards from oral pills to today and on liquid insulin, my read is that it is idiotic to be on the oral pills that simply override pancreas and force out the insulin - unknown quantity which one has to match up with the food - eat enough. Trying to control your weight on those dam oral pills - now theres a laugh.
I think the bad press has to do more with the aspect of needles and injections not insulin per sae - or shouldn't be.
Today, I find the aspect of flexibility of the liquid insulin dose size and matching up with what one eats as well as complementing the pancreas operation is so much more powerfull.
The beauty of the liquid insulin is that the pancreas is still free to control the insulin it does release on its own rather than being overdidden by oral hormone pills.
Excess weight was always a pain on the oral glyburide/starlix while on liquid insulin, I have been very happy.
My real read is that while the oral insulin hormone pills a nice attempt, the oral stuff is really not ideal for type 2's.
Lastly, I would not describe liquid insulin use as an either or with metformin.
When the metformin is problematic to you or kidney issues, yes insulin can cover for no metformin.
For me, metformin stops the liver excess glucose release and drops the amount of insulin needed dramatically.This may not apply to all. The roles of each drug are dramatically different.
