Newly (sorta) diagnosed Type 2, What meds work best

Hello,
Hope all are well. So for a quick rundown of my situation. About a month ago I went for my yearly exam and a few days later I got a call. Well, I had an elevated A1c of 8.6%. I have Kaiser so, I actually figured it out on my own but waited for confirmation. So rather than diagnose me my Doctor has given me 6 weeks to try and see if a lifestyle change (diet and exercise) would work. I have taken it upon myself to also get a meter and record my levels (ranging from 72 to 240, most mornings I’m either 130 or 140) so if I am diagnosed, which I assume I will be I can provide evidence for aggressive care. Now, I am a full-time student (CSULB woot-woot!) and really don’t want something that will take me away from my studies or interfere with classes. I have done a great deal of online research and it seems I should push for starting with insulin. I would love some feedback from those who have used insulin vs. metformin or any other treatments. I really appreciate your input! Thank you all.

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Hi, @Sean_O_039_Dizzel! So glad to see you have written. Welcome aboard. It sounds like you have at least two wonderful things going for you already…
-common sense
-a positive attitude

Can’t value either of these highly enough. Well done!

Go with your gut on this. You seem to already know what your doctor is unwilling to confirm: you have diabetes. Also, you are not alone. I’m so glad you’ve found this group and hope that you can find other groups that will also support you.

As you suggest, insulin may very well be a wonderful choice for you, and there is no reason whatsoever that it would need to interfere with your classes. There is a learning curve with it, and it can be a major pain, but it is also life-saving. HAving said that, it might help to know that many doctors resist prescribing insulin before wanting to prescribe other medicines (like metformin) first. This can be frustrating and might require your being firm. It was my experience, at least.

The only question that remains in my mind is your type. Being accurately typed can really help you in discerning what treatment options would be best for you. As you might have seen elsewhere, there’s a simple blood panel that can search for autoimmune antibodies. If you can request that at your earliest convenience, it would tell you whether your diagnosis would be categorized (to insurers) as autoimmune (type 1, type 1.5 or lada). This becomes important down the road as you explore other options for management (like a continuous glucose monitor–CGM).Many insurers simply won’t cover them if the diagnosis is Type 2.

Wishing you all the best on this journey. I’m sorry that you find yourself on it. Hoping you can take comfort in the company you have along the way.

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Metformin made my stomach upset. I could not use it without trouble. YDMV = Your Diabetes May Vary.

It took me a long time to get used to Insulin, so actually nothing is all that easy.

Good luck. Keep at it.

Thank you for all the information and the warm welcome. Type 2 I believe is going to be the diagnoses. So much information to learn in a short time. Definitely glad to have found a group with so much information.

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Okay, well don’t settle for a diagnosis without confirmation of it. We’re here to help in any way we can. It’s scary how many people in our community are being misdiagnosed and find that their treatment options simply don’t work until they get the appropriate diagnosis. You may well be Type 2, but make sure they rule out other things before owning that dx.

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Hello, yes I have been seeing lots and lots of information about the side effects of Metformin, it’s tough having to make a choice based on which side effects will be less invasive. Thank you

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Also wanted to add, bravo you for taking it upon yourself and getting a meter. Should have listed initiative in that initial list of things you have going for you. You’re going to be just fine.

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As a Type 1 who supplements my insulin with metformin ER to very good effect, if I were Type 2 and in those ranges, I would absolutely try metformin ER + diet before adding insulin to see if it works because why not? Personally, I tolerate metformin fine (I was told to definitely get the ER to help with that). If your issue is more with insulin resistance, throwing more insulin at it may not be the best answer anyway—that’s essentially what I was doing as a Type 1 with increasing insulin resistance, and with higher doses came weight gain and still not ideal control. If you have insulin resistance (one of the major signs for me was going from an hourglass figure to gaining weight at my belly), metformin will target that more directly. Having a flexible attitude about treatment is great though in terms of being willing to experiment until you find what works for you.

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Hi Sean,

You’ve come to the right place. You’ll find TuDiabetes to be full of two really vital things: a bottomless well of information from people who actually live with diabetes every day rather than having just studied it, and a source of strength and support for those occasional moments when it gets difficult and you just need to converse with people who actually get it.

Let me reinforce the comments above about getting a correct diagnosis. Not only is it a vital ingredient in working out the best possible management plan, it also has profound implications for insurance, i.e., what it will pay for and what it won’t. I would personally insist on the definitive antibody tests to either prove T1 or rule it out with certainty. T2 isn’t really a “true” diagnosis but rather a diagnosis of exclusion. It’s what doctors fall back on when there is no proof of T1, LADA, MODY, etc. The “gotcha” is that they often do that without running the tests that would nail down the true answer.

Regarding metformin, it’s one of the safest and best studied meds in the entire pharmacopoeia, and while it’s mostly prescribed for T2, its action and effects are such as to be potentially helpful to anyone with any form of diabetes. It’s becoming less and less surprising nowadays to see T1 patients using it. As for those side effects, they are a bit like those dreadful things that are in the fine print, or that the announcer speeds through at the end of a commercial. They do happen, but they don’t necessarily tell you that this or that dire thing only happens to one patient in 10,000, or whatever. As with any medication, each individual responds differently. Some people can’t tolerate metformin at all, some have moderate side effects, and some (like me) have hardly any at all. There’s only one way to know what your experience will be, and that’s to have some experience.

With all the progress made in treating diabetes in recent decades, which is immense, insulin is still the most powerful weapon in the arsenal by a wide margin. Joslin, pretty much the gold standard of diabetes clinics, often prescribes it to newly diagnosed T2 patients, even if only temporarily to reestablish good control before proceeding with a personalized, detailed treatment plan. It’s certainly nothing to be afraid of.

Once again, welcome to the community. We’re glad you found us! :sunglasses:

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Thank you, everyone, for all the great information. If you all don’t mind I’d like to add another question. Thank you for the suggestion on the antibody test (I will definitely request it now). But my question is, can you be overweight and get type 1? What would the blood level via the meter look like?
My symptoms so far have been the tiredness, loads of urination at night time, day time, and so on. Also major headaches, and super thirsty. I realize these symptoms can be for ether type. I’m just curious.

Thank you all again!

I will let others answer, but from my perspective, the only RULE about Diabetes is that there are no rules. There are skinny Type 2s and overweight Type 1s and everything in between. People present differently, and there are as many variations as there are people with diabetes - at least!

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Citation, please?

Per Joslin’s “Pharmacological Guidelines (Rev. 10/2016)” insulin is only initiated in “severe” cases – defined as follows – per their algorithm.

Severe

Marked hyperglycemia (e.g. if FPG >250mg/dl, A1C >10%, random glucose >350mg/dl) OR
Significant weight loss OR
Severe/significant symptoms OR
2+ or greater ketonuria OR
DKA/ hyperosmolar state OR
Severe intercurrent illness or surgery

Perhaps you know of a particular physician at the Joslin Clinic who doesn’t adhere to Joslin’s clinical practice standards? If so, perhaps you will be so kind as to share his/her name?

Hi Sean,
I agree mostly with most of what is written here. But I think that a couple of basic things are missing.

  1. As much as you think that you know and understand today,
    You will know and understand more and better tomorrow.
    and 2) Diabetes is for life so you’ll be learning for life

  2. There are side effects and there are side effects -
    I remember the 1st week I was taking metformin - I thought to myself that with the way I was feeling I was going straight back to the doctor ask for different medication. But I was patient and by the end of the week my body and my mind had got use to having a lower blood sugar. What metformin does to a % of patients in a long term - that’s another question.

  3. Now your 1st question or dilemma: metformin or insulin - great question - but it’s only part of the question…
    You should be advised to (obviously according to the results of your blood tests) be put on a regiment of medications

  4. But it’s not all about medication. I like to call it the triangle of Medication, Food and Exercise. All of these contribute to your general well being. All three are different for every single person. And every individual must learn how all of these will interact together to find what we’re all looking for.

  5. Now this is most important - Diabetes is horrible. Things that can happen to us - I wouldn’t wish on my worst enemy. But they don’t have to happen. And another thing - They won’t happen tomorrow.
    Everybody makes mistakes in their process of learning about their own body and adjustments to diabetes.

Learn - DON"T PANIC - DON"T BLAME YOURSELF - Learn then move on

I also read a lot about insulin vs. metformin -
It’s only 1 of many decisions you’ll be making over the next couple of years.
And once again - Learn from it. It’s not the end of the world if you choose a and not b and guess what there maybe a c!!!

I hope that I have written something coherent here.

All the best

Davo

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There’s a famous rhetorical device that Dr. William Polonsky uses when lecturing on diabetes. It goes something like this:

Speaker. Who here believes that diabetes is the cause of heart attack, stroke, kidney disease and blindness?
Audience. [most raise their hands]
Speaker. Wrong. Poorly controlled diabetes is the cause of those things. Well controlled diabetes is the cause of nothing.

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Hey Sean:

There is research that recommends that a T2 diagnosis should be treated aggressively at the outset with Metformin and basal insulin. It the fastest way to get your fasting numbers below 100 and avoid any potential damage to your remaining beta cells which are getting killed off via glucotoxicity at sustained levels around your current fasting numbers.

One of the rationales is that aggressive initial treatment gives your pancreas a chance to recover and can lead to weight loss and a resulting decrease in insulin resistance, thus requiring less insulin. A virtuous circle of sorts. Once your BG levels are normalized the insulin may be discontinued. A once or twice daily basal injection is less trouble than brushing your teeth. Your Dr.'s recommendation of “lifestyle change only” seems to imply that he might be suffering from a longstanding misconception that it was your “lifestyle” and poor choices that got you there in the first place, when the current research suggests that it is the insulin resistance/T2 that caused the weight increase, not the other way around. Also, anything that relies on willpower alone has a high chance of failure. It’s human nature. As you’ve already suggested, why not utilize some safe and proven therapies to help you right at the outset? Yes, Metformin can lead to GI issues for some, and for many the extended release version (ER/XR) seems to address that.

And lastly, as others have said, it’s important to get the antibody tests done to rule out T1. You’d be surprised how many T1 adults get initially misdiagnosed as T2, myself included.

You’re doing a great job in researching your condition and reaching out to this group. You’re tackling this the right way.

Christopher

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True.

Besides which, too many in the medical professions still regard insulin as a “last resort” to be tried when nothing else works (and plenty of damage has been done), rather than as the weapon of choice to attack the problem with maximum firepower, early enough to make a real dramatic difference.

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Thank you, Guys, so much for all the information.
So when I see my doctor what is the name of the exact test(s) I will be asking for? Also is type 1 genetic? I can’t seem to find a sold answer in this. Reason I am asking is I went ahead and gathered family information On who has type 2 (the researcher in me needed analytical fulfilment I suppose). Come to find out that on one side of my family I currently have an aunt and uncle who were recently diagnosed type 2 including my grandmother type2. Turns out in the other side I have 2 cousins who are type 1, and both my grandparents were type 1. I’m just curious to know the general odds.

Again thank you guys all for you help!
-Sean O.

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This site lists ans describes the tests: http://www.diabetesforecast.org/2015/sep-oct/tests-to-determine-diabetes.html Most doctors will order a fasting C-Peptide test and the anti-GAD65 tests (as my doctor did), but some of those other tests might be important as well.

Yes. No. Sometimes. It used to be said that only Type 2 is genetic, but there seem to be many examples of Type 1 diabetes “running in families” – I think the real answer is that there are multiple factors that can lead to either kind of diabetes - some of which may be genetic. There is a lot more research needed.

Welcome,I take metforminXr and it works well. No " tummy " issues. Less likely to go low,than starting on insulin. Weight loss if needed,eating better, and exercise you may be off of medication before you know it. Nancy

http://www.webmd.com/diabetes/blood-sugar-coach-17/diabetes-plan/video-diabetes-small-changes?ecd=wnl_dia_032317&ctr=wnl-dia-032317_nsl-ld-stry_1&mb=OHixghSgvH8%40ZWWGgfX7Z2dEpmNqbUHL6WMlFmTPgnA%3D - just found this - it’s not bad and just remember nothing is written in stone