In short, diagnosed in January 2010 as type I diabetic. Started on Lantus immediately. Lantus 10 units daily along with diet and exercise (no short acting and no other diabetes meds) has been effectively keeping my fasting blood glucose around 100-120 and my latest A1C was 6.3 (I still have some natural insulin production from pancreas). My post-meal sugars do still spike up to 200 sometimes, but usually not any higher and my gp has been reluctant to start me on a short-acting because of my residual own production of insulin and he doesn't want me to go hypo with the use of the short acting.
Now (July) I go to see an endocrinologist just to make sure my current routine started by my gp is the best treatment route, and the specialist says I am a type 2 diabetic based on a negative result of my anti islet cell antibody test. He wants me to ween myself off of Lantus and start taking Onglyza & Actoplus met.
I am worried about taking Onglyza because of DPP-4 inhibition, lowering of lymphocytes, and questions regarding safety in regard to CHF.
I am worried about taking Actoplus met, mostly because of Actos and concerns of CHF.
If I am truly a type 2, then why would Lantus alone be so helpful in lowering my glucose and giving good control?
Anybody else with experience taking Onglyza and Actos and what their experience has been?
FOLLOW-UP 8/10/2010
Finally met again with GP today. Decided we would try adding some metformin (very low dose) to my current regimen of insulin alone and see if that helps bring down my morning fasting sugars. If so, all the better. Will not be taking Atoplus met or Onglyza. Too many side effects and I really do feel like my control is good with insulin alone.
Just wondering if they did the antibody test??? And yes Lantus will help with control, that little extra!! You didn’t say how much Lantus. My mom uses Lantus and she is type 2.
There are T2s who use Lantus or Levemir. What’s your Lantus dose? Do you take it once or twice daily? A high dose of Lantus will keep a newly diagnosed T1 (or LADA) with some insulin production level or a T2 level.
Keeping your BG as close to normal as possible will preserve your remaining beta cells.
I’m assuming the endo did a C-peptide test that determined you have some insulin production. Did he also do GAD antibody tests to see if your pancreas is under auto-immune attack? This helps to diagnose type.
I don’t get the weaning off suggestion. I’d be concerned with med side effects also. Most doctors prescribe Metformin for T2s. It’s been around for a while & is considered safe.
Unfortunately it can be hard to get a proper diagnosis. If you arrive in the ER with DKA, you are T1, otherwise you must be a T2. The proper tests to determine whether you are T1 are the antibody tests as Gerri mentioned. Often, you can appear to be a T2, but you are really a T1 and are in honeymoon as your pancreas is slowly attacked by the autoimmunity that is the hallmark of T1.
It does seem odd to start you off with a three drug regime, particularly with Onglyza, which is a very new drug. You may well find that you respond reasonably to oral medication as a T1 for a “while.” And in fact, oral medications may work better if you have highly variable insulin production. But it can also be dangerous to be a T1, be taken off insulin and told to just go off for three months with just oral medications. Should you stop producing insulin, oral medications won’t be helpful at all and you can have serious consequences.
Personally, I would push back at the endo asking for “proof” that you are T2. There is little relative danger taking lantus as a T2, but a real danger that should you really be a T1, oral meds just won’t cut it.
Thanks for the reply. I had an Anti Islet Cell Antibody test done on 07/22/2010 which came back as <1:4, which apparently is negative for islet cell antibodies, meaning I am a type 2 and not type 1. Is this definitive or are there other antibody tests I need? Like I said, up to this point Lantus alone (10 units daily with NO short acting, just Lantus, diet, and exercise has been my treatment for the last 6 months) has been my treatment and it seems to have worked just fine, with an a1c of 6.3/5.8/6.5. I thought a hallmark sign of type 2 diabetes is insulin resistance. If I am truly a type 2, then why would Lantus alone have helped so much?
According to the endocrinologist, the main goal should be preserving the beta cell function that I do still have and just taking Lantus alone will not do that, so he wants me on the Onglyza and the Actoplus met.
Thanks for the reply. I had an Anti Islet Cell Antibody test done on 07/22/2010 which came back as <1:4, which apparently is negative for islet cell antibodies, meaning I am a type 2 and not type 1. Is this definitive or are there other antibody tests I need? Like I said, up to this point Lantus alone (10 units daily with NO short acting, just Lantus, diet, and exercise has been my treatment for the last 6 months) has been my treatment and it seems to have worked just fine, with an a1c of 6.3/5.8/6.5. I thought a hallmark sign of type 2 diabetes is insulin resistance. If I am truly a type 2, then why would Lantus alone have helped so much?
According to the endocrinologist, the main goal should be preserving the beta cell function that I do still have and just taking Lantus alone will not do that, so he wants me on the Onglyza and the Actoplus met.
Thanks for the reply. I had an Anti Islet Cell Antibody test done on 07/22/2010 which came back as <1:4, which apparently is negative for islet cell antibodies, meaning I am a type 2 and not type 1. Is this definitive or are there other antibody tests I need? Like I said, up to this point Lantus alone (10 units daily with NO short acting, just Lantus, diet, and exercise has been my treatment for the last 6 months) has been my treatment and it seems to have worked just fine, with an a1c of 6.3/5.8/6.5. I thought a hallmark sign of type 2 diabetes is insulin resistance. If I am truly a type 2, then why would Lantus alone have helped so much?
According to the endocrinologist, the main goal should be preserving the beta cell function that I do still have and just taking Lantus alone will not do that, so he wants me on the Onglyza and the Actoplus met.
There are three main antibodies that are usually tested for. The tests are not definitive. The GAD test catches perhaps 80%. The ICA test which you had diagnoses much less.
Bottom line, the test you had (ICA) suggests with about 50% accuracy that you don’t have type 1. Having all three antibody tests is perhaps thought to be about 90% conclusive.
Some type 2s can bring their blood sugars down into control with diet and exercise alone. The real question is how high your postprandial numbers are going. Most type 2 medications are focused on bringing down those postprandial numbers.
I am frustrated that I have been treated as a type 1 for the last 6 months and then based on the anti islet cell antibody test, the endo says I am a type 2 and recommends oral meds. I want a definitive answer as to whether or not I am a type 1 or a type 2 before I start a treatment protocol with some serious side effects.
I guess my next step should be to go back to my GP tomorrow and ask for the insulin antibody test and the GAD test to see what those show before changing my treatment.
My postprandial numbers on my current therapy RARELY go over 200 with my current regimen of insulin, diet, and exercise (no short acting) and my a1c numbers have been good (5.8/6.5/6.3).
Perhaps my best treatment plan if I am type 2 would be to continue taking some insulin (reduced amount from what I am taking now) and adding metformin to see what that does? Does this protect the beta cells I have left?
I am less worried about the metformin and more worried about the Onglyza (Onglyza being a newer medication and questions about it’s safety with regard to the heart as well as “theoretical risk” of developing cancer because it is a DPP-4 inhibitor).
Whether T-1 or T-2 the overall goal is to get a normalized blood sugar. That 6.5 and 6.3 A1-C would be a concern to me which is twice a normal blood sugar. Your fastings should be between 80-100 and you shouldn’t be spiking above 135 on your posts. How are the carbs going? Are you low carb? If you are snacking or overeating carbs very difficult to control sugars in a T-2.
Insulin will give your beta cells a rest and the Metformin will reduce insulin resistance.
Ask your Dr what he/she considers a normal blood sugar? What A1-C does he want personally?
You have to be your own advocate with this condition. Dont take no for an answer. Peace of mind is paramount and if you want the tests make the Dr do them.
My comment of the 6.5 and 6.3 a1c being good was based on the fact that when I was diagnosed 6 months ago it was 12, and it has come down as much as it has with Lantus alone. My doctor seems happy with an A1c in the 6’s since according to him anything less than 7 is good control.
Cool and congratulations on getting it down from your high of 12.
Your Dr is following the ADA guidelines it sounds. I would ask him if he would want to walk around with a average blood sugar of 140 for himself and be in the 6’s. I challenged my Dr and he said no he would not want to have a 6 for an A1-C.
I follow Dr Bernsteins guidelines and have read his books so I am biased out of the gate. LOL
If you had an absolutely perfect pancreas your fastings would be in the low to mid 80’s fasting and your posts would be there too and your A1C would be in the lower 5s if not 4’s.
As I said you have to fight like He** in this condition both with your self and your medical team to get normalized blood sugars. I am still waging war too, dont know if I will ever get there but I fight.
