Overmedicated?

I’d like some opinions on this - I see my family dr. only for my type 2, and I’ve achieved good control with his help. My last A1C was 6, which is a VAST improvement from the 13.6 it was a little over a year ago. He sent me to a diabetes educator and dietician, which is something my previous dr. never did, just told me to take metformin, no counseling on diet whatsoever…and they’ve helped tremendously.
The DE thinks I’m on the wrong insulin. I take Lantus at bedtime, and Novolog 70/30 mix before breakfast and dinner, along with Welchol for BS and cholesterol. I have to be sure I eat a snack at bedtime,or I wake up with lows during the night fairly frequently. DE thinks I should be switched from the mix to straight Novolog, since with the mix and Lantus I’m taking fast-acting, intermediate-acting and slow-acting. My dr. says that what I’m on is keeping my A1C down and he doesn’t want to make any changes. So I need some advice from you all. I’ve considered going to an endo on my own, but my dr. has been great to me and to my hubby, who has no insurance coverage right now and the dr. sees him at a very minimal cost to us, so I don’t want to upset him by seeing someone else if he hasn’t sent me. But at the same time, I want to be sure I’m being treated correctly.

Discuss it with your doc, but I agree 100% with your DE, you should probably go to Lantus + Novolog only. It’s usually either 70/30 OR lantus + novolog separately. NPH is “intermediate” compared to lantus because it is out of the system faster, but it was primarily used as a basal insulin in the days before lantus and levemir. By taking both, you’re unnecessarily duplicating your basal which can cause problems with lows and makes adjusting things more complicated than it has to be. When switching to Lantus without 70/30, you may need to increase the dose to cover what you’re losing from NPH but that shouldn’t be a big hurdle.

You will have more flexibility without 70/30. The lantus will provide you the 24 hour coverage you need. Then you just take the amt of novolog that you need to cover meals. You won’t be ‘forced’ to eat at specific times the way you are with NPH. NPH and 70/30 are dinosaurs that still have their uses in special cases but they aren’t the ideal option for most. If your doc disagrees, then try to get a second opinion even though it might hurt his feelings:)

Good luck!

You are possibly correct. 3 kinds of insulin must make control difficult. I use 2 shots of lantus a day one at 6 am and the other at 6 pm. Lantus works better when splitting the TDD in two. And then novo as needed for meals.

It’s a bad idea to mix Lantus and 70/30 mix. NPH works for a certain amount of time and has a definite peak. Lantus is specifically made for being a background insulin and has little or no peak. The mix and the Lantus could cause some serious hypoglycemia.

I also agree with your DE. Lantus & 70/30 is a risky combo & unnecessary.

The right doses, using the correct ratios, will keep your A1c down. The lows at night are evidence that something’s not right. You shouldn’t need to eat to feed the insulin. Backwards, really.

Unfortunately, many GPs don’t know much about insulin. Since he sent you to the DE, hopefully he’ll listen to the recommendation. Show your doc your log of lows.

I the advice you all gave me and asked my doc again to switch me to novolog, but he still refuses. I told him the DE recommended it, but he still said no. So now I’m even more inclined to see an endo on my own.