Sudden change in BG

I was diagnosed Type 2 20 years ago. I was not terribly overweight and very active. I couldn’t be diet controlled so was put on 1000 mg of metformin, watched what I ate and continued to exercise. This worked for years but the dose of metformin made it to 2000 mg. Then glimeperide was added. 1mg and moderate diet and exercise worked for a few years. Then I got cancer. BG wasn’t good during 2 surgeries and radiation and a couple years after. Lantus crept up from 10 units to it’s current 16.

During this time endo determined I’m not insulin resistant but don’t make enough insulin. My anti-bodies are normal so I’m not Type 1 or Lada but my pancreas is failing and will continue to do so until I’m fully insulin dependent. I’m still technically a type 2.

Anyway, over the last few months I have been feeling more and more tired. My BG has crept up to 200-300 after even a low carb meal. My fasting went from 125-150 to 135 to 175. If I eat a piece of cheese, an egg or other protein for breakfast I can end up at 300. My lunch of lettuce, lunchmeat and basalmic vinegar and a medium apple will send me over 200. Dinner is generally better, low carb will only get me to 175, higher carb will range from 175 to 300.

I have been increasing my dose of lantus, I doubled glimeperide from 1 mg at breakfast and dinner to 2mg. This has made me feel better but I still battle the after meal spikes.

Is it time for short acting insulin? How do I convince my doctors. I generally don’t see the endo anymore but he is available. My regular doctor and he keep saying my A1C isn’t over 7 so I don’t need anything else although they didn’t argue when I just asked to have my glimeperide doubled.

I generally take my lantus right before bed, if I took more and earlier would that get my fasting level down some? When I start the morning high I don’t feel well the rest of the day. I also don’t like to drive if I’m rising toward 300, I get so tired I’m not very attentive. I have had to call in to work and tell them I will be late. I’m lucky I have a job that is pretty flexible.

Well, that’s really the issue, not the presence or absence of antibodies, one way or t’other. If you’re not producing endogenous insulin, you need exogenous insulin. Changing these designations can be a bit of a PIA because insurance carriers make decisions about your coverage based on them, and the antibody thing could be a snag. But are several types of antibodies that can be tested for, not just the most common one. And they don’t always show up at all if you’re being tested long after initial diagnosis (I wasn’t tested until 30 yrs after dx, and I didn’t show antibodies either). What was your endo’s judgment based on if not that?

Sounds typical. Type 2 is in your average GP’s comfort zone; Type 1 is not, especially for adults. “Pills, diet ‘n’ exercise, that’s the ticket!” is an easy regimen to oversee and doesn’t require any specialized knowledge on their part. Even a daily dose of Lantus lands squarely in the GP T2 toolkit. Lantus is really pretty safe, hard to get yourself into a bad hypo with that stuff unless you work at it. But Novolog/Humalog is a different proposition entirely and they don’t want to go there. The patient needs to know what they’re doing or they can get into real trouble and all the knowledge and gear is very specialized and they aren’t generally comfortable with it. If you’re an adult, they’re gonna try much harder to shove you into the T2 box even if it doesn’t fit. Insurers will be happier too. Sounds like a case of YDFLNCA: “You’re Doing Fine, Let’s Not Change Anything,” even though your <7 a1c includes a lot of times when you’re well over that number–it’s an average!–and feeling so crappy it’s interfering with your work schedule.

Short version of the above:

YES. Go see the endo. He is trained in all this stuff, and that bypasses all the GP reticence I alluded to in my longer rant. It does sound like you’re reaching the limit of what can be done with your current treatment, and it’s interfering with your quality of life. Generally the assumption is that patients are terrified of “going on the insulin,” but if you let him know you’re amenable to trying rapid-acting and willing to learn how it’s done, I would expect he’d agree. He can also write the prescriptions and get you whatever training you need without your PCP having to give you permission. You might find that it’s actually a lot easier to deal with than the increasingly complicated stuff you’re having to do to manage with pills and lantus.


Thank you for your thoughts. My PCP really is pretty good and is the one who finally put me on Lantus when I first started seeing her. All my other Drs. said I didn’t need it because my A1C was good. Back then in was closer to high 5 because I was so careful about what I ate.

Endo did warn me that someday my pancreas would fail and I’m thinking it is reaching that point now. I’m just so used to it being my fault, I ate wrong, didn’t exercise enough that I’m not certain that I’ve really done what I can.

You can buy Regular insulin over the counter at Wal-Mart. No prescription needed and it’s the perfect insulin for a low-carb diet and dealing with protein spikes.

Being too tired to drive to work because of high blood glucose levels is an inexcusable situation that your doctor should have responded to a long time ago. It is NOT your fault! I think you were misdiagnosed years ago as a T2 instead of LADA and have done the best you can under the circumstances. You did very well in spite of the wrong tools handed to you. Go to the endo and get the right tools (fast acting insulin) that you now obviously need and have needed for a long time to ease your DM management and stay healthy.


Thank you for the reassurance. It really isn’t my current doctor who makes me feel this way but most that I have had in the past and the general opinion that I fail to care for myself vs I need more drugs. Current doc is pretty good but I still fight that T2 label. People get in the mindset that I shouldn’t be on insulin. My A1C stays reasonable because I end up not eating when my BG is bad and it ends up dropping to something that keeps me under a 7.

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IOW, you’re not managing your diabetes; your diabetes is managing you. :slight_smile: An all-too common effect of YDFLNCA treatment (see above).

Do you know the list of antibodies you were tested for? Some doctors stop at the GAD 65 test. I believe there are about six auto-antibodies that can be tested. Not every T1D tests positive for every or even any auto-antibody test. Testing positive on one or two of the auto-antibody is enough to produce a T1D diagnosis but testing negative on all auto-antibody tests is not conclusive for ruling out T1D.

Do a search on posts written by @Melitta. She has written posts with incredible detail on this topic.

You need insulin! I would seriously consider putting yourself on the Regular insulin sold at Walmart if your doctors refuse to prescribe a short-acting analog insulin. Perhaps you will find the action curve of the Walmart Regular suits you well as @Scott_Eric suggests.

Good luck!

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Yes, I’ve been thinking of that lately.

Whirlygig, you aren’t alone. I’m in the same boat. I’ve made an appointment with my PCP to get another endo. Based on my insurance, I have to obtain a referral from my PCP in order to make an appointment with an endo. I know my PCP will want to handle my diabetes and thyroid, but with all my complications and AI issues I need a well-seasoned/experienced endo.

I’m ready to go on insulin and stop starving and exercising myself to death–which is only harming not helping me. It’s time for the next step.

Good luck to you.

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