Well, I was advised by my doc to do a c-peptide test. This was never done earlier, when i was diagnosed 4 years back.
Turns out, my pancreas are still kind-of functional.
(Value obtained: 2.0 non-fasting, within the suggested range of 0.79 to 5.2 in the lab).
I have been on humalog (8+10+8 units) and lantus (26 units post dinner).
my doc has now advised me to get an islet test done, to verify if i’m type 1.5 or type 2.
The results will come after 15 days.
For now, I have been advised to take (2*1000mg Glucophage), while continuing my lantus.
i just checked my BG 2 hours post dinner. It is 13 mmol/ml (230 mg/ml).
I wanted to ask, if the switch from lantus to tablets will take a lot of time to start showing effects??
And what is the peak and duration of Glucophage.
Also, my GAD 65 is 3.03 (Normal range is shown <10 in y reports).
I have only started taking care of myself very recently.
Please advise.
Glucophage (metformin) will take something like 4-6 weeks before it starts working. While metformin will make you more insulin sensitive, it won’t just fix your diabetes. From what you describe, having diabetes and a positive GAD test suggests that you are LADA/T1. The fact that you have a seemingly normal c-peptide only means that you have not totally burned our your pancreas.
A reading of 230 mg/dl 2 hours after dinner suggests means that it is likely that lantus/metformin is just not enough to control your blood sugars. You could do a low carb diet which might help a lot, but the plain fact is that metformin only reduces your A1c by 1% on average. If you are 230 mg/dl 2 hours after a meal your blood sugar control without insulin is likely to be so bad that metformin just won’ be enough.
Sometimes, even with LADA/T1 your pancreas can continue to produce insulin. This doesn’t mean you are cured, nor are you T2 and it doesn’t mean you should stop insulin. It may simply mean that your insulin production is waxing and waning. If you can’t achieve good blood sugar control after meals with lantus and a bunch of pills you should not put up with your doctor telling you that “you aren’t doing it right.” We have a right to normal blood sugars. If you need insulin, you need insulin.
ps. That being said, many of us find that restricting carbs turns out to be important to blood sugar control and even with insulin you need to take care of yourself.
Not that I disagree with your advice (especially if the OP has been on insulin for four years and it’s working for them), but the OP’s antibodies were 3.03 when normal is <10, so I read that as being negative since 3.03 is below 10.
My gad 65 was 0.3 on two consecutive tests separated by about 4 years— both were flagged as a positive out of range result. I don’t know or understand the units of measurement.
Although my doctor absolutely contradicted himself on that subject-- stating before the second test “your result is so low on the first test-- the level does matter… , let’s retest it… I had a patient yesterday with a level of 80+. His result was POSITIVE-- yours, not so much”
Then after the second test with the EXACT same result he said “well it was positive but very low level— that’s kinda like being a little tiny bit HIV positive-- point being, positive is positive and you’re type 1”
This was the most gnarley contradiction in statements I’ve ever encountered with him.
@Melitta what is your understanding of this? Significance of levels of measurable gas65 auto antibody
Regarding your c peptide test— it’s only meaningful with a simultaneous glucose level test AND if you’re not taking exogenous insulin— so although your level is “normal” in my opinion, that is completely meaningless. It’s a normal level but it’s not known if the demand was exceptionally high (as if it would be if your BG was 300 and “normal” was all your body could muster.) It’s not known if your natural production was being suppressed by exogenous insulin— this is why my doc refers to this lab result as limited to either “it’s zero or it’s not zero” once a patient has started insulin… so your pancreas produces some insulin in, not zero— but this lab on no way indicated if it is capable of producing ENOUGH… if it had been sky high above the reference range that might have been a bit meaningful towards insulin resistance… but otherwise it’s just super ambiguous unless it’s zero in your case
I think you are right @Jen. The units, reference range and interpretation likely vary widely. In either case, it is prudent to defer to a doctors assessment. But I do think that such an important diagnosis probably warrants getting a second opinion. The worst outcome would be to have @kabirkaushal1 truly have LADA/T1 but be misdiagnosed as T2 and treated with an ongoing litany of medications that don’t work and not have a well controlled blood sugar. I just would be very wary of moving from a treatment that presumably works to a treatment that is a shot in the dark.
Interesting question, @Sam19. TrialNet has done the most extensive autoantibody testing, and they use number of autoantibodies and titre to predict time to overt diabetes. Higher titre means faster onset of Type 1, I believe. Sam, it seems that you had a slow onset and still have endogenous insulin production based on low daily TDD, so that seems to make sense in your case. And I have heard "low positive " described as “a little bit pregnant.” Regarding the OP, I would get a second opinion and also get the full suite of autoantibody tests. If I were in the OPs shoes, I would ask for mealtime insulin, and go the full insulin route to achieve better control.
I’ve never had diabetes-related antibodies measured, but when I’ve had had other types of antibodies measured for other conditions, and the “range” for those has been expressed as “<##” where my result is flagged as high only if it’s above that number.
Given that the OP is posting blood sugar in mmol/L, it’s very likely that the antibody units being used are also different than what’s used in the US.
Thank you everyone for your time and responses.
My BG has been ~12mmol/ml today (~230mg/ml).
My doc says the med may take time to act.
He is constantly asking me to cut on carbs, and this is so frustrating, when i literally had zero carbs for b’fast and lunch.
I am hoping the med works. It would be auch a relief from 4 shots a day.
I am waiting for my islet test results. That will co firm T2 or LADA.
For now, I feel miserable. Having high BG, and just waiting for this med to act
Why not take an adequate insulin dose to correct your BG while you wait for the Metformin to “kick in”?
Did your endo actually tell you that you will be able to go off insulin? I’m doubtful this will be the case. (Many folks with Type 2 require insulin. And I’ve always been under the impression that a GAD level, if not negative, indicates Type 1/LADA.)
I’d take a correction. The size of the needles these days is so small, most of the time I use a syringe (not often, as I am on an insulin pump) I don’t even feel a thing.
I’d also be interested in what you actually ate for breakfast and lunch. You may be eating carbs and not realize it.
We’d like to help you ---- welcome to our community!
Is there a particular reason why you aren’t correcting a sustained high in the 200s? I’d never knowingly do this, unless I wanted a crappy A1c and wanted to play Russian roulette with complications…
Again, My sincere thanks to all the members who are trying to contribute in this thread.
The reason why I am not taking a correction as yet is because I want to give the medicine a fair chance to kick in. Because, I know for a fact that coming from 3 doses humalog + 1 dose lantus, to a single lantus dose is big news for me. I cannot express enough what I am feeling! So, I wouldn’t mind my BG in 200s, if thats the cost I pay to wait for the numbers to come down, when the pills start working.
Also, I am keeping a check on the carbs, meaning, I am consuming equivalent (or lesser) amount of carbs as when I was on humalog.
I plan to visit my doctor again, in case the numbers dont come down in the next 2-3 days.
i’ve had quite a significant BG rise consuming meals that are absolutely carb free - try adding a tiny amount of carb to those meals to prevent that rise - something around 6 grams of carb like a little salsa with your eggs and sausage. I’m not clear on the chemical process behind the BG rise with carb free meals - maybe Brian can better explain that process?
I have to say, I was diagnosed as T2 more than a decade ago. Medications really didn’t help me much at all. Six years ago I started insulin. Insulin works. Since that time I’ve been very happy with my diabetes control. I have been tested for all the antibodies, all negative. I was even tested for MODY. Negative. I’ve had doctors suggest I could use some new medication and stop using insulin. I am fine trying a new medication. But demonstration that a medication works will be that it reduces my insulin doses. This is the way I have tried medications (like the SGLT2 which did reduce my insulin dose but certainly didn’t stop my need for insulin). I definitely would not stop insulin thinking I would be “saved.” My endo has for all intensive purposes diagnosed me for insurance as a T1 since that is the treatment that works and I need coverage for insulin and other things.
And I have to be honest. If your fasting blood sugar 13 mmol/L (230 mg/dl) that corresponds to an A1c > 9%. According to the AACE (an association of endocrinologists, see slide 7), with a blood sugar like you have, as a new patient insulin is indicated. Nobody following the AACE guidelines would expect any single medication or probably any combination to not be able to control your diabetes.
My advice to you is that if you have insulin you should be using it to keep you blood sugar normalized. If you need to correct after a meal, then correct. If your blood sugar at 2 hours comes down to within 140 mg/dl then lower your mealtime dose. And keep doing so. If the medication truly does work (and let there be a miracle), then your mealtime does will be reduced to zero. But I am highly doubt that this will happen from what you describe.
You are no a lab animal. In my opinion, you can determine whether a medication works without endangering your health. You need to either get your doctor to adopt a safe way of trying out these medications or you need to see a new doctor.
If I were you, I wouldn’t wait around another hour for the numbers to come down while you’re waiting for Metformin to “kick in” (which I don’t believe will make a huge impact on your high BG to be honest), much less a few days. Just saying…
Glucophage doesn’t work that way @kabirkaushal1. It takes weeks or even a month to build up in your system and start having an effect, and it doesn’t lower your blood glucose the way insulin does (so it won’t ever “correct” a high). It makes your cells a bit more sensitive to insulin, and it helps suppress the liver’s release of glucose (so dampening Dawn Phenomenon and workout highs), and it can help in losing weight for some people. But you shouldn’t expect it to just lower your postprandial highs the way insulin or some other orals might.
Hey. So the news is… Glucophage is working. Much lower BG levels over the last 3 days. Going strong-going good. Celebrated with a pizza last night. BG back to 280 fasting.
Damn this diabetes
I know that you don’t want to hear this, but you have diabetes. And pizza and diabetes are a volatile mix. I had to face the sad fact that I would never be able to eat traditional pizza without serious blood sugar consequences. That being said I have developed my own low carb pizza recipes. I use a low carb burrito wrap like this, brush it with olive oil. I then toast it in a hot oven on both sides and then put all the traditional toppings on it and it goes back in the oven. With only 10g net carbs for a 12 inch wide personal pizza, this is heaven.
