go to islets of hope.
You can get a list of what you can buy and what you can't
Thanks for your confidence. I am actually a bit offended that the modern analog insulin's have been made prescription only. In many countries, there is no need to maintain exclusive control of prescriptions in doctors hands, there are too few doctors. And what is really sad is that despite medications being available, they don't get into the hands and used by the people that need them.
I also like those cheese latkes. They are almost like a crepe, and if they are a big hit, you might try dressing them up with whipped cream and sugar free jelly for a dessert treat. I make whipped cream at home from heavy cream, vanilla extract and splenda.
I do think you are right, there is an influence of insurance on this. But what is strange is that my insurance was quite happy to cover my Victoza which cost $400/month even though it was not effective. And some of the difficulty is that treatment should be suited to an individual, not an average population. What really gets me is that it seems my doctors have never measured the effectiveness of their prescribed diabetes medications, instead, they just see if I still meet their "target." And when we have talked about the side effects, they could care less. But with insulin, there is concern over the side effects. The difficulty I have with the stepwise approach is that it can use literally years, searching through the combinations of the more than a two dozen diabetic medications keeping the patient in a poorly controlled state. That probably does not lead to the best outcomes.
You can find the 2008 CMA guidelines Here. They are basically the same model, stepwise increasing treatment when blood sugar is above 7%. The CMA does appear to have a bit less bias against insulin, but insulin use is secondary to trying all medications.
I guess I'm really lucky. When I was diagnosed, all there was were sulfonylureas. And it took only a few weeks to prove that they didn't work.
So we went on the whole stepwise progression of insulin (Type 2 protocol) -- first only NPH at night, then 70/30, then mixing N with R, then Humalog when it came out, still using N at night. I hated all the lows, and when there was no insulin in my body I went high, regardless of whether I ate or not.
Shortly after I went on insulin, my GP enthusiastically offered me metformin, but I was doing so well on insulin that I declined.
Finally, in 1999, I went on the pump, and have never looked back. FAR fewer lows, and it controls my dawn effect very well. And I always have my insulin with me. I hope you will be as happy with insulin as I have been!
If I had had to wait for an A1c above 7%, I would not have been treated adequately for years! I'm a low glycator, and ALL my A1cs were below 7% except when I was diagnosed, when it was 7.1%. Wouldn't have mattered that I was symptomatic, and running BGs above 150, and usually above 200, ALL the time.
The only time I ever had a high A1c was 10.1, and a month later 10.7, when I was comatose.
I'm SO adamantly opposed to this over-evaluation of the A1c, because I'm sure I'm not the only low glycator in the world, and here we are again, railing against the one-size-fits-all mentality!
Thanks a lot BSC saves me from looking for this some more in the archives I must of had the 2003 version. there was a lone Canadian doctor from Hamilton Ontario who believed insulin first to normalize the BG ASAP and once that was done that if you want you can f–k around to see if anything else works. My GP told me he did not know anything about diabetes and the first endo I saw said : You do not want to touch that s–t with a ten foot pole". Well now I am touching it by the tonne which makes me very obese. A unit of insulin in time saves nine. is my new moto but too late for me.
Wow victoza = cool and useless. insulin = not. same in my case avandia = cool but totally useless
The main problem with the step wise approach is that it may kill your pancreas completely and with type 2 turns the disease into your worst nightmare. because with insulin resistance you may gain weight uncontrollably leading to a weight gain spiral.
Dear Natalie
The same problem with me the A1c was always much better than the BG readings which were very accurate ten years ago. My Endo only looked at the A1c and stopped there because it was good ( in his opinion 7 was good and 6 spectacular). He refused to look at the BG plots.
Anthony, are you on any orals at this time? It sounds like you are very insulin-resistant, and maybe metformin or another insulin-sensitizer in addition to insulin might help bring down your dose?
It's probably best to use as little insulin as you can -- and anything you can do about the weight problem would be good -- some of the oral meds do help with weight loss.
I pigged out tonight at dinner with friends -- had a filet mignon (skipped the potatoes) and some tiramisu for dessert -- I know it was pigging out, and I will eat little for the next 3 days to make up for it.
Wishing you a good year 2011!
Natalie ._c-
I was going to ask the Doctor for Avandia but now he is likely to say no. Metformin is so highly rated and for good reason my Ophto said he thinks it prevents eye damage and was thinking of taking it himself to prevent cancer. He wrote me a 6 month prescription.
Unfortunately my body does not like it no gastro problems worth mentioning but after 3 weeks on 2000 mg/day I cannot get of of bed I feel literaly dead. any thoughts?
Metformin is well thought of and of all the oral diabetes medications is probably the safest and most effective. It can cause gastrointestinal problems, that is why I call it “metfartin.” But for most people, you can work through the worst of those symptoms by starting with a small dose 500 mg/day and working up. Leaping into a nearly maximum dose right away may have been a problem.
bsc ,I am confused ..I clicked on " HERE " and got to the Canadian Diabetes Association 's website and the 2008 Clinical Guide Lines ??? ....I did eventually find this statement on the CMA's website and I highlighted the last few words.
( Canadian Medical Association ) related to type 2 diabetes :
The main goal of diabetes management is to maintain blood glucose levels within the normal range as much as possible.
They may need to take medications in order to keep glucose levels within a healthy range. Medications for type 2 diabetes are usually taken by mouth in the form of tablets and should always be taken around meal times and as prescribed by the doctor. However, if blood glucose is not controlled by oral medications, a doctor may recommend insulin injections.
I would certainly make certain , I show my finger poke results to my Doc ....this is where the patient's education and acceptance comes into focus .
In the guidelines on page s53 there is a section titled "Pharmacologic Management of Type 2 Diabetes." The algorithm on s56 shows a graph that basically is exactly the same as found in the AACE glycemic control algorithm I referenced earlier.
Without trying to be " difficult " and all time consuming without getting to the real question : will Dr's prescribe insulin or not ,I like to refer to my question to Anthony , Dec 23 , who commented the C. Medical Association's guide lines about insulin treatment of 10 years ago ...reference to p-age s53 are the CDA's guide lines ...please help , I like to see the CMA's guide lines , other than what I noted earlier today .
Well.BSC, it is time for a journal and then a book. Perhaps the PCP and Endo's will finaly listen to their patients instead of looking at the clock on the wall. Sorry to say, today's healthcare has gone to pot. To me the pros' feel their patients are stupid and unable to search a computer. Then when you put your findings and suggestions in front of them, your time is up. My experience with the endo is she does not care for a patient that knows as much or more then she does. This brings us back to THE PATIENT'S BILL OF RIGHTS, where we have a say in our care. Not sit down and be quite. Sorry, have been an RN for 49 years and have seen all the do's and dont's, done and not done.
So GO FOR IT and good luck. Just be careful and take it slow. DON'T GIVE UP. CHELE
I agree Chele, I actually had a conversation with one of my doctors last month that I said I feel like because I have health problems, doctors seem to think that it is OK to just let me die (I did point out that I did not include him in that statement!). My doctor said that he actually hears that from his patients about 3-4 times a week. He said that he has also noticed a big change in attitudes of doctors and he hopes that he never gets sick.
friend,
It's time to tell how your basal test is going! What's happening? :)
Well, I'm afraid it is too early to tell. I have not apparently reached a dose sufficient to lower my basal blood sugar. In fact, my fasting blood sugars are higher, as though my body is counterregulating against the attempts to lower my blood sugar. Fastings are basically 120-140.
Despite that, I have had good luck using R to cover dinner with an I:C ratio of 5, returning to my preprandial number in 2 hours pretty closely. I've had two readings below 100 mg/dl over the last week, both postprandial.
I'm just going to continue to slowly increase my dose.
It might take a few days (a couple or three) before basal insulin takes effect. When she went on Lantus, it took two or three days to start taking effect; by the end of the week good basals. NPH did not lower her basal blood sugars (they were in the mid 200s the month she was on it). Likewise, if we stop the pump, it will take a few days to stabilize blood sugars with Lantus. Effect is not immediate.