Jenny, I agree, education is key. I never received that proper education until presented with an insulin pump. My trainer is now my CDE and a fantastic teacher and resource.
Another problem is that many T2’s will never do well with a sliding scale. They seem to be based on the insulin needs of T1’s who don’t require as much insulin as T2’s due to our insulin resistance. If a doctor is telling you to use a sliding scale, a diabetes educator is prohibited from going against those orders and letting you know that there are better ways to gaining control.
I certainly did not mean to imply that an insulin pump is the only way to gain control over diabetes when using insulin. In my case, once the pump orders were signed off on, THEN I started getting the education I needed. If I were on a pump without that education, I’d still have poor control.
A sliding scale is when they tell you to take a certain amount of insulin based on your blood glucose reading. For instance , they might say take 5 units of insulin if your bg is 100-140, if it is 141-180, add one unit, etc., before a meal.
I started using insulin in February 2008 after routine kidney function tests indicated the onset of problems related to the Metformin (Glucophage) that I was then taking pretty much since diagnosis in 1998. It was a big step and, like others, I initially thought I had failed at controlling the diabetes. Now almost a year later I can see that I was wrong and enjoy the benefits of better control and more energy that allows me to lead a more normal life.
hummm,now i am really worried,i have been on metformin for over 5 years,and i dont think i have had a kidney function test,are these included in the blood work i have every 3 months for the A1c,etc?
Debbie, if you don’t mind sharing, what was your C Peptide? I don’t know what insurance you have but my doc wants me on a pump and the C Peptide is the key to qualifying if you have Medicare. I have that thru being disabled. You are younger so unless you are on disability, you probably have a different type. Anyway, I tried for a pump last year and missed by 0.2 points. I’m going to try again and a friend on here gave me some pointers. Anyway, if you are interested in a pump, that might be an option if your C Peptide is low. The thing about that test is that for Type 2’s the amount of insulin we make seems to change all the time so kind of a crap shoot on the test. I will keep trying I guess as I’ll never have control for any lenght of time due to other health issues. BTW, when my doc was increasing my lantus, he did it by 10 uts at a time and when I got a bit too much, I went back the other way. I’ve now learned to do the increase and decrease thing my self. Makes it easier for unstable BG’s like mine. Keep us informed how you do…Karla
Manny, thanks for starting this discussion. Just met with my primary care physician this morning. He thinks it’s time for me to begin using insulin. He is going to set up an appointment with an endo near my home. I was diagnosed with T2 September 17, 2001. I was sent to the ER with skyrocketing blood pressure and was diagnosed at that time. Currently, I am using Metformin ER and Byetta. Both have caused some gastric distress. Was on Actos briefly during 2007. I asked to come off of that one after gaining 10 lbs and feeling bloated all the time. It did it’s job though. My A1c was down to 6.5. Since coming off of it my number is up to 9.1. There has been a lot of stress in the last 4 months which I feel has contributed to the rise. My blood pressure in under control with a great drug regimen. I am not afraid of using needles, just bummed out that it has come to that so soon.
Jenny, thanks to you for always giving detailed and factual information that the ordinary lay person can understand. I am a certified pharmacy technician and familiar with the various medications available, but still have tons to learn about the different insulins and how they are used.
Your blood sugar is still to high. You should shoot for 8 as a short term goal and when you managed that then your next target should be lower. Go to the library and borrow some books on low carb diets. Eliminate all the foods that you presently eat that do fit into the picture that the books describe. Once you are on track with a low carb diet adjust your insulin to get in the 8’s. Live with that for awhile so that your body can get used to the lower blood sugar and if your ok without shakes or sweaty symptons of low blood sugar. Proceed to lower the target to 7 and see if you can achieve that.
Borrow a book on how to use insulin to make sure you understand the ins and outs of that stuff.
I was useing Metformin at first abd my A1C was 5.8 so I stayed on that and at the beginning of 05 my sugars stared to go up.So mt Dr. put me on Beyeta and metformin and I stayed on that for about a year and my A1C went up to 8.9. So then my Dr took me off Beyeta and put me on Lantus, Metformin and Glimpride and my last A1C in Dec.was 5.9 . I give my self a shot in the moring along with 1 1000 mg of Metformin.I really hate having Diabetes its a big pain in the rear,But I kknow iIhave to take my medicine.I have diabetes since feb 18 04.My deiabetes have progreased that now I have ( DNP) Diabetic Nerve Painin my feet so Im taking Lycrica for it, I don’t know what to do about it I was taking 300 mg 2 x day and I gained 14 lbs in a mounth 1/2 so my Dr. cut meback to 150 ix day and now my ft r startying to hurt worse especially after i get off work.Please help.
Sorry to hear about your nerve pain, the more so since you have done very well in controlling your BG given the tools you had. I find it may be a shame that diabetics are not put on a proper insulin regime right off the bat.
Weight gain is a problem with insulin and even more so with glimpride. I am not familiar with lycrica sounds like a horror if you gained so much weight in so little time on it.
I would suggest that you ask your doctor about keeping the Lantus and the metformin and replacing the glimpride with a fast acting insulin. The fast insulin before meals will give you much better control than the pill and possibly less weight gain. Try and shoot for normal BG’s at all time if you can and see if the nerve pain goes away. Get a book(off Amazon if need be) called “using insulin” and read it carefully to get the best control possible. Dr. R. Bernstein claims that it may be possible to reverse “complications” with BG in the normal range. His book is: “Diabetes solution” he also states with incontrevertible logic that a very low carb (and low calorie) diet is necessary to achieve normal BG at all times.
Hope this offers some hope. Not easy to do but nerve pain can be a very strong motivator. I had simultaneous tummy ulcer and back pain and felt like a spear had been driven thru my body so I can sympathise.
I was first diagnosed with type2 diabetes in 2002 or 2003. The DR initially prescribed Glucophage and something else. They really didn’t seem to handle it very well. about 6 months to a year later, I was moved to insulin at 20 units (Lantus). I still have trouble maintain a consistent BS, but that’s more my fault. I also just changed to 70/30 Novolin (Cheaper) and today was weird. I took 20 units last night, woke up with 239 glucose. Took my second shot in the morning as prescribed, 25 units, went to the gym. didn’t check my numbers, but by about 3 hours after my injection, I could feel my bs bottoming out. Guess I’m just gonna have to work on it. Gordon
I have been a T2 for about 12 years now. after a few years on Orals only, I noticed that my nubmers were not good. I talked to my doctors about it and the only thing they had to say was that I was not taking my meds. Or I was the problem. After some time of this, I stopped taking my meds. I stopped going to doctors. I was off all meds and not under a doctors care for about 5 years. Yes, I dont even want to know how much time I cut off my lfe cycle with that stunt. This was after trying out 3 or 4 different doctors. You know the game, Wait till the precriptions run out, then take on a new doctor just for the precriptions, let them run out and get a new doc. I think my insuracnce got aware of what I was doing and assigned me a doctor. He kept on trying to contact me, I was having nothing to do with him. He would mail me, email me, have his staff call the house. After a while, My Mother-in-Law had a diabetic episode and I lost a friend to complications of diabetes. At this point, I started to think, I need to go in and get checked out. I went in, Had a good talk with this new doctor. He was someone who listened to me. Didnt judge me. Gave me options. Told me what would happen if I did option A, and its drawbacks. Option B and so on. Then came to medications. He gave me options of oral meds alone or insulin alone. I chose the insulin since I no longer trusted oral meds to control my diabetes. asked around and found that this doc has a good reputaion of being a good helpfull doctor. That was a few months ago. Since then, he keeps in contact with me via email. Has since truned over my case to a diabetic nurse on his staff. But he still watches over me. He even sent me a note via email telling me how much better I am doing now than I was 4 months ago. I guess he gets to see the emails I send my nurse since I am still techiclly under his care. I am now under the care of a good team and take both oral and insulin. So this is my story.
Hi Gordon,
I read this and wanted to ask if you stopped Lantus and are just taking the 70/30? If so, you are talking about 2 totally different kinds of insulin that aren’t really interchangeable. I use Lantus for my 24hr. basal control and then take 2 shots of Humulin 70/30. Those are at breakfast and dinner. I sometimes use a fast acting insulin for those highs during the day or night. If you are using the Novolin only, did your doctor tell you to stop the Lantus? Just don’t want to see you get real sick.
Karla
I would doubt that any amount of metformin will bring your BG anywhere close to normal which you MUST DO very soon or it is going to be big trouble. But you can try the maximum dose. I would demand to supplement you metformin with a long term insulin like lantus or may be better for weight gain levemir and a quick acting insulin for use before meals.
You can use metformin and the slow and fast insulins all together no problem. The main thing is to prevent your pancreas from dying completely at this point. This will transform your diabetes from a manageable disease into your worst nightmare, because you will be a type 1 diabetic with insulin resistance no fun whatsoever. It is amazing that doctors discourage patients from getting insulin right away when they need it the most. My Doctors let my pancreas die completely before I was allowed insulin and this ruined my life totally.
Plus it is interesting that your full fleadged diabetes broke out after anathesia for an operating same thing in my case. Could be that this is such a traumatic event that you get the disease immediately instead of a few years later.
I was diagnosed with T2 back in 1994 and I was only 18. Several doctors told me that I should been diagnosed with T1 and be placed on insulin, but no one every did so. Over the years I had many struggles with controlling my BG with oral medications. Finally, I found a DR who changed my life. She put me on insulin last November and things have been looking better. I have to really watch what I eat, to the point that I sometimes go a bit crazy, but overall I am doing well. I have even lost some weight, which my DR told me was virtually impossible with my PCOS. In some ways I wish I had been diagnosed with T1 because I would have started on insulin much sooner and I would not have had 10 years of struggle upon struggle.
Luis, this was similar to my experience. I even asked my last doctor to put me on insulin and she wouldn’t do it, which I still don’t understand. I moved to a new city and found a new doctor, thank goodness. My new doctor has been great, putting me on insulin and keeping in touch with me through email.
Be careful what you wish for. I think it might be difficult for you to find a Type 1 that wouldn’t characterize ten years of their condition as something other than struggle upon struggle. But I understand what you mean about getting quality health care from a professional that knows how to treat you.
