Which drug for post-prandial control?

Type 2
1

It’s looking like I’m finally getting good fasting control using Lantus. I haven’t yet figured out the exact dosage, but it’s gonna be around 12-14 units.

Talked to doc on phone today about post-prandial numbers, which still tend to go high depending on what I eat. I’d like to keep those numbers under 140 and still be able to eat a reasonable amount of healthy carbs. I know that there are diabetic diets out there that recommend 10-15 carbs per meal, but man oh man, that’s not much. I would rather take a drug and be able to eat a whole-grain healthy sandwich without worry than be so incredibly low carb. Low-carb, I can do. but I’m just not happy on ULTRA low carb.

Problem is, which drug? My endo really likes Januvia, but I know a lot of people have good reasons to not like it (hi Jenny! :-)). That said, it seems like most of the evidence against Januvia has to do with people who have had cancer in the past and/or are the type of people who have prostates. I have neither a prostate nor previous cancer, so maybe it’s not so bad for me.

Of course, Januvia hasn’t been tested with insulin, and the Endo wants me to continue on Lantus along with it, so that’s of some concern as well.

I discussed my concerns with him, and he pretty much told me that he’d be willing to put me on Januvia, a sulfonylurea, a pre-meal rapid-acting insulin, or Byetta. I think with all of those, with the exception of Byetta, he wants me to stay on the Lantus.

Part of me wants to go straight to the rapid-acting Insulin, because it seems like a safe bet. We know Insulin works, it’s got a long history of medical research, and it’ll let me eat pasta every once in a while if I want :slight_smile:

That said, if I can get nearly the same results with an oral agent, then sure, I’d rather not risk going hypo and not have to inject myself so much. Problem with orals is that each of them seem to have drawbacks. Januvia per the above, and sulfonylureas may decrease what little pancreatic insulin production I still have.

I’m not sure what the drawbacks to Byetta are, other than there were 6 deaths that may or may not be connected to it.

So… can anyone give me some opinions?

2

Fast acting insulin can do the job but at the expense of massive weight gain. This is a Faustian bargain as the weight gain will undo your BG control over time and decrease QOL. Pills forget it. Byetta not available in Canada, this may mean or not that there are problems with it.

3

>>Fast acting insulin can do the job but at the expense of massive weight gain

This is not a given for everyone - I know several Type 1s who are quite thin, and the Type 1 forum here seems to have plenty of trim Type 1s.

I’m not in Canada (though I’m close!) so Byetta is an option for me.

4

Yes a bewildering disease and some diabetics on insulin may not gain weight. The only guaranties in life are death and taxes. Go easy on the insulin or try the Byetta, the carbs, insulin, weight gain feedback loop is also a probable outcome.

5

Hi Barbra,

Happy Lantus is helping–yay!

Type 1 here & trying to gain weight:) In all fairness though, I do low carb. I’d rather avoid most carbs than take insulin to cover them & play the up & down game.

Not true for everyone of course, but Byetta causes dizziness & gastric problems for some–nausea & diarrhea.

6

Dear Gerri

Eat carbs and inject more near sure fire for weight gain.

7

But is that because of the extra insulin or because of the bad diet?

My understanding of insulin is that the reason people gain weight on it is that they tend to eat at their pre-insulin levels, which were artificially high because their blood sugar was out of control. Once your blood sugar is in control, you have to eat amounts like a non-diabetic person, or (just like a non-diabetic person) you’ll gain weight.

I’ve been on Lantus for two weeks now, and if anything, I’ve lost some weight. But I’m eating a really healthy diet, so it doesn’t surprise me. And two weeks isn’t all that long :slight_smile:

This page from Joslin says pretty much the same thing: http://www.joslin.org/managing_your_diabetes_691.asp

8

Both. It’s because of the insulin, food choices & level of activity. The role of insulin, of course, is to regulate blood glucose & whatever isn’t needed by the body for fuel is stored as fat. Insulin in both diabetics & non-diabetics leads to fat storage, if the excess glucose isn’t used up. Of course, many other body systems, factors & hormones are at play as well, but insulin is a fat storing hormone.

It’s extremely difficult, if not near impossible, to match insulin to food intake. We try, heaven knows we try, but despite our best efforts it’s far from perfect. This is why I’ve chosen to go low-carb. It makes it things more easily controlled. Less carbs, less insulin, fewer mistakes on dosing & easier to correct those mistakes. To me, it’s not worth taking mega insulin doses to eat something like pizza. Hope I haven’t scared you off from using insulin:) Does take experimenting, trial & error.

I don’t know if such a relatively small dose of Lantus would cause weight gain, especially in someone as active as you.

9

I think the Joslin page is old conventional talk. I never measured any sugar in my urine. Insulin is a make fat drug. So extreme care is required in its use. The least amount possible is best. A lot of truth in what Gerri says. Mismatch between insulin and food is the least when you use the least amount and this implies a low carb diet. 12 to 14 units of Lantus is a puny amount so it is not surprising that you have no problem. Keep your daily insulin requirement as low as possible.

10

I’m on Byetta, and I am on it for the same reasons you are thinking about it. I have experienced the side effects - nausea, gas, bloating, but I stick to under 45 carbs/meal and 15/snack - note that stick to is a relative term. I do eat chocolate and sandwiches, so I’m not ultra low carb. I, too, cannot survive on ultra low carb. I did that for 7 years, lost 80 pounds, kept it off for most of that time, but once I strayed, I gained all the weight back plus some.

The 6 deaths from pancreatitis do concern me. But for the most part, my fastings have been below 115, and my 2 hour pp have been below 120, unless I really go hog wild.

I am just about to switch over to the 10 mcg dose, where weight loss can really be maximized.

Weight gain is a problem for me - that’s what caused me to go on meds in the first place. I could control my diabetes with diet and exercise under 170-180 lbs. However, I do have cardiovascular damage and HBP and hi Cholesterol - so I think even though I thought I was controlling my BS, the damage had to start somewhere - whether it was when I was gestational or when I thought for the 10 years after my babies that I was under good control.

11

If you’re worried about side effects, insulin is your best bet. And your best bet to do really well with insulin is education. The books Using Insulin by John Walsh or Think Like A Pancreas by Gary Scheiner are very helpful. So is a good CDE who can help you figure out your insulin:carb ratio and insulin sensitivity factor.

I’m on an insulin pump, but I still take Metformin because of my insulin resistance. Then again, when I took Levemir, 12-14u wouldn’t have done anything for me at all! We’re all different. So do what research you can and then decide what’s best for you. If that means trying a few different things, go for it. Seems to me you’re taking the right approach. You want to eat healthy even after you add an additional med. Some people go on additional meds thinking they can eat whatever and however much they want. So I am sure whatever route you decide to take, you’ll ultimately be very successful.