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Medical Forum / Diseases and Disorders / Diabetes / May 2008Insulin for type 2 question
I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the diagnostic line. Initially I low-carbed fairly strenuously then got on metformin, and I was doing very well for a few years until my body stopped tolerating the metformin. After finally admitting that it was the met that was causing the chronic diarrhea that was so negatively impacting my quality of life, I went off it entirely. Periodically I try going back on at a low dose, and the diarrhea and cramping returns within 24 hours. I'd been having trouble staying a strict low-carber before I went off the met, and now I'm off it for 8 months my FBGs sometimes run in the 130-165 range. Not good. I can stay in the range of 80-120 during the day if I stay away fairly strictly from carb-laden food items and/or keep up my exercise, but that FBG scares me. I've been looking at my options. I'm increasing my exercise (it's gardening season, and I'm looking forward to the arrival of a great bike I ordered), but that's not enough. I hesitate to go on a beta stimulator because a) I don't want to stress out my beta cells and b) I don't want my meds to dictate my eating. Actos and Avandia are out due to the recent discoveries about higher rates of heart problems with them. Byetta doesn't sound like a lot of fun. So I thought, why not be a little old-fashioned and try an insulin? So, here's my question: might a small amount of a background insulin like Lantus help with my morning numbers and give me a little more wiggle room during the day by keeping my pre-meal numbers a little lower? I know I also need to go back to seeing a real endocrinologist. My excellent one left the state two years ago, and I've been relying on internist support, but at this point I don't think her knowledge of my condition is sophisticated enough. She keeps pushing beta stimulators even after I say I won't take them. I think she's working up to labeling me non-compliant. Anyway, any information about using a background insulin without a bolus would be helpful. Thanks! Priscilla, T2, diet & exercise, last A1c 5.7 > I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the > diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 32 lines] > > Priscilla, T2, diet & exercise, last A1c 5.7 here is the 'blurb' that Lantus puts out for use of Lantus as a type 2 http://www.lantus.com/why_lantus/adding_lantus_to_oral/combination_therapy.aspx then there is this interesting video link ( you have to sign up for medscape but they don't spam you ) Insulin Therapy of Diabetes: Pathophysiology and Indications CME http://www.medscape.com/viewarticle/563291 this is an excellent overview of diabetes, and the diagnosis of it, and the reasons why earlier insulin intervention might be a better way for us to go, than to stick to the sulf meds and beat our reduced pancreatic function to death (for type 2's)  Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html > > I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the > > diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 47 lines] > us to go, than to stick to the sulf meds and beat our reduced pancreatic > function to death (for type 2's) Thanks, Kate. I'll look at it when I get a spare moment. Priscilla >>> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >>> diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 51 lines] > > Priscilla it took a while to watch the video...... i think it was 30 min or so ! but i was impressed enough with the link that i bookmarked it ;) Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html > >> here is the 'blurb' that Lantus puts out for use of Lantus as a type 2 > >> http://www.lantus.com/why_lantus/adding_lantus_to_oral/combination_therapy. [quoted text clipped - 19 lines] > > but i was impressed enough with the link that i bookmarked it ;) That link gave me a written article, which I printed off to read on the bus. Priscilla >>>> here is the 'blurb' that Lantus puts out for use of Lantus as a type 2 >>>> http://www.lantus.com/why_lantus/adding_lantus_to_oral/combination_therapy. [quoted text clipped - 23 lines] > > Priscilla oh......... oops......... well, that's better to take to your Dr then now, where is that video one???? it was really good too! i'll keep looking Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html >I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the > diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 32 lines] > > Priscilla, T2, diet & exercise, last A1c 5.7 Hi Priscilla, I agree with your reasoning on the meds. Fortunately, I'm not at the crossroads, but my mind has wandered down that path a few times and come up with very similar conclusions. However, it seems to me that your daytime numbers are just fine, and you are experiencing dawn phenomena. I'm wondering if insulin might actually exacerbate this? Or if it took care of your FBG number, if it might make you prone to hypos? Not having any experience, I don't know the answers, but wanted to throw out the questions. Hopefully, someone more knowledgeable than me will know. SignatureBest regards, Michelle C., T2 diet & exercise BMI 21.5 > However, it seems to me that your daytime numbers are just fine, If I low-carb rather strictly, which is not always easy. I wouldn't mind being able to ease off a bit. > and you are > experiencing dawn phenomena. I'm wondering if insulin might actually > exacerbate this? Or if it took care of your FBG number, if it might make > you prone to hypos? Not having any experience, I don't know the answers, > but wanted to throw out the questions. Hopefully, someone more > knowledgeable than me will know. I've also emailed one of my MDs asking for the name of a good endo. The MD I'm asking is pretty savvy, so I trust his recommendations. Priscilla >> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >> diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 45 lines] > but wanted to throw out the questions. Hopefully, someone more > knowledgeable than me will know. Michelle, follow the link to the video that i posted on pubmed there are 3 Endo's discussing the different approaches to treating type 2 and their reasons why they like their method after watching this video, i sided with the Endo who felt that a low dose of Lantus at bedtime was beneficial for type 2's Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html > > However, it seems to me that your daytime numbers are just fine, and you > > are [quoted text clipped - 10 lines] > after watching this video, i sided with the Endo who felt that a low > dose of Lantus at bedtime was beneficial for type 2's Yup. Just because it's dawn phenomenon doesn't mean I shouldn't do something about it. ;-) Priscilla, T2 On May 21, 12:31 am, "Priscilla H. Ballou" <vze23...@verizon.net> wrote: > In article <69glc5F30gpg...@mid.individual.net>, > [quoted text clipped - 17 lines] > > Priscilla, T2 I was diagnosed type 2 diabetic last year, and was given medicine Zolid, used for one month. After Reading the book Eat to live by Dr Fuhrman I quited the medicine and all my blood sugar levels are within the range. My HbA1c was 5.5 and now I am targeting 5. I have to change me entire lifestyle which included eating low calorie high fiber diet, avoiding sugar and sugary items, eating fresh ruits and vegetables, increase the potassium intake bu eating bananas, dried apricots and tomatoes and last but most important I walked for an hour , two hours before the bedtime. All this helped me to quit the medicine and now I am enjoying a healthy life. visit http://www.reddiabetes.com for more information. >>> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >>> diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 52 lines] > after watching this video, i sided with the Endo who felt that a low dose > of Lantus at bedtime was beneficial for type 2's Thanks Kate! I'll have a look. SignatureBest regards, Michelle C., T2 diet & exercise BMI 21.5 >>>> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >>>> diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 53 lines] > > Thanks Kate! I'll have a look. sorry, Michelle, it's not the video i'm looking for........ but it's a written document, that has good info in it (i hope) :) Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html >>>>> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >>>>> diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 60 lines] > sorry, Michelle, it's not the video i'm looking for........ but it's a > written document, that has good info in it (i hope) :) Hi Kate, I've already begun reading it. Didn't get it done since it's long, but I've saved it on my hard drive for later SignatureBest regards, Michelle C., T2 diet & exercise BMI 21.5. : Hi Priscilla, : I agree with your reasoning on the meds. Fortunately, I'm not at the : crossroads, but my mind has wandered down that path a few times and come up : with very similar conclusions. : However, it seems to me that your daytime numbers are just fine, and you are : experiencing dawn phenomena. I'm wondering if insulin might actually : exacerbate this? Or if it took care of your FBG number, if it might make : you prone to hypos? Not having any experience, I don't know the answers, : but wanted to throw out the questions. Hopefully, someone more : knowledgeable than me will know. Priscilla, As I mentioned in another thread, a SMALL dose of a sulph at bedtime can work wonders with the fbg's. at least it did for me. Loretta also tok a tiny dose(I believe hers was 1/2mg) while mine is 1, which is 1/4-1.8 of the normal dose. I have beenon this for quite few years now with no rise in bg's or Aic's or other signs of a slowing pancreas. I am older than you , sothe long range outlook may be different, but it is not the end f the world, or een the nd of your pancreas in tiny amounts. Wendy >I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 32 lines] > >Priscilla, T2, diet & exercise, last A1c 5.7 Henry (hemyd) did what you are considering for similar reasons and appears to have succeeded very well. He has time limitations so sometimes only appears on mhd. It may be worth repeating this over there. Cheers, Alan, T2, Australia. d&e, metformin 1500mg, ezetrol 10mg Everything in Moderation - Except Laughter. -- http://loraldiabetes.blogspot.com Latest:What to Eat Until You Get Your Meter. Angkor Wat http://loraltravel.blogspot.com Hi Priscilla: > I've been looking at my options. > > Anyway, any information about using a background insulin without a bolus > would be helpful. Thanks! > > Priscilla, T2, diet & exercise, last A1c 5.7 I started off using 5 units of Ultralente at bedtime. I averaged 87 mg/dl for 12 month while also using 500 mg of metformin. Another possibility that you did not mention is Januvia. It is weight neutral and it does not cause nausea. It should help with postprandial control, but it would not reduce your A1c very much. Maybe an A1c reduction of .2 to .4 %. Women generally have higher levels of GLP-1 than men. Januvia would inhibit DPP4, the enzyme that changes GLP-1 to it's inactive form. Frank > Hi Priscilla: > > [quoted text clipped - 14 lines] > than men. Januvia would inhibit DPP4, the enzyme that changes GLP-1 to > it's inactive form. Thanks. I had forgotten about Januvia. I really need a good endo! Priscilla > Hi Priscilla: >> [quoted text clipped - 15 lines] > > Frank Januvia, Symlin and ....... oh.......... another one........ aren't available in Canada yet hopefully soon Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html >> Hi Priscilla: >>> [quoted text clipped - 18 lines] > > hopefully soon http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/phase1-decision/drug-med/nd_ad _2008_januvia_103039_e.html Date issued February 5, 2008 NOTICE OF DECISION for PrJANUVIA™ On December 14, 2007, Health Canada issued a Notice of Compliance to Merck Frosst Canada Ltd. for the drug product Januvia™. Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html >>> Hi Priscilla: >>>> [quoted text clipped - 26 lines] > On December 14, 2007, Health Canada issued a Notice of Compliance to > Merck Frosst Canada Ltd. for the drug product Januvia™. can't find Symlin in Canada yet......... lots of people asking WHEN will we get it, but no info on it being released in Canada Signaturekate type 1 since 1987 www.diabetic-talk.org http://www.diabetes-support.org.uk/newly%20diagnosed.html > Another possibility that you did not mention is Januvia. It is weight > neutral and it does not cause nausea. It should help with postprandial > control, but it would not reduce your A1c very much. Maybe an A1c > reduction of .2 to .4 %. Women generally have higher levels of GLP-1 than > men. Januvia would inhibit DPP4, the enzyme that changes GLP-1 to it's > inactive form. I love my Januvia! FBG has never been my problem (once I took control after dx) so the pp effect is welcome & just what I need. I still have to be careful about what I eat, but I can eat a whole meal with its carbs at once instead of spreading it out into "snacks". It's had little effect on my already satisfactory A1c, but it has made life easier than either the d&e alone or the Prandin that I took for a few years. I've never had any side effects from it. And no heading-for-lows as sometimes happened with Prandin. I can almost feel like I'm not diabetic -- I still test (though not as often as before) & log my food, exercise, & other "how am I" notes. It is, however, expensive (but "I'm worth it" as those hair-color ads say...). bj "Priscilla H. Ballou" <vze23t8n@verizon.net> wrote in news:vze23t8n- 1CED02.11030220052008@individual.net: > I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the > diagnostic line. Initially I low-carbed fairly strenuously then got on [quoted text clipped - 32 lines] > > Priscilla, T2, diet & exercise, last A1c 5.7 Hi Priscilla, I'm on vacation and thought I'd drop by. Well kinda a vacation - I only had to work half of this weekend:) I'm still using Lantus and Novolog - just 18 units of Lantus (I almost never need the Novolog), along exercising and watching my diet. My last A1c was 4.7. I feel great 99% of the time. I started with insulin and I'm sticking with it because it is freeing to know that I can control my numbers instead of them controling me and I can control them very quickly. Now days I use the Novolog for illness or if I just feel like splurging with some carbs. There are times once in a blue moon when I lose control and get to 200 and I just wack it with 20 units of Novolog and drop it down quickly before it effects me much. But most of the time the normal day to day routine and some exercise acts as my 'bolis'. Every doc since I left my first endo tried to get me to try some pill and I flatly refused because insulin is working great and it has no side effects. But each to their own. Good to see some of the familiar names again. Gene (Chief) T2, insulin, A1c 4.7 Signature"I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it." Thomas Jefferson "History is earmarked by the successes of liberals and mistakes of conservatives." - ETG >Gene (Chief) >T2, insulin, A1c 4.7 G'day Chief Welcome back. Cheers, Alan, T2, Australia. -- d&e, metformin 1500mg, ezetrol 10mg Everything in Moderation - Except Laughter. http://loraldiabetes.blogspot.com http://www.flickr.com/photos/alan_s/ http://loraltravel.blogspot.com Latest: Bangkok Grand Palace >>Gene (Chief) >>T2, insulin, A1c 4.7 [quoted text clipped - 11 lines] > http://loraltravel.blogspot.com > Latest: Bangkok Grand Palace Hey Alan - Sorry for the delay but my one day off turned into another work day. It's nice to be needed again - but this is getting crazy. I shouldn't complain in this economy here. Anyway I gotta check out your Thailand trip. Take Care Gene Signature"I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it." Thomas Jefferson "History is earmarked by the successes of liberals and mistakes of conservatives." - ETG > Hi Priscilla, > [quoted text clipped - 26 lines] > Gene (Chief) > T2, insulin, A1c 4.7 Nice to hear from you, Chief! I ended up going for Byetta, which, so far, is proving out its reputation in a good way. My A1c in the new endo's office was 5.9. Eeeek! I'm glad I'm doing something about it again. Priscilla, T2; diet, exercise, & Byetta >> Hi Priscilla, >> [quoted text clipped - 35 lines] > > Priscilla, T2; diet, exercise, & Byetta Heck 5.9 is good. The only reason I'm so low is I'm working in a plant that is full of machines running at 350 degrees and no air conditioning so I lost about 20 lbs and walking the plant floor all day long. A heck of a conditioning program. Good luck with your meds and take care Gene Signature"I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it." Thomas Jefferson "History is earmarked by the successes of liberals and mistakes of conservatives." - ETG > I'm working in a plant > that is full of machines running at 350 degrees and no air conditioning > so I lost about 20 lbs and walking the plant floor all day long. A heck > of a conditioning program. AND you're getting paid to do it! Congrats. bj Hi Gene good to see you. Hope you are doing well. Cheri Gene wrote in message ... >"Priscilla H. Ballou" <vze23t8n@verizon.net> wrote in news:vze23t8n- >1CED02.11030220052008@individual.net: > >> I was diagnosed type 2 in 2003 with a FBG of 130 -- just over the >> diagnostic line. Initially I low-carbed fairly strenuously then got on >> metformin, and I was doing very well for a few years until my body >> stopped tolerating the metformin. After finally admitting that it was >> the met that was causing the chronic diarrhea that was so negatively >> impacting my quality of life, I went off it entirely. Periodically I >> try going back on at a low dose, and the diarrhea and cramping returns >> within 24 hours. I'd been having trouble staying a strict low-carber >> before I went off the met, and now I'm off it for 8 months my FBGs >> sometimes run in the 130-165 range. Not good. I can stay in the range >> of 80-120 during the day if I stay away fairly strictly from carb-laden >> food items and/or keep up my exercise, but that FBG scares me. [quoted text clipped - 5 lines] >> stimulator because a) I don't want to stress out my beta cells and b) I >> don't want my meds to dictate my eating. Actos and Avandia are out due >> to the recent discoveries about higher rates of heart problems with >> them. Byetta doesn't sound like a lot of fun. So I thought, why not >be >> a little old-fashioned and try an insulin? >> >> So, here's my question: might a small amount of a background insulin >> like Lantus help with my morning numbers and give me a little more >> wiggle room during the day by keeping my pre-meal numbers a little >> lower? I know I also need to go back to seeing a real endocrinologist. >> My excellent one left the state two years ago, and I've been relying on >> internist support, but at this point I don't think her knowledge of my >> condition is sophisticated enough. She keeps pushing beta stimulators >> even after I say I won't take them. I think she's working up to >> labeling me non-compliant. [quoted text clipped - 43 lines] >"History is earmarked by the successes of liberals and mistakes of >conservatives." - ETG > Hi Gene good to see you. Hope you are doing well. > [quoted text clipped - 106 lines] >>"History is earmarked by the successes of liberals and mistakes of >>conservatives." - ETG I/m doing really good - so far. I'm surprised how much just jumping back into life helps with this diabetes stuff. Course the wife wishes I was making her breakfast every morning and doing all the house chores some days. How are you? Well, I surely hope. Take care, Gene Signature"I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it." Thomas Jefferson "History is earmarked by the successes of liberals and mistakes of conservatives." - ETG >Gene (Chief) >T2, insulin, A1c 4.7 Hey, Chief! Looking good : ) Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>Gene (Chief) >>T2, insulin, A1c 4.7 > > Hey, Chief! Looking good : ) How the heck are you Nicky? Glad to see you around the old stomping ground!! - I was thinking many of the folks went off to other net destinations. I can't stay long - I just got back from work and I'm bushed. Any good news on the T2 front? (I haven't kept up much these past months.) Take Care of yourself Nicky Gene > Nicky. > T2 dx 05/04 + underactive thyroid > D&E, 100ug thyroxine > Last A1c 5.6% BMI 25 Signature"I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it." Thomas Jefferson "History is earmarked by the successes of liberals and mistakes of conservatives." - ETG >How the heck are you Nicky? Glad to see you around the old stomping >ground!! - I was thinking many of the folks went off to other net >destinations. I'm good - get my vampire results back next week, expecting more of the same. Most of the nice folks are still around, some of the not-so-nice ones have gone away :D We also have some fast-learning newbies, at a steady rate, although it seems to me fewer than at busy times in the past? Quentin and Jenny have both published books, which are both excellent reading, and Alan is writing up this year's walkabout sooner than usual :P Can't think of any other momentous events... a few more grandkids have arrived, is the nicest news... Glad to see you around, anyway! Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 |
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