Replies to This Discussion

Permalink Reply by Anthony Holko on November 18, 2010 at 9:23am

I think one should be put on insulin ASAP to get the BG into the normal range. high BG i.e more than 140 will help wipe out the remaining beta cells. Once the blood sugars are normal then you can fool around with other alternatives. If the doctors are un-cooperative about this then metformin is better than nothing.but if you are misdiagnised it will be of limited use. With metformin you need a minimal dose and a very low carb diet helps.

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Permalink Reply by Tom T on November 18, 2010 at 9:32am

Getting your body to use the insulin it makes more efficiently will relieve some of the stress from your beta-cells (provided that insulin resistance is the problem). If there is a time to try met, then now is probably it. You may see some functional preservation, and you'll get to see how your body responds to it before it becomes mandatory. You'll probably also see an improvement in your quality of life if you have to exercise so much to get a 6. I'm sure you've already been hammered on about the possibility that you're LADA, so I probably don't need to say that it won't help. But even finding out oral meds don't help could be a useful piece of info.

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Permalink Reply by LiL MaMa on November 18, 2010 at 9:54am

Good point..thanks!

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Permalink Reply by Oz Striker on November 18, 2010 at 4:22pm

Lil Mama, I presume those fasting numbers are mg/dl? Its just that in the UK we're used to mmol/L. If so, going by those figures, it sounds as thoug you may have "Impaired Glucose Tolerance", which is like i mentioned often a precursor to Type II DM. Quoting my Oxford Handbook of Clinical Medicine, "Diagnosis of DM: a fasting plasma gluocse greater than or equal to 7.0/126"........."Fasting plasma gluocse in the range of 6.1/110 - 7.0/126, is an impaired fasting glycaemia. Do a glucose tolerance test (GTT) to clarify"
GTT: >200 = patient has DM
GTT: >140-200 = patient has Impaired glucose tolerance
GTT: <140 = Patient is not diabetic

Regarding HbA1c's, its true that a HbA1c of 6.0 can be misleading, if your BMs are going very high and very low and so the average can be falsely reassuring, but this is usually the case with Type I's who are on Insulin, I dont think that would be that could be the case with yourself because you are currently diet controlled. Only today i met a young lad, who had previously got his HbA1c down to 5.9 while on insulin, but a continous blood glucose monitor showed that his sugars were yo-yoing throught the day. As he snacked during the day, BMs went up, he then countered with correction doses of Novorapid and then over the following hours his BM's dropped to less than 4 mmol/L (or ~80mg/dl).

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Permalink Reply by Melitta on November 18, 2010 at 8:49pm

I am glad you are checking into the possibility that you may have slow-onset Type 1 diabetes. There is actually "autoimmune gestational diabetes"--an article in the July 2007 issue of Diabetes Care indicated that autoimmune gestational diabetes (new onset Type 1 diabetes) accounts for about 10 percent of all Caucasian women diagnosed with gestational diabetes. The British Diabetes Association, Diabetes UK, states, “About five to ten percent of women with GDM develop Type 1 diabetes sometime in their life. These women have a slowly developing form of Type 1 that is ‘unmasked’ during pregnancy.” If in fact you have slow-onset Type 1, the only way to preserve beta cells is to be on intensive insulin therapy, and many people can preserve beta cells for many many years that way.

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Permalink Reply by Gerri on November 18, 2010 at 9:12pm

Getting C-peptide & GAD antibody tests is what's needed. Hope you're successful in convincing your doctor. Some people present clear for diagnosis, others don't without testing. Far too many are misdiagnosed based on age/weight.

Metformin helps with insulin resistance, if you are T2, as the others have said. It's not the body getting used to Metformin that leads to higher doses, but futher deterioration of the pancreas requiring higher doses & finding the dose that's correct. The goal is having good BG by whatever means it takes. If you're T2, pushing your pancreas harder to produce more insulin will result in problems for beta cells.

If your doc refuses the tests, do try Metformin to see if it helps any. May be process of elimination if it doesn't work. Ask for extended release & you don't want generic Metformin.

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Permalink Reply by LiL MaMa on November 19, 2010 at 4:02pm

Oh ok I see... is there a reason you say to do extended release over the regular and not generic??

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Permalink Reply by Kathy on November 19, 2010 at 4:45pm

You need a copy of your c-peptide. Remember this number needs to be evaluated along with your fasting glucose number.
Forget about your family history for now. Deal with your situation - your labs, your physical appearance, do you have any autoimmune conditions,your age.
Things to look at on your labs:
1) your lipid panel. How high is your triglycerides?
2) your blood pressure - is it normal?
Those two questions along with where your c-peptide is *may* give you a clue about IF you have insulin resistance.
When I took metformin I took it along with meals by breaking up a regular one in pieces - then taking a piece with my meal. You can NOT do this with extended. My problem has been going up when I eat.
It worked somewhat then I went off of it and my GP let me go on Levemir (background insulin - not a perfect solution but it's been my best so far). I don't have a high fasting. That is normal for me, I don't have insulin resistance (I've have insulin levels during the oral glucose tolerance test done). I do have other autoimmune conditions but I am negative for antibodies for T1. I'm listed as T2. My brother is more classic T2. I take the Levemir 2 units in the am and 2 in the afternoon - none for nighttime.
Guess what I am saying is you need to figure out you. My system won't work for many/most people.
Your labs & if you need to get more labs will tell the truth :-)Heck, I had a specialist tell me my iron stores couldn't be low but she tested them only to find out they are in the basement. Speculation will only get ya so far.
Best!

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Permalink Reply by LiL MaMa on November 19, 2010 at 5:14pm

I am 23 years old. My cholesterol is perfect it's actually low and my good cholesterol is very high. My blood pressure is low, about 90-100/60 and yes I do have an autoimmune disease- Hashimotos Hypothyroid.
How do you like being on insulin?? Do you have a lot of hypos? Haven't thought about some of the things you have said...thanks!

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Permalink Reply by Kathy on November 19, 2010 at 6:18pm

I think I'll take another bet you are not classic T2. Ok, I would stand out in a thunderstorm holding a lighting rod doing the 'Singing in the Rain' dance.
Ok, maybe not that extreme but you fit the LADA profile much more than T2.
Second day on insulin - this April (I started with only one unit in the am). Heaven is the only word I can use. I felt like me again. I metered everything and slowly worked up to 4 total units a day. My A1c was 5.6 (think that was it) before starting with a FBS around 90. Sounds like no need for insulin but when I would 'break' on food I was going in 250+ (not greater than 300). I'm a bouncer - meaning I still have insulin but my system doesn't have first phase response and then it over reacts causing me to bounce up and down with my glucose after eating. This can happen regardless of type for early onset.
Me: BMI 22. BP 110/70 but can be 90/60.
Celiac, early onset Psoriasis, thyroid has been out of whack but going gluten free it's behaving much better now. Endo said no to the insulin because I don't have antibodies for T1 - all her T2's she likes to get off of insulin and she loves things like Junivia (however that is spelled). I didn't care for the concept of making my system pump out more insulin with the OGTT showed that IR wasn't my issue. Even if it was, it seems contrary to what makes sense for me. Metformin is the only other solution in my mind. I didn't want to take more of it since I did have a bad reaction when first diagnosed. (my profile states more)
Back to insulin - hypos really are not an issue for me. Only once did I feel shaky and that was entirely my fault. I was talking to a friend and knew it was coming on and should have done something. I did end up excusing myself and get something to eat. I always carry something with me - it's not a big deal but on the safe side. I've spoken to a friend of mine who knows diabetes much better (Jenny Ruhl, bloodsugar101.com) and I think she might be right.... what I am doing is a stop gap. Eventually this won't work anymore and I'll go to insulin after meals. Doing what I am doing doesn't allow you to 'eat up' so to speak. But I finally could eat!! Same game but it got me back to a better position.
See a specialist and you *may* consider NOT telling them any family history at first. That hole is hard to dig out of - once they hear T2 in the family they no longer look for the needle in the haystack :-)

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Permalink Reply by Gerri on November 19, 2010 at 6:25pm

Less gastric side effects with extended release & some have better results. The generic isn't as effective, according to Dr. Bernstein.

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Permalink Reply by KimKat on November 19, 2010 at 6:32pm

I think you mean regular Metformin and Extended release Metformin. Metformin I believe is the "generic" name for the drug. It comes in two forms:reg and extended.

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