Replies to This Discussion

Permalink Reply by tmana on July 13, 2011 at 12:42pm

Metformin ER is an extended-release version of metformin which tends to be easier on the GI for most people. It may also be less effective as a strictly-prandial (mealtime) medication and more effective as a background medication. Since you're already taking Novalog with meals, your new doc might think the prandial metformin was overkill, or he might have wanted you to have the protection of metformin over a longer period of time (in which case he might have upped the dosage as well, since IIRC one can take up to 3000 mg metformin/day).

There is a theory of diabetes therapy that suggests that the more insulin you take, the more resistant to it you become -- particularly in the case of Type 2 diabetes, where insulin resistance is often at play from the get-go. So the idea of adding Byetta sounds reasonable, as long as you are also dealing with reexamining your diet and making changes if they are warranted.

That all said, I know that Type 2 folk on insulin need a lot more insulin than Type 1 folk do, because of the insulin resistance. I don't know how much is "normal" for either type.

Being that you are reporting your morning numbers being a lot higher than they should be, I'd call the doctor's office, tell them what sort of number you are having, and insist on getting them down, pronto. While it may be do-able with the met ER and no second Levemir, you may need to keep the morning Levemir dose going for a month or so until your body adjusts to the new rhythms of metformin and Byetta.

The big question I have here is, how much experience does your new endo have with Type 2 diabetes, as opposed to Type 1 diabetes, because a lot of what he is saying sounds like it's more appropriate for someone with Type 1 than with Type 2.

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Permalink Reply by Clee on July 19, 2011 at 6:41am

Thanks for your reply tmana. What you are saying about the insulin resistance is what my endo said. He's trying the Byetta and it seems to be working. I have not gotten on the scale just yet but I am to go back to see him in 3 weeks. He also gave me Glipizide 5 mg. I assume he will assess my condiction in the 3 week interval and adjust my medication at that time. I have been asking the question also of how much insulin is normal and I have not been able to get that answer. BUT....I'm just glad to be coming off some of the insulin. I can deal with the highs while trying to get my blood sugar under control after coming off the "insulin overdose". Thank you ....I'll keep you posted on my progress.

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Permalink Reply by Alan S on July 19, 2011 at 7:34am

G'day

You've mentioned levemir and novolog insulin and a lot of meds: metformin, byetta, and glipizide.

All of those are apparently needed to manage your blood glucose levels. But you haven't mentioned the thing that raises those levels in the first place: the food you eat.

What dietary advice have you received? What way of eating do you follow?

Modifying your menu may enable you to reduce or eliminate some of those medications as you gain control of your diabetes. This may help, it is the technique I used myself: Test, Review, Adjust

 

I'll add a caveat. As you use insulin sudden changes from too many carbs to too few can lead to changing your blood glucose levels from too high to too low. That is very unwise and can be dangerous.

Please proceed cautiously after discussing this method with your doctor. Test after eating and if the result is high review the meal. Make a small change to the menu at the next meal of the same type. Repeat the process at that meal and continue with small changes, without risking hypos, until you see good numbers.

 

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

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Permalink Reply by Clee on July 19, 2011 at 11:43am

I think what he is trying to do is to get my weight down so that I will use less insulin. My meals are very good. I LIVE veggies and I could live without bread or sweets, potatoes and the like. I like the green stuff. I kind of understand what is trying to be done and I'm hoping it works.

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Permalink Reply by MossDog on July 19, 2011 at 11:51am

What you do not want to happen is that it is done at the cost of high blood sugar. If you are really watching your carbs (with the insulin resistance I would suggest going as Low Carb as possible) and exercising then the amount of insulin you need is the amount of insulin you need.

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Permalink Reply by Clee on July 19, 2011 at 12:47pm

This is the reason I'm going back in 3 weeks. My initial follow-up was in one week, now the second follow-up is in 3 weeks. He wants to see how much my blood sugar comes down on the oral medicaion along with just on injection of Levamir at night. As I said, he is tweaking my oral medication gradually. With losing weight, my need for insulin should decrease (I'm not saying I will NOT need insulin, but the amount I am taking should decrease).

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Permalink Reply by Alan S on July 19, 2011 at 6:38pm

I think what he is trying to do is to get my weight down so that I will use less insulin. My meals are very good. I LIVE veggies and I could live without bread or sweets, potatoes and the like. I like the green stuff. I kind of understand what is trying to be done and I'm hoping it works.

Would you mind expanding on that?

 

For example, what did you eat for breakfast today? Did you test an hour later? If so, what were your fasting and 1hr post-meal numbers?

 

If you didn't test at that time, try it tomorrow to see what happens.

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

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Permalink Reply by Clee on July 27, 2011 at 7:33am

Well, I called my endo yesterday. He tweaked my medications by having me take Gipizide 5 mg 2 x a day and my Metformin ER 2 x a day. Then he took me off the Levemir and put me on Novolog 70/30, 30 units 2 x a day. I took my first 30 units last night and saw a difference in my overnight numbers this morinng. I know I will have to take the Novolog 70/30 for a few more days before I see a hugh difference in my numbers but I'll just have to be patient. I have an appointment Aug. 5, and I'm really hoping I have great numbers to report. I plan to stick to my 140 grams of carbs each day. So far, I have lost 5 lbs. Oh...I also take Byetta 10 mcg 2 x a day.

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Permalink Reply by Alan S on July 27, 2011 at 4:32pm

I'm glad things appear to be improving.

You may have missed this earlier: what did you eat for breakfast today? Did you test an hour later? If so, what were your fasting and 1hr post-meal numbers?

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

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Permalink Reply by Clee on July 28, 2011 at 9:23am

I had curried chicken and broccoli. My fasting was close to 202 before the meal. I took my blood sugar after dinner about 3 hrs. later and they were 254....I'm hoping things get better. Before I went to the new endo, my dose of Levemir was 80 units at night and 60 in the morning. I was on a sliding scale of Novolog for lunch. He was conscerned with me being on so much insulin.

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Permalink Reply by Alan S on July 28, 2011 at 2:46pm

Was that breakfast, lunch or dinner? Did you have rice or breads or any other starches with the curried chicken?

With numbers like that I would think the doctor would be less concerned with your insulin levels and more concerned with your blood glucose levels.

Please consider testing at your peak after meals, rather than so much later, then reviewing the meal that led to the test result. If you don't know your peak, use one hour after your last bite. Please read this to see why I suggest that: Test, Review, Adjust

 

If you decide to apply that technique, be cautious in your approach. Because you use insulin sudden changes from too many carbohydrates to too few can lead to changing your blood glucose levels from too high to too low. That is very unwise and can be dangerous.

Please proceed cautiously after discussing this method with your doctor. Test after eating and if the result is high review the meal. Make a small change to the menu at the next meal of the same type. Repeat the process at that meal and continue with small changes, without risking hypos, until you see good numbers.

If you reach a stage where you feel your insulin or medication needs to be adjusted because your blood glucose levels are improving, discuss that with your doctor.

 

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

Permalink Reply by jims on July 28, 2011 at 8:00pm

i found metformin ER useless and had bad time with Teva ER and when I went back to regular metformin numbers returned to normal.

Some Doctore believe in the big bang - one large dose of metformin works all day.

the part that shuts down liver adding too much glucose and puts it back to fasting relies on metformin up to strength in blood and once it gets sweeped out, liver jumps back to add sugar mode.

For me, metformin takes 2.5 hours up to full strength and lasts 1.5 hours and I string around clock - one 500 mg for each meal.
I cannot recommend you do anything as layman and I would recommend your Doctor try you back on old regimen for a week asap and see if better numbers come back.

I hate Teva products and especially ER versions as being problematic.

There is argument in industry as how metformin works. For me each time a 500mg pill up to strength in blood liver's blood glucose add operation is suspended. You need CGMS to really watch this nonsense. John Hopkins research has released comment that metformin signals liver directly and a minimum amount in blood required to cause this. My a1c before cranking on metformin in correct charges and timing was 13.3. Last year November 6.9 and now 6.4.

You must check with Doctor you trust before you modify your treatment in any way.

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