Hi all I have not been on here for awhile, but was hoping for some feedback. I am currently taking amaryl and onglyza and watching my carbs. The meds have worked great but find they are not consistant. By 5pm the meds seem to be not as effective and bg starts going up. Than in the morning about three hours after taking it I start going low :( So my question is are there any other meds that would keep me more level. I feel realy drained from all these bg swings. Any advice?

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It sounds like you may need to split your doses. Maybe you should talk to your endo about doing that.

You see, three hours after you take the meds, they'd hit your system all at the same time, making your BG drop. But because they aren't lasting the whole time, your BG goes up. Splitting the dose would mean covering those hours during which the meds don't seem to work as well (because they're wearing off, I guess) and keeping the lows at bay.

On the other hand, you said your BG goes up starting at around 5. Does it go up on its own, without eating? That sounds...interesting for Type 2.

This is excellent comments. One needs to study effigy tables on the medicine to identify the run time of a dose. Some folks , this is not issue; but for me and many; one needs to string doses around clock to get full 12 hour or greater coverage. Some folks geta longer run time while the rest of us barely scrpe their worst case run time - ie 4 to 6 hours.

My read is this is badly handled and I have had discussions with drug company safety officers where there is this mindset - take one a day and a larger dose once. Eventually they cave and say oh allright string the smaller dose around the clock.

For me such a scheme was useless. This included heart pills, metformin et all.

Amaryl is a sulfonylurea and stimulares your pancreas to generate more insulin. Although it is recommeded that you take it once a day, it has a very definite profile and timing. I have to be honest, I am not a big fan of sulfonylureas. Many believe that sulfonylureas burn out your pancreas, maybe so, maybe not. Studies I have seen suggest that sulfonylurea treatment does fail within a few years. These days most advice prefer the GLP-1, DPP-4 and TZD classes of drugs as preferable to sulfonylureas. There is research that suggests that the use of Metformin, TZDs and GLP-1s are both effective and durable. It might be good to discuss dropping the sulfonylurea and perhaps starting a GLP-1 like Victoza.

My doc says the progression of drugs for T2 should be 1. Metformin 2. Victoza 3. basal insulin and 4. basal + bolus insulin, completely skipping the sulfonylureas. This is a change in his thinking, a year ago he was still prescribing sulfonylureas. I am presently on Metformin + Victoza. Victoza stimulates the pancreas to produce insulin only in response to a meal thus avoiding the lows.

I agree. Best thing that happened to me was end up on metformin and insulin and tossed the starlix, glyburide and the actos in the ash can.

With Glyburide and starlix one is eating to keep pils under control. If diet and weight gain an issue boot the glyburide and starlix et all. At least one can match the insulin to diet and carbs more effectively and as needed.

Thank you all for your advice:) I have tried metformin and was taken off of it because of weight loss. I am 5'7 and 108 pounds. I have lost about six pounds in the last few months,and don't know if the meds are causing it or what is so don't know what the next best choice would be for me.I don't go back to the endo until may, but can not continue to lose weight so need to do something else.

Is there any way you can see your endo earlier? Even if you can't, you should call and see if there's anything that can be done. I'd hate to advise you to change your medications without your endo's permission. Especially because of the weight loss...I'm 5'1" and even I wouldn't be happy at 108...

I found that while you can't necessarily get a scheduled appointment with a new endo for months, you can often get on a waiting list for any openings. Endo's often do scheduling months out, but patients often cancel or reschedule, leaving openings. If your end has a list and you have some flexibility you might be able to get in much more quickly.

Another thing I just thought about. I presume you are still eating low carb, but are you actually eating enough? Are you eating enough protein and fat?

My brother is a very skinny T2  (5-11" / 145lbs) and he struggled with oral meds for 7 years with little success and the lack of insulin just caused him to loose even more weight. Last year when we where out of the country on a family vacation I convinced him to buy some insulin and give it a try. He has stopped all of his oral meds and his doctor was not upset when he confessed that he was using insulin. His doctor said I was just trying to keep you off insulin I did not want to put you through that any sooner than you had to. He had watched me use insulin for half our lives and he has took to it like a duck to water. He is happy now, he actually has some control , feels better, and now he understands there is no shame in having a occasional high or low BG it's just part of our Diabetical life, even insulin is not a perfect fix.

question is how many endo in some countries treat T2 with insulin in UK i think nearly 65% are now taking combo oral and insulin or just insulin with treatment,In japan its about 50% and only 30% of T2 americans are on insulin.Insulin is a better control factor over oral drugs and once a base line for control is used by the patient i think it best form of control overall

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