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Permalink Reply by Leo2 on December 10, 2009 at 2:49pm

Makes sense.
You will want to learn about adjusting your basal insulin, so get Using Insulin by Walsh and schedule yourself with a Certified Diabetes Educator. Think Like a Pancreas by Gary Scheiner should also be read. Some of the targets in the books are a bit high since that was the vogue when the books were written, and you may find that what you read currently has gone beyond those. But the reasoning is important.
Get the books, read so you understand use of insulin, basal and bolus, and come to the CDE with questions. Write your questions down before you go.
Blood Sugar 101 can be read online and it is a book for Type 2s. We always wish we are trending down, but sometimes it doesn't happen. The Endo wants success for you.

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Permalink Reply by David Turkel on December 10, 2009 at 2:53pm

Thanks for the great reply. I will look the books up. I guess I'm concerned because I was having continued success with the mix of drugs and don't currently use any bolus insulin for covering meals.

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Permalink Reply by Tim on December 10, 2009 at 3:03pm

Did your endo give you any specific reason why he wants you to stop the Januvia? There's nothing incorrect about using insulin, but its curious that he would have you stop taking it if it was working. The one downside to increasing the Lantus is possible weight gain, but it's certainly reasonable to control your BG this way. There may be some aspect of your management that isn't clear from your post.

If he didn't give you a reason, I would go ahead and ask.

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Permalink Reply by Brian (bsc) on December 10, 2009 at 7:21pm

I can't really explain this to you. The Glimepiride is a sulfonylurea which pushes your pancreas to constantly produce insulin. I would have considered it to be redundant with the lantus which is a basal insulin. Hence, if you are being put on a basal insulin, I would have thought your doctor would drop the Glimepride. On the other side, the Januvia helps you have a stronger insulin response when you eat. So previously you had the Glimepiride helping you maintain your fasting and the Januvia helped you with meals. Now you have the Glimepiride and the lantus helping you with fasting and nothing helping you with meals. It does not make any sense to me, but I don't really have any detailed information.

Why did your doctor make a change? Was your fasting getting worse and worse? Were you have any trouble with postprandial numbers? I don't know.

In either case, presumably increasing your lantus dosage will address your high fasting numbers. But as Tim notes, if you are still have large blood sugar surges after meals, attempting to use lantus to cover meals is a recipe for weight gain.

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Permalink Reply by David Turkel on December 11, 2009 at 7:37am

Actually, my fasting was getting better and better, around 100 consistently, and all of my other numbers were coming further in line with the introduction of Lantus. I gave the Endo a call back to clarify that he meant to stop Januvia, as I understand it handles a different part of the glucose equation. It is very frustrating to feel like i've taken many steps back, I feel awful, and for no apparent reason.

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Permalink Reply by Tim on December 11, 2009 at 7:57am

Are you taking any other meds? I agree with BSC that I feel like something is missing here. Using lantus is totally acceptable in T2 diabetes, but usually not in the combo that you are describing. A sulfonylurea/lantus combo seems odd, like BSC mentioned above. Were you ever on metformin? I'm sure your endo is making this decision for a reason, and its probably the case that there is some piece of info missing from the equation here.

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Permalink Reply by David Turkel on December 11, 2009 at 8:58am

I was on metformin + sulfonylurea at first, and my numbers started decent, but gradually increased.
Then we tried Janumet + sulfonylurea with some short-term success, but again a steady ascent in daily BGL trends and A1C.
That is when we went to just Januvia + sulfonylurea with little success, and finally added Lantus.

I've been on the Lantus (10-15 units) for the past two months with this success.
I'm 5'7", 135 pounds, so my weight is good, and my diet is well under control. The missing part of the equation is consistent, daily exercise.

I have to ask some more questions obviously and perhaps get a second opinion.

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