Author Topic: Insulin & Tablet Combunation  (Read 567 times)

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Offline waldo65

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Insulin & Tablet Combunation
« on: 10 October 2017, 08:29:36 PM »
Hi all, its been a while since i was last here and in need of some advice.


I an fighting the battle to control my levels. I am on the most tablets that can be prescribed and how much I have tried my levels cannot get below 8.2 and my pancreas isnt playing fair.
I have an appointment with the doc on Friday where its predicted that I will have to go on a combination of insulin & tablets.


so is there any advice or information which can help me get around this??


   
T2 since Sept 10
4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day
Hb1ac - 2013 - 7.6,    2014 - 7.1
Chol - 2013 - 3.6
Trigs - 2013 - 1.26

Offline sedge

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Re: Insulin & Tablet Combunation
« Reply #1 on: 10 October 2017, 10:55:53 PM »
Waldo - You've been taking tablets to make your pancreas produce more insulin for quite a while.  Now, it's evidently telling you 'Sorry chum - I'm wearing out - I can't do this anymore - well not enough for your needs anyway'

On the assumption that you're already eating as low carb meals as you possibly can and taking as much exercise as you can manage - I really don't think there is anything else anyone can do except offer you insulin.

My pancreas stopped playing fair - in fact playing at all ever as far as the bit of it that produced my insulin was concerned, the rest of it didn't stop doing its things - in 1972.  I'm still here and there's no reason you won't be after you progress onto insulin - it's not a death sentence -  but poorly controlled blood glucose, IS !
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: Insulin & Tablet Combunation
« Reply #2 on: 10 October 2017, 11:12:33 PM »
To be honest, if, as Jenny suggests, you are eating low carb and exercising then it is more than possible your pancreas cannot keep up and insulin may be the next step.  Do not fear it, there are worse things.

Tell us why you are reluctant. What are your worries?  Maybe we can help allay them and support you appropriately.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline waldo65

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Re: Insulin & Tablet Combination
« Reply #3 on: 11 October 2017, 07:57:47 PM »
It came a bit of a shock but deep down I knew this was going to happen one day.


Im not sure how it works, she only told me briefly that 1 injection in the morning then tablets (not a clue how many) but she eluded to tell me anything else, so any help on this bit would be appreciated.


I suspect that I will go over to the specialist diabetic clinic at Exeter hospital to learn all about it.
T2 since Sept 10
4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day
Hb1ac - 2013 - 7.6,    2014 - 7.1
Chol - 2013 - 3.6
Trigs - 2013 - 1.26

Offline himtoo

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Re: Insulin & Tablet Combunation
« Reply #4 on: 11 October 2017, 08:32:09 PM »
hi there Waldo65
from your description it sounds as though they are following the "pathway"

from that I mean that as your current regime has not reduced your "fatty liver " -- thus allowing your pancreas to recover and start producing enough insulin

you could still try going ultra low carband intermittent fasting for 4-6 weeks to see if you can bump start things -- but again suspect that as you have been doing what you do for a long while you have gone past that point.

the pathway is to start you ( progress you ) on a once a day background insulin ( such as lantus or levemir )

this should hopefully help to pull your background levels down and allow the glic and metformin to work more effectively.

it won't allow you to change your diet and start eating a lot of carbs.

as you will be going on insulin -- please do ask for an adequate supply of test strips to keep you safe.

I hope you are lucky and do get to see the endocrinologist at Exeter , but my experience of how type 2 is treated is that you will still be seen by your GP and practise DSN ( I genuinely hope you can get to see the endo )

do keep posting and let us know how you get on !!!!!

paul ( himtoo )
xx
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Alan

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Re: Insulin & Tablet Combunation
« Reply #5 on: 11 October 2017, 09:01:45 PM »
Hi all, its been a while since i was last here and in need of some advice.

I an fighting the battle to control my levels. I am on the most tablets that can be prescribed and how much I have tried my levels cannot get below 8.2 and my pancreas isnt playing fair.
I have an appointment with the doc on Friday where its predicted that I will have to go on a combination of insulin & tablets.

so is there any advice or information which can help me get around this??

G'day again.

I can't comment on insulin as I don't use it yet, I'll leave that to the experts who have answered already. One point to add. When you start insulin you should question whether you still need all of those oral meds.

What are those meds and doses, by the way?

A lateral question. Jenny suggested you eat low carb. It may help to know what you are actually eating. What was on the menu, in excruciating detail, over the past 24 hours? Did you test over that period? If so, when did you test related to meals and what numbers did you see?
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline sedge

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Re: Insulin & Tablet Combunation
« Reply #6 on: 11 October 2017, 10:18:03 PM »
Exeter Uni (ie the hospital) are known to be excellent at 'doing' diabetes so I really hope you do get referred to them - cos if there's anything else you could do to help yourself - then they should definitely know and be able to tell you.

However on the assumption that you see someone you've never met before - DO ask that question - 'Before we embark on this - is there anything else you can think of that I could do, to help myself, that I haven't done?'

(You know all the newer stuff - trying to think of the names - Januvia or Byetta or Forxiga etc -I wonder if any of them could help ? - although at least some of em seem more to do with kick starting weight loss, just wondering if ...... )
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Alan

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Re: Insulin & Tablet Combunation
« Reply #7 on: 12 October 2017, 12:16:14 AM »
I asked about the meds - my apologies, I missed reading your sig:

4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day

The doc should review the need for the glic and the sitagliptin if you add insulin.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline Pattidevans

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Re: Insulin & Tablet Combunation
« Reply #8 on: 12 October 2017, 08:51:48 AM »
Hi there Waldo


I’m maybe getting the wrong person, if I am please correct me.  ISTR you came to one of our meets one summer and if it is you, then I recall you had just come out of the army, were relatively young and had a very very fit, slim and muscular physique.  Very untypical of a person who would get early T2.  At the time we all expressed some surprise that you’d been diagnosed T2.  Paul is talking about fatty liver, has anyone told you that you have one? If they have missed out the steps of putting you onto one of the injectable T2 meds such as Victoza then it suggests you do not have any weight to lose.  It may be that tests would prove that your Pancreas isn’t producing enough insulin and is giving up.  It may be only your own fitness that has carried you this far.


If I were you I’d have a lot of questions to ask the doctor and I don’t think the GP’s nurse is necessarily qualified to answer them.  I would certainly be asking to be referred to Exeter on the grounds that you are very atypical for a T2 and that you would like a C-Peptide test to see how much insulin you are producing. There is the off chance that you are not T2 but slow onset T1 and getting the right treatment depends on getting the right diagnosis as I well know.  I had to insist on tests and once properly diagnosed my treatment was much much better in many ways.


To get back to your question, it sounds like they’re putting you on a basal insulin, possibly Lantus, but more likely Insulatard or one of the cheaper ones they prescribe for T2s.  Then they expect the tablets to push your pancreas to produce enough insulin to cover meals.  You really do need to ask questions about this regime.  You need to know what insulin, what tablets and what do all these meds actually do I.e. how they work.


Meantime it will be a good thing to answer Alan’s question about diet so we have the full picture.


Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline waldo65

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Re: Insulin & Tablet Combunation
« Reply #9 on: 20 October 2017, 08:48:47 PM »
My diet is fairly good, I gave a 2 week food diary to the nurse and apart from eating more fish and veg on the whole its good.
I am on the highest limit of tablets, however the doc has removed the 100mg of Stiagliptin and replaced with 100mg of canaglifozin. the new one is suppose to remove access sugars through the urine.
I must admit that since ive been taking it my sugars have averaged 7 over the past week with no side affects so fingers crossed :)
T2 since Sept 10
4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day
Hb1ac - 2013 - 7.6,    2014 - 7.1
Chol - 2013 - 3.6
Trigs - 2013 - 1.26

Offline himtoo

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Re: Insulin & Tablet Combunation
« Reply #10 on: 20 October 2017, 11:10:07 PM »
that is a good result -- you must be pleased ----

keep doing what you are doing
hopefully the insulin won't become one of your meds !!!!!!!
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Alan

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    • Type 2 Diabetes - A Personal Journey
Re: Insulin & Tablet Combunation
« Reply #11 on: 21 October 2017, 12:03:35 AM »
My diet is fairly good, I gave a 2 week food diary to the nurse and apart from eating more fish and veg on the whole its good.
I am on the highest limit of tablets, however the doc has removed the 100mg of Stiagliptin and replaced with 100mg of canaglifozin. the new one is suppose to remove access sugars through the urine.
I must admit that since ive been taking it my sugars have averaged 7 over the past week with no side affects so fingers crossed :)

I am always interested in diet. Would you mind defining "good" in terms of your carb portions per meal please? Even better, are you able to post a full day or two from your 2 week diary?
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)

Offline waldo65

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Re: Insulin & Tablet Combunation
« Reply #12 on: 21 October 2017, 11:07:54 AM »
Hi Alan,


My typical daily diet consists of the following:
Breakfast - Porridge, unsalted and unsweetened
Lunch - Home made bread (so I can control salt and sugar portions), meat and salad, Tortilla crisps and fruit like green banana and apple.
Dinner - Meat, mixed veg, 3 small potatoes (sometimes no potatoes)
Supper - May have some dark chocolate or a small treat.
Booze - Guinness (depending if im out) or a bottle of wine at weekends. 


Hope this helps  :) [size=78%]   [/size]
T2 since Sept 10
4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day
Hb1ac - 2013 - 7.6,    2014 - 7.1
Chol - 2013 - 3.6
Trigs - 2013 - 1.26

Offline Venomous

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Re: Insulin & Tablet Combunation
« Reply #13 on: 21 October 2017, 12:53:36 PM »
I asked about the meds - my apologies, I missed reading your sig:

4 x 500mg Metformin per day
4 x 80mg Gliclazide per day
1 x 100mg Stigliptin per day

The doc should review the need for the glic and the sitagliptin if you add insulin.

Depending on what insulin they introduce, I think they will remove the glic and sitagliptin and keep you on metformin Waldo.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Alan

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    • Type 2 Diabetes - A Personal Journey
Re: Insulin & Tablet Combunation
« Reply #14 on: 21 October 2017, 10:23:44 PM »
Hi Alan,

My typical daily diet consists of the following:
Breakfast - Porridge, unsalted and unsweetened
Lunch - Home made bread (so I can control salt and sugar portions), meat and salad, Tortilla crisps and fruit like green banana and apple.
Dinner - Meat, mixed veg, 3 small potatoes (sometimes no potatoes)
Supper - May have some dark chocolate or a small treat.
Booze - Guinness (depending if im out) or a bottle of wine at weekends. 


Hope this helps  :)

Please consider finding when you peak after meals and testing to see the effects of those meals, especially the porridge, bread and potatoes. That does not mean you should not eat them but portion size is critical. Starch matters just as much as sugar. So does fruit, especially bananas.

Also note the carb content of Guinness. I like it but have to be careful when I drink it and limit myself to a half-pint. Similarly, I have no problem with dry wines but there can be significant carbs in sweet wines.

My limits may not apply to you; the only way to know is to test after meals or drinks at your peak time.

These are the techniques I use:

A cautionary note. As you are on insulin-stimulating meds and may go on insulin if you decide to give that a try do not make drastic changes to the menu. Modest changes made consistently will still work without risking hypos. You may need to discuss reducing meds or insulin with your doctor as you reduce the carbs. If you are not sure of your peak time use one hour after your last bite until you discover your peak.
Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
Born Under a Wandering Star (Latest:Dambulla, Sigiriya and Polonuwarra, Sri Lanka)