Author Topic: Victoza + Insulin  (Read 1808 times)

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Offline Lucy

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Victoza + Insulin
« on: 07 March 2016, 08:50:15 PM »
Hi all,


had an appt today for a diabetes review (with a really nice doctor). My a1c was the same as december at 8.3% and i had lost 3kg and (apparently) grown 2cm. We talked about where the problems are, wanting to reduce my weight and bgs more, and what i've tried before etc. The summary is he was keen for me to try a t2 non-insulin medicine in combination with my insulin to see if it does anyting to improve my bgs or my weight. This was a new suggestion to me and i hadnt really realised it was an option before other than metformin.  The options suggested were forxiga, victoza or januvia. I have tried januvia and byetta (similar to januvia) before, amongst other medicines, and havent managed to achieve / maintain good control with them, but never tried it combined with insulin. Maybe it will help weight or bgs, maybe it wont, but it seemed worth a try in case it does help. I'm on 0.6 for a week from today, then going to 1.2 from then on, if side effects are ok.


The other change is to stop the tresiba and go back to lantus. I've said to previous drs that i dont see much if any benefit in tresiba over other basals, and the negative of not being able to adjust dose to account for more or less active days or illness etc is annoying. Basically it costs double the normal basals without particularly offering any benefits other than not running out before 24hrs, and offers a big negative. My a1c hasnt reduced using it. Previously i've always been told to stick with it though and not switch back. I'll be switching to lantus when i've finished the remaining cartridges of tresiba in my fridge, so in a month or two.


As a precaution to start i'm reducing my basal from 30/day to 20/day, and keeping the same 1:10/1:15/1:15 ratios. I'll be increasing / decreasing the basal as necessary once settled on the victoza once i see if anything happens to blood sugars. I'm also going to see a dietician to see if it helps with the weight loss. Was a bit reluctant as not sure it will be any use but i'm just going to see her once, if its a waste of time then i dont need to see her again, if it happens to be useful then great. Worth a go anyway.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

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Re: Victoza + Insulin
« Reply #1 on: 07 March 2016, 11:19:43 PM »
 
Quote
The options suggested were forxiga, victoza or januvia. I have tried januvia and byetta (similar to januvia) before, amongst other medicines, and havent managed to achieve / maintain good control with them, but never tried it combined with insulin. Maybe it will help weight or bgs, maybe it wont, but it seemed worth a try in case it does help. I'm on 0.6 for a week from today, then going to 1.2 from then on, if side effects are ok.


Januvia is a DPP inhibitor http://www.medicinenet.com/sitagliptin/article.htm

Victoza is an incretin mmimetic http://www.medicinenet.com/liraglutide/article.htm as is Byetta   http://www.medicinenet.com/exenatide/article.htm so whether it will work for you when Byetta didn't is for anyone to guess.  I suppose you can only try it Lucy.
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 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Victoza + Insulin
« Reply #2 on: 08 March 2016, 06:54:53 AM »
Even if it does nothing for my blood sugars, if it helps weight loss then that in turn may help stabilise my blood sugars. Worst that happens is it does nothing or does nothing and gives me loads of side effects. Problem I had with byetta was it did nothing after meals till I was high teens/20s then I would come crashing down to hypo in a very short space of time. That is my worst fear with the victoza, but as it works all day and the byetta had to be taken with each meal maybe that will make a difference.

I'm not convinced it will do anything for my bgs, as I'm not sure how much my pancreas is willing to be stimulated. Hoping it will help the weight side of things though. Don't know how long it takes to kick in. Took my first dose with dinner last night. So far no bg change just a headache.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Venomous

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Re: Victoza + Insulin
« Reply #3 on: 08 March 2016, 09:38:43 AM »
Hopefully the victoza wont have that effect Lucy, I never hypo'd on victoza at all, it just used to cap my BGs from rising higher than 9. The problem I had with it was the nausea, it made me not want to eat and that's how I lost weight.

I was really miffed when they refused to allow me to go back on victoza recently.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, tibolone, estrogel.

Offline Lucy

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Re: Victoza + Insulin
« Reply #4 on: 08 March 2016, 09:52:35 AM »
Is that because of cost V? I'm reducing my basal cost by switching back to lantus and if after the trial period I haven't had improvement from the victoza then I'll stop it. The consultant justifies the cost of trying it in his letter to the GP I think.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Venomous

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Re: Victoza + Insulin
« Reply #5 on: 08 March 2016, 02:23:46 PM »
My hba1c's have been really good on insulin. It has to be over 7.5 for them to consider victoza.

I did point out that it would be daft of them to make me produce a high hba1c just to tick the right boxes but they weren't interested.

Crazily enough if your hba1c drops under 7.5 whilst on victoza they will withdraw it then too...instead of applauding themselves for finding something that works.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, tibolone, estrogel.

Offline Lucy

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Re: Victoza + Insulin
« Reply #6 on: 08 March 2016, 03:59:11 PM »
I think it should depend on weight change v. If you've lost a load of weight then maybe it's worth trying without the victoza to see if body is better able to cope. I don't know if I'll stick on it beyond six months we didn't discuss that, will have to see if it does anything first.

So far experience is just had some headaches but I get those often. Wasn't hungry at lunch but that could have been the larger than usual breakfast or the victoza. And bgs unchanged so far though I imagine it takes a while to do anything. I reduced my basal by a third this morning but that will take a week to work through too. I know someone on the forum was wanting to try tresiba recently but honestly I'm not sure why anyone would prefer it. Maybe I'll change my mind when I switch back to lantus.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

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Re: Victoza + Insulin
« Reply #7 on: 08 March 2016, 05:34:36 PM »
Can't recall Lucy, but have you ever been on Levemir?
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 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Victoza + Insulin
« Reply #8 on: 08 March 2016, 07:08:42 PM »
Yep, used lantus and levemir (both once/twice a day) and tresiba. Levemir is more flexible than lantus but neither did exactly what i needed and levemir definitely needs 2 jabs whereas lantus can get away with one. Since i'm adding an injection in the victoza i'd rather not do 2 for basal unless i need to.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

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Re: Victoza + Insulin
« Reply #9 on: 09 March 2016, 08:20:05 PM »
Ah OK, but don't entirely dismiss it - Victoria thought it didn't work for her, but actually once it was titrated properly she was getting great results with it.
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 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Victoza + Insulin
« Reply #10 on: 09 March 2016, 08:36:16 PM »
Its the mornings that neither did properly for me patti - getting morning blood sugars down whilst not causing hypos in the afternoons. I have 4 cartridges of tresiba left though anyway so its probably 2 months till i switch over. Gives me time to sus out victoza first anyway rather than changing two things at once. The victoza may help morning blood sugars as i understand that part of what it does it that it reduces the action of the liver, making it pump out less glucose, which may help morning blood sugars.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

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Re: Victoza + Insulin
« Reply #11 on: 10 March 2016, 03:17:19 PM »
I'm glad you haven't got to change 2 things at once Lucy.  Do let us know how you get on!
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 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Victoza + Insulin
« Reply #12 on: 11 March 2016, 09:14:09 PM »
First lesson about victoza: stop bolusing before meals. You might feel hungry before you start eating but that can soon change once you have eaten a bit and finishing the amount you've bolused for can be hit and miss.

No effect on blood sugars so far, and still on the 0.6 dose for the rest of the week, but definite feeling of fullness and getting full quickly whereas i used to never really feel full. From what i've read online most effect and side effects happen when you go up to 1.2 so i'll see what happens then. Not lost any weight yet but its only been 4 days so early yet.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Pattidevans

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Re: Victoza + Insulin
« Reply #13 on: 11 March 2016, 10:08:05 PM »
Will await further reports Lucy
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 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Victoza + Insulin
« Reply #14 on: 16 March 2016, 11:05:13 PM »
Short update,
side effects wise i've just had a dry mouth and some headaches. Don't know if the headaches are from the victoza though as i do get them a lot anyway, just more than usual at the moment. Initial nausea has faded and appetite is reduced compared to previously, though have more appetite than i did initially on starting victoza.

I've not had any need to reduce my insulin doses, so i'm not sure if it's having any effect on making my pancreas produce more insulin. I'm using pre-victoza doses now of 30u basal, and 1:10, 1:15, 1:15 for ratios.

Where it does seem to be having an effect is in the mornings. I think it must be the liver supressing that is having an effect, and my morning blood sugars have been much improved this week, much better than levels i'd seen pre-victoza. Slight negative perhaps in that stuff like running for trains yesterday led to sharp drop in bg, whereas normally i imagine my liver jumped in as i'd not have that happen for sudden exertion (i'm rubbish at running for trains), would only really see drops in bg for longer easy exercise like walking.  Bg dropping for exercise is whats supposed to happen though :)

Blood sugars through the day are improved because of the better morning starting point, the evenings are spiky which is when i tend to eat more carb, but not any more spiky than previously. It's the morning blood sugars where i can see the improvement. Was worried that hypos would be worse without the liver helping but no evidence of that yet. I'll upload some bg graphs when i've got my meter plugged in.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol