[alexg]

I haven't posted here in a while and in about two weeks, I am going to the doctor again. I haven't seen many good results lately from using Glipizide and following a low carb\sugar diet. There were some days I got good readings in the 90 to 120 or so mark, but recently I have seen only higher, not always though. For instance, yesterday I had my blood glucose at 216 before dinner and tonight before dinner it was 236. Good thing that for the past four months or so, I haven't seen past 250. Anyways, I have not felt bad or anything, no side effects, thank God. Though my doctor will not be happy, well neither am I, but he will again insist of giving me insulin shots which I don't want to start. For those of you who may know more, what other medication can I ask him to try on me before he give me insulin? I have seen around here that some people take glipizide with other medication. Please help!

Alex

[barko]

Byetta has been a good option for me, but its an injection 2x daily.
really brought my sugars in line (combined with a low-carb diet, etc.)

http://www.byetta.com

[Harold]

There is a lot more than glipzide that you could try before taking insulin. Metformin would probably be the first choice, it is an insulin sensitizer. Unlike the glip which makes you produce more insulin which makes you more insulin resistant.

[BlueSky]

Actos and Avandia are getting bad press at the moment, so maybe you don't want to go there. But Januvia sounds like good stuff. It stimulates your beta cells to produce more insulin, but it only does this when your blood glucose is high. I see the FDA has just approved Janumet, which is a combination of Januvia and Metformin.

[barko]

Just for reference...

this link from the Mayo clinic shows a nice basic break-down of type 2 medications:

Diabetes treatment: Medications for type 2 diabetes - MayoClinic.com

[alexg]

First of all, thank for the replies!

So basically Janumet is in its first stages? If I have been taking Glipizide for a while now, being that you say it make me less insulin resistant, does it matter if I switch to another medication?

Alex

[alexg]

After reading this, I am sure to tell my Doctor to change me. Hope it doesn't matter that I have been taking Glipizide for a while now.

So according to the chart, glipizide is

Sulfonylureas
Glipizide (Glucotrol); glyburide (DiaBeta, Glynase, Micronase); glimepiride (Amaryl) By mouth Stimulates your pancreas to release more insulin Combines well with other oral diabetes drugs for maximum effect on blood sugar May cause low blood sugar (hypoglycemia) and weight gain.

Main issue is "May cause low blood sugar (hypoglycemia) and weight gain" - No wonder I keep getting weight every time I go into the doctors office.

Biguanides
Metformin (Fortamet, Glucophage, others) By mouth Reduces the amount of sugar your liver releases into your bloodstream between meals May promote weight loss; may reduce cholesterol and triglycerides May cause nausea, upset stomach, diarrhea and, rarely, a harmful buildup of lactic acid (lactic acidosis)

Metformin sounds like a better medication to try.

Alex

[princesslinda]

Metformin helps with the insulin resistance by making your cells better able to absorb the insulin you are making. Many T2s are insulin resistant and make more insulin than average, but aren't able to use the insulin they make appropriately. You can take it with the medicine you are already on, as each will affect your body in a different way.

Are you avoiding breads, potatoes, rice, pasta and sugar? Whenever you have the really high readings, try eating very low carb the next 3-4 meals and see if you notice a difference in your readings.

Also, exercise helps with the insulin resistance. Every little bit helps. If you are just not making enough insulin, you may need to go on insulin, but it may be that you are just insulin resistant and the metformin and lifestyle changes may make a difference.

[alexg]

I don't think I need to go on insulin. To prove it, I used to take one meal out and substitute Glucerna Shakes and my readings would be good around 90 to 115, though my Doctor said for me to stop drinking them cause it wasn't good for long term use.

I have this problem which he doesn't understand, I get high readings if I take a blood test after I wake up before my first meal, though I get good readings before dinner. I can't figure out why though, if my meals consist of the same things, mainly of salmon and green salad. This is why my AIC is always bad. Maybe this new medication can help.

Should I suggest to him to add Metformin to my Glipizide dosage or change me to just Janumet?

dja2k

[princesslinda]

What was your most recent A1C?

[alexg]

My current AIC is 9.0.

Alex

[princesslinda]

By my conversion chart, 9.0 A1C is equal to avg blood sugar of 243...mine was 9.6 at diagnosis. Are you feeling bad? I know before diagnosis, I was so tired I couldn't hardly stay awake to drive home from work. If 243 is avg, you are probably having some higher than the 243...you definitely need some type of medicine adjustment, as you don't want the complications that will come from being this high for very long.

If you are exercising and eating low carb, it may be that oral meds aren't going to be as effective on you at this point. It may be that will you need insulin to get you lowered and then after you are better controlled, you may be able to get off it. I know many of us don't like the idea of insulin, but you can't stay that high indefinitely without problems.

My mom had a blood sugar over 400 at diagnosis and was started on diabinese, which she took for many years. She was a very non-compliant patient and had lots of complications, including amputation, before she died of renal failure at age 54. By the time she went on insulin, it was too late for her. I wish she'd started it years before, as it might have made a difference.

It really sounds like you're working very hard for good control and it's just not happening. I urge you to see your doctor (or a new doctor/endocrinologist) and get something done sooner rather than later.

[alexg]

Thats the thing, I don't feel bad at all and don't get the high blood glucose symptoms people are suppose to get when that high. When I first found out of high glucose, it was at 400 or so. That was going on 2 years now. After that, my sugar got down with dieting and then my Doctor noticed it was rising and he started me on Glipizide. Then he just said last visit, I want to start you on insulin, I said no first try medication, he said ok lets give it another 4 months on Glipizide.

Last Blood Test at the Hospital showed a glucose level of 162 MG/DL and the AIC of 9.0.

Alex

[princesslinda]

Your body may be so used to the abnormally high results that it things those results are "normal."

Personally, i'd be afraid to go 4 months knowing I was regularly going into the 200's. I've read here on the forums that damage starts at over 140 readings (I do get those occasionally, esp. if I eat too many carbs).

Fortunately, i've not been 200 since starting on my meds at diagnosis (just last August).

What's your problem with insulin? Is it the fear of injections, the fear of lows or the idea that insulin is "last resort" treatment in T2s? My doc told me 80% of T2s eventually end up on insulin anyway, so if it lowers your results quickly and reduces your risk of blindness, kidney damage, amputation and all the other things we all fear, why not at least give it a try. Your doctor can't force you to continue it, but if you tried it, you might find it to be "not as bad" as you think it would. I didn't think i'd ever be able to stick my finger, but now I do it many times a day....and the T1s say the insulin shot hurts less than a finger stick.

At any rate, we all have to make our own decisions...and live with the consequences. If you are going to try another medicine, I sure wouldn't give it 4 months to work...metformin reaches optimal dose in 3 weeks, so you should see results in a month on it if it's going to work.

BTW, are you seeing a family doctor, an internist, or an endocrinologist?

[alexg]

I am seeing an endocrinologist. I don't always get high 200's, usually down at the mid to high 100's. I was just referring that these past days, they are high over 200.

So you think I will be able to switch to metformin, try it out, and if I don't see changes, go to insulin?

Look below, here are some of my readings, vary before breakfast, before lunch, and before dinner.

Alex