Need some Advice...

[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 (http://www.mayoclinic.com/health/diabetes-treatment/DA00089)

[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

[princesslinda]

To have an A1C of 9.0, you've having some pretty high #'s, even if they aren't showing up at the time you're monitoring... I'm glad you're seeing an endocrinologist, though I am surprised that he is letting you go as long as he is with such a wide range of numbers.

I totaled up all the #'s you gave me (6621) then divided by # of tests (42) and got an avg of 157.6 (158) which should correlate to an A1C of 6.6 if you had these same type #'s for 90 days.

[alexg]

It so happens these numbers are for various days in the last 4 months. There were several times I ran out of strips for testing, so I didn't test several days and\or weeks. But I did test most of the time consecutively.

Alex

[princesslinda]

Alex, i'm not questioning the # of times you're testing, i'm sure you're doing all you possibly can, as you seem quite pro-active and knowledgable about diabetes. I was merely pointing out that even though we can test a lot, there still may be times our blood sugars raise or drop and we don't realize it.

Case in point...I have problems with my morning #'s being higher than the 110 goal that the doctor advised me to strive for...i'm almost always higher than that...I read about the dawn phenomenon and set my clock for 2:30 a.m...sure enough, my blood sugar was in the 70's on 2-3 occasions...so I go down somewhat low at night then swing back up in the mornings. I wouldn't generally be aware of this, as who tests in the middle of the night.

Also, my co-worker is diabetic (On glyburide, metformin and Byetta). Her A1c's last A1C was 6.8, yet she hardly ever has a fasting level under 200, usually 250 or more...however, once she takes her morning meds (3 Glyburide, 1000 metformin XR and byetta shot), she will drop to 80, sometimes 60-70, so her average is good, her control is not.

My response was not meant as criticism, rather concern. I know we all struggle daily with the trials and frustrations of diabetes and I just want you to find an answer to your situation soon.

All the best,
Linda

[alexg]

I understand. I added more reading I had and made it total of 59 and got an 160 average. So your calculations and mine show that my AIC of my readings stay around the same. I got 160 in my totals and you got 158. That is not much difference when I added 17 more readings.

I will talk to my Doctor. I think he is not that concerned with my glucose level as he is focused more on my cholesterol levels, don't know why though. I will tell him to change my diabetes meds first and then try insulin.

Alex

[princesslinda]

At diagnosis, my cholesterol levels were "off" and I had abnormal liver function...my HDL was 23 and my LDL was 143...total cholesterol was within normal limits. Doc told me to exercise and that would help the HDL and LDL. I started on the treadmill (i'm quite overweight, lost 56 lbs so far, have 90 more to go). I also added fish oil tablets and started having a glass of red wine before bedtime 3-4 nights a week. 3 months later, my HDL had risen to 44 (doc wanted it over 40, though i've read over 50 is better) and LDL had dropped to 120. Total cholesterol stayed the same. Liver function is now normal. I really didn't want to start on any of the statins as I had heard bad side effects.

I'm certainly not suggesting you start having red wine, fish oil or more exercise (on the glyburide, alcohol could cause you to drop low if you're not careful), just throwing out what worked for me.

I just saw my doctor yesterday, so I don't know my new results yet, but he attributes my better #'s (blood sugar and lipids) mostly to my weight loss (so I don't know that the fishoil or wine helped).

I think once your blood sugars are in line, your triglycerides and cholesterol should follow (or at least improve).

Keep us posted on how things are going...it's a journey we're all taking together and having this support has meant the world to me.

Linda

[alexg]

Looking around, I found sites on cinnamon and glucose, but this one caught my eye.

HERE (http://www.cinnamonpills.com/)

It says Recommended Dosage:
Take two (2) Capsules, two (2) to three (3) times each day with water at mealtimes.

I wonder if that works and if its worth trying out.

Alex

[pdxdennisj]

I resisted going on insulin for many, many years. I hate shots and the idea injecting myself gave me the creeps. I finally failed on max doses of the mainline meds and was forced to go on insulin. Much to my suprise I found the injections really were not a big thing - while not totally painless, I hardly notice them 95% of the time. I am, in fact, giving myself insulin and Byetta twice a day. It is a relief not having those high readings.

[alexg]

Wow you are sure taking a lot of meds and shots. I just did a reading right now before dinner and got 150 mg\dl. Not the best but not ridiculously high. Better than my 236 last night.

Alex

[xMenace]

Alex, please don't shoot the messenger, but probably more sooner than later you will be on insulin. Not only is it the best control option, but it also offers the most flexibility. The needle thing is nothing. Seriously. If that's what's holding you back, don't let it. Finger pricks are painful; insulin syringes are not. Trust me when I say you don't want to experience long term complications. A trillion needles are infinately more fun than some of the stuff I've been through. I'm all for questioning doctors, but when the doctor says it's time, accept it.

[alexg]

HAHAHA! Okay lets see what the Doctor says this time.

Alex

[alexg]

Went to the doc today and bad news. My AIC went up to 10 % from 9%. Last blood test had 162 glucose and this time it was 144 md/gl. He change my med glipizide to amaryl instead for one week and see if it changes my results. If not, insulin shots will be taken as supposedly my liver can't handle any other diabetes medication. My cholesterol went up also to 308 (with zetia) from 225 (with crestor). Now he gave me Welcho. He said my liver is normal but not good enough. Everything else is okay.

Alex

[princesslinda]

Alex, i'm sorry that you didn't get the news you wanted...diabetes is frustrating in that it seems to have a mind of its own sometimes, in spite of our doing all we can to make it otherwise. Seems like elevated blood sugars and elevated lipids go hand in hand as well.

I do hope the Amaryl gives you good results. Do you see your doctor again ina week? Sometimes it takes the medications awhile to build in your system and see an improvement. I don't know how long it takes with the Amaryl, but you might want to check with your doctor and see how soon you should note an improvement. I know on metformin, it can take up to 3 weeks to get the best results.

I know you dread the idea of taking insulin...I do myself, but I hope that if/when the time comes, i'll find the courage to do whatever it takes to get my blood sugars at a level that will minimize my risk of complications. All of us want the best life possible, and if it takes insulin injections to have this, it should definitely be worth it.

You hang in there, just resolve to do whatever it takes to make your #'s where they need to be. Keep us posted.

All the best,
Linda

[LancetChick]

Well, ya never know until you actually try. I HATE pills, have hated taking pills since childhood, and won't take a pill that doesn't offer instant gratification like allergy pills do. I take vitamins, but they're all chewable. I don't like getting injections in the doctor's office or hospital because they really are painful, but insulin syringes are a whole different kettle of fish for some reason, and they don't bother me at all, even after reusing the same one for two months and the lubricant has worn off. I prefer insulin injections to pills by far, and am very glad I'm not type 2.

[alexg]

I am already going back to the doc on Tuesday for directions and my first prescription of Insulin shot via an Insulin Pen. For those of you who read this that know about Insulin, what do I need to know from taking pills to going into taking Insulin Shots? Any details are welcome and appreciated.

Alexg

[alexg]

Went to the doctor today and he now gave me 6 ml insulin shots twice a day plus two Amaryl tablets daily as well. Seems rather easy with the insulin pen. Tonight is my first shot so wish me luck.

alexg

[alexg]

I am concerned now that my levels are sometimes down to 86 in range up to 130. My doctor now wants me to jump from 6 units of Novomix to 10 units. He however still wants me to take the Glimepiride 4mg tablets twice a day as well. Like someone said, that combination might bring my glucose level way to low. What do you think?

Alexg

[Lloyd]

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.



dja2k

High morning readings before eating is what is called Dawn Phenomenon. Fatty acids are released into the bloodstream, increasing insulin resistance. Sometimes eating certain foods before bed can help, that is a very iffy proposition.

I had bad dawn phenomenon, readings in the 160's to 180s, sometimes over 220 before breakfast An insulin pump cured this, by giving me about 4x as much insulin between 2 am and 10 am as the rest of the time. Now my readings are 80 to 115.


Many many type 1's and type 2's have DP, different causes but the same result. It's not your fault, but it is hard to treat except with insulin.

-Lloyd

[alexg]

My readings with Novomix Insulin Shot are much better now before breakfast, lunch, and dinner. For example, today:

Before Breakfast 119
Before Lunch 108
Before Dinner 86

I still need to ask about my concerned that my levels are sometimes down to 86 in range up to 130. My doctor now wants me to jump from 6 units of Novomix to 10 units. He however still wants me to take the Glimepiride 4mg tablets twice a day as well. Like someone said, that combination might bring my glucose level way to low. What do you think?

Alexg

[ladytaz]

I'll tell ya what I would do Alex. I'd stop taking the Glimepiride, and go ahead and increase the mix to the 10u he's asked you to. TEST TEST TEST!!! Keep a close watch on your numbers. Try this for a week or two.

If you see a significant rise in your numbers, well, then it's up to you what to do. Add the glimepiride back, or again increase your dose of the mix. by a unit or so, until you find the "right" dose for you. If you see that they are the same, or even better, again, it's still up to you.

If it were me, I would quit the glimepiride no matter! If you need to increase your insulin dose yet again, so be it. at least it's more predictable than the glimepiride!

Remember, it's YOUR body, and YOU are in charge of taking care of it! Do what YOU feel is best! He can't FORCE you to continue taking the glimepiride! If he wants to ***** you out for it, explain to him just how glimepiride works (stimulates the pancreas to produce more of it's own natural insulin, but that it's NOT regulated in any way, therefore you do not know how much insulin nor when it will be spit out!) and how that puts YOU in danger of going too low!

Personally, I'd be finding myself another doctor!

[alexg]

LOL Thanks for the reply and yeah I think I do need a new doctor, he is being a little .....

Alexg

[ladytaz]

:wink: Keep us updated!!

[alexg]

Well still on the pill and 10 U of Novomix now. Here are my results for today, something must be working....

Before Breakfast 113

Before Lunch 100

I thought of testing right after lunch....

2 Hours After Lunch 92

Before Dinner 98

Alexg