To Bolus or not to Bolus?

[Spartan300]

Hi,

Went for my three month check in with my PCP. The news was good all the way around. A1C has dropped from 13.4 to 10.6 to 7.4 in the last six months. Weight has dropped 22 lbs in the last 7 weeks. BP has dropped from 140/90 to 118/80 in the last three months.

Needless to say, we were both pleased. My only sticking point now is spikes after a meal. These spikes are not consistent. They really depend on what I'm eating, which I'm still feeling out.

My PCP has suggested that it may be a good idea to drop the Byetta and start an injection of fast acting insulin at each meal (i.e. bolus). Dosage to be determine by estimating carbs in the meal. This should handle the spikes.

So, good idea or not? I want to discuss it with my endo first. My PCP says there's no rush on a decision. We're going to keep with the current plan and see where things are in December. Maybe continued weight loss will change the number. I only see convenience as an issue. I'd have to haul a needle and insulin to meals at work or out with friends. I'm not sure of the timing, but do you actually inject at the meal?

Thanks for any and all advice.

[Dawn]

I don't know anything about insulin so I can't help with that...but I just wanted to say congratulations on your weight loss and numbers!!!! Keep up the good work!!!! :)
Dawn

[Jan B]

I read in the Star Telegram a couple days ago, that more Type 2's should start on insulin sooner. It makes sense to me -- I know a Type 2 (over 10 yrs) who refuses insulin until his doctor "makes him" take it. He's always complaining about feeling tired, not well, etc..

I like that you are willing to take insulin -- it might be just the answer you are looking for. Shoot & eat works pretty good!

[Funnygrl]

Excellent idea imho.

[iDream]

Well a 7.4 a1c would suggest taking insulin?

[owlyn]

I am usually a proponent of insulin for everyone, but it's tough to lose weight when you're on insulin. What you are doing seems to be working on both sides of the problem (your A1C is ciming down, and so is your weight. I would stick with this for another 3 months and see what happens. If your A1C doeesn't come down any, it would probably make sense to start insulin.

[notme]

The plus side would be easier control with the addition of insulin. However, the weight loss may become an issue. If the insulin alone doesn't make weight loss more difficult, the ability to eat more foods and bolus for them might.

I don't think everyone suffers from weight gain with insulin, but many do so you should take that into consideration.

Other than that, I would be all for the addition of insulin to your regime to help get that 7.4 lower. ;)

[Spartan300]

Thanks for input everyone! I think my PCP feels the same way about the weight gain, although Lantus isn't supposed to effect your weight as much.

Just a question for clarification. I thought Lantus was insulin? Is it not?

Also, to address Jan B's comment, my Dad was dead set against my starting Lantus. He resisted taking insulin himself for about 40 years; until he had his heart attach and coronary bypass. It's odd that there's such an "old school" prejudice against it. Any idea why?

[notme]

Lantus is an insulin spartan, but it is an insulin that you use for a basal insulin. Lantus is not a short acting insulin that you take at meals. it is taken once a day usually at bedtime to give you a constant basal rate. Some people have split the dose to give them better coverage.

[kgm0612]

Congratulations on the improvement of your A1c and for the 22-lbs you've lost thus far. Keep up the hard work!

Why can't you do both.......stay on the Byetta and add Novolog or Humalog? My friend's brother is doing this with very good results.

Karen

[Olidus]

If you are taking insulin to Bolus does that not make you Type 1? Can someone clear that one up for me?
I always thought that the main difference between Type 1 and Type 2 was being insulin dependent.

[Spartan300]

Hi Karen,

My PCP is trying to keep my injections down. So, removing Byetta gets rid of two injections, adding Humalog/etc. would add three, for a net increase one. He thinks I probably won't need the Byetta anyway if I bolus. I want to see if my endo agrees.

Olidus - Taking fast acting insulin doesn't make me Type 1. According to my PCP, endo, and CDE, there's still a chance of going back to pills if my numbers can get low enough through diet and exercise. I don't know if I could eliminate medication completely. The disease is also progressive, so at some point I'll need more medication, exercise, or diet changes.

The approach to T2 has definitely changed. My Dad (also a T2) was "controlled" on pills for most of his life, but he never went for regular checkups. I know he didn't have any kind of test equipment until he moved to Florida thirteen years ago and got a new doctor. So, honestly, none of us know how "controlled" he was. He didn't know what an A1C was until I was diagnosed four years ago. :eek:

[rzrbks]

Fighting weight gain is fair price to pay for having betterv control and living longer/better-----imHo.


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Olidus, try this link What Type Of Diabetes Do I Have? (http://www.diabetesnet.com/diabetes_types/whatype.php)