Hypoglycemia roller coaster

[MODY-RN]

So, the Endo says I have MODY... pancreas doesn't know when to make extra insulin in response to my elevated BG. Initially my Internist put me on Metformin, didn't do much for me other than make me feel sick and cause un-needed weight loss. Saw the Endo and he put me on Starlix with meals (60 to 120 mg). Fasting was still too high, so added Amaryl in the evening. Initial dose of Amaryl 1 mg, now at 2 mg in order to have fastings in the 113-120 range. My problem is this... I am having hypo episodes with the Starlix, most often in the evenings. If I eat my meal (nearly always < 45 gms Carb) and then check 2 hours later is can be 120's to 140... good, right? But then if I take me dogs for a brief walk, or walk to the store, all the circulating insulin released by the Starlix will push all the still circulating sugar into the cells and I am now hitting 47 and a wreck! If I take a 1/2 Starlix with the meal my post prandial sugar is too high for my liking. If I don't take the Starlix, my sugars are elevated all the time. If I take the Starlix, my sugars are too high if I am not active and too low if I am...
UGH! Groan! Seems like managing things with a sledge hammer when what is needed is a scalpel!
Thoughts, suggestions? :confused:

[MODY-RN]

So the increased dose of Amaryl seems to have stabilized my sugars all around without the need for any Starlix at meal times with low carb meals, 60 mg if a high carb meal... No Hypo's now for the past 24 hours with not taking the Starlix... I wonder how long the Starlix stays effective? Is it still working to some degree? Time will tell. Can't afford to be late for meals or skip snacks as the Amaryl keeps working with it's long action/half life. Had a fasting sugar this am of 100! Haven't seen that for 2 years. :D

[tealas]

:)

That sounds good! Have your fastings always been sort of high? I'm wondering if your are more likely MODY2 than something like MODY3. Do you have a low renal threshold? (Easy way to screen for MODY3).

The reason I'm asking is that I'm MODY3 - I tried Byetta in Dec and it was horrible for me. My blood sugars were amazing, but bad GI symptoms. Basically stopped my digestive tract. But I'm wondering whether Amaryl might be beneficial.

I've made huge strides with a raw food diet since March. Just sort of stumbled into it trying to lower my LDL's. Got my first "normal" HbA1c in June. And I dont really want to go back to eating alot of cooked food. There are too many other advantages of mostly raw diet. However it might be good to be able to eat more carbs (fruit, veggies) than I'm currently eating?

[tealas]

Whoops, I was confusing the Amaryl and amylin!

If you are sensitive to sulfa's and have a low renal threshold - these would both be very strong pointers to MODY3. If you search on PubMed you can see that MODY3's process sulfs more slowly (due to the regulatory protein changes in the liver).