[jambo101]

If my diabetic condition is caused by a lack of insulin why am i taking Metformin,Glyburide, Januvia and Lantus? why not just Lantus dosed to the polint where my sugar levels are normal?

[Rddoms]

Type 2 diabetes is initially caused by insulin resistance, which can be controlled with metformin and similar drugs. Insulin resistance causes your pancreas to produce a lot more insulin than normal because your cells need more insulin to use the glucose in your blood. This will eventually cause your islet cells to **** out, and they will then decrease insulin production. This leads to a lack of normal insulin levels PLUS insulin resistance. If you only took lantus, you would still be insulin resistant. Metformin and similar drugs allow you to take a much lower dose of insulin. Metformin is saving you a lot of money by decreasing the amount of lantus you need. Plus metformin can prevent heart complications. Hope this helps!

[Subby]

To put it another way, your particular condition is not caused by lack of normal amounts of insulin, it's caused by not being able to use normal insulin levels properly in the body. There is a subtle but big difference. When you are overproducing already, it makes a lot of sense to try and sensitive the body with drugs and other efforts so that the existing insulin (and added, if required) is more effective and a more healthy amount, rather than layering even more insulin on top of heightened amounts.

Yes, lack of insulin production (as in, less than normal) can become the issue for a type 2 over time, which is why I'll mention looking into c-peptide tests so you actually know what amount of insulin your body is currently producing. Doctors don't tend to see this as mandatory, or even important, the reason seeming to be that they are happy with other diagnostic tools (or lack thereof), and as they have faith working out treatment by what is effective or not. But it can help inform you if your problem is as expected, resistance to insulin (and likely you are pumping a lot of insulin out already) or whether you also have a defecit of insulin production as well as resistance to it.

[foxl]

Having not read your story, I am not sure!

What is your C-peptide? That should give us an idea of how much insulin you are making.

[davef]

Originally Posted by Subby

To put it another way, your particular condition is not caused by lack of normal amounts of insulin, it's caused by not being able to use normal insulin levels properly in the body.

Subby hit the nail on the head. Typically, when a person is first diagnosed with T2 (assuming it's caught relatively early) the problem is that your body is producing insulin BUT due to insulin resistance the body is not using the insulin to transfer the sugar from the blood stream to cells.

The Metformin you take is used to lower insulin resistance, if you are not longer producing enough insulin then the doctor will also prescribe insulin for you to inject.

[dbaratta]

Originally Posted by jambo101

If my diabetic condition is caused by a lack of insulin why am i taking Metformin,Glyburide, Januvia and Lantus? why not just Lantus dosed to the polint where my sugar levels are normal?

Because you need something to cover meals, met and Januvia do that, Lantus covers you for the rest of the day. If you are concerned with all that medication ask your do if you can try using Lantus only for a while, I take it that the pills didn't do it for you that is why you are on Lantus? that is what happened to me and I voiced my concern over taking 2000mg of met when it didn't do that much for me so doc took me off, but, I use novolog to cover my meals. Discuss with your Doc, I bet he won't mind letting you experiment. But be sure to ask before you do.

[dbaratta]

Originally Posted by Subby

To put it another way, your particular condition is not caused by lack of normal amounts of insulin, it's caused by not being able to use normal insulin levels properly in the body.

.

how do you know this person is resistant?

[Richard157]

In the 1990's I gained weight when I switched from beef/pork insulin to modern day insulins. I gained so much I became insulin resistant. I was a Type 1 with insulin resistance (double diabetes). I started taking a Type 2 med (Avandia) in 1999 to help help with the resistance. This greatly reduced my total daily insulin dosage, and that enabled me to lose weight. So, under these conditions, even Type 1's have to use a Type 2 med and insulin. The number of double diabetics is on the rise.

[Funnygrl]

Originally Posted by dbaratta

how do you know this person is resistant?

Because they have type 2 diabetes.

[foxl]

Originally Posted by Funnygrl

Because they have type 2 diabetes.

My official dx is Type 2. My Endo considers anyone non-insulin dependent to be a Type 2! I have GAD antibodies however.

[Funnygrl]

Originally Posted by foxl

My official dx is Type 2. My Endo considers anyone non-insulin dependent to be a Type 2! I have GAD antibodies however.

If you have GAD antibodies, why aren't you on insulin? Obviously your a1c is fantastic, but even very low doses of insulin have been shown to extend the life of what remaining beta cells you have.

[jps]

Maybe I'm an odd case, but because my liver enzymes were high, my doctor put me on Lantus and Lantus only from day one. Never went the traditional route with orals.

Granted, I jumped on the low carb lifestyle right away, but my sugars became normalized very quickly with only modest doses of insulin. As I low carbed, the weight came off, the IR reduced. That happened for about 6 months, then I took the chance and went of Lantus altogether. I stayed low carb, but I actually added some carbs to my diet (namely fruits) while being med free. The weight continued to drop, my IR continued to drop and I turned in my best A1c without meds.

Now I'm maintaining relatively normal blood sugars without meds via diet and exercise. I'm still probably running about 10% higher than a "normal" person, but I don't see that as bad (fasting around 95, 2 hour post meals the same).

Even so, I'm contemplating going back on very small doses of insulin to take a little more burden off the beta cells, depending on what my C-Peptide comes back with.

I guess my question is, given the the way it's explained above, if I were suffering from high amounts of IR rather than insulin depletion (I'm assuming this to be the case because I'm producing enough insulin now - I didn't have a C-Pep initially), then why was it that insulin only helped me to get over high levels of IR? I didn't need the oral meds to sensitize me to insulin.

[Funnygrl]

I guess my question is, given the the way it's explained above, if I were suffering from high amounts of IR rather than insulin depletion (I'm assuming this to be the case because I'm producing enough insulin now - I didn't have a C-Pep initially), then why was it that insulin only helped me to get over high levels of IR? I didn't need the oral meds to sensitize me to insulin.

I'd guess your low carb lifestyle was paramount in reducing your insulin resistance. Type 2 diabetes is actually a combination of insulin resistance and beta cell death. You become insulin resistant and your pancreas works to make more insulin to keep up with this resistance. Eventually these beta cells start to exhaust. Once about 50% of your beta cell's insulin producing ability is lost, then glucoses start to elevate. Your beta cells are still on overdrive, but overdrive is less than it was before. Therefore, by taking small amounts of lantus, you were able to supplement what your beta cells were doing. That, plus your exercise and low carb lifestyle, resulted in your glucoses normalising. I'd blame the low carb lifestyle more for helping to lower your glucose, and your weight loss for ultimately eliminating your insulin dependence.

Kudos to you- it sounds like you're doing a great job.

[Moonglo]

Actually, jps, I've wondered something similar (or maybe it's essentially the same question; if so, forgive me): why would type 2's be able to benefit from insulin therapy in place of metformin? It just seems to me that adding more insulin to the already elevated supply wouldn't help if we're not responding to it, especially when I have heard people here say that they are stopping their medications like metformin, which is supposed to help them utilize their insulin, only to turn around and take more insulin that their body cannot use? Never has made sense to me, but that's why I'm not a doctor

[Funnygrl]

Originally Posted by Moonglo

Actually, jps, I've wondered something similar (or maybe it's essentially the same question; if so, forgive me): why would type 2's be able to benefit from insulin therapy in place of metformin? It just seems to me that adding more insulin to the already elevated supply wouldn't help if we're not responding to it, especially when I have heard people here say that they are stopping their medications like metformin, which is supposed to help them utilize their insulin, only to turn around and take more insulin that their body cannot use? Never has made sense to me, but that's why I'm not a doctor

That's exactly why insulin isn't the first line treatment for type 2, unless they have extremely high glucoses at diagnosis, in which case it's insulin + orals.