Brand New 1/1.5 - advice and about Avandia

smartwork · #1 (**permalink**) 10-08-2007, 03:40 PM

10 weeks ago I was diagnosed Type II. Started 500 mg Met with Glyburide and everything came into control. The Glyburide has been discontinued. I dropped about 25 pounds with major diet change. Have since seen an endo and now I'm told I'm Type I in the honeymoon. I will find out the tests and the results used for that diagnosis this week. I think they want to change me from Met to Avandia... which I'm very hesitant about. I don't know if that's for the remainder of my honeymoon or forever. Not only for the heart reasons, but everything I read from users is negative and it appears everyone has side effects. I've had no side effects from the Metformin (thankfully). Would you change or stay with the Met? Does anyone have any advice, experience, opinions? Cany anyone cite good scenarios or examples of using Avandia? Other than D, I'm in great health and tests show liver, kidneys, blood pressure, cholesteral, etc. are excellent.

Help is greatly appreciated.

shockme · #2 (**permalink**) 10-08-2007, 04:22 PM

hi smartwork and welcome to df! why does the endo think you're a type 1? oral meds are usually given only to type 2's,as type 2's have insulin resistance. oral meds treat the insulin resistance. type 1's require insulin.....i take actoplus met-which is actos and metformin.actos is like avandia and i've had no heart issues.....tho-avandia and actos can cause weight gain....take care,trish

smartwork · #3 (**permalink**) 10-08-2007, 04:57 PM

Thanks for the reply. The oral meds were started first by an ER doc at diagnosis and then refined by my regular physician - all why assuming I was Type II. Upon seeing the endo, more blood work was done to condclude Type I. I'll find out this week which tests and results concluded Type I. I believe the move to Avandia is to help ease the stress on the remaining beta cells by making easier use of the insulin they are still producing, but I thought the Metformin also did that. Is it simply preference of medication? With a current working forumula on relatively little Met with no side-effects, I'm hesitant to change, so I'm trying to research any reasons to support the change. I assume when my beta cells degrade more, they'll then move me to the insulin. It's all new to me now as I had been cramming my head full of Type II information for the last 10 weeks.

BlueSky · #4 (**permalink**) 10-08-2007, 05:18 PM

Quote:

Originally Posted by smartwork

... I assume when my beta cells degrade more, they'll then move me to the insulin. ....

Type 1s normally get put on insulin immediately. It is the best way to rest the beta cells and prolong the honeymoon. Avandia improves insulin sensitivity and is, by all accounts, very effective. But it is, at best, a temporary measure if the beta cells are being destroyed. Meformin also has some insulin-sensitising effects, but its main action is to inhibit the production of hepatic glucose. Your doctor may be putting you on these meds because, in addition to being a T1, you are also insulin resistant. But I would have thought that you should be started on insulin as well ASAP.

xMenace · #5 (**permalink**) 10-08-2007, 05:20 PM

From now on you are in control of your own health. If you have issues with Avandia, you decide not to take it. By all means discuss with your doctor(s), but the choice is yours. The same with insulin. As a type 1 we have to take it, but we have the choice of what kinds to take, how much, and when. My only caution about insulin is to resist 70/30 mixes. These offer much less flexibility, and many get into trouble with them. You want MDI/Intensive Insulin Therapy or even a pump.

smartwork · #6 (**permalink**) 10-08-2007, 05:39 PM

Thanks for both your replie. I am doing all this so I can rapidly get up to speed with the brand new information put upon me. I'll definitely ask the endo all the questions to get explanations and definitions resulting in my changing diagnosis. I'll inquire about the insulin/oral meds for me if I'm really a beginning Type I.

Thanks so much!

sofaraway · #7 (**permalink**) 10-09-2007, 01:39 AM

if you are confirmed as a type 1/ 1.5 I think it's a good idea to get on insulin early, even if your numbers are well controlled at the moment. you may only need a small amount of basal insulin to begin with (1 injection of long acting insulin per day).

welcome to the club

Harold · #8 (**permalink**) 10-09-2007, 01:57 AM

Just so you know, it's not all doom and gloom with Avandia. Been taking it for 6+ years since dx. The only diabetic drug I have taken.

smartwork · #9 (**permalink**) 10-09-2007, 08:07 AM

Having originally been diagnosed as Type II, I of course now want all the info that concluded that and then all the info that caused the change in diagnosis. Not denial - just want to understand. What exactly do they test initially to conclude "resistance", or is that an assumption when they thought I was Type II? What I'm getting at is that I don't want to be prescribed something... anything... for resistance if deficiency is really the issue. Is it normal for Type I to take orals in combo with insulin - either during honeymoon or after that period is over?

Thanks for the Avandia comment, Harold. Aside from the press-related info/scare, I'm hard-pressed to find people bragging on their results from it in terms of side-effects. Is there a group out there who just loves it?

Thanks!

BlueSky · #10 (**permalink**) 10-09-2007, 12:05 PM

The best way to identify insulin resistance is to do an insulin level test. If it is high, there is insulin resistance (T2). If it is low, there is deficient insulin production(T1/T1.5). Another way to tell is to do a Glucose Tolerance Test. If there is insulin resistance, BG goes up for a while but comes down again (T2). If a lot of beta cells have been lost, BG goes up and stays there (T1). Problem is that if most beta cells are still functioning (T1.5), the BG profile looks like that of a T2. T1.5s also respond to oral drugs in the early stages, which is confusing.

I suggest that get your doctor to do an insulin level test. It will show if you have insulin resistance and whether you would benefit from oral drugs.

mortis505 · #11 (**permalink**) 10-10-2007, 12:21 AM

Might also want to ask about a GAD antibody test and a C-peptide test. See if they have been performed and if not, ask if they can be done. Your endo should be able to order those tests.

shabbie6247 · #12 (**permalink**) 10-10-2007, 01:32 AM

i was intially diagnosed as type 2 and placed on metformin, within 3 months i started on insulin and i believe that was the best thing for me because i immediately started to feel so much better, the best i'd felt in about 5 years! i couldnt get my numbers down with just diet and met. i dont know about avandia but i do know that insulin will have to be an option for you sooner if not later. as type one your beta cells are already winding down. my honeymoon lasted 9 months.

i'm glad im on insulin and i enjoy feeling well.

welcome to DF btw

smartwork · #13 (**permalink**) 10-10-2007, 12:52 PM

Thanks for all the great info and advice. I discovered that my GAD was about 60 or so when I believe it should be 0-1.5 according to the test page. My treatment was changed to discontinue the Met and go to Avandia to provide easier use of my natural insulin for the time being since my BG is still good and in the range for a non-diabetic - since radically adjusting my diet 10 weeks ago upon diagnosis. I was also provided some insulin pens for when my beta cells do start winding down and my after-meail numbers begin to creep up which is where I'm told I'll see the difference begin. Once we start seeing a pattern of that, we'll then take action on moving toward more insulin and the long-term plan of pumping or injecting.

NoraWI · #14 (**permalink**) 12-28-2007, 04:28 AM

With a 60 result on your GAD65 antibody test you are definitely a T1 LADA! I would suggest you go directly to insulin and forego all the orals. Using insulin actually does keep your own beta cells going longer.

Doctors seem to be needle-phobic and assume that all their patients are, too. They tried to put me on Avandia (before the big flap in the news over it causing congestive heart failure) and I refused. I, for one am extremely pill-phobic and had to fight to be prescribed an MDI (Multiple Daily Injection) regimen of basal and bolus insulins. Control became immediately easier and much, much better.

smartwork · #15 (**permalink**) 12-28-2007, 07:08 AM

Thanks for the follow-up. A lot has changed since this thread left off in October, and yes, I am Type 1 for sure. I am currently on 4mg of Avandia. Since it all began in August, I'm now about 40 pounds in better shape, and my 30-day average (of all measurements) is about 85.