[NewdestinyX]

Do any of you T2's on Lantus have any experience with backing down your Met or going off it altogether and using the Lantus and diet alone or Lantus, Bolus + diet to control numbers?

By accident about a week ago I missed my evening dose of Met.. Had taken my 500mg in am.. But fell asleep without taking my bedtime 500mg. The next morning I woke up with a FBG of 104. Now I know Met builds up in the system and would need to ramp down. But I've not taken it now for about 5 days.. Last two days FBG numbers and before meal numbers have crept back up to 118-125 range with no real change in diet. So clearly the Met dose is part of this equation.

I'm wondering if more Lantus less Met would be equal tradeoffs if my diet and exercise remain the same. Or are we talking about two unrelated processes in terms of what the Met and Lantus do.

Thanks for any thoughts!

[foxl]

Grant they do different things.

I would guess with met slowing gluconeogenesis, you would need less Lantus.

So, why would you want MORE circulating insulin (Lantus), upping your complication risk, instead?

I will be interested in others' answers.

[NewdestinyX]

Originally Posted by foxl

Grant they do different things.

I would guess with met slowing gluconeogenesis, you would need less Lantus.

So, why would you want MORE circulating insulin (Lantus), upping your complication risk, instead?

I will be interested in others' answers.

What complication risk would you be referring to, Linda? I've read a lot about Lantus and there are very few if any complications I've read about yet (potential weight gain if you don't exercise being the most noted one). I haven't gained a pound and have kept losing.

Met is also supposed to reduce insulin resistance.. that is a super valuable help to keep with the Met. I remember JPS never using Met and only using Lantus -- hopefully he'll chime in.

[NewdestinyX]

Originally Posted by foxl

So, why would you want MORE circulating insulin (Lantus), upping your complication risk, instead?

The other reason I'd like to consider it -- is that some of the symptoms of Met, gassyiness and cramps, have returned over the last 3 weeks or so.. Don't know if it's the presence of the Lantus with the Met -- that has that NUISANCE back..

[Hammer]

Yes, I wonder what complications Linda is referring to with increased levels of Lantus.(other than possible weight gain). I know there are problems with excessive insulin in the body, but only if it's your body's own insulin, not artificial insulin. The artificial insulin, like Lantus, doesn't cause any problems that I know of.

I asked my doctor that question, and that's what he told me. He explained why, but I don't remember the details.

[fgummett]

Why would you expect high levels of exogenous (injected) insulin to act any differently than high levels of our own endogenous insulin... surely it is made to do the same job(s)

Hyperinsulinemia - Wikipedia, the free encyclopedia

* May lead to hypoglycemia
* Increased synthesis of VLDL (hypertriglyceridemia)
* Hypertension (insulin increases sodium retention by the renal tubules)
* Coronary Artery Disease (increased insulin damages endothelial cells)

Remember that we are not talking here about Type 1 D where we are replacing a [relatively] small amount of insulin, but Type 2... which commonly includes IR where the need, for ever increasing amounts of insulin just to maintain BG levels in the normal range, can lead to insulin levels that would be considered [very] high for someone without Type 2 D.

I have explored this road and based on my own experience I would recommend that you are far better off trying to eat so as to minimise your need for insulin.

[Subby]

As an injecting T1 for a long time, I have come to Metformin as a supportive medication for my insulin, and it appears to play an important role for me in making control a little more predictable and less volatile. Primarily by reducing the amount of unnacountable highs that seem to occur in the background on a pretty regular basis for me. By unnacountable, an example might be a basal insulin regemin of insulin might work quite well for 2 days and then, given very similar conditions, I go right out of control at various times of the day. Repeating but variable control issues, that cannot be "pinned down" with one regimen of basal insulin, and cannot be easily be predicted, therefore the amount of highs and lows become excessive. The Metformin, once I worked out the right time and way to take it, has helped to iron these issues out quite significantly.

This improvement may be to do with reducing IR issues in the body, or it may be to do with getting the liver to behave itself and not release glucagon and glucose so excitably through the day as I suspect it does in me. It also appears to have reduced the height of spikes from many medium to high carb meals, if I have them.

For these reasons I see it as performing a useful function in reducing my blood sugar variability, alongside the basic action of the insulin. If insulin is a vehicle I drive along a curvy, bumpy and slippery road trying to keep it smooth and centred, metformin gives improved traction and suspension. I cannot say if this occurs for others. It is just my experience.

My thought would be, as you have been off metformin for a while, you could if you wish keep experimenting to see if you can do without at an acceptable price. If it only saves you a couple of units of Lantus, and the responsiveness of your system seems to remain the same (ie, you don't see worse variability to the likes of food, stress, DP, etc) then maybe dropping the metformin would be a good option. It's good to keep your insulin dose down, but I don't think it's practical to stress over a couple of extra units at the cost of feeling sick all the time, if that is what Metformin is doing to/for you. On the other hand if your dosage needs go up significantly and you are finding control more problematic, you've shown that the met is indeed helping your glycemic control and utilisation of insulin, and may want to consider keeping with it in some form.

[NewdestinyX]

Originally Posted by Subby

As an injecting T1 for a long time, I have come to Metformin as a supportive medication for my insulin, and it appears to play an important role for me in making control a little more predictable and less volatile. Primarily by reducing the amount of unnacountable highs that seem to occur in the background on a pretty regular basis for me. By unnacountable, an example might be a basal insulin regemin of insulin might work quite well for 2 days and then, given very similar conditions, I go right out of control at various times of the day. Repeating but variable control issues, that cannot be "pinned down" with one regimen of basal insulin, and cannot be easily be predicted, therefore the amount of highs and lows become excessive. The Metformin, once I worked out the right time and way to take it, has helped to iron these issues out quite significantly.

This improvement may be to do with reducing IR issues in the body, or it may be to do with getting the liver to behave itself and not release glucagon and glucose so excitably through the day as I suspect it does in me. It also appears to have reduced the height of spikes from many medium to high carb meals, if I have them.

For these reasons I see it as performing a useful function in reducing my blood sugar variability, alongside the basic action of the insulin. If insulin is a vehicle I drive along a curvy, bumpy and slippery road trying to keep it smooth and centred, metformin gives improved traction and suspension. I cannot say if this occurs for others. It is just my experience.

My thought would be, as you have been off metformin for a while, you could if you wish keep experimenting to see if you can do without at an acceptable price. If it only saves you a couple of units of Lantus, and the responsiveness of your system seems to remain the same (ie, you don't see worse variability to the likes of food, stress, DP, etc) then maybe dropping the metformin would be a good option. It's good to keep your insulin dose down, but I don't think it's practical to stress over a couple of extra units at the cost of feeling sick all the time, if that is what Metformin is doing to/for you. On the other hand if your dosage needs go up significantly and you are finding control more problematic, you've shown that the met is indeed helping your glycemic control and utilisation of insulin, and may want to consider keeping with it in some form.

Wow.. Another super helpful post, Subby. Thanks so much!

That's exactly my dilemma in this decision in that I have indeed seen a rounding of the highness of my spikes since I started Metformin -- even BEFORE starting Lantus. And Lantus now has made those spikes even less sharp.. The question is can the Lantus still create stability without the Met.. I think I'll keep experimenting for another week without my nighttime Met and up the Lantus another couple units and see if it creates the same stability..

It also occurred to me that some of the change I'm seeing this last month (in having to up my Lantus to keep the same control as those early 10unit days which were amazingly effective at that low a dose) is corresponding to about exactly 30 days since I stopped the Actos™. It supposedly reduces IR too. I started Lantus and STOPPED the Actos -- so the ACtos is about out of my system now -- I'm sure making for the need more Lantus OR more Met.. I think I'll try some more Lantus.. I see people with much higher unit usage than my 23u at this point...

[NewdestinyX]

Originally Posted by fgummett

Why would you expect high levels of exogenous (injected) insulin to act any differently than high levels of our own endogenous insulin... surely it is made to do the same job(s)

Not sure how you inferred that from my question. I don't. I DO know your own pancreas rests in the presence of an exogenous insulin -- and therefore you're not really doubling up on the insulin.

Hyperinsulinemia - Wikipedia, the free encyclopedia


Remember that we are not talking here about Type 1 D where we are replacing a [relatively] small amount of insulin, but Type 2... which commonly includes IR where the need, for ever increasing amounts of insulin just to maintain BG levels in the normal range, can lead to insulin levels that would be considered [very] high for someone without Type 2 D.

I have explored this road and based on my own experience I would recommend that you are far better off trying to eat so as to minimise your need for insulin.

yeah. It's a delicate balance, Frank, I know.. And as Hammer said the issue of hyperinsulemia (another name for out of control IR) is more a complication of the body's insulin and not a complication of exogenous insulin to my knowledge. At the level I'm at now -- my doctor said there's virtually no chance of those things listed happening as I'd read what you posted there before considering the Lantus. The artificial insulins tend to be more effective in a T2 and create lesser chance of the complications you mention. And my test results show everything fine in all the major organs mentioned there. When you use an artificial insulin too your own pancreas rests - this is why, as you know, insulin therapy for T2's is increasingly being considered a first line of defense rather than a last resort.

[retired60]

About two years ago I reduced the met from 2,400 mil a day to 1,000 without very little change in the Lantus. I did start watching the carbs more closer. I now take 500 mil in the morning and 500 at night......I also split the Lantus to 13 units in the morning and 13 at night. A1c's are always under 6%. The doc keeps writing the scripts for 1,000 x 2 plus 500 at lunch.... so I come out way ahead on the met.

[NewdestinyX]

Originally Posted by retired60

About two years ago I reduced the met from 2,400 mil a day to 1,000 without very little change in the Lantus. I did start watching the carbs more closer. I now take 500 mil in the morning and 500 at night......I also split the Lantus to 13 units in the morning and 13 at night. A1c's are always under 6%. The doc keeps writing the scripts for 1,000 x 2 plus 500 at lunch.... so I come out way ahead on the met.

Thanks, Retired.. Maybe someone can explain this logic of splitting the Lantus dose -- when it's a 24 hour med..??

It would seem that that would create certain times of the day when you had more in you than others... OH -- wait -- maybe if you use the exact dose 12 hours apart then maybe it is staying at a consistent 26 units, in your case, Retired... And then that just allows for some 'strong' peak time in the AM and after dinner??? I'm trying to work out that logic..

[Subby]

Originally Posted by NewdestinyX

Thanks, Retired.. Maybe someone can explain this logic of splitting the Lantus dose -- when it's a 24 hour med..??

It would seem that that would create certain times of the day when you had more in you than others... OH -- wait -- maybe if you use the exact dose 12 hours apart then maybe it is staying at a consistent 26 units, in your case, Retired... And then that just allows for some 'strong' peak time in the AM and after dinner??? I'm trying to work out that logic..

Here's a diagram that should help to illustrate just how (not) flat Lantus is over the 24 hours. Lantus of course being the Glargine. This is the reduced version, a larger version of this picture does go into details of the study and how they came about this data, can be found.

If you split at 12 hours apart, you get a more even effect over the 24 hours. I don't have a diagram for that, if you can't visualise it, try drawing it - repeat the curve at the 12 hours mark, overlapping the first curve, and notice the resulting more even top line over the time period.

As well as this curve of action found to be inherent in the insulin, people can metabolise insulin at a different rate, and some find Lantus runs out before the 24 hour mark.

[NewdestinyX]

Originally Posted by Subby

Here's a diagram that should help to illustrate just how (not) flat Lantus is over the 24 hours. Lantus of course being the Glargine. This is the reduced version, a larger version of this picture does go into details of the study and how they came about this data, can be found.

If you split at 12 hours apart, you get a more even effect over the 24 hours. I don't have a diagram for that, if you can't visualise it, try drawing it - repeat the curve at the 12 hours mark, overlapping the first curve, and notice the resulting more even top line over the time period.

As well as this curve of action found to be inherent in the insulin, people can metabolise insulin at a different rate, and some find Lantus runs out before the 24 hour mark.

Ah great! Super helpful picture.. I AM the visual type for sure.. Lantus is also the most even burn it seems. So with me taking my full dose at 9:30am -I am virtually getting no help from Lantus overnight and by my wake up time... Interesting.. But a 9:30 am, 9:30PM of 12units each... would give me a smoother burn but at NO point would it be MORE then 24 units -- right? That's what I'm trying to avoid.. And I also don't want to go low overnight -- So maybe it would be better to back down to 10 units + 10 units and see what that does and then work back up.. Because at my current dose from an 8:30am-9:30am injection -- when I exercise mid afternoon I've gone low twice now -- because that's the peak.. Interesting..

I guess for a T2 you'd have to figure in your most carb sensitive times of the day too. For me that's am.. So maybe even a 8 units am and 12 units PM split would account for a more carb sensitive am.. Am I think correctly about that?

Thanks again, Subby!

[Hammer]

Originally Posted by fgummett

Why would you expect high levels of exogenous (injected) insulin to act any differently than high levels of our own endogenous insulin... surely it is made to do the same job(s)

Okay, I am trying to remember this from what the doctor told me, so I may have this wrong. He said something to the effect that artificial insulin differs from natural insulin in a number of ways. Research has shown that excess amounts of natural insulin causes coronary artery disease, whereas artificial insulin doesn't.

He said that they aren't sure why this is so, but they think that it might have to do with the binding of C-Peptides. C-Peptides are bound together in a ladder-like configuration, whereas synthetic insulin isn't. It's these bindings that they think cause coronary artery disease. The bindings are like the rungs of a ladder.

Like I said, it's been two years since I talked to him about this, so I might be remembering this all wrong. I won't see him again until December, so I'll ask him again then.

Remember, synthetic insulins are designer insulins....meaning that they are designed with or without some things that natural insulin has, in order to do certain things.

[fgummett]

Seems to me that there is an awful lot of blind faith in medical science to do a better job of insulin than nature has... I wonder how much of this is based on unbiased research and how much comes from the companies making the insulin... oh well... I'll say no more for fear of taking this thread off track.