[RobW]

Hello all, I will be starting a fast acting insulin in the next few days but now i am on 1000 metformin a day as well as 20mg of glyburide. Now i would think i would be stopping the glyb. how will that effect my back ground numbers? I do 46 units of lantus and my mornings are 6.4/6.8/5.8 will that change much?
My last A1c was11.8%, i manage my diabetes with walkin clinics and the internet, i will see an Endo. but not till late March. Any advice would be a great help, it's time for a change.

[fgummett]

Hard to predict the future but I suggest you go slow... make small repeatable changes, test often and keep a detailed log

I expect that taking a fast-acting bolus with meals would negate the need for Glyburide... which I understand is supposed to stimulate your own insulin secretion but in doing so could potentially exhaust your beta cells.

How effective is your Lantus as basal control... I wonder if you have tried any basal testing? In broad terms: your BG should remain stable, within your "normal" established range, if you skip meals. A predictable basal seems to be a key to success with MDI.

Once the basal is working predictably, then you can focus on your fast-acting bolus needs around meals/snacks.

Do you have access to the book "Think Like a Pancreas" by Gary Scheiner? As I'm sure you realise your (our) needs are different than a Type 1 who has no insulin production... you clearly still do have some of your own insulin so the MDI approach is more of a "top up" to assist your own beta cells. In practical terms this may mean than you may err on the side of less injected insulin with less risk than someone who may have none of their own insulin.

Diet is important in that "feeding the insulin" is a recipe for excess fat storage... which tends to increase IR which tends to increase the need for insulin... and so on...

[RobW]

Originally Posted by fgummett

Hard to predict the future but I suggest you go slow... make small repeatable changes, test often and keep a detailed log

I expect that taking a fast-acting bolus with meals would negate the need for Glyburide... which I understand is supposed to stimulate your own insulin secretion but in doing so could potentially exhaust your beta cells.

How effective is your Lantus as basal control... I wonder if you have tried any basal testing? In broad terms: your BG should remain stable, within your "normal" established range, if you skip meals. A predictable basal seems to be a key to success with MDI.

Once the basal is working predictably, then you can focus on your fast-acting bolus needs around meals/snacks.

Do you have access to the book "Think Like a Pancreas" by Gary Scheiner? As I'm sure you realise your (our) needs are different than a Type 1 who has no insulin production... you clearly still do have some of your own insulin so the MDI approach is more of a "top up" to assist your own beta cells. In practical terms this may mean than you may err on the side of less injected insulin with less risk than someone who may have none of their own insulin.

Diet is important in that "feeding the insulin" is a recipe for excess fat storage... which tends to increase IR which tends to increase the need for insulin... and so on...

Thanks for your fast response - I have so much to learn.
The 46 units of lantus i take each day has my numbers down to 6 ish in the morning,today i did 6 units of aprida and cut glyb. in half i will see how that gose for a week, thanks again
Rob

[Jonathan_R]

Originally Posted by RobW

Hello all, I will be starting a fast acting insulin in the next few days but now i am on 1000 metformin a day as well as 20mg of glyburide. Now i would think i would be stopping the glyb. how will that effect my back ground numbers? I do 46 units of lantus and my mornings are 6.4/6.8/5.8 will that change much?
My last A1c was11.8%, i manage my diabetes with walkin clinics and the internet, i will see an Endo. but not till late March. Any advice would be a great help, it's time for a change.

As others have said, take it slow. Journal everything. I have a spreadsheet if your interested.

I tracked everything from BG, to amount of liquid I drank, to what I ate and their nutritional values (calories, fat, protein, fiber, net carbs, total carbs), mood, diabetic meds, non-diabetic meds, exercise, location of injection, blood pressure and pulse.

Also be ready with snacks, in-case you drop suddenly.