Dropping Oral Meds And Switching To Insulin

[DaftThoughts]

I'm currently on 10u Toujeo once a day in combination with metformin and gliclazide.

My doctor increased my gliclazide dosage to cover post-meal spikes in bloodsugar after I'd started basal, but I'm having very mixed results. The gliclazide works, but sometimes it doesn't, and sometimes it works so well that I produce an excess of insulin and have to eat incredible amounts of carbs to compensate.

I'm only gaining weight and not losing despite exercising regularly and limiting my food intake where possible, and after some research I found that many people share this problem on gliclazide. I don't think I'm insulin insensitive as just a bit of basal has made a dramatic difference to my numbers, and when my own production is on point, I almost never have hypers nor hypos. So I think it's time to drop the gliclazide and start bolus, as was suggested by other members here.

Approaching my doctor about it will be interesting. She's one of the few medical professionals here who knows about LADA and caught it early on me, so I trust her judgment, but I still have underlying fears that she will disagree and encourage me to keep trying the gliclazide for longer. I need to lose weight because of back problems and this makes it a bit stressful for me.

I plan on telling her that I've met other LADAs, talked this over and considered it carefully, mention my weight gain and fluctuation problems, and ask her if I can switch over to rapid working insulin for meals instead. I have absolutely no problems with injections (high pain tolerance after a herniated disc turned out to be a blessing in disguise huh?) and feel like this will lead to better control with less surprises.

What are your experiences like with this? Should I consider requesting the half unit bolus pens because of my current insulin production and it allowing me to be more flexible?

 

[Kristin251]

I would encourage the half unit pens. Of course insulin can cause hypos too but you'd have s better idea when to expect them rather than some random squirt. I am both very carb and insulin sensative and I eat VLC small meals and bolus 1/2 unit. I can also have a few nuts or scoop of avocado in between without bolusing. I think you would have much more control after working out your ratios. Do you eat low carb?

I was on amaryl and rode the rollercoaster everyday. Then finally discovered I'm T 1 and insulin is much better. That being said, I do believe amaryl completely burned out any beta cells I had.

 

[DaftThoughts]

I would encourage the half unit pens. Of course insulin can cause hypos too but you'd have s better idea when to expect them rather than some random squirt. I am both very carb and insulin sensative and I eat VLC small meals and bolus 1/2 unit. I can also have a few nuts or scoop of avocado in between without bolusing. I think you would have much more control after working out your ratios. Do you eat low carb?

I was on amaryl and rode the rollercoaster everyday. Then finally discovered I'm T 1 and insulin is much better. That being said, I do believe amaryl completely burned out any beta cells I had.

I don't low carb for the very reason that I fall into hypos ridiculously fast, especially when I exercise. I'm already eating to match my insulin output, low carb just isn't possible with that happening. (Bike is main mode of transport, so I get about 5 hours exercise a week on average in.) I think the gliclazide may be the cause of it, as I didn't have that problem to this extent until I started basal and increased gliclazide to deal with the peaks.

Nuts also don't really affect my bg at this time, so they're my go to in between snacks and probably continue to be.

If my food budget allows it, I want to try low carbing as much as possible once I'm off the gliclazide.

Thank you so much for your input, it really strengthened my resolve more.

 

[Kristin251]

I don't low carb for the very reason that I fall into hypos ridiculously fast, especially when I exercise. I'm already eating to match my insulin output, low carb just isn't possible with that happening. (Bike is main mode of transport, so I get about 5 hours exercise a week on average in.) I think the gliclazide may be the cause of it, as I didn't have that problem to this extent until I started basal and increased gliclazide to deal with the peaks.

Nuts also don't really affect my bg at this time, so they're my go to in between snacks and probably continue to be.

If my food budget allows it, I want to try low carbing as much as possible once I'm off the gliclazide.

Thank you so much for your input, it really strengthened my resolve more.

Happy to help. I believe gliclazide is the same class of dug as amaryl. I would literally go from 100 to 45 and up to 200 within an hours time and it could happen any time of day. It was a nightmare and no control. I hated the thought of insulin but now I would fight anyone who tried to take it away. Eating LC HF is easy on insulin. It's a matter of finding meals and boluses that work. I eat basically the same macros at each meal and I know my bolus to keep me flat. I mix up proteins and fats to suit my mood but they are always 80 fat, 15 protein and 5 carb. 1/2 unit. BF is either 1/2 an avocado or a piece of deli turkey on a lettuce wrap with mustard and mayo. BF needs to be the smallest almost no carb meal as I am most IR in the morning. This holds me from 8 am until 3. Then lunch and dinner are usually lately chopped salads. Various fine,y chopped veggies like celery radish green onion purple onion and some chunks of avocado topped with various proteins and drizzled with olive oil. A few nuts or a scoop of avocado for snack. Actually I could even skip lunch if I keep bs steady I'm not hungry.

Not sure how this would work with what your doing but avocado has been a magical food for me hence eating it all day long. What it does is keep me from dropping as well as keep me from spiking. It bridges the gap between insulin getting there too soon and dropping me as other foods not getting there fast enough and the fat and fiber slow and lower any potential spike. Maybe that would at least help until you figure things out. Nothing worse than feeding low bs when you don't feel like eating.

Before I got the half unit pen I had to eat more than I could stomach to stop dropping. Now it's a perfect match to my food. It's also a great correction dose.

Hope that helps.

 

[Daibell]

I would certainly pressure your doctor to stop the Gliclazide and add a Bolus insulin. With Gliclazide it can be difficult to adjust/time the dose for the right effect. With Bolus insulin you have much better control. Basically if you need Basal insulin and Gliclazide then you are now effectively a T1 probably out of LADA honeymoon and Basal/Bolus is the standard treatment for T1 (see NICE T1 Guidelines on the web). BTW once on Basal/Bolus low-carbing will be much easier as long as you carb-count with the Bolus.

 

[DaftThoughts]

Happy to help. I believe gliclazide is the same class of dug as amaryl. I would literally go from 100 to 45 and up to 200 within an hours time and it could happen any time of day. It was a nightmare and no control. I hated the thought of insulin but now I would fight anyone who tried to take it away. Eating LC HF is easy on insulin. It's a matter of finding meals and boluses that work. I eat basically the same macros at each meal and I know my bolus to keep me flat. I mix up proteins and fats to suit my mood but they are always 80 fat, 15 protein and 5 carb. 1/2 unit. BF is either 1/2 an avocado or a piece of deli turkey on a lettuce wrap with mustard and mayo. BF needs to be the smallest almost no carb meal as I am most IR in the morning. This holds me from 8 am until 3. Then lunch and dinner are usually lately chopped salads. Various fine,y chopped veggies like celery radish green onion purple onion and some chunks of avocado topped with various proteins and drizzled with olive oil. A few nuts or a scoop of avocado for snack. Actually I could even skip lunch if I keep bs steady I'm not hungry.

Not sure how this would work with what your doing but avocado has been a magical food for me hence eating it all day long. What it does is keep me from dropping as well as keep me from spiking. It bridges the gap between insulin getting there too soon and dropping me as other foods not getting there fast enough and the fat and fiber slow and lower any potential spike. Maybe that would at least help until you figure things out. Nothing worse than feeding low bs when you don't feel like eating.

Before I got the half unit pen I had to eat more than I could stomach to stop dropping. Now it's a perfect match to my food. It's also a great correction dose.

Hope that helps.

I believe it is. I have no issues with insulin thank god, I was only weirded out at first because I'd never done injections, now they don't bother me at all. The gliclazide is giving me so much trouble that MDIs sound sooo much better than this bull I'm going through at the moment.

I've never had avocado before due to their prices, but it sounds like something I could try when they're on sale!

I would certainly pressure your doctor to stop the Gliclazide and add a Bolus insulin. With Gliclazide it can be difficult to adjust/time the dose for the right effect. With Bolus insulin you have much better control. Basically if you need Basal insulin and Gliclazide then you are now effectively a T1 probably out of LADA honeymoon and Basal/Bolus is the standard treatment for T1 (see NICE T1 Guidelines on the web). BTW once on Basal/Bolus low-carbing will be much easier as long as you carb-count with the Bolus.

I think I'm definitely still in the honeymoon phase, but I'm slowly phasing out. (And isn't LADA a form of type 1 regardless of your place in the honeymoon?) I'm looking forward to trying low carb, I already count carbs as preparation for the inevitable as I've known this was coming for 2 years now.



My doctor is calling me on Monday so I'm keeping my fingers crossed that she'll agree and get me started.

 

[Kristin251]

I believe it is. I have no issues with insulin thank god, I was only weirded out at first because I'd never done injections, now they don't bother me at all. The gliclazide is giving me so much trouble that MDIs sound sooo much better than this bull I'm going through at the moment.

I've never had avocado before due to their prices, but it sounds like something I could try when they're on sale!



I think I'm definitely still in the honeymoon phase, but I'm slowly phasing out. (And isn't LADA a form of type 1 regardless of your place in the honeymoon?) I'm looking forward to trying low carb, I already count carbs as preparation for the inevitable as I've known this was coming for 2 years now.



My doctor is calling me on Monday so I'm keeping my fingers crossed that she'll agree and get me started.

LADA is slow onset type 1. It starts with characteristics of 1 and 2 but eventually insulin is required. I am LADA and was diagnosed at 50 but should have had some insulin sooner. I don't think I had much of a honeymoon as I think the dr killed my honeymoon with amaryl. I never had any random lows after figuring out my dose to match my meals. I actually consider that fortunate. You'd never know when your pancreas was going to ranomly give you some insulin. Just using injected insulin is much easier to control. Injections don't bother me either unless of course I hit a muscle or vein. Lol.
If your dr gives you bolus insulin and you do go low carb start with low doses and work your way up as needed. Carb counting never worked for me. I always roller coastered, low then high. Low carb is much easier for me to control as I like very flat bs. Some people manage to eat carbs but I have no idea how. I tried everything. Wishing you luck with your dr

 

[Daibell]

Hi. Yes, LADA is just T1 but slow onset coming later in life. Carb counting with Bolus insulin means adjusting the dose to match the carbs in the meal you are about to have. This is often started at 1 unit of insulin to 10gm of carb.

 

[Kristin251]

Hi. Yes, LADA is just T1 but slow onset coming later in life. Carb counting with Bolus insulin means adjusting the dose to match the carbs in the meal you are about to have. This is often started at 1 unit of insulin to 10gm of carb.

Do you ear low carb or carb count? What do your bs range from? If you eat carbs, other than a few or course, how do you stop swings? I could never get my insulin there at the same time as my carbs.

 

[azure]

Do you ear low carb or carb count? What do your bs range from? If you eat carbs, other than a few or course, how do you stop swings? I could never get my insulin there at the same time as my carbs.

The timing of the bolus is key

That's something you learn from experience and careful experimentation.

 

[DaftThoughts]

I have to say that when my insulin output appears stable, I don't have any problems with carbs. I'm curious to see what my ratio will be and how sensitive I really am. I've already found out that it can take up to 4 hours for my bg to go up if I eat a lot of fiber and protein in my meals. (A neat little trick to sneak in a hamburger is by eating a big, dressingless salad before the burger, wait 15 mins, then eat the burger - I tend to have completely leveled out values when I do that because the absorption is slowed down so much.)

So bolus timing sounds like something I'll have to be careful about!

 

[Daibell]

Do you ear low carb or carb count? What do your bs range from? If you eat carbs, other than a few or course, how do you stop swings? I could never get my insulin there at the same time as my carbs.

Yes, Bolus timing is very important and I never get it right, but guessing the amount of carbs in a meal can be just that 'a guess'. Experience has guided me on both, but I'm certainly not optimal. Sometimes my BS goes into the teens as a spike after meals. I could get more obsessive about it but you need to be realistic. All I know is that carb-counting is much better than having a fixed Bolus dose.

 

[Kristin251]

I

Yes, Bolus timing is very important and I never get it right, but guessing the amount of carbs in a meal can be just that 'a guess'. Experience has guided me on both, but I'm certainly not optimal. Sometimes my BS goes into the teens as a spike after meals. I could get more obsessive about it but you need to be realistic. All I know is that carb-counting is much better than having a fixed Bolus dose.

I agree, bolus timing helps and carb counting to a degree but each macro gets there at different times and either speeds up or slows down the rest of then meal. So that all needs to be considered as well as the carbs. Insulin isn't just about the carbs. It's about the whole meal which is why I could never get my insulin there at he same speed as my meal to keep me flat. I don't like fluctuation. It messes with my emotions.

 

[azure]

If you eat a moderate amount of carbs, you don't have to worry so much about the other elements of the meal @Kristin251
Also, you can perfect the doses for your regular meals so you don't have to count each time. Eating very minimal carbs can make matching insulin to food trickier.

 

[Diakat]

Testing will be key. But you will get there, although this diabetes thing and hypos still sneak up on us sometimes.

 

[DaftThoughts]

Update: My doctor called me on Monday. I explained to her the issues I'm having with my weight and values. She told me that it's possible to switch to bolus, but that weight gain is also imminent with insulin. I agreed with her on that, but also mentioned that my 'having to eat to cover the insulin' seems to be the main culprit here, and that injecting less insulin for a meal before exercise helps weight loss much better - something I can't control with the gliclazide.

She agreed with that and is going to consult with the hospital diabetic nurse she's in contact with for a second opinion before making the call on what I can do. I'll be hearing from her either Thursday or Friday if all goes well, and then I'll see what she has to say.

I'm still 50/50 on what will come of this. I do trust my doctor but I also know that the lack of 'official guidelines' on how to treat LADA are giving her a hard time deciding what to do. Opinions vary so widely it can't be easy for her either. I'll keep this topic updated when I know more.

 

[Kristin251]

Just in my experience, I did gain my much needed weight back when 1st put on insulin but I was skin and bones. I was told to eat 20 carbs per meal and take a dose based on a sliding scale as to where my bs was at the time. After 2 months of this I could not get my bs flat so cut carbs back to my 20 a day and of course cut insulin back. The weight gain immediately stopped and stayed where I was was before I started losing. I also attribute this stall from not having to feed hypos. Since then I have kept carbs to under 20 a day, take small doses of insulin and have not gained an ounce. I don't exercise either. Insulin does not make you fat UNLESS you are 'eating to feed insulin' which is what you are doing. If you use your insulin and don't need to eat to feed hypos you should not gain weight. At least that is my experience.
The things that make me gain weight are carbs, all forms of grain, dairy and feeding hypos.

Good news they're considering it and that you have knowledgable information to throw at them.

 

[Diakat]

Just for info and I know we are all different but my weight has remained constant since starting insulin. However, I do not have your issues with back pain so I do go to the gym two to three times a week.

 

[Kristin251]

Just for info and I know we are all different but my weight has remained constant since starting insulin. However, I do not have your issues with back pain so I do go to the gym two to three times a week.

Doesn't the gym raise you? All exercise raises me now and I don't feel like playing the insulin hypo game yet though I totally miss yoga. I can take slow strolls and that's about it.

 

[Diakat]

Doesn't the gym raise you? All exercise raises me now and I don't feel like playing the insulin hypo game yet though I totally miss yoga. I can take slow strolls and that's about it.

This is where it all gets complicated. Walking, swimming and rowing lower my sugars.
Running lowers it and then I get a spike after. Similar but not as dramatic with weights.
So I try to time a meal for after the gym so I can dose insulin accordingly.
timing seems to be the key for me.
I also notice changes in sensitivity of I am active two or three days in a row rather than having a rest day in between.