Dropping Oral Meds And Switching To Insulin

[DaftThoughts]

Exercise lowers my values plenty. Too much with the gliclazide, but it raises without (less now with the basal, but still). I have a very good idea of how my body uses insulin now and I am 95% convinced that if I hit the sweet spot with the amount of insulin before a meal and exercise, I will be able to successfully lose weight without getting hypos or hypers. Right now I am gaining just because I eat more calories than I burn due to hypos (which I either catch in time or have to fix as they happen). I lose by default because I can't control insulin amounts, is my best guess. I can't explain it otherwise.

I think plenty of diabetics gain on insulin because their bodies suddenly become able to utilize the glucose in the blood. If you eat more than you use up, the insulin stores the glucose as fat. As some people are eating but unable to use the calories they consume, they are bound to gain weight after they start insulin on their former diet unless it's immediately finetuned to their caloric needs. That's my theory on why people gain, at least.

I can easily bike for 2 hours a day even with my back issues, thankfully. If I can't find alternate forms of exercise, biking it is. I'll just plan a route and use Zombies, Run! on my phone as I go lol

 

[DaftThoughts]

Doctor called this afternoon. She consulted with the diabetic nurse at the hospital, and they're both of the opinion that switching to MDI will only cause me to gain, not lose. They're recommending that for weight loss, I should get a specific (new) drug that's recently gone on the market that helps diabetics lose weight, instead. My GP cannot prescribe it for me however, only the specialist can.

I'm not sure what to think of this. I don't know what this drug is, I can make an appointment with the nurse at the hospital and get more information, but from what I understood I will stay on the gliclazide and Toujeo and add this drug to my daily or weekly regime (one shot a day or week?). I don't want to dismiss it immediately, so I told her I want to think on this and she'll call me back on Monday.

While my goal is weight loss through proper diabetes management, my main problem has been having no control over my own insulin output. I take a pill and cross my fingers hoping that it will be just enough to cover my food intake, and not too much or too little. Often I find it becomes too much, sometimes it's too little. Yesterday I overslept and had to rush out the door without breakfast or meds, and it was obvious once I got home that my own insulin production is just too low - my values had gone up again without the meds (not enough fuel reaches the muscles due to low insulin levels, so the liver releases glucose?) and being in a fasting state. I had no hypo to explain it either.

My day curves that I log for my doctor all look really good. They don't tell the whole story though, and I fear my doctor is basing this decision on the fact my diabetes appears under control from 2 days in a week that I log (when it really is wonky at best). My day curves don't show that I eat extra because I have to, they just show I managed to fix it and get the right numbers after juggling around.

This drug she mentioned is also new. Again, no info on what it is, just that it helps with weight loss. But is that really the answer when my problem is my pill makes me have too much insulin that I need to eat to cover?

The final decision is, of course, up to me. I want to say 4 injections a day, possibly with half unit pens, can be fine tuned to my food intake and exercise and keep my levels above 5.0 without having to eat 500 calories in carbs just to not drop dramatically. Therefore resulting in weight loss. I obviously don't make enough insulin to have to worry about my own production being a major factor once I drop the gliclazide because time and time again I see evidence of that in my values.

What do you guys think of this? Should I investigate this new drug further and see if it can help me? Or should I ask to be started on MDI next week, try it for the next 6 months and see if that helps me lose weight and stabilize my levels instead?

If MDI do make me gain weight over the next 6 months, I always have the option of switching to the new drug. The opposite is also true.... So I'm not 100% sure which direction to go from here.

 

[Diakat]

I think I would see the specialist and get the information. The specialist should listen to your experiences and be able to answer any questions.
At theoment you can't make arational decision because you don't have the information about the new drug.
Keep us posted. X

 

[DaftThoughts]

This is still one hell of a ride.

Summary: finally saw the specialist, they're really trying to push this new drug on me called Victoza, and after looking into it I'm vehemently against it in every single way.

I was not given a clear answer as to why this drug would be a better alternative to taking properly regulated bolus insulin (he just repeated that 'insulin turns glucose into fat' and that 'victoza regulates insulin output from the body to what the body gets in carbs', none of which really tells me anything) and I am, quite frankly, angry.

Victoza is not for type 1 treatment. I don't even qualify for it right now as I'm on basal (which the specialist said I should ditch in favor of victoza, what the hell?!) which means insurance won't cover it. There are many strict regulations for having this injection covered (have a BMI of 35+, be on oral meds that don't regulate my glucose well, not taking insulin and whatnot), which makes me feel like them trying to push it on me is part of an effort to see how people respond to it. AKA I become a guinea pig.

After all the research I've done on it, I absolutely refuse to take it. I'm not going to exhaust whatever functionality is left with something that is so new it hasn't even been patented yet. I'm not going to take a drug that is explicitly marketed for type 2 diabetes when I'm not a type 2 diabetic.

I have scheduled an appointment with my GP for coming Monday to have a serious talk about this nonsense they're putting me through. I'm not on basal and a high dose of gliclazide because I make enough insulin of my own. I want to have better control over my illness and my body. I am smart, I have educated myself, and no matter what I do I WILL eventually be fully insulin dependent and I see no valid reason for just screwing around with oral meds for any longer than I have to.

If my GP will not prescribe me insulin, I'm getting a second opinion.

 

[Diakat]

It does sound like a second opinion would be useful.
I can only share what my consultant said which is 'by the time we mess about with other drugs to get the dose right, you'll need insulin anyway so we may as well start straightaway' that made perfect sense to me and might be worth using as an argument to the GP?
Hugs.

 

[Diakat]

Just a thought, they might be offering the victoza to help with weight loss? But you would have to stop the insulin I think.

 

[DaftThoughts]

Just a thought, they might be offering the victoza to help with weight loss? But you would have to stop the insulin I think.

That is what they're trying to do, but I can also achieve weight loss if I can fine tune my insulin levels to my exercise and diet. Something I'm unable to do with the oral meds, which is my problem and the reason I reached out for this. So I don't see the point in it, plus it's a very new drug, plus the list of side-effects is not something I'm keen on, plus it's not even to be used on type 1 diabetics in the first place.

What your consultant said is exactly how I feel. It's been progressing rapidly since the beginning of the year in my own experiences and I'd rather just take the insulin and get used to it now than to go through several other drugs before we get there.

The biggest kicker for me in this process is that the specialist very casually agreed that novorapid would be the next step if I end up fully disqualified for the drug to begin with, which further reinforces the idea of being a guinea pig in all of this.

 

[Kristin251]

IMO, people gain weight on insulin from correcting hypos and chasing insulin/ bs . I eat small meals, vlc and small doses of insulin. Very rarely do I chase hypos. I have a BMI of around 18-19. When I ate carbs I constantly chased hypos only to hypo and need more insulin.

From all you've said you are smart, have researched and I believe would do well on basal bolus. Many type 1 or LADA s eat carbs and do well. I don't.

I would continue to dispute type 2 meds if you're t1. I can control bs and weight and food intake much better on insulin than when I was on amaryl. And amaryl killed my pancreas however I think that may have been easier than a honeymoon with random insulin output.

 

[Lifeissweetenough]

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?

Hello. I am a LADA and am now on a basal/ bolus regime which I find so much easier. I can eat moderate amounts of carbs throughout the day which I find gives me a much more balanced diet and mind. I'm still on metformin- and hoping to ditch this too as I feel the insulin route is a pure replacement of what my body is struggling to make. Hypos do not bother me and if they do, hey bring on a digestive!! Every cloud, eh? Good luck with convos with doc- sounds like you have a gd relationship

 

[DaftThoughts]

Hi again everybody!

It's been a rough ride, but I can finally say that I am kicking off 2017 with a full insulin treatment. Finally.

The short version: the specialist (who turned out to be an intern) told me that the Victoza was going to be covered for people who take basal insulin (and fit all the other requirements) but that it could take months before the changes would go through. I insisted on a change now because I've been dealing with irregular values that make no sense no matter what I eat for the past 6 months, and I was determined not to leave without a change in my treatment. He agreed to put me on Novorapid and gave me the prescription I needed.

He said to take 4 units with every meal. (I was not really offered any help for figuring out insulin:carb ratios, he just asked me if I knew how to inject at home aaaaaaand that was it!) I had already taken gliclazide that morning, but for lunch and dinner I took 2 units - figured I'd rather start low than jump straight into a hypo because the oral meds were still working. I dropped from 11 before my cheese croissant to 6.7 in about 2.5-3 hours. I wasn't dropping at my usual "oh no a hypo" rate so I didn't worry and made dinner. Didn't inject for dinner immediately and waited 2 hours cause I figured the bolus from before was still working, and climbed back up to 8.3. Then I injected another 2 units for a sugary pudding dessert. Ended up on an 8.2, two hours later.

So this is obviously not bad. Not ideal either, but I'll get there! I've stopped taking the gliclazide as of today and will see how many units I'll need to cover my carbs. It looks like I might have a 1:30 ratio going right now, although this might change over the next couple of days. The gliclazide might have affected my values more than I anticipated. I knew I was very insulin sensitive the moment I started with Toujeo though, so who knows?

How DO LADAs figure out their i:c ratio? Do you stick to them hardcore or do they end up being variable for you throughout the day or weeks?

 

[Kristin251]

Mine definatley vary throughout the day. Carbs are horrid for me in the morning but I am much more insulin sensitive by dinner. That applies for my proteins as well. I need triple the insulin with little to no carbs at bf as I do for dinner. Other than bf I figure one carb raise me about 7 points. Bf a million lol. Not really but I cannot eat carbs for bf nor can I fast. Not eating makes me rise even more. Recently I take a small dose with some avocado. An hour later another small dose to stop the rise and then two hours later another small dose to stop the continuous rise. After lunch all is well but mornings are a ******. If I don't get my basal right ( which is changing) the day isn't right

 

[Brihaze]

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?

As an LADA it took about 2. 1/2 years before gaining reasonable control as my pancreas was spasmodic in producing insulin My endo put me on actrapid and a basal insulin no tabs but that was 40 years back I consider myself as type 1 as there is no difference in the long run it is a good idea to get 1/2 increments for the fast acting insulins but the basals single increments is adequate as they are over assumed 24 hours

 

[DaftThoughts]

Thanks for the feedback everyone!

It's been almost 3 weeks since starting Novorapid and I'm doing super. I'm experimenting a lot to see what my body does and it's making it a lot easier to make meal decisions. Also figured out that injecting 15-20 minutes before a meal helps a ton. I'm close to a 1:15 ratio at this time which seems to work out okay for me. Most of the time I vary between values of 6-10, which is way better than what I had before. In the past 4 months I was running high most of the time, now I'm in a more acceptable range most of the time. Improvement!

I haven't adjusted my diet yet, I want to stabilize all of this first, hopefully around the 8 week mark I will be in a routine strong enough to introduce 3 days of low carb into my week. I had to up my basal from 10 to 12 units though, I guess without the gliclazide my pancreas is just chilling out now and giving me the finger for what it went through.

My biggest improvement so far is no more hypos during exercise. I'm seeing the opposite in that I get liver dumps even after I ate and injected the right amount of insulin for what I ate. Sometimes that means I spike into a hyper, but a snack and a correction dose fix it pretty fast.

So far no weight gain. I actually lost almost an inch around my waist and 1kg on the scale. I can eat less now because I don't have to deal with the crazy random lows from the gliclazide and don't have to eat to correct hypos as much.

Very happy with this progress and eager to see what happens in the next couple of weeks.