possible change ahead with medication..some ideas needed

[Finsky]

Ok...I have finally got appointment to see diabetic nurse for 'training' with new medicine. Couple weeks ago doctor recommended me to start with GLP-1 once a week medication with instant 50% reduction with insulin intake.
Ok..I get it so far...but I have already managed to reduce my slow acting (Lantus) from 40 units to 34 and taking short acting no more than 10 units a day when being good girl and not eating many carbs I also take metformin and Linagliptin.
I've have read bits and pieces about this type of medicine though not all is quite sunk in yet. But now I have some doubt about it all. To start with, doctor didn't really listen about my dietary changes and didn't really look my recent blood sugar readings..he just kept on about my old HbA1 figures that admittedly were high, but they won't correspond with what has been going on with me last 6 weeks.
Since I have been on LCHF diet..'numbers' have absolutely crashed down
I'm now wondering...is this new type of medication better for me than insulin, is it 'healthier'? I was told their side effect making you possibly feel sick for few weeks..'but it will pass away'... Is there any other obvious side effects/health scares I should be aware of? I did asked but the 'dear' doctor assure me there wasn't. For some reason I didn't feel like trusting that opinion.
As far as I have found on net, NHS only have 2 different 'once a weekly' injectables...of course the doctor failed to tell me what he has prescribed me.
I also wonder.....as this kind of medication is affecting one's food absorbtion, "slowing it down" (or so I was told), would that have issue with my eating regime that 'is not what NHS recommend' ? I was also told that as the food is absorbed slower, I won't feel so hungry and should loose some weight. Doctor didn't listen when I said..."I don't feel hungry and have cravings"..as for the loosing weight, well yeah, of course little would be nice but do I really need to take another medicine to achieve it. He was on about my BMI...well, yes I could loose about 5 kg and I would be happy with that...but I ain't gonna be skinny girl! I've got some muscles and good frame work to carry (should have stripped off front of him to show that I'm not that big under all my baggy winter clothes)
I just feel like I need to know more, so when I go and see nurse and question her, I know something about it already and they are not able to 'feed' me with info that is as 'good' as their eating plans
Anything you can think of that I should ask or point out to the nurse would be good too

 

[himtoo]

i would take your fully up to date and completed daily diary with all your BG readings , a listing of all your food intake , your reduction in insulin doses

and maybee..... she will listen and put the brakes on following through with the new med.

 

[Finsky]

i would take your fully up to date and completed daily diary with all your BG readings , a listing of all your food intake , your reduction in insulin doses

and maybee..... she will listen and put the brakes on following through with the new med.

Thank you...yes, I will have print out of my meter readings, and I have kept full diary of anything and everything I've done and eaten.
As for the brakes...that will be my totally my decision and that's why I'm after some advance info so I can judge nurses opinions little better. I do have better opinion of our diabetic nurses than doctors...so far they have been more open and honest with me...BUT, they do tend to carry on the same 'by the book' jargon that whole NHS does.
The 'selling point' for this new injection, 'once a week' does sound tempting..but there is too many 'buts'. Is this medication 'flexible'..if my sugars go too much down...do I have to start eating for the medication? Is it better for my body than insulin? I don't seem to find any answers, just basic 'leaflet' info.

 

[himtoo]

I suppose I can only recount my own experience ( and I am not sure if that will help or hinder..)

I was diagnosed with Type 1 in 1972 and placed on 1 injection per day that was made up by mixing 2 insulins into 1 syringe and injected at the ( pretty much ) exact same time every morning ( 7am) . this regime carried on for about 9 years until at one appt with my endocrinologist he just announced I was going to be put on 2 injections per day of a pre-mixed insulin.

now i am sure i was not the first person to be changed to this new regime but at the time it made me actually sick because it was like my whole life was being disrupted yet again.

another similar episode when changed from animal to synthetic insulins in the very early 1990's.

ok -- so repeat that when I was switched on to multiple daily injections in 1997 ( that was scary because so much more freedom was given but no education really to speak of ( education courses didn't come for a few years after)

move forward to 5 months ago and i went on a pump and I truly had to teach myself all over again because a pump behaves quite differently to injections. and there is nothing like the lonliness of being told by the DSN that if I had a problem on a saturday night that first weekend on the pump I was pretty much on my own because nobody in A&E would have any knowledge on what to do If I went DKA ( really high bloods and ketoacidosis) -- so they give you a page of written instructions.
I cried a fair few tears that first few days on the pump because it took me back to how i felt all those 43 years ago all over again.

i am sure by now you have figured out there is a pattern and I can't answer what you should do - your attitude to change , and to risk , your routine , and lifestyle will all play their part in coming to a decision.

I am sorry if this has not helped but I hope it has

all the best !!

 

[BooJewels]

@Finsky I'm going to reply to this properly later as I have some ideas but I need time to find a couple of links I want to post and I don't have time just at the moment. But for what it's worth I can fully relate to all that @himtoo says as well - each time you change it's like starting afresh and I find it quite challenging too.

I will ask one thing first though - why the proposed change - does what you're currently doing not suit you any more? Is it just because you've improved so much on a lower carb routine?

 

[kesun]

@Finsky I would look up both the possible injections and see what the "indications" for use are; then I would compare them with your current HbA1c and meter readings. It's quite possible that with lower readings and a downward BG trend (i.e. an upward trend in control) you don't need the jabs - though you may well need to keep decreasing the insulin you take. If you don't fit the criteria any more it would be helpful to print them out to take to the nurse and show why.

Kate

 

[Finsky]

@himtoo

[COLOR=rgb(0, 0, 0)]I will ask one thing first though - why the proposed change - does what you're currently doing not suit you any more? Is it just because you've improved so much on a lower carb routine?[/COLOR]

[COLOR=rgb(0, 0, 0)]The reason...according the doctor...change is needed because .."as 'they' on the medical profession have failed to adequately reduce my HbA1 level with medication and it has been like that looong time.." with the additional note.."it is not my fault ..it is them.."
And without listening my recent developments when I tried to explain my newly found eating habits...he carried on telling me about this 'wonder drug' and how it would benefit me. Last appointment felt like it was more about him and his excellence..
When he was having a breath between his talk...I managed to get word in and mentioned that my blood sugars were on downward trend and how I've achieved it, his reaction was "why do you do that...you should not need to do that ...and on and on he carried on talking....
It is not that the current medication is not working...it is and now that I have FINALLY been given right tools with low carb eating regime...(no thanks for NHS)...my blood sugars are getting better.
I can fully relate what [COLOR=rgb(0, 0, 0)]@himtoo [/COLOR]has gone through with medication changes. I was eventually referred to 'type 1 course' (even though I'm type 2) as they found it might be beneficial for me for taking insulin....but never ever it was about cutting carbs...and heaven forbid if you dared to mention fats in positive light! But enough of that....[/COLOR]
[COLOR=rgb(0, 0, 0)]
What I have managed to found out about of this new medication and reading some stuff from here...thing that would benefit my case is not because the achieved better blood sugar levels ...but the 'once a week' aspect.
I'm already achieving right sugar levels and since I started my new LIFE STYLE 6-7 weeks ago (ahem!)...I've had [B]only[/B] 5 higher readings while testing myself 4-5 times a day (though not higher than 10)..and I know what triggered those and I could have avoided them too by using my brains bit better (at least I am learning).
And they can't sell it for me because it would 'help me to loose weight' through it being appetite 'reducer'. I have lost 1lb a week last 5 weeks and not being hungry for a moment! That is quite achievement for me...weight has never dropped off from me so easily! It is not literally dropping off neither but is slooooowly reducing and if I could get another 5kg off, in my opinion that would be ideal level for me. I'm not in denial and seeing myself thinner as I am, but VERY aware that the BMI doctor was quoting is not correct for me. He did questioned my height and if I'm sure it is right when he was doing his calculations ...and he said that even though I don't fit in to NICE qualifying category for this new medication..he can still prescribe it to me for it being 'just right king of medicine for me'..."he rather prescribe it for me now than wait few years along line and wait until I have gained enough BMI numbers to fit the bill..." Like I'm going to let myself go that direction....! NEVER been that big that I would fit the NICE recommended criteria for this medication!
Ok...now I'm building up my rant levels....
So there....I nearly managed to type 'the story of my life so far'.....and in the process of doing so...I think I've more and less managed to convince myself that this medication is not for me....
I will still go and see the nurse and hear what she has to say..[/COLOR]

 

[BooJewels]

You've obviously removed your post about the previous post colour, but it seems to be that all the text is a clickable link - it seems the text is wrapped in 'user' tags which make it link to your profile.

I'm at a proper keyboard now, so it's easier to type. Thank you for explaining, it does preclude some of what I was thinking.

I am however of the school of thought that if something ain't broke, don't fix it. If insulin is working for you and isn't causing any specific problems, why change it? Sounds like it might be for the sake of it or to just fit the doc's personal preferences - doesn't sound as though there is a pressing clinical reason for it.

You're on two insulins, a background and rapid acting, so you have lots of potential to tweak your doses as your numbers improve, as you already have, as you're still on quite a decent Lantus dose, so there's capacity to reduce it further. I spent the last year on two different mixed insulins (not at the same time, progressed from one to a different one), which worked very well at getting me back under control, but their lack of flexibility and 'best guess' nature meant they weren't as good for long term management when your numbers are decent. But it all went awry a few weeks ago, so it was time for me to make a change and I've not fully completed that yet.

I came off the insulin for a week to get stabilised as I was rebounding low to high quite dramatically, so I needed to reset my numbers and start over. At that time we (with DN and with my husband) had much discussion about how to move forwards and I was of the view that as I'd done well on insulin and felt significantly better on it (i.e. no side effects and it actually works), compared to meds that weren't working anyway, so I'd rather stick with it. The DN suggested various options I could consider, but the thought of going onto either newer meds (Forxiga she suggested) or the type of injectables I assume you're talking about (Victoza?) - all of which had the potential for new side effects - to which I am very prone.

My own view was to stick with what I knew worked for me, I felt well on and also gave me some personal flexibility to manage in accordance with my own monitoring and diet. Luckily my DN agreed and was the path she'd already thought for herself was probably best for me. I'd personally rather inject 10 times a day and feel well and be able to manage my BG with flexibility, than inject once a week and feel poorly and only have one chance a week to manage my dose - if at all. But that's my personal preference and my thinking to remain on insulin. I'd totally lost control on meds, they just didn't work, even at maximum doses, yet I can manage well on a modest insulin dose (currently 8u Lantus and 6u NovoRapid, but that will increase, we're not fully titrated yet).

I'm currently on a regimen called 'Basal Plus' which seems to work well for T2s in my circumstances. In quick and dirty terms, you have a basal and set it at a level to ensure your FBG is at your target number and then add a bolus to the meal where you have what they call the 'widest post prandial excursion' - i.e. your highest spike - mine's my evening meal. You set that bolus to ensure that you stay under your target for that meal. I'm pretty settled with this regimen to a range between about 6 and 10 all day at the moment - I'd like to get that to between 5.5 and under 9 - I'll do my next weekly dose tweak tonight, so should be a bit better next week.

So you need to find a routine and treatment that works for you. I would be equally uncomfortable in feeling potentially bullied into a new med and all that potentially entails. I think you need to perhaps listen to what they suggest initially and their reasons, but then stand your ground if you don't think it will suit you. It sounds like you've already got a good handle on what works for you diet-wise - and as you say, you've not been doing it that long yet, so stand to improve yet more.

Keep us posted.

 

[Finsky]

... Thank you for explaining, it does preclude some of what I was thinking.
I am however of the school of thought that if something ain't broke, don't fix it. If insulin is working for you and isn't causing any specific problems, why change it? Sounds like it might be for the sake of it or to just fit the doc's personal preferences - doesn't sound as though there is a pressing clinical reason for it...
Keep us posted.

Oh boy!...am I happy to read your reply...you have got it exactly what I'm thinking and feeling.
I just couldn't quite put in words all the 'if's and but's' that keep bothering me.
I'm just scribbling some notes down so I don't forget to ask them from the nurse...
I tend to react negatively many medications too so anything new always causes another set of issues.
Yes, it is that flexibility that is so important to me. Just like this morning...I'm having little hypo...but I know what caused, what to do and how much to eat and what not to take, another insulin lowering doze ahead with Lantus ahead and what's best...I can also NOT take short acting insulin as it doesn't necessary raise my sugars over normal level in a hurry when low carb'ing otherwise..
My appointment is not for another few weeks yet...so it will give me plenty of time to build up evidence for my 'defence'.