Januvia and type 1

[Deleted member 527103]

... it's time to start considering bolus to cover the spikes I get after meals and to make things more comfortable for me. I knew that it was only a matter of time but I feel like I'm letting myself down.

Why do you feel you are letting yourself down?
Type 1 is an autoimmune condition that you have no control of. The cells that are producing insulin are dying and there is little you can do to prolong their lives.
Please please please do not feel you are letting yourself down.

Taking two different types of insulin and having to carb count may sound intimidating at the moment but it is something that most of us with Type 1 get used to and after some time just take in our stride as part of daily life. And that life should not have to be restricted because of it - there are famous actors and musicians and athletes and even politicians who have Type 1 diabetes and have very successful careers.

 

[Jantype1]

Why do you feel you are letting yourself down?

I know it's irrational . I haven't yet come to terms with being type 1 at 67 years old, fit and healthy albeit a little overweight.
But you are right, people do lead full lives with diabetes and I will!

 

[Becca]

Hello Jan, I hope you're getting used to the highs and lows of Type 1: it's a shock to the system but it can be lived with.

I wanted to ask here about Januvia and Metformin as supplements for Type 1 diabetics. I've been Type 1 for 15 years: 1st 10 very well controlled. The past 5 have gotten increasingly difficult to manage. I think because of my age (46) I might be perimenopausal and thus my hormones are making everything wonky. I tried to talk to the consultant at the hospital about trying other medication to increase insulin sensitivity because I seem to be very resistant. They completely refused to listen to me and just told me to exercise (I do!) and take more and more insulin. My ratios were huge and I was piling on weight.

Has anyone here been prescribed metformin for insulin resistance in Type 1? I really need to find a way out of this vicious cycle.

 

[Antje77]

Has anyone here been prescribed metformin for insulin resistance in Type 1?

I asked to try it to see if it would make a difference. My endo didn't expect it to be helpful but was happy to let me try, so I've been on 1000 mg for about 7 months.
It didn't seem to do very much in my case so I stopped again.

 

[Becca]

That's so interesting, Antje77. My contact with my local diabetes clinic has been pretty fitful due to covid and then a human error which left me off the system for 2 years (!!). I asked my GP about it and he deferred to the consultants, but when I finally saw one they totally ruled it out. Exercise and more insulin, they said. The problem being that I was already super-active and there was no pattern to how exercise would affect blood glucose. More often than not it skyrocketed I would like to try it because I'm at the end of my tether...

 

[Jantype1]

Hello Jan, I hope you're getting used to the highs and lows of Type 1: it's a shock to the system but it can be lived with.

I wanted to ask here about Januvia and Metformin as supplements for Type 1 diabetics. I've been Type 1 for 15 years: 1st 10 very well controlled. The past 5 have gotten increasingly difficult to manage. I think because of my age (46) I might be perimenopausal and thus my hormones are making everything wonky. I tried to talk to the consultant at the hospital about trying other medication to increase insulin sensitivity because I seem to be very resistant. They completely refused to listen to me and just told me to exercise (I do!) and take more and more insulin. My ratios were huge and I was piling on weight.

Has anyone here been prescribed metformin for insulin resistance in Type 1? I really need to find a way out of this vicious cycle.

Hi Becca, Here in France they don't normally prescribe Metformin for type 1 diabetes. I was given it when they presumed that I was type 2 but it really didn't agree with me.
Januvia seems to be doing some good - some of the time. I still have a lot of highs, then lows, but my average glucose readings are much better. I just wish that I could find something to keep me stable; I fully understand how you feel! I find that the slightest change in my routine will increase my readings despite no change in my diet. I tend to adjust my insulin accordingly and not really abide by the rules the endo laid down. For example if I'm playing tennis I'll do 6 or 8 units over two days, so before and after my game. This will be followed by a couple of days when my readings will go high so I up my insulin to 10/12 units. Then I get hypos and feel so hungry so I have to reduce again....Luckily my weight is stable but my insulin production is so erratic I immediately regret having a slice of toast - hyper, or forgetting my teatime snack - hypo!

 

[Jantype1]

That's so interesting, Antje77. My contact with my local diabetes clinic has been pretty fitful due to covid and then a human error which left me off the system for 2 years (!!). I asked my GP about it and he deferred to the consultants, but when I finally saw one they totally ruled it out. Exercise and more insulin, they said. The problem being that I was already super-active and there was no pattern to how exercise would affect blood glucose. More often than not it skyrocketed I would like to try it because I'm at the end of my tether...

I find that if I play tennis the adrenaline pushes my glucose up, but the following day I get reactive hypos.
If I go for a long walk without having a snach I'll have a hypo!
But recently whilst playing tennis I had a hypo and had to stop as despite having sugar and waiting 10 minutes as soon as I started playing again my reading dropped even lower. So it can go either way and that is not really being helped by Januvia. Sorry not to be more positive. Are you on basal and bolus?

 

[Jantype1]

The time has come!
Beginning bolus today. Lyumjev 4 units 15 minutes before meals. Abasaglar 11 units each morning.
I am feeling a little scared as I've been getting a lot of hypos lately.

 

[Antje77]

The time has come!
Beginning bolus today. Lyumjev 4 units 15 minutes before meals. Abasaglar 11 units each morning.
I am feeling a little scared as I've been getting a lot of hypos lately.

Let us know how you get on, and always keep your glucose meter and some quick acting glucose at hand!

 

[Jantype1]

Let us know how you get on, and always keep your glucose meter and some quick acting glucose at hand!

Thanks! I did and I needed that sugar !!! After a lunch of burger, veggies with half a bun and some ketchup, a lactose free yoghurt, and a latte my glucose level went DOWN instead of going up! It continued going down (arrow pointing down in an almost straight line) until it got to the level when I know I have to act (everyone has their own low sugar limit, mine is 0.80mg - 4.4mmol)
So two lumps of sugar and a biscuit later I felt better but a bit annoyed as I just cannot see the point of taking insulin then topping up with extra carbs!
The same thing happened in the evening after some cauliflower cheese, cornbread, and ham, so I drank a glass of fruit juice and was ok for the night, thank heavens.
Breakfast time ditto. So I have just eaten half a banana and it's leveled off.
I guess it's going to be like this until my body gets used to it but it is making me wonder!!!

 

[Antje77]

I just cannot see the point of taking insulin then topping up with extra carbs!

I guess it's going to be like this until my body gets used to it but it is making me wonder!!!

There is no point in takig insulin if you consistently need to top up with extra carbs.
If you go low after insulin and eating, you haven't found the correct dose for you yet.

The abasaglar is meant to keep you stable when you're not eating, the Lyumjev is to deal with your food and to correct unexpected highs.
The amount of insulin people need varies a lot from person to person, so the only way to find out the correct dose is trial and error. It's not a matter of your body getting used to it, it's a matter of finding the correct dose for your meals.

At the moment, you are on fixed doses. As long as this doesn't change, you'll need a more or less fixed amount of carbs to go with the fixed doses of insulin. Up to you (and possibly your diabetes nurse) to work out how many carbs you need for your 4 units of Lyumjev.

The meals you chose so far obviously didn't have enough carbs for the insulin you took.
Are you already having a go with working out the amount of carbs in your food? This is a very good start to work towards adjusting your insulin to what you eat, instead of the other way around.

For now, I'd see if you can urgently (today if possible) contact your diabetes nurse to discuss lowering your doses.

Good luck, and well handled with the dropping BG!

 

[Jantype1]

There is no point in takig insulin if you consistently need to top up with extra carbs.
If you go low after insulin and eating, you haven't found the correct dose for you yet.

The abasaglar is meant to keep you stable when you're not eating, the Lyumjev is to deal with your food and to correct unexpected highs.
The amount of insulin people need varies a lot from person to person, so the only way to find out the correct dose is trial and error. It's not a matter of your body getting used to it, it's a matter of finding the correct dose for your meals.

At the moment, you are on fixed doses. As long as this doesn't change, you'll need a more or less fixed amount of carbs to go with the fixed doses of insulin. Up to you (and possibly your diabetes nurse) to work out how many carbs you need for your 4 units of Lyumjev.

The meals you chose so far obviously didn't have enough carbs for the insulin you took.
Are you already having a go with working out the amount of carbs in your food? This is a very good start to work towards adjusting your insulin to what you eat, instead of the other way around.

For now, I'd see if you can urgently (today if possible) contact your diabetes nurse to discuss lowering your doses.

Good luck, and well handled with the dropping BG!

Thank you so much for taking the time. I am waiting to hear from the doctor now as I already contacted them. Yes I can count up my carbs but I guess I'm not doing it properly yet. Trial and error !

 

[Antje77]

Thank you so much for taking the time. I am waiting to hear from the doctor now as I already contacted them. Yes I can count up my carbs but I guess I'm not doing it properly yet. Trial and error !

Glad to hear you'll speak to someone today!

What about counting the carbs for your meals, and logging them together with your before and after BG numbers, plus the insulin dose you took with it?
That way you'll be able to find patterns which will help you and your HCP work out your insulin to carbs ratios.

Don't be surprised if you find out the ratio isn't the same during the day. Best to compare breakfast with breakfast, lunch with lunch, and dinner with dinner. It takes some work, but it will be a great help in getting a handle on your diabetes!

 

[Jantype1]

Glad to hear you'll speak to someone today!

What about counting the carbs for your meals, and logging them together with your before and after BG numbers, plus the insulin dose you took with it?
That way you'll be able to find patterns which will help you and your HCP work out your insulin to carbs ratios.

Don't be surprised if you find out the ratio isn't the same during the day. Best to compare breakfast with breakfast, lunch with lunch, and dinner with dinner. It takes some work, but it will be a great help in getting a handle on your diabetes!

Yes! It's beginning to make sense. I really will write it all down and look for pattern. I have reduced to 3 units - still waiting to hear from the hospital but I had to do something to avoid provoking those nocturnal hypos. Hopefully things will be better tomorrow!

 

[Finnlee]

What about counting the carbs for your meals, and logging them together with your before and after BG numbers, plus the insulin dose you took with it?
That way you'll be able to find patterns which will help you and your HCP work out your insulin to carbs ratios.

This is a great idea. I did this before I was taught to carb count and have one piece of advice to add to Antje's:
Keep your list itemised (xx food, ## carbs; xx food, ## carbs) rather than just a total. The person teaching you might spot some foods have different effects on you or that you're counting carbs in a way different than they want.

I wish I'd done that rather than just go with the math completed.

I including carbs from veg in my math before my training and was then told to not count carbs. I didn't realise the significant difference the veg carbs would make (I'm vegetarian) and applied the 'with veg' ratio I'd come up with before training to the 'without veg' carb counting as instructed. I went very low my first day carb counting, then realised the mistake and redid my math. Of course, then I realised that because of the quantity of veg I eat, I do need to count the veg carbs, so I redid my math again and it was much better.

My diabetes team agreed with my findings when I mentioned it at my next appointment and they said that everyone responds to carbs differently – the important things is that I found what works for me, not that I'm following their instructions without question.

 

[Jantype1]

I am doing a detailed list of everything that I eat at the moment as I already noticed that some carbs cause bigger spikes ie anything made with refined white flour! I also drink a lot of milky coffee and am careful to include the carbs from the milk.
I do eat a lot of veg too so I am careful to count the carbs there. I noticed that veggie carbs don't usually lead to spikes - unless I have a portion of french fries, so I tend to full up my plate with veggies, maybe 70% and the rest is carbs and protein in equal parts.
I've been injecting three units before meals since yesterday and it's going much better. Although I did have a hypo during the night but it righted itself so it may have been a glitch with my monitor.

 

[Antje77]

Way to go @Jantype1 , this sounds like you're on a flying start to understanding what you're doing and owning your diabetes!

 

[Jantype1]

Way to go @Jantype1 , this sounds like you're on a flying start to understanding what you're doing and owning your diabetes!

Thanks to this group!!

 

[Antje77]

Thanks to this group!!

We can only share what we think, and what works for us.

You went from here:

So two lumps of sugar and a biscuit later I felt better but a bit annoyed as I just cannot see the point of taking insulin then topping up with extra carbs!
The same thing happened in the evening after some cauliflower cheese, cornbread, and ham, so I drank a glass of fruit juice and was ok for the night, thank heavens.
Breakfast time ditto. So I have just eaten half a banana and it's leveled off.
I guess it's going to be like this until my body gets used to it but it is making me wonder!!!

to here:

Yes! It's beginning to make sense. I really will write it all down and look for pattern. I have reduced to 3 units - still waiting to hear from the hospital but I had to do something to avoid provoking those nocturnal hypos. Hopefully things will be better tomorrow!

in a matter of hours!

I think this is the quickest I saw anyone go from passively following a static prescription to deciding that diabetes decisions are your own in the first place, immediately followed by actively working on finding out all the patterns to be able to make better decisions in the future.

That's all your own doing!