Info

[nuovo1]

Hello, good morning. I would like to explain the health problem I am experiencing.

Three years ago, I was diagnosed with type 2 diabetes, with morning values of 170 and after eating approximately 220. I was then prescribed 750 mg of Metformin three times a day, which worked for a while.

After about two years, it stopped working, and now every morning I find myself at 220 on an empty stomach.

I changed doctors, and he prescribed Metformin and Semaglutide once a day, but nothing works; it doesn't go below 200, and I noticed that it was causing me pain in my legs and teeth, which were always inflamed and had tartar, which was awful, as was my breath.

Now I'm taking 14 units of insulin once in the morning, and I'd like to ask you a question about the medication.
Tresiba

Do you find that in the first three days your blood sugar rises quite a bit and then drops? And after three days, should I increase the dose by two? Is it normal for it to work like this? How long does it take to take effect?

I think it is causing me problems with my triglycerides at 1000, but I think diabetes is the problem or vice versa.

I don't have a very active lifestyle, and I eat a little poorly.

I weigh 94kg and am 1.80m tall.


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[Mark Rawlinson]

you are best to ask your Dr or nurse re the medications
exerzis whatever kind will help a lot though even if it just a walk for half hour
try your nest to improve your food choices it will be amazing the slight differences make

 

[grantg]

tresbia is designed to work as a long lasting insulin which lasts over 24 hours single injection basal.

Tresiba® (insulin degludec) injection 100 U/mL, 200 U/mL Product Profile

Once-daily Tresiba® (insulin degludec) may be the right option for your patients over 1 year of age starting on or switching to basal insulin. Read Important Safety & Prescribing Info.

www.novomedlink.com

gives some info on it.

the purpose of basal is generally to try keep the glucose levels stable at a fasting state. it might be that fast acting may also be required such as novarapid/fiasp. possibly even a mix such as humalin will be worth discussing that with your DSN/endo.


different counties use various measurement methods. Triglycerides in uk unit of measurement usually mmol/l

below is taken from mydiabetesmyway (uk) had 63.2 mmol/l when diagnosed which steadily improved.

Triglycerides are usually part of a lipid profile used to identify the risk of developing heart disease. Triglycerides increase significantly when blood sugar is poorly controlled and will also increase after a fatty meal, so must be interpreted in context. They are a useful part of an overall 'lipid profile'.
Triglyceride levels should be less than 1.7 mmol/l after fasting from night before.

 

[nuovo1]

I eat whole-wheat pasta, whole-wheat bread, sugar-free mayonnaise, and lean meat. On Saturdays, a pizza with chips. Are you coming to see? Morning, milk, cereal. The absurd thing is that triglycerides at 1000 aren't high? Is there a supplement to lower them? So, couldn't using two insulins be risky?

 

[grantg]

What is the unit of measurement that was used? mg/dL?

The following link maybe useful.

The Diagnosis and Treatment of Hypertriglyceridemia - PMC

Hypertriglyceridemia affects 15–20% of the adult population and is associated with overweight, metabolic syndrome, and diabetes mellitus. It is often discovered incidentally. This review is based on pertinent publications retrieved by a selective ...

pmc.ncbi.nlm.nih.gov

With regards to the query if using 2 insulins is risky regardless of type of diabetes some people need basal)bolus regime. Different insulin to carb ratios can be used.

I note you've said about wholewheat pasta although a complex carbs body will take longer time digest those. All carbs are converted to glucose. Some people can handle various forms better than others some have to avoid certain types altogether. Other people can produce enough insulin to cover upto a certain unique amount which is entirely unique to that person.

There are no one solution that fits all.

Purpose of basal insulin is to try keep blood glucose levels as flat as possible in a fasting state. Purpose of bolus to deal with meals as faster acting.

Forum rules only allow us to speak from personal experience.. experience has shown me that when glucose levels start to be controlled lipid profile results can also improve. If there is inflammation of pancreas it will not be working as well as it otherwise could be.

 

[grantg]

Other thing forgot to mention earlier pizza is generally very high in carbs. Potatoes also fairly high in carbs. Maybe look into a more keto style of pizza base if pizza is something you really enjoy. the same pizza dough if made into a 6 inch pizza same thickness as 12 inch, the 6inch would have significantly less carbs. portion control likely a good idea.

regards breakfast cereals, usally at least in the UK in general have suggested portion sizes.

a couple of examples

wheatabix per 100g contains 69g of carbs. the suggested portion size is 2 bisctuits (37.5g) which would be 26g carbs per portion. all carbs convert to glucose. so if you ate 2 wheatbix it would be hugely different than if ate 4 or indeed 3 or 1.

rice crispies per 100g 86g carbs. suggested portion size 30g (which isnt a lot and hard to judge without weighing) would contain 26g carbs.. a smaller bowl would result in less carbs than a larger bowl.

have no idea which country your from, net carbs is something to watch out for. uk removes fibre already, whereas usa doesnt so carbs-fibre if usa.

here is a link for some ideas for lower carb breakfast alternatives:

50 Genius Low-Carb Breakfasts That Are So Good, You Won't Miss The Carbs

You won't be missing toast when you've got these low carb breakfasts!

www.delish.com

another fairly useful recourse: https://www.bbcgoodfood.com/recipes/collection/ketogenic-diet-recipes for other meals.

have a good browse through the success stories section of this forum. https://www.diabetes.co.uk/forum/category/success-stories-and-testimonials.43/

I'd be looking into possibly reducing your carb intake somewhat in slow and steady stages. its a marathon not a sprint. slow and steady wins the race

it could well prove very useful to ask for a referal to a diabetic dietician if at all possible.

best wishes.

 

[nuovo1]

I'm from Italy and I didn't know you had to look at carbs. I usually look at fats. Thanks for the advice. From now on, I'll check my carbs. And believe me, this triglyceride level at 1000 is a bit scary. One thing I've noticed is that if I take insulin in the morning, I feel rumblings in my stomach in the evening. Is this normal? And if you measure my blood sugar, I see that after this feeling, it goes down.

 

[Rokaab]

Do you find that in the first three days your blood sugar rises quite a bit and then drops? And after three days, should I increase the dose by two? Is it normal for it to work like this? How long does it take to take effect?

Do note that with Tresiba, it is definitely one of the longer lasting insulins and it can take a couple of days after a change in dosage to take effect, so if you are changing the dosage of it, you'll need to be patient to see any results (I used to be on Tresiba before I got my pump, so have seen this)

 

[KennyA]

I'm from Italy and I didn't know you had to look at carbs. I usually look at fats. Thanks for the advice. From now on, I'll check my carbs. And believe me, this triglyceride level at 1000 is a bit scary. One thing I've noticed is that if I take insulin in the morning, I feel rumblings in my stomach in the evening. Is this normal? And if you measure my blood sugar, I see that after this feeling, it goes down.

Hi and welcome. I'm a T2 and have maintained normal blood glucose levels for over five years now solely through diet. I eat all sorts of meat and dairy, above ground (usually green) vegetables, and limited amounts of peas and beans, which I've found I can tolerate. I don't eat cereals, bread, pasta, rice, pastry, potatoes, fruit, anything sugary, or beer in any quantity.

Fats in the diet are not converted to glucose - while your body can convert your own stored bodyfat and use it for energy. Carbohydrates in the diet - the starches and sugars - are all converted to glucose and are the biggest single influence on blood glucose levels (Bilous and Donnelly, Handbook of Diabetes).

My experience is that carbs are carbs - whether they come as whole-grain or whatever has no measurable difference. They will all cause a rise in blood glucose, and if our insulin responses aren't sufficient to deal with the excess, glucose levels will stay elevated for a longer time - which can cause physical damage.

As you're on insulin you would need to balance any reduction in carbohydrate intake with your insulin regime, and we always recommend that you do this in discussion with your medical team.

 

[nuovo1]

but is it worth replacing insulin with Metformin 1000 mg per day?

 

[KennyA]

but is it worth replacing insulin with Metformin 1000 mg per day?

I can't answer that - I have no personal experience of either medication, and this forum does not allow anyone to advise on medication levels directly. Insulin and metformin are completely different medications. You would need to get your own medical advice about it.

 

[grantg]

triglyceride level at 1000 is a bit scary. One thing I've noticed is that if I take insulin in the morning, I feel rumblings in my stomach in the evening. Is this normal? And if you measure my blood sugar, I see that after this feeling, it goes down.

for your country they tend to use mg/dL 1000 would indeed be considered high. to help perhaps put into context my measured 63.2 mmol/L i would of had 5597.6 mg/dL upon diagnosis on diabetes. your 1000mg/dL is equivilent to 11.29 mol/L something that you should ask when tested again, "should you be being getting the said lipid profile test on a fasted state." for the uk it is fairly common to be tested on fasting state (around 8+ hours no food with only water) 1.7mmol/l which would be 150mg/dL is considered upper end of the 'normal range'

I really would strongly recremend asking for referal for dietician specalising in the field of diabetes. usually for uk at least they have various education programs for people with diabetes. prob worth asking about being placed on a structured education program should one exist (a quick google search turns up with turin/romeo being the 2 most popular no experience with either) have experience with dafne (a uk course designed for type1) there are also courses for type2 in the uk as well very vaguely recall parts of that. course is different usually if on insulin than without. carbs will make a difference, dont cut out too much at one go small steady changes to see on the effects whilst having medical input is likely the best way forward.

find enclosed a link to research. https://www.cuh.nhs.uk/patient-information/dietary-advice-for-management-of-high-triglycerides/ usually with better glucose management (for those with diabetes) the levels of triglycerides will usually get much much better.

My mum had several bouts of pancreatitis she was type2 with high tg's found at that time.

regarding feeling hungry - you liver tries to be helpful raising levels of sugars to what it thinks is 'normal' when you've had a raised levels above normal for a while it tries to keep the levels at what it considers to be normal. it can take time for body to adjust to actual 'normal levels'.

 

[nuovo1]

my measured unit mg/dl

 

[nuovo1]

Good morning, I'd like to ask a question. Shouldn't my blood sugar go down with Tresiba 24 units? Instead, it stays around 240 in the morning. Has this happened to you? I've been taking the drug for 20 days.

 

[grantg]

Good morning, I'd like to ask a question. Shouldn't my blood sugar go down with Tresiba 24 units? Instead, it stays around 240 in the morning. Has this happened to you? I've been taking the drug for 20 days.

tesiba is long acting insulin, thats supposed to keep blood sugars stable whilst fasting. If levels stay around the same its doing its job. if it were rising whilst fasting it would be worth speaking to your dsn/endo on having the dosage upped at the same token if it were going down whilst fasting speaking about possible reduction. any changes can take a few days. bolus fast acting would bring down (with food).

here is the relevant info on tresiba alongside a graph to show how it works pretty much 60-90 mins then releases at a constant rate over a very long period of time.

Tresiba® (insulin degludec) injection 100 U/mL, 200 U/mL Product Profile

Once-daily Tresiba® (insulin degludec) may be the right option for your patients over 1 year of age starting on or switching to basal insulin. Read Important Safety & Prescribing Info.

www.novomedlink.com

added below link.

There are a number of different insulin regimens to fit in with the varying requirements of different people with diabetes.

There are a number of different insulin regimens to fit in with the varying requirements of different people with diabetes.

www.diabetes.co.uk

 

[nuovo1]

Hi, I have to say that fortunately it's stable on an empty stomach, although it should be around 130, let's say, but it's fine. I spoke to an endocrinologist and he told me to increase the dose every four days. Honestly, I don't take Metformin and Semaglutide because they've given me leg and dental problems.

 

[grantg]

Might be worth letting endo issues as there is other meds which could perhaps work better. Some with type2 do a basal/bolus treatment regime

 

[nuovo1]

give me an explanation what it is basale/bolus?

 

[grantg]

give me an explanation what it is basale/bolus?

multiple daily injections, faster acting alongside long acting insulin. relevant urls.

There are a number of different insulin regimens to fit in with the varying requirements of different people with diabetes.

There are a number of different insulin regimens to fit in with the varying requirements of different people with diabetes.

www.diabetes.co.uk

A basal-bolus injection regimen involves taking a number of injections through the day.

A basal-bolus injection regimen involves taking a number of injections through the day.

www.diabetes.co.uk

Basal-bolus regimen in type 2 diabetes
People with type 2 diabetes may be put onto a basal-bolus regimen if they experience significantly high blood glucose levels after meals and need to have a flexible insulin regimen to fit in with their lifestyle.

People with type 2 diabetes may take a combination of short acting and intermediate insulin, or may be put onto rapid acting and long acting insulin.

theres some advantages which can be helpful one of those is perhaps able to get cgm via prescription depending on various factors. it should also in theory allow greater control its more common however to be used for type1. as type2 insulin resistance can play a large factor.

disadvantages would meal several injections per day rather than the singular one which you are currently doing. It would also require more frequent testing to check sugars ie more fingerpricks over the course of the day should you not fall within the criteria of cgm. it could also increase chances of hypos (if monitored more frequently offsets this somewhat).


another option which could be worth discussing is premixed. see page:
https://www.diabetes.co.uk/insulin/twice-daily-insulin-regimen.html this would work with the fast acting

Twice daily insulin regimen in type 2 diabetes
A twice daily insulin regimen may be recommended for people with type 2 diabetes who experience significantly high blood glucose levels after eating.

People with type 2 diabetes on twice daily insulin regimes may also take tablets in addition to insulin.

Pre-mixed insulin will state the ratio of the mix of short and intermediate acting insulin.

For example, Insuman Comb 25 is a pre-mixed insulin which is 25% short acting insulin and 75% intermediate acting insulin

if dsn/endo thought it would be adventagous. requires to be discussed with specalist just some other options which could be available. The likes of using CGM's recording activity/exercise levels alongside noting down carbs in the foods meals eating etc specialist would be able to use that to determine which is the right treatment plan for you (which would likely be fine-tuned over time...)

hope you find above helpful.