How long does Insulin take to drop levels?

[Smudger]

I wonder if you can offer any advice. I am a 52 year old overweight guy who is still fairly active, I’m fat but not floppy (if you know what I mean), I go to the gym and do my bit three times a week but have stayed a fairly constant 220kg for over 30 years. I was first diagnosed type 2 in 1999 when I was 39, I was put on Metformin and managed to keep my levels sort of controlled for a few years, then it started to go up so my nurse added Gliclazide which worked for a bit, then the Metformin was increased, then the Gliclazide too. I’ve never been very good at checking my levels and relied on the HBA1c result every 6 months.

Anyway, we tried Byetta about five years ago, my HBA1c had gone up to 8.5 and I was hoping it would magically reduce my weight and drop my levels, sadly it did neither! So after about 12 months, I was moved on to Victoza and all was well - except that did nothing whatsoever for my weight! When I really tried hard with my diet I got my HBA1C down in the low 7s my nurse was pretty happy.

About 2 years ago, I was testing daily and my resting level was around the 5-6 mark, then for some unexplained reason, it shot up to 10+ and whatever I tried, I could not lower it. My HBA1c shot up and my nurse suggested insulin. I really didn’t want to go down this route as I really worried about putting on weight, so I tried even harder with my diet, to no avail, my levels stayed at around the 10 mark first thing on a morning (she wants it under 7) and my HBA1c went even higher. So I was put on Levemir three weeks ago. I was told to up the dose every three days until my levels come down to 5-6 on a morning. The reason I’m asking for advice is that my **** levels haven’t come down at all – in fact they tend to be going the other way – This morning it was 12.8!

This is my current diabetes medication:

Metformin 500mg x 4 tabs a day (2 morning and 2 evening)
Gliclazide 80mg x 4 tabs a day (2 morning and 2 evening)
Victoza 1.8mg on a morning
Levamir (now up to) 18u/ml on a night

I’m really at a loss – any ideas? Anyone had the same problems?

HELP!

 

[Anonymous]

Hi Smudger
It appears they've only put you on a basal insulin and not bolus also. Can I ask, have you had a recent c-peptide test done? The reason I ask is that I was diagnosed a year before you were as type 2 and I had a c-peptide test done early 2010 and they discovered that oral meds will not work at all on me because I do not produce enough insulin... so my pancreas has beta cell damage... I had the GAD test done at the same time and there were no antibodies present. This could be the case with you???? If so... you should be on bolus insulin also and no oral meds. Then it's a matter of getting your basal and bolus units right and you should see quick results with BGLs dropping. It's still trial and error at times though.... but I find it is much better for me than popping pills. Also just to let you know my endo did start me on basal insulin only too at first and then when result of c-peptide came in... he said that oral meds were useless for me. I hope this helps you.

 

[david252]

Hi,

Mep73 is right, you may well have type 1 or 1a I think they are calling it now. C-peptide levels are rarely done though (I'm presuming you're in the UK here), partly because it's a specialised test and costs more and partly because it really won't change the management in most people's cases. It will perhaps SHORTEN the time it takes to get onto the correct treatment but it wont change it. By this I mean, you either have pancreatic insufficiency or you don't. If you don't then all the treatments you have tried are appropriate but if they fail, you have little choice (realistically) but to start insulin. If you do have pancreatic insufficiency then you will have to start insulin. If you see what I mean - the end point is the same, you just might take a little longer getting there. Also if you're overwieght they tend to keep you on oral meds as well (at least in UK they do) because there will probably be an element of insulin resistance present.

Insulin for type 2 is always the last resort as it can lead to a vicious spiral of increasing weight gain and increasing insulin demands. There may be an argument to try other forms of aggressive weight management first, depending on your personal circumstances and PCT funding! You will need to discuss it with your Dr.

 

[AMBrennan]

How long does Insulin take to drop levels?

To actually answer that question: <24h - the reason you are told to wait 3 days between adjustments is to make rule high readings due to random events.
However, your dose is quite low for your weight - being overweight decreases insulin sensitivity. Interestingly, prescribing information for Levemir only give a starting dose of 10u of T2 patients whereas Lantus (the other long acting analogue) lists 10u or 0.2u/kg (i.e. 44u in your case).

 

[david252]

Oops, I missed the point of your question didn't I?

The answer is not that straightforward in type 2 DM unfortunately. Levemir is a very long acting insulin and doesn't peak but gives a low basal or background level of insulin. There is also usually a high level of insulin resistance, so higher doses are needed and it also takes 3 days to see the full effect of any dose increase as the doses overlap - levemir lasts 24 to 36 hours and possibly longer in some people. Hence increments are done gradually, usually no faster than one dose change every 3 days and it takes time.

Unfortunately insulin also tends to make you gain weight, thereby increasing your insulin demand and hence you need to increase the dose further etc etc. I have seen type 2 that have NEVER managed to get their blood sugars down. Levemir is a relatively new insulin and is meant to not cause weight gain and this vicious spiraling upwards of demand (although this has not been clinically proven). So give it time - it may take several weeks potentially (anything less is a bonus) and keep an eye on your weight (which really is the most important thing). Any weight loss would be a bonus ( I appreciate it is very difficult (because of the reasons already mentioned) but whatever else, do your best not to GAIN any weight.

 

[Smudger]

Hi again, i just wanted to update my position and even though I don't reply, I do read and take on board your comments.

This past year has been a bit of a nightmare, the Levamir really did nothing for me and so last October, I was put on Humulin M3 and the Gliclazide stopped all together. All this seems to have done for me however is add to my weight and I've gradually put a stone on in this time, so I'm well fed up about that.

I ended up pumping 60 units on a morning and 60 at tea time, and then a 20-30 before bed to get my am reading down and it hardly ever was below 10! I saw my DN last week and she felt (after advice) that this was not ideal and today I've started on Humalog 50Mix 40 breakfast, 20 lunch, and 40 evening meal.

Obviously I don't have a clue if this will work but wondered if anyone else had similar symptoms and how they deal with it.

Cheers!