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Is my medicine controlling my peak?

J

Joepubli

Active Member
Messages
25
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I am a T2 of some years. Recently I haver got a Libre2 and can follow my blood glucose.
My question is what level of peak is acceptable and I can be comfortable that it is being handled adequately by my medicine.

Example: My glucose reading at 10:30 was 6.3. This morning at 11 I had Beans on Toast (1 piece of bread with reduced sugar Baked beans) and one mug of Tea with no sugar - a dash of skimmed milk. I also took a Janumet 50/1000 at the same time. My reading went up pretty quick from around 7 to a peak of 12.9 about 90 minutes later. And at 14:30 is still 9.4.
Doesn't seem to me that my medication is controlling it? I appreciate that it wasn't a low carb meal but still with medication it should have been lower?

Any wisdom gratefully received.
 
It seems Januvia lowers your HBa1c average for example, by 0.7% from an 8% start. These types of medications by themselves are like bandaids without diet changes as they will still let you deteriorate over time and develop complications of diabetes as you still run your blood sugars out of the normal range.

https://www.januvia.com/sitagliptin/what-is-januvia/
 

Janumet is a combination of of sitagliptin and metformin.
A Gliptin is a drug that should have a direct effect on how high you spike because it increases the amount of insulin that you need to help with your food. Maybe the dosage is too low. Maybe it's because you are still eating too many carb laden meals, it could be that your insulin resistance is worse when first given the drugs. Maybe as a T2, that you need a different drug or that you still are not getting enough insulin for the carbs laden meal. You may have hyperinsulinaemia, which is too much useless insulin circulating. If you continue spiking at those levels, it's not good.
White bread is 100% carbs. That is far too high for someone who may have an intolerance to wheat. Beans even with reduced sugar, is still full of sugar and you should only be eating a few beans anyway.
Use your cgm to discover similar foods you should not be eating.
 

Hi,

It's great you use a device to monitor your BG trends.. I'm an L2 user too.

The way I see it. Your breakfast choice just didn't seem to compliment what you are prescribed for your diabetes.
You are looking at the carbohydrate content with your beans which get digested & broken down to sugar.
Assuming a half tin on the peice of toast? 19.6g? Outlined here on a generic brand. https://www.tesco.com/groceries/en-GB/products/295444766
Then looking at the bread. Which in most packaging panels regarding nutritional value. The carb content can be somewhere upto & around the same as a half can of low sugar beans? (As a guide.)
Both types of food mentioned are by "design" are to aid satiety for the average consumer whilst also conforming to the low fat ethos? Regarding "health."
Unfortunately for the diabetic. It can still also lead to a disappointing effect on BGs..

But all is not lost.. You're armed with a device that can gauge what can work for you..
There can be a lot positive to be said for something like the traditional "fry up." Sans the bread, beans & hash browns..
Or even a smoked kipper..??
 
Thanks for the responses. I had assumed that the medication would control this amount of carb. I am a vegi and therefore difficult to avoid carbs. I had assumed that the beans would digest slowly - but I guess the sauce doesn't help, and then the bread.

A sitagliptin 50 with Metformin 1000 seemed to me to be a significant medicine - and if it cant even handle this amount of carb then its its looking grim! It seems everything I enjoy is carb rich!
 

Checking a couple of things.

Firstly the timing of your medication.
Are you expecting the Sitagliptin and the Metformin to kick in as soon as you take them to counteract the meal?
As I understand it they are both long term acting drugs which can be taken at any time of the day.
Then again you are supposed to take Metformin with a meal.

Secondly the dosage.
https://www.nhs.uk/medicines/sitagliptin/
I am assuming that you are on 50 mg Sitagliptin and 1,000 mg Metformin.
50 mg Sitagliptin is a lower dose as the above link says 100 mg is the standard dose.
1,000 mg Metformin is half the maximum dose.
So there appears to be scope for increasing the drugs if they are not being fully effective.

Having said that, I think you are giving your body a hard time.
I am on 2,000 mg Metformin (split between morning and evening) and if I regularly ate what you have I would have a glucose spike which takes a good few hours to come down again.
It is likely that drugs alone won't give you good control.
Diet also plays a crucial part and the drugs that you are currently taking don't seem to enable to eat what you are currently eating and get a normal blood glucose response.
I would expect you to see better results with less carbohydrates.

I must say that in general for diabetes pills aren't a magic fix which allow you to keep on eating what you used to.
When combined with diet (and hopefully exercise) they can assist you in getting your BG levels down but you have to work with them not just rely on them to fix things.
I am guessing that you have made changes (hence the low sugar beans) but I am wondering if you have changed enough.
Could you give us an idea of your usual eating habits so we can try to help and advise?

I assume the 6.3 was a fasting reading?
Or did you have something earlier.

Oh, and what was your last HbA1c?

Libre is an excellent tool for taking control, by the way.
 
 
@Joepubli you say
"It would be good if there was a library of before and after pictures using Libre - I realise that everyone reacts somewhat differently, but it may still be a useful guide."

Could you clarify what sort of pictures?
Are you talking about screen shots from LibreLink showing glucose readings?
There are some about on the forum but may be hard to find.
 
I guess what I am saying is that if there was a database of glucose response for diabetics of specific foods (for example Beans on Toast) on how much it raises glucose by, it would be easier to choose stuff. But may be there are too many variables.
For example something like https://www.youtube.com/channel/UCrNUkC1AUfrgzGhcHRP39gw
 

Too many variables, everyone is different, some may be able to have that beans and toast with a very small raise, some may get a humungous raise. The only way to tell for yourself is by testing.
 
Rokaab said:
Too many variables, everyone is different, some may be able to have that beans and toast with a very small raise, some may get a humungous raise. The only way to tell for yourself is by testing.
Click to expand...

Agreed, though looking up the carb values is a good start to see the likelihood of your body coping with a meal. As a T1, that's the primary way to determine insulin dosing (with an awareness of glycemic index and the rest of the meal to see how fast the carbs are likely to add). For T2s, with little/no flexibility as to dosage, I agree that testing is their best resource, as some carbs do seem to suit some people better than others.
 
Joepubli said:
Thanks for the responses. I had assumed that the medication would control this amount of carb
Click to expand...

Hi there, all I would say is that even using insulin doesn't 'control' the carbs that are eaten to any great degree of accuracy and we at least can alter the amount of insulin at any given time...I wish it did.....Most of us find we have to look at the carbs we consume in conjunction with the medication and accept that medication has its limits and any control we wish to establish comes also from the type of food we eat, more so in many cases. Your beans on toast for example. A few days before diagnosis, (when I was found to have levels in the mid 20s) I had to wait a weekend before going back to the GPs to see another Dr. I decided to eat beans on wholemeal bread, a staple meal for me at that time, especially when at work, nice and easy to do. Well.....that meal has been the only meal that shot me up to 'hi' on my meter meaning it was above 30. Since then I have experimented with various higher carb meals and for some reason, that one, EVERY time sends my levels rocketing.
 
All I can add is for some of us, who are carb intolerant, a carb is a carb is a carb. Regardless of low GI or high GI, complex or advised as healthy and ok for eating.
We just spike high, which we need to avoid. And if you are taking a Gliptin, then besides the dosage, your initial insulin response is too low and cannot cope with the carbs derived from a carb laden meal.
Please use the cgm for testing, if you spike high, then, there is too many carbs in that meal for you.
You will only find this out by using the cgm properly.
 

Hi,

You'd probably be surprised at the variable responses to the same foods regarding non Ds who stay within the healthy parameter BGs?
You could be being unfair on yourself setting the guy in the you tube video series you highlighted as a benchmark? (I took time out to watch a few?)
I've seen other stuff like this using sensors. Involving bananas an ex athlete now Pre D & a non D journalist?
 
Not do-able, as we're pretty much snowflakes. Your insulin resistance/sensitivity, production, metabolism, activity etc are all absolutely unique to you. There's no way to tell exactly how you'll respond to anything, except that something carby'll cause a rise. Can't get more specific than that, alas... So it'll be a matter of testing your heart out. I do know beans on toast would make my blood sugars soar, and the odds are they'd do the same to yours, (with little to no matter what medication you throw at it, unless you start on insulin), so yeah... Measure.
 

Thanks JoKalsbeek. Please let me understand a bit more - what if I say, its OK I am ready to take insulin to neutralise that carb? I measure my carb and take the right dose-why aren't people doing that?

How do I know whether its not enough insulin - or there is enough but my beta cells can't process it or both?
If my beta cells can't process it, does that mean that even taking insulin won't help?

Apologies for all these questions!
 
Thanks KK. Its weird that some specific foods cause large highs. Another day I also tried a pot noodle - assuming that it would be terrible. It wasn't good, but not nearly as bad as baked beans on toast! - which to my thinking is slow carb. I am surprised by the degree of randomness.
 
Type 2 generally produce large amounts of insulin. The problem is more they are resistant to it. So they make more to overcome this resistance. Like turning up the volume if you’re hard of hearing and have damaged your ears. Some medications help you make more still like gliptans or even inject some. So eventually the aim is the massive amounts of insulin eventually brings the glucose levels back down.

The problems however is that these high levels of insulin make you even more resistant and the underlying problem gets even worse and you need more and more medication to keep control. And add to that the hyperinsulemia causes other problems related to metabolic disease eg high blood pressure, fatty liver, cardiovascular diseases. This is why type 2 is seen as progressive and even if blood glucose levels are controlled by medication complications still occur.

Most of us in here seek to address the fundamental problem of insulin resistance. That controls the blood glucose levels by allowing us to respond better to more normal amounts. Medication is either not required or used less. And we address the problem by stimulating less insulin by eating foods that don’t require as much of it. Ie lower carb foods. This is why many choose not to rely on insulin, unless diet has failed to control us

note: Insulin doesn’t cancel out carbs. It processes them. Beta cells don’t process insulin, they make it.
 
Never apologise for asking questions, it's the only way to learn!

A type 2 usually has plenty of insulin going around. There's so much of it we become insensitive to it, so adding more insulin in the mix isn't exactly helpful, more often than not. The more you put in, the more insensitive one becomes, so it just makes the problem exponentially worse. Every carby meal triggers an insulin response. And you want to inject even more in there? It could work for a bit, yes, but if you need, say 10 units now to cover a meal, you could be looking at 100 units a few years from now, as your sensitivity to insulin isn't improving. Just getting worse and worse. Now, if someone's on medication for another condition that drives blood sugars up, they might not have much of a choice but to inject ten, twenty or hundreds of extra units a day, or are a T1 variant with resistance in the mix or... That would be a solution when it's a complicated issue with no other workable options. But if you can avoid it... More insulin would also mean more weight gain, for instance. (Also, your beta cells don't process insulin, they make it.). It'd basically be fuel to an already raging forest fire.

So what you're saying, why people aren't taking insulin to cover their carbs..? That's what T1's do. They count their carbs, and cover for them with a bolus. (There's also the background insulin which is their basal). But they don't produce any insulin. You've got lots. There lies the rub.

The issue is solved easily enough by adjusting your diet, but it's sounding a bit like you're not willing to do that? Because if not, then you'll just keep consuming carbs, worsening your insulin resistance, and require more medication along the way. With complications down the road, if you're not suffering those already. Diet isn't the only option you have, but it is, in my personal opinion, the best one. If you don't feel like you can tolerate a diet change (I'd take my eggs with bacon, ham, cheese, and roast beef over bread with beans any day though!), you'll have to discuss a medication change with your doc, most likely, because your meals and your meds right now, don't match. And yes, that could mean you'll be put on insulin, just keep in mind you'll have to adjust your dosage as the years pass.

You do have options. You might want to read the Diabetes Code by Dr. Jason Fung. Though it does advocate a different way of eating, it also explains exactly what goes on in a T2... And it sounds like these are things you're wondering about. Ignore the diet bit if you like, but I think you'll find the T2 dynamics fascinating.
 

Thanks for your detailed response. I am just trying to get the issues clear in my head. For a lifelong vegetarian its not quite as easy to drastically reduce carbs as might appear, particularly if you are often not in a position to make your own food. But thanks to you, I now have a better understanding of it.

Am I right in saying that if I am "Insulin Resistant" then peaks will take much longer to come down? Just out of interest, if its straight up and down quickly, its unlikely to be insulin resistance? (hasten to add - mine doesn't come down overly quickly). Is there a definitive test that confirms whether its lack of insulin, Insulin resistance or both?

My one week old Libre is showing HbA1c of 6.5. So that doesn't look too bad and my average glucose is 7.7.
 
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