Type 2 Just gone on insulin and my sugars are worse than ever

[daffy1]

Hi it’s been a long while since I last posted but ive just gone on insulin the last two weeks and my sugars have sky rocketed. I was taking metformin, gluclazide and empagliflozen. I had to stop the last one but even tho it worked for my sugars it gave me horrendous thrush so I had to stop it.
As my sugars went back up they decided to stop the metformin and replace it with insulin. (I’m still 9n gliclazide) I started on 10 units of insulin and am now on 20and was told my sugars need to be between 5-10 but they are averaging 15-18 on a morning and between 15 and 20 on an evening. Whereas before insulin I was averaging 9 on a morning and between 8-12 on an evening. I’m not sure if stopping the metformin was a big mistake or that I need a much higher dose of insulin.
I have a blood disorder that causes my blood to clot easily and that I was told would possibly make it difficult to regulate the sugars.and ive also heard that some people are insulin resistant
Ive tried contacting the nurse but all I keep getting told is that she will phone me and she hasn’t done in two days.

Is 20 units considered a low dose
Any advice would be appreciated

 

[Antje77]

Is 20 units considered a low dose
Any advice would be appreciated

The dose we need is highly individual, the important part is having the dose which works for you.

Some need only 10 units or less over the day, others need a couple of hundred units.
Finding the right dose is trial and error, the dose is slowly built up to find the sweet spot.

Is there a particular reason why the metformin was stopped? It's often used in combination with insulin.

 

[daffy1]

She didn’t give a reason. I just assumed you don’t take both and never thought of asking

 

[daffy1]

Just realised it was probably because I’d had persistant diarohea for 4 weeks and she said sometimes after several years of taking metformin it can cause diarohea. I’d been on it for 10 years without a problem so was surprised to hear this

 

[Antje77]

She didn’t give a reason. I just assumed you don’t take both and never thought of asking

You can always contact her and ask if you can go back on the metformin.
How long ago did you stop the empagliflozin?

 

[Antje77]

Just realised it was probably because I’d had persistant diarohea for 4 weeks and she said sometimes after several years of taking metformin it can cause diarohea. I’d been on it for 10 years without a problem so was surprised to hear this

Ah, that's a good reason!

 

[daffy1]

I stopped empagliflozen in July . I would have happily stayed on it as my sugars were averaging 7 which they were pleased at but they’ve gradually increased since then

 

[jape]

Two questions:
1. What kind of insulin are you taking? Is it fast acting (eg Novorapid) or basal insulin (eg. Tresiba/Levemir)
2. Does your eating regimen have a significant carb content.
These factors might explain why your blood sugar levels are not responding as you would like.

Also, no longer taking empagliflozen/Jardiance may also contribute to your higher blood sugar levels. It is very effective in removing blood sugar from one's blood stream - it certainly works for me. But, as you said thrush could be a real problem, it seems for women, and for men who are not circumcised.

 

[daffy1]

Im taking Levimir 20 units at night. I’m fairly good on carbs. Yesterday I ate
Porridge with semi skimmed and 1 tsp sugar
1 orange
Meat pie with vegetables no potatoes
1 pot of zero sugar jelly
Banana sandwich made with 2 small slices of bread
2 cubes of aero chocolate, I know it’s bad but I eat very few sweets
3 teas no sugar and 1 bottle water
I appreciate that porridge is high in carbs but the diabetic nurse Said to eat that instead of cereals as it fills you up for longer .
I dont think I have a bad diet and rarely drink and eat very little after 6 pm so I’m puzzled as to why their so high.
There is no history of diabetes in the family and I’m not overweight so the doctors have put this down to a medication olanzapine that I was on .This medication now has a warning that it can cause diabetes and you need regular glucose tests whilst on it but I think it has damaged my pancreas so much that it’s now irreversible

 

[Daibell]

Hi. I take Metformin SR with insulin as my DN said the protective properties or Metformin were having. I have no problems with it and it reduces my BS by about 1 mmol. Your nurse should have changed you to Metformin SR (Slow Release) previously. I don't believe the bowel issues get worse the longer you take it. If empagliflozin was giving you thrush it was probably doing it's job and ridding the body of some glucose? What sort of BMI do you have as this might indicate insulin resistance if too high? Are you on Basal Bolus insulin as it sounds like you should be unless IR is the problem. You need to carb count your mealtime Bolus. This means adjusting the amount to match the carbs in the meal. If you are only on a Basal insulin this may need to be split with different amounts day and night as I do.

 

[Hertfordshiremum]

Im taking Levimir 20 units at night. I’m fairly good on carbs. Yesterday I ate
Porridge with semi skimmed and 1 tsp sugar
1 orange
Meat pie with vegetables no potatoes
1 pot of zero sugar jelly
Banana sandwich made with 2 small slices of bread
2 cubes of aero chocolate, I know it’s bad but I eat very few sweets
3 teas no sugar and 1 bottle water
I appreciate that porridge is high in carbs but the diabetic nurse Said to eat that instead of cereals as it fills you up for longer .
I dont think I have a bad diet and rarely drink and eat very little after 6 pm so I’m puzzled as to why their so high.
There is no history of diabetes in the family and I’m not overweight so the doctors have put this down to a medication olanzapine that I was on .This medication now has a warning that it can cause diabetes and you need regular glucose tests whilst on it but I think it has damaged my pancreas so much that it’s now irreversible

Hi
From the info you have posted if your pancreas is producing less and less insulin due to medication (I know a few people who have been told this) you need to ask for a c-peptide test via your GP, this will tell you how much insulin your pancreas is still producing. You may be in need of fast acting insulin (bolus) as well as the background insulin (basal) that you already have. Your typical days food listed is quite high in carbs. Milk, oats, pastry, banana, bread the 2 cubes of chocolate probably the least of your worries. I couldn’t eat any of that. How about trying one day bacon and eggs, salad with ham, cheese, tuna.. zero jelly is great. Meat or fish with veg. Really low carb. See what happens on that day, if you are much better you will have an indication that it’s the food and a starting point to discuss insulin requirements with the GP/diabetic nurse. Best wishes.

 

[Hertfordshiremum]

Just realised it was probably because I’d had persistant diarohea for 4 weeks and she said sometimes after several years of taking metformin it can cause diarohea. I’d been on it for 10 years without a problem so was surprised to hear this

I stuck metformin slow release for just under a year, regular upset stomach’s eventually turned to diarrhoea almost daily. I came off it and was so much better. My blood sugars lowered, they thought as my stomach was so aggravated it was having the opposite effect. It doesn’t agree with everyone unfortunately.

 

[daffy1]

Hi my bmi is 25.5 and I weigh 9 st 12 lb so just fractionally overweight . I try to keep my carbs to under 120 g The diarohea with metformin is now recognised as ive found out and it stopped within 2 days of stopping metformin it so it’s pretty sure it was that but I had been on it for over 10 years with no problem
https://pubmed.ncbi.nlm.nih.gov/11714216/
I’m on levimir basal 20 units.
Ive tried yet again to contact the dn but she was booked up again so I have to phone back at 12 to see if I can get a telephone appointment and I’m going to ask for a diet plan. But as ive been trying for the last 2 days to speak to her I dont hold out much hope

 

[Grant_Vicat]

Im taking Levimir 20 units at night. I’m fairly good on carbs. Yesterday I ate
Porridge with semi skimmed and 1 tsp sugar
1 orange
Meat pie with vegetables no potatoes
1 pot of zero sugar jelly
Banana sandwich made with 2 small slices of bread
2 cubes of aero chocolate, I know it’s bad but I eat very few sweets
3 teas no sugar and 1 bottle water
I appreciate that porridge is high in carbs but the diabetic nurse Said to eat that instead of cereals as it fills you up for longer .
I dont think I have a bad diet and rarely drink and eat very little after 6 pm so I’m puzzled as to why their so high.
There is no history of diabetes in the family and I’m not overweight so the doctors have put this down to a medication olanzapine that I was on .This medication now has a warning that it can cause diabetes and you need regular glucose tests whilst on it but I think it has damaged my pancreas so much that it’s now irreversible

From a male point of view, elevated blood-sugar caused me thrush on many occasions. It also caused diarrhoea, especially if the reading was higher than 12. As others have said, the carb content is likely to raise your blood sugar and this might be the cause
of both the above. As you say, Metformin caused no problems for years and it would be a simple experiment to considerably, but gradually lessen the carbs. Good luck!

 

[Dr Snoddy]

I'm going to go all out here. At the moment nearly all of your daily intake of food is carbohydrate. Porridge, milk, sugar, orange, pastry, banana, bread, chocolate are all carbohydrate sources. Thrush is generally due to high blood glucose levels.
Many of us base our meals around protein and healthy fats instead of carbohydrate so that blood glucose is kept low. I suspect from your ongoing medical advice that the DN is sticking to the NICE guidelines for treatment of Type 2 diabetes - eat carb, get worse, add in more medication, continue to eat carb, add in even more medication, eat carb, insulin! Sound familiar? It does not have to be this way and I know people who have, over time, been able to come off all medication except for Metformin by radically altering their diet.
I agree that a c-peptide test should be done to check how much insulin you are actually producing.

 

[finzi1966]

Your diet seems very worryingly high in carbs to me. Porridge AND a banana sandwich? I can’t even begin to imagine what that would do to my blood sugars. Like others have said, the two squares of Aero would be the least of your problems.

I would suggest trying to base your meals around proteins, vegetables and healthy fats (olive oil, coconut oil, butter). You don’t need to lose weight, so that’s not an issue, but I really, really would suggest that you drastically cut your carbs (although obviously keep an eye on your sugars as you’re on insulin).

I’d aim for no more than 50g carbs a day, in total, fron vegetables and maybe some berries and full fat Greek yoghurt. No bread, cereals, porridge, pastry, oranges, banana, milk or chocolate.

 

[daffy1]

Hi
From the info you have posted if your pancreas is producing less and less insulin due to medication (I know a few people who have been told this) you need to ask for a c-peptide test via your GP, this will tell you how much insulin your pancreas is still producing. You may be in need of fast acting insulin (bolus) as well as the background insulin (basal) that you already have. Your typical days food listed is quite high in carbs. Milk, oats, pastry, banana, bread the 2 cubes of chocolate probably the least of your worries. I couldn’t eat any of that. How about trying one day bacon and eggs, salad with ham, cheese, tuna.. zero jelly is great. Meat or fish with veg. Really low carb. See what happens on that day, if you are much better you will have an indication that it’s the food and a starting point to discuss insulin requirements with the GP/diabetic nurse. Best wishes.

I was told that my diet was fine and to stick to 45- 65 grams per meal . I was told recently when I was in hospital that I wasn’t eating enough carbs as I wasnt eating any bread or potatoes at all and my carb intake was measured at 120. The only one that goes over was the Porridge which with the milk and sugar comes to 81 grams but I wont eat anything else for several hours whereas with cereal I would be hungry within the hour and start to snack. I definatly couldn’t eat bacon and eggs as I cant have fried foods for health reasons. My carbs yesterday totalled 162 including 2 pieces chocolate at 20 grams (bad I know)which is well within the diabetic limits. The meat pie I checked was 38g which I had with green beans and the bread is 13 g per slice as on the label. I know I had 2 pieces of fruit which comes to about 40g.
I must admit I dont so as much exercise as I should but I have other health problems and use a crutch but I try and go for a walk most days

 

[Dr Snoddy]

There is a clue here. You were told that your diet was fine. If it were you would be fit and healthy. Given that we have to eat to live what would have to lose by changing what you eat?

 

[daffy1]

[QUOTE="finzi1966, post: 2462276, member: 548675"
I’d aim for no more than 50g carbs a day, in total, fron vegetables and maybe some berries and full fat Greek yoghurt. No bread, cereals, porridge, pastry, oranges, banana, milk or chocolate.[/QUOTE]

Im not sure what to think when my DN is telling me my carb intake is fine yet everyone here seems to be telling me different. I think I might try a fish and vegetable diet and see if that makes a difference . I was told to have porridge for breakfast as long as it was measured and only a small amount of sugar but sometimes I put chia seeds on it which are very low carb. I really dont know how i would manage on 50 g per day as we need carbs for energy and I am diagnosed anaemic due to previous low carb and also b 12 deficiency
Can I ask you what your diet is as I’d love to get down to 50 g but also keep my anaemia at bay

 

[Dr Snoddy]

Hi, the idea that we need carbohydrates for energy is a fallacy. We have to have protein and fats in our diet and both of these can be digested and used as energy sources.
I cannot understand why you would have been told that your anaemia would have been due to a lack of carbohydrate. There are various types of anaemia and the treatments vary but your variety could be due to low B12 levels. A common side effect of Metformin is low B12. I had this as a side effect and had to supplement with B12 spray to get my levels back to normal.
It takes a leap of faith to go against medical advice and should you decide to do so you will find recipes, support and knowledge here. Fish and above ground vegetables would be a good start. Low carbohydrate bread is an option if toast with non carb toppings appeals for breakfast.