possible steps before going on to insulin?

[djm]

Hi All,

I was diagnosed in Feb this year. Currently taking 1000mg Metformin 2 times a day and 3mg glimipiride (just increased from 2mg) once.

Morning sugar levels were down to the 6s and the HbA1c was reducing until the last check 2 weeks ago. My glimipiride was increased to 3mg but my morning sugars have not been under 9 since then. The diabetic nurse is now talking about insulin.

Is there any point in trying something other than glimipiride, anything else I can try? Insulin feels like a major step and I want to see if I can put it off as long as possible.

More info, i'm 53, female and not overweight. Late onset diabetes is common on my mother's side but I have it earlier than most. I have 2 autoimmune issues so I always suspected that I would end up on insulin once I was diagnosed. Oh yes, I actually live in the Netherlands, though I am Scottish. Anything else I should tell you?

Thanks in advance for any advice you can give me.

 

[hanadr]

Rather than change your medication, you could try changing your eating.
Since it's mainly starchy carbs which raise the blood sugar, reducing them in some way may do the trick.
I've been diagnosed over 6 years and consistently keep my BG in the 4s and low 5s. ( It's taken me a while, but I've got there ) I take 2 x 500mg Metformin per day only.
My choice has been to eat almost no carbs most of the time, but to allow myelf a few( not even daily!) treats. For example, I had a tiny portion of a friend's birthday cake on Monday and a bite sized piece of dumpling yesterday.
Another possibility is to cut all portions back hard.
For some people, the low GI approach works.
Read through this forum and you'll find a number of ways that work for different people.
Hana

 

[phoenix]

I have 2 autoimmune issues so I always suspected that I would end up on insulin once I was diagnosed. Oh yes, I actually live in the Netherlands, though I am Scottish. Anything else I should tell you?

Have you been tested for the antibodies asscociated with diabetes (GAD in particular)? People with one autoimmune condition often have another.
If your diabetes is autoimmune, even if slower developing, you will eventually need insulin. There is a school of thought (more so in Europe than the UK) that it is better to use insulin earlier than later as it may help preserve some beta cell function for longer so making the diabetes easier to control. Insulin itself is not the 'ogre' that some people make it out to be, in simple terms you are trying to replace the insulin that your own system isn't producing.
see http://www.locallada.swan.ac.uk/faq.html

 

[djm]

Rather than change your medication, you could try changing your eating.
Since it's mainly starchy carbs which raise the blood sugar, reducing them in some way may do the trick.
Hana

Thanks, Hana, I have considered low carbing, I have done it in the past before I knew about the diabetes Both Atkins and Carbohydrate Addicts. I will give it a try again.

 

[djm]

I have 2 autoimmune issues so I always suspected that I would end up on insulin once I was diagnosed. Oh yes, I actually live in the Netherlands, though I am Scottish. Anything else I should tell you?

Have you been tested for the antibodies asscociated with diabetes (GAD in particular)? People with one autoimmune condition often have another.
If your diabetes is autoimmune, even if slower developing, you will eventually need insulin. There is a school of thought (more so in Europe than the UK) that it is better to use insulin earlier than later as it may help preserve some beta cell function for longer so making the diabetes easier to control. Insulin itself is not the 'ogre' that some people make it out to be, in simple terms you are trying to replace the insulin that your own system isn't producing.

Thanks for that link Phoenix, that is exactly what I suspected, though I have not heard it called LADA before.
Here in NL they say they treat all diabetics by the blood sugar and HbA1c and so they don't bother testing for antibodies. They did check my c-peptides a while back because I suggested my diabetes is probably autoimmune. The result was at the very bottom of the normal range.
I have been feeling resistant to the idea of using insulin, but mainly because I think it will be a hassle. Your link has made me feel a bit better about the idea.

Thanks again.

 

[FordPrefect]

If you are on double med therapy already and at max doses about the only other option bar insulin that I know of is exantide(byetta) or Victoza, one thread about each on the diabetes discussions forum. The byetta thread in particular is huge. Am currently on double meds + Byetta. Byetta is the first drug I got that actually seem to make a difference as I never noticed any difference when I started on metformin or pioglitazone. Worth a look particularly if you are overweight as people on them tend to lose weight whereas people put onto insulin gain.

 

[djm]

If you are on double med therapy already and at max doses about the only other option bar insulin that I know of is exantide(byetta) or Victoza, one thread about each on the diabetes discussions forum. The byetta thread in particular is huge. Am currently on double meds + Byetta. Byetta is the first drug I got that actually seem to make a difference as I never noticed any difference when I started on metformin or pioglitazone. Worth a look particularly if you are overweight as people on them tend to lose weight whereas people put onto insulin gain.

Thanks FP, I just saw your post.

I am not overweight, which is why LADA is quite likely. I am heading over now to have a look at these threads you mention.

Thanks very much.

 

[FordPrefect]

I know that for byetta the NICE guideline is that you should have a BMI greater than or equal to 35 unless there is another overwhleming reason to offer it over insulin such as occupational factors, ie you cant drive a bus or HGV if you are an insulin controlled diabetic but I think you still can on byetta/victoza.