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Type 2 Quadruple therapy

C

carpur

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Dear forum peeps.
I have been diagnosed DM2 for over 5 years and am now on quadruple therapy, but still HbA1C at 67.
Am on Metformin / sitagliptin, Dapa and Lantus (14iu at night). I can't seem to get it down further than that.
I do exercise, watch my carbs and have changed from drinking wine to G&T. I'm about 11 1/2 st. 5ft 6 and active.

I have many questions:

Do I really need to stay on quad therapy?
How do I know if my pancreas is actually producing Insulin?
Can I take another dose of lantus in the morning bearing in mind that my BSL usually is between 4 -7 first thing before breakfast?
I have noticed that post meals my BSLs do raise quite a bit so I don't think I'm producing any insulin at all?

All these questions ..
any one have any suggestions on where to start.

Catpur
 
Think you need to discuss those treatment questions with a medic - people here will probably have a range of views but none of us are medically qualified
 
Hi. The c-peptide test is the normal one for checking roughly how much insulin you are producing. You can always ask the GP for the test. I had mine done privately and it helped confirm my suspicions that I was LADA. If you don't mind me saying, your BMI sounds slightly high? Would you consider yourself 'normal weight' and hence little insulin resistance? If your BMI is a bit on the high side then reducing the carbs further, if possible, might help. I can only guess of course. You could also ask to be swapped over to Basal/Bolus and reduce the tablets?
 
carpur said:
Do I really need to stay on quad therapy?
Click to expand...

Given that the current treatment is leaving you with average blood sugars of over 10 that doesn't seem wise to discontinue. Are you having any particular issues with you treatment regiem that is making you ask this question?

carpur said:
How do I know if my pancreas is actually producing Insulin?
Click to expand...

Well, you're not dead and youre only on 14 units of lantus a day, so being alive is a pretty good indication you are producing insulin. If you want an answer in numbers, ask for a cpeptide test which will tell you what your endogenous insulin production is looking like.

carpur said:
Can I take another dose of lantus in the morning bearing in mind that my BSL usually is between 4 -7 first thing before breakfast?
Click to expand...

You should discuss this with your doctor. Your fasting blood sugar is in an excellent range if it is usually between 4-7, that's bang on target.

For type 1s the job of the basal insulin (lantus) is to keep blood sugars flat when not eating or bolusing. For a type 2 on basal only the therapeutic aim might be broader, so it seems unwise to suggest basal testing.

carpur said:
I have noticed that post meals my BSLs do raise quite a bit so I don't think I'm producing any insulin at all?
Click to expand...

As above, it's unlikely you're not producing any insulin at all and only on 14 units a day and still alive.

The average total daily dose for a type 1 (ie someone without insulin resistance) is >38 units. You are on a comparatively low dose of insulin.

What sort of post prandial levels do you see?
 
Hello and welcome,

Post meal spikes are generally food related, so maybe you need to look at your diet a bit more carefully. Your Lantus won't help with that, neither will Metformin, and I don't know about the others. The Lantus and Metformin will be helping with your fasting morning levels.

As for your question on meds, only your doctor can advise you on those.
 
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