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So many options I don't know what to choose

W

Wshelledy

Well-Known Member
Messages
52
Type of diabetes
Type 2
I was diagnosed with type 2 diabetes in Aug. by my gp. She put me on a 70/30 insulin mix. It isn't working well for me and due to many other oversights about my treatment (she prescribed insulin but forgot to prescribe anything to inject it with for one thing) I made an appt with a diabetes specialist. My appt was wonderful. They spent a full 3 hrs talking with me about my condition , medical history and explaining possible treatment plans.Before I go any further with my questions I need to thank all of the knowledgable people on this forum. My gp gave me no real direction except to say test a couple times a day (and then didn't prescribe a meter or test supplies so insurance would cover them). The people here gave me great advice: testing before and after every meal, counting and logging carbs, etc. The endo group were so impressed that after such a short time I was on top of all this. Anyway. The dr says because I have so successfully managed my disease that I now have many treatment options. I hope I can get some feedback from you all to help me nake a decision. One option is a standard baseline bolus treatment. She says it will give me more control than the insulin mix. From my logs she says I am working for the insulin instead of it working for me. The long acting portion is too strong so I get hypo and eat to bring up my bg. Another option is something called V-go. It isn't and insulin pump as it doesn't monitor bg. But it does give you very very small amount of insulin continuously. Then when you eat you count carbs and press a button to give a bolus. This sounds promising but I'm concerned about having something attached for so long. I think it might be a constant irritant and I worry about mechanixal problems. A third option is to go off insulin ( which she said I can only do because of my dramtic improvment in my A1c) and replace it with a new drug called Farxiga. This drug works very differently from metformin which I can't tolerate. It works by eliminating blood glucose through the kidneys. When your bg rises above 120 (US units) the drug kicks in and eliminates the excess in urine. As far as I can find, the side effects are an i creased risk of UTI and vaginal yeast infections. Since I got such great advice when I started all this on this forum I'd like to here what you all think of these options. Thanks in advance!
 
As the prescribers seem to be more like headless chickens than most I've read about, I do wonder if you need medication - rather than eat carbs to stop the treatment causing you problems - what happens if you eat low carb and test to see if you are able to get normal readings?
If you do not have high blood glucose then the Farxiga is a wasted effort, if insulin makes you hypo - and Metformin - sheesh - bad news for me too, so control by diet would seem to be an option for you, though I expect you'll need to work with your doctor to find out how to stop the insulin safely.
This information is somewhat biased as I found that I don't need medication to control my blood glucose only after nasty side effects from the tablets.
 


If there is any way you can do this without insulin injections you should give it a try. Insulin is definitely needed for those who no longer have a functioning pancreas for whatever reason, however that is usually quite a long way down the line . Many diabetics are diagnosed many years before that has happened. You can ask for tests to check just how much insulin you have - both fasting insulin and c-peptide test but even without these the chances are you have a lot of insulin already, just that its not working very well.

You don't say what your starting figures are, or where you are now . By way of example mine was 90 on diagnois, 42 now , no drugs just proper LCHF diet. I'm not alone. If you don't put glucose in in the first place, you won't need a drug to eliminate it ! that comes from cutting out the carbs and processed foods and replacing them with a diet of real foods focused on above ground veggies plus meat, fish and diary, nuts and seeds to taste. If there is anyway to stay away from the medication it makes a lot of sense to try because its so much better not to be dealing with the side effects. It took you years to get to the final diagnosis you have, so a few months experimenting with diet alone is not going to make much difference in the scheme of things and basically the success rate here is huge, so no reason to suppose you are any different from the rest of us ! good luck !
 
I've wondered the same thing. The endo says its the ratio in the insulin combo drug that is wrong for me. Too much long acting which gives me the hypos. I eat a fairly low carb diet of about 20 g per meal and about 8g in a snack. With out the short acting i sulin my 2 hr postprandial goes up to over 150 (US units) so that's the indication I need something to control my bg. I am leaning towards the new pills as it seems the safest route. Thanks for your input!
 
I agree that diet alone would be best. I think I want to take baby steps though at this point. I'm already eating a somewhat low carb diet. My numbers went from 11.9 to 7.3 in 7 weeks doing low carb plus insulin. I still have between 50 to 75 g of carbs a day though. That is mostly from veggies, milk products and nuts. I'm not sure I can go lower than that and still be 'satisfied' so I stick to the regimen. Also, I did control my prediabetes for almost 10 years with diet and exercise alone. I was NOT testing though so the big jump in A1c caught me by surprise. At this point I am leaning towards the pill along with diet. Then if testing shows I am stayi g low enough that the pill is a waste I'll drop it and see what happens. Thanks for your input!
 
Thanks for your input! I have considered going back to just diet and exercise but after almost 10 years of doing that something changed and my A1c jumped. It really shook me up! I know I allowed my diet to slip some but had no idea it was as bad as itvwas!
 
If I was you I would go onto Farxiga, then hit very low carb and intermittanat fasting with as much wellpower as possible. Farxiga (on its own) does not have a risk of Hypos so lets you be much more agressive. (However remember to drink a lot of water)

Remember that the fewer carbs you have the less sideeffects you will get from Farxiga.

Maybe along with bolus insulin pen so if you are too high you have opitons without waiting for the next apointment with the specialist, but aiming to limited your carbs so you never need to use the bolus insulin.

I am fully expecting you to come back in 6 months time and say you no longer need the Farxiga as you have reversed your Type2......

--------------------

PS, Putting someone on mixed insulin short term to keep them alive is a safe option for GPs, unlike most Type2 drugs that can be harmfall if the GP has got the type of diabetes wrong.
 
I have just read up on the go-vgo, interesting system, but as it does not let you reduce the continuous insulin rate and only lets you add inulin at meal time two units at a time it just does not make sense unless you are unwilling to try to improve your diet.

(It looks like it is aimed at people who find MDI too hard due to issues using pens etc while being a lot cheaper than a pump. It comes in 3 version 20 units a day, 30 units a day and 40 units a day background insulin.)
 
Sounds like you have had some good help from the diabetes team and have worked hard to achieve the lower gluocse levels..
Sorry that the metformin upset you
If you have type 2 diabetes, at this early stage, there is a lot of choice; some might give a course of insulin to get a very high glucose level down and then switch to a different treatment for long term control.
The Forzyga is interesting and works as you describe; it needs normal renal function to work (eGFR > 60), and reduces weight and blood pressure alos; other members of the class reduce risk of heart attack and stroke - useful. There is generally 1 episode of thrush per year which is generally easy to treat but is sometimes awful. One gets UTIs on this class, but only a many a one gets with poorly controlled diabetes.
You might want to consider a gliptin tablet which has similar HbA1c reduction and is very well tolerated; they also let people lose weight .
You probably do not want to consider a sulphonylurea at this stage (eg glicazide) cos it puts weight on and has risk hypos.
Might want to consider piolitazone tablets cos it reduces risk heart attack stroke and dementia (we think) but puts weight on, and there are some other side effects eg swollen ankles, anaemia, rare risk of fractures of bones in feet.
Or a GLP-1 RA injetion such as Victoza controls the glucose as well as insulin, has no hypos on its own, loses weight eg 3-5 kg, and reduces risk stroke and heart attack - not all the GLP-1 RAs reduce heart attack / stroke rate
Your choice is influenced by your renal function and your body mass index, and that you have type 2 diabetes which gives a wide choice of treatments.
best wishes
 
Thanks for the input simon and ringi. Just curious what you both consider low carb? I see that some do <30 a day. I'm told by the nutritionist that my 50-75 is considered low carb. I think the farxiga along with a bolus insulin is my first choice of treatment but I'm not sure that's an option. She spoke in terms of the pills OR the shots. My 30 day avg bg is 108. So I think not too much of the farxiga would actually be doing anything. But the 108 is just that: an average. I have maybe 4 or 5 readings a week over the 120 threshhold. Most are in the 125 range but a few are 150. The 150's are the times I'd like to have a bolus of insulin. Its not related to what I eat but usually due to not being able to do my exercise or due to illness.
 
Remember your current BG is based on you overdosing on the mixed insulin, so will increase when you stop mixed insulin. Thereofre the farxiga will be doing a lot.

Low carb is condiered to be anything below 100g a day, some peole have to go as low as 20g along with limiting their protain to reverse their diabetes. Personly I think the best option is to do somethink like "The New Atkins Diet For a New You" and remain on the first state until you get very good BG control then use the process in the book to see how many carbs your body can cope with. (Use post meal BG rather then weight as the check.)
 
I think the best part of being diagnosed (almost a year now) is no more yeast infections, so I would never consider a medicine that will make me pee sugar. I would always choose basal/bolus over mixed insulin, because I like to be free to eat different things at different times all the time, and I wouldn't like to be forced to eat a lot if I suddenly decided to go swimming or help someone to move house or such. I'm happy with my pens of tresiba and fiasp (after trying some other insulins), and I think I wouldn't like to be attached to a pump all the time, although I got used to wearing a free style libre sensor real quick.
But all that is just me and my preferences, they might be completely different from yours. Good luck with finding the treatment which suits you best!

Oh, and I'm not sure whether I'm LADA or type2, but I don't think it's very important in my answer. Other people already suggested low-carb possibilities, I'm just reacting to the insulin-part of your question.
 
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One thing I realized quite early was that I react differently to a small amount of a high carb food than the same amount of carbs from a low carb food. The high carb food seemed to raise my BG levels for longer - which would impact on my Hba1c I think.
Could you have been eating something which is fairly high carb but you were seduced by the 'a little bit won't hurt' idea?
I try to keep my foods in the ten percent carbs or less range after those eye opening early tests, but I will not be having Hba1c tests regularly to see if my numbers are continuing to fall. I seem to be not diabetic enough.
 

One can mix injections and tablets - it is a very common practice. Insulin and sulphonylurea tablets tend to put weight on and cause hypos. Gliptin tablets, SGLT-2 tablets and GLP-1 injections on their own do not cause hypos and help lose weight. There are so many options now, if one has Type 2 Diabetes. Yes, the odd highs are a bother; one study by Umpierrez compared correcting bedtime highs to doing nothing - glucose levels were the same the next morning. It might be that if you were on modern agents, these agents and improved pancreatic beta cell function and insulin sensitivity due to better glucose levels would all together keep your glucose levels under control and you would be less likely to get these peaks; one could give it a go and see what happens.
best wishes
 
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