Worried As Nothing Is Working

[josh010]

I am a type 2 and have been for last 10 years and 50, I am not overweight to a level where my blood sugars should be high, but I am now getting worried, i have been on Gliclazide 40mg and Metformin 2000mg daily, I was on Invokana and Sitagliptin and my Hbac1 was 8.5, I thought was ok, Gp advised its too high.

Three weeks ago, I was informed that I may have to go in Insulin, I advised no as my mother is on this and her weight ballooned from 9.2 stones to 12.5 Stones, they then advised I stop Invokana and I stop Sitagliptin too. I did this 3 weeks ago and was started on Victoza 0.6, which supressed my cravings, but did not make me feel any better in fact my sugars and fasting sugars increased from the normal 8mmol to 9.5mmol, week 2 I went on to 1.2mg again no improvement in sugars and have put a Kilo on, so now weight 95Kg, I have a very slow digestion now and its causing me constipation, but I am still hoping, informed GP and now been advised to go onto 1.8mg, so did this yesterday and my sugars are before any meal and 4 hours after lunch 14.6mmol my sugars this morning post waking were 13.2mmol.
I am now getting extremely worried, I have taken 80mg of gliclazide as my 40mg dose has not worked and 30 minutes after my sugar remains at 11.2mmol and not even eaten yet!!

My concern is - how long before Victoza works in the body? How can I go on with this if nothing is changing and in fact getting worse and shall I be ok to go back onto Sitagliptin and Invokana as I am not going on Insulin.
Any advise and help is greatly appreciated.
Thank you

 

[Daibell]

Hi. You don't mention whether you are on a low carb diet? If you have some excess weight needing Victoza It's unlikely that Gliclazide would have much effect as you may already be producing too much insulin and insulin resistance may prevent it being used properly. Insulin doesn't cause weight gain but the carbs you have with it do. Do let us know more about your typical diet.

 

[josh010]

Hi there

I am not on a strict low carb Diet, but no flour - sugar or anything white, no rice or pasta, the above sugars are after having boiled egg sandwich with wholemeal bread and before now having a omelette and salad, so I dont know where I am going with Victoza now! should it not have started to work by now, its my second week and yesterday was start of 1.8mg at week 3, no improvement at all?

 

[ally1]

I am on victoza and have been since last November and inject 1.2. I was told that it would kerb my appetite, lose lots of weight and that my bs levels would go down. I did feel full for the first week but after that my a petite came back, put on weight, bs levels rose but had no side effects apart from the feeling full for the first week.am still on it, but in saying that, since around end of June, I had to help myself and cut my portion size in half and my bs level have come down dramatically and am at last beginning to lose weight, but slowly. I have been told that in december/January when I have another blood test and my hca1 has dropped then either the victoza will be dropped to 0.6 or stopped completely. I was told this was a miracle drug and that's why I accepted to try it. In my opinion, it is not a miracle drug and the bs levels and weight have come down to sheer hard work on my part. I was told that if the victoza didn't, t work that I would go onto insulin and I didn't, t want that to happen. I changed my diet completely for which I feel this has helped. I did try the low carb diet but that was not for me. I,m not saying the victoza doesn,t work and it must have helped in some ways. But I do feel my bs level and weight have come down by my work in watching what I eat and cutting down on portion size

 

[josh010]

Thank you for your reply ally1, I will just have to see how this pans out for me, as I can not see the sense in the GP saying I HAVE TO go on Insulin or Victoza and now Victoza is upping my sugars, I will of course work with it, as I am pleased the Victoza started working for you after 8 months, so hopefully its still early days, but when you read some American reviews they state they have lost loads of weight, I AM SURE that must be extreme examples, I I have gained a kilo;-((

god bless

 

[Clivethedrive]

I am on victoza and have been since last November and inject 1.2. I was told that it would kerb my appetite, lose lots of weight and that my bs levels would go down. I did feel full for the first week but after that my a petite came back, put on weight, bs levels rose but had no side effects apart from the feeling full for the first week.am still on it, but in saying that, since around end of June, I had to help myself and cut my portion size in half and my bs level have come down dramatically and am at last beginning to lose weight, but slowly. I have been told that in december/January when I have another blood test and my hca1 has dropped then either the victoza will be dropped to 0.6 or stopped completely. I was told this was a miracle drug and that's why I accepted to try it. In my opinion, it is not a miracle drug and the bs levels and weight have come down to sheer hard work on my part. I was told that if the victoza didn't, t work that I would go onto insulin and I didn't, t want that to happen. I changed my diet completely for which I feel this has helped. I did try the low carb diet but that was not for me. I,m not saying the victoza doesn,t work and it must have helped in some ways. But I do feel my bs level and weight have come down by my work in watching what I eat and cutting down on portion size

Well done @ ally1 you are bringing those levels into a good place

 

[ally1]

I also gained weight. I had to completely change my diet. To me it's not the miracle cure but that's just me maybe thinking that

 

[ally1]

Well done @ ally1 you are bringing those levels into a good place

Thank you but it's been down to sheer hard work

 

[Clivethedrive]

Thank you for your reply ally1, I will just have to see how this pans out for me, as I can not see the sense in the GP saying I HAVE TO go on Insulin or Victoza and now Victoza is upping my sugars, I will of course work with it, as I am pleased the Victoza started working for you after 8 months, so hopefully its still early days, but when you read some American reviews they state they have lost loads of weight, I AM SURE that must be extreme examples, I I have gained a kilo;-((

god bless

Please see Dr Richard Bernstein's book : Diabetes Solution 4 th edition,feel you will benefit from his advices and experience

 

[TorqPenderloin]

Thank you for your reply ally1, I will just have to see how this pans out for me, as I can not see the sense in the GP saying I HAVE TO go on Insulin or Victoza and now Victoza is upping my sugars, I will of course work with it, as I am pleased the Victoza started working for you after 8 months, so hopefully its still early days, but when you read some American reviews they state they have lost loads of weight, I AM SURE that must be extreme examples, I I have gained a kilo;-((

god bless

Your GP is saying you need to go on insulin or Victoza because you have an obvious insulin deficiency based on the readings you've shared with us.

(Artificial) insulin needs to be respected, but it shouldn't be feared. Furthermore, insulin in the right circumstances can promote weight gain, but it's incorrect to assume that insulin directly causes weight gain. It's easy to misunderstand those statements which is why some people have a negative view of artificial insulin. Insulin helps to deliver energy (glucose) throughout your body. When too much energy is delivered it is stored as glycogen or fat. Insulin by itself cannot be converted into fat.

The bottom line is that your doctor is trying to help you find ways to match the insulin levels inside of your body with your blood glucose levels. The sulfonyulrea (glyclazide) you're taking as well as the GLP-1 agonist (Victoza;liraglutide) are effectively causing your pancreas to produce as much insulin as it possibly can. There is (inconclusive) evidence to show that that can lead to cell apoptosis (cell death) over time.

In layman's terms: you can take drugs to make your pancreas work harder to produce more insulin, or you can get additional insulin from a pen. The trade-off is that the former can potentially destroy your body's natural ability to produce insulin while the latter means that you may have to carry around an insulin pen with your glucometer.

 

[josh010]

Thank you for your advice TorqPenderloin, just a further question, what would insulin resistance be, and could it be that the pancreas be producing the insulin but the cells have become blind, as I had thought that this was part of the reason why I was put on Victoza, but it appears that its not working as yet?

How long before the Victoza is recommended to start working, ?

Thank you and god bless

 

[TorqPenderloin]

Insulin resistance comes in many forms. One of the more common explanations is that fat develops around the pancreas. Unfortunately, it's been said that it only takes about 1 ounce of fat before insulin resistance begins to develop. There's no easy (proven) way to get rid of it either. There are the small group (roughly 10%) who develop insulin resistance even though they're at a normal BMI. Some are eventually forced to go on insulin which again doesn't necessarily cause them to gain weight.

As far as how long Victoza takes to work, that I haven't looked into that. A few months back I took an interest in learning about how various diabetes drugs work which is where my knowledge stems. I have no professional training related to the medical field.

The point of my previous post was to say that you shouldn't fear artificial insulin if it's going to get your blood sugar levels down to normal levels. If you're eating 4000 calories a day then yes, you're probably going to gain a considerable amount of weight if/when you start insulin injections. Under normal circumstances, as long as your diet/exercise continue to be a part of your diabetes management there's no reason why you should ever gain a pound if you eventually have to start on insulin.

 

[AndBreathe]

@josh010 - Whilst I respect TorqPenderlion's right to an opinion, what I dispute is necessarily that your your Doctor was saying you have an insulin deficiency. He wasn't there. It may well be that you have a dwindling insulin producing capacity, or as you suggest yourself, it is possible your insulin resistance is worsening. Without proper tests we can't know how much insulin you are actually producing. Do you know if

Firstly, can I suggest that a 1kg weight gain could be anything really, including your constipation. If you've just begun hanging on to your waste products since you changed medication, or if it is markedly worse, that could be your issue, rather than actual weight gain. Which ever, I would suggest you try upping your fluids as that often helps sort things out in that department.

I'm sure it must be alarming feeling your bloods are somewhat out of control. If I were in your shoes, I too would be keen to see some improvement sooner, rather than later, and also like you, I would want to avoid insulin if I could. To be fair, there are many people who post on this site who have found that taking insulin has been the best step they have taken on their diabetes journey, but as you have already highlights, it can bring challenges.

I don't know how tall you are in trying to guess whether your 95kg how ideal for you.

I know you say you are "....not overweight to a level where my blood sugars should be high", the problem with that is nobody knows the point at which anyone's weight begins to impact upon their ability to metabolise carbs efficiently. There are many slim people who developed diabetes. I never carried much weight., but trimming up, along with modifying my diet worked wonders on my T2.

Personally, in your shoes, I'd want to give this my very best shot before seriously contemplating insulin. I would look seriously at what I was eating and drinking with a view to attempting to trim back on my carbs a bit more, and to lose a bit of weight.

I really hope you can find a way forward to whatever outcome you want.

 

[ally1]

What AndBreathe said about tweeting what you eat is so right. When I was told that victoza was a wonder drug, I thought great, that I could eat what I wanted. How wrong I was.
It was only from the end of June is that I realised that to help myself was to totally change how and what I ate. It was hard as I was so hungry. Now I eat half what I did prior to end of June, as I Don, t work, I found eating breakfast at 9am and most times I have a pot of porridge where you add water, I find that porridge does note spike me, have lunch at 2pm and dinner between 7.30 and 8pm. I find eating at these times stops me eating late at night. I tend to go to bed around midnight. If I do feel hungry later in the evening, I now realise I am not hungry of sorts but just bored, thought I sometimes have a small amount of sugar free jelly.
Since 30th June I have lost 5kg. Not alot by some people but it's a fair amount for me.

 

[chalup]

If I were you I would ask for a fasting c-peptide test or fasting insulin and find out what is going on for sure. Once you and your doctor have that information you can make a decision based on what your body is actually doing. Without knowing your own insulin production it is just stabbing in the dark.