Metformin, Insulin & Glipizide?

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Metformin, Insulin & Glipizide?


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Old 07-15-2014, 08:10   #1
Nyx
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Default Metformin, Insulin & Glipizide?

Hi everyone

I am new here. I am on metformin 2000 mgs/day. Since they put me on a statin and just generally I guess, my waking reading has been getting up in the 10.3 region and I have had to go very low carb to control my after meal readings.

They now want to put me on Glipizide. I read a few things that make me wary of drugs that make you use up your own insulin faster and being very heavy they are linked to weight gain which causes me concern. I wondered whether I would be better off (more healthy??) asking for a single dose of insulin to set me up for the day. On a very low carb diet about 40 per day, I can generally manage my blood sugar after meals as long as I don't eat carbs in the morning.

Or is a larger dose of metformin worth trying? Does anyone have any advice as although I have had diabetes for a while, I don't know that much about it, having controlled it by insulin when pregnant, diet for 2 years and metformin for 5 or so years.


Last edited by Shalynne; 07-15-2014 at 08:22.
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Old 07-15-2014, 08:59   #2
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Drugs that stimulate the body to produce insulin (whether you need it or not) strike me as using the same technique as red lining a car engine with a cracked cylinder head. As a way of prolonging the lifetime of beta cells I consider it (as do some doctors like Richard Bernstein) highly suspect.

It also traps you into a situation where your low carbohydrate way of eating is undermined by the need to avoid the hypo that your surge of insulin may generate. And if the drug doesn't deliver - perhaps because of beta cell burnout, you leave yourself in a hyper state.

To sum up, I agree with you - a basal insulin dose and (if necessary) a pre meal bolus dose calculated to cope with the carbohydrate load you have chosen to accept in your meal strikes me as a much safer route.

It's the regime I've followed for the last four years so successfully that my medication need is currently zero!

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Old 07-15-2014, 09:07   #3
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So John when you say you are no longer on medication do you mean you no longer take insulin? Or do you not consider insulin a medication? Nyx

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Old 07-15-2014, 09:23   #4
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As you'll see in your other thread, back in August 2010 I left hospital with a prescription for Prandin and Levemir (basal insulin).

The prandin is still in its box but I used the Levemir as prescribed. The rule was that if my fasting blood sugar was below 4 mmol/L three days running, I was to cut the dose by two units (I started on 20). If I went over 6.6 three days running it was to go up by 2.

Anyway, following a low carb diet my final insulin dose was in early November 2010 and I currently average around 4.7 in the morning.

Other than Metformin, Insulin is the only medication that I consider safe and if the need arises, that's the only one that will be used as long as I have any say in the matter!

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Old 07-15-2014, 12:04   #5
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Nyx, I hate to say this but some/quite a few of us are unable to eat 40g/carb a day and maintain BG control. Some (happened to me) had to start much lower then gradually work up. Some, of course, are able to eat well above 40g/day.

What do you eat? Can you offer some examples of meals? And when you tested/what the BG test results were after the meal. It could be some dietary tweaking can continue you on the path to manged BG.

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wf, 63yo, 5'4", 110 lbs
LCHF diet-controlled T2
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8/26/14 HbA1c 5.5
avg BG: 90 - 95 before meals, 100 - 110 one hour PP, 95 2 hours PP
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Old 07-15-2014, 13:19   #6
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At the moment, I am eating smoked salmon and home made French dressing (only carbs from mustard) with a few (3) cherry tomatoes or AN oopsie roll with almond butter for breakfast (LATE MORNING) mainly.

Lunch (around 3) tends to be one piece low carb bread (8C per slice)with something heavy on it like salmon cream cheese, egg mayonnaise etc but my BG doesn't seem to like the bread.

Dinner varies but mainly steak and salad with avocado tomato, lettuce and dressing or pork chop and various veges (not root veges) and sometimes, 1/2 a pot of yoghurt if I am desperate (10C).

I have coffee with every meal and it is about 1/2 a cup of full fat milk each time as I have espresso. So that maybe ups the carbs. However I have tested the coffee with cheese or a sausage and that seems to be down around 6 or below after 2 hours.

I have always had a problem with overnight readings. I once did a rigorous 15 to 20 carbs daily for six months, never lost more than 2 kilos and still had a morning reading of 8. Ended up going off the reservation because I couldn't hack that regime in the long term and ultimately gave up low carbing over time and got metformin and have been on about 80 - 90 carbs/day for a number of years until recently.

For the last 4 weeks I have been back on the wagon having got an HBA1c of 10.2. Tried 60C daily low GI foods for a few days but my BG hated it. Now I am back to the same pattern of semi starvation all morning while waiting for the numbers to come down and morning reading is in the 9's.

Snacks are nuts and cheese when I have them. 1 to 2 times a day.

Carb wise, my best intake would be 30 and on the odd day maybe around 50. Mostly 35 - 40.

N

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Old 07-15-2014, 13:47   #7
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I was on Metformin, 2550 mg/day (split into 3 doses of 850 mg) and Diamicron (Gliclazide) 90 mg/day (single dose). With that and avoiding sugar and starch like the plague, I was able to get my fasting blood sugars into the 8 to 10 range (usually closer to 10), but no lower. (I try to keep my daily carb intake under 30 grams.)

In May, my doctor put me on Lantus; at that time he dropped the Diamicron on the grounds that doing both Lantus and Diamicron puts me at great risk for dangerously low hypos.

So now I am still on the Metformin, plus one shot of Lantus (~ 25 units) once a day (about 9 pm). Fasting blood sugar is now in the 5 to 6 range, occasionally into the 4's.

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Old 07-15-2014, 14:09   #8
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Nyx? Low-carbing is only possible if you do high-fat along with it. Trying to low-carb without high-fat is indeed a starvation plan and none of us could do it for any extended time period.

There are two essential nutrients which are protein and fats. Protein is for the sole purpose and building and maintaining the cells which compose the various body tissues, so protein does not provide energy. Carbs are not essential nutrients, but they provide energy by converting to glucose which our cells then take up IF there is not a deficiency of insulin or a resistance to insulin. But for us diabetics - who can be either insulin deficient, insulin resistant or BOTH - carbs raise our blood sugar to dangerous levels, which is eventually life-threatening.

The answer to this conundrum is to stop eating carbs in any form and replace them with fats. Fat does not convert to glucose, it converts to ketone bodies, and those ketones can fuel our bodies every bit as efficiently as glucose.

The self-styled experts will tell you your brain needs carbs, and you must not go below 130g of carbs per day. That, my new friend, is gen-u-wine original authenticated hogwash. Your brain does not function on carbs. Your brain functions on glucose and a very small amount of glucose at that (about 5%). Furthermore, our bodies do not require carbs to manufacture glucose. Our bodies have another metabolic pathway called gluconeogenesis which can convert amino acids and other non-carb sources to glucose.

If you would please, consider these trustworthy sources and continue slashing the carbs from your meals. But replace them with fats, and you will discover almost immediately that your blood sugar will drop, the extra pounds will drop too, and you won't be hungry or listless from starving yourself. And if you will adopt the practice of eating to your meter, you will surely be able to manage your diabetes a lot more easily.

Low-carb/High-fat Way-of-Eating
Ketogenic Diet Resource
How did we come to believe saturated fat and cholesterol are bad for us?
Ending the War on Fat
The Fat Question: Why fat doesn't make you fat
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Old 07-15-2014, 14:59   #9
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Shanny - I agree theoretically about the fats but I am wondering how to manage this?

At the moment I am hungry a lot of the time and am still having carb cravings every other day. When I managed on 15 - 20 carbs previously I wasn't hungry at all but my diet didn't feel healthy. I seemed to be eating a lot of cream and cheese and meat and I really didn't feel like it was healthy. It was very high in protein and I felt unhealthy although did have lots of energy. I also wondered if that was why I didn't lose weight when others on similar vlc diets had it fall off. This time I decided to only use healthy fats but with the exception of avocado with most meals and lots of olive oil based dressing and salmon, I am stumped for how I can get my fats (and to an extent veges) up without heavy reliance on dairy and meat.

I think that is a fundamental dilemma for vlc.

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Old 07-15-2014, 15:19   #10
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Nyx,

As Shanny said, you need to replace the energy that came from carbs with energy from fats. Since August 2010, I have been eating a diet of around 2,200 calories broken up roughly as follows:
  • Protein - about 100 grams
  • carbohydrate - about 50 grams
  • fats about 180 grams
I'm never hungry but I am ready for my meals when they arrive. In the first six months of the exercise my weight dropped from 82 KG to its current level of 70kg.

A typical three meals a day routine looks something like
  • Breakfast:
    • 100 grams home made beef burger
    • 2 eggs fried in butter
    • Green salad
    • 30 grams of nuts
    • Big mug of black coffee
  • Lunch
    • Meat portion - chicken, beef, pork, lamb ...... (stew, roast or stirfry)
    • Low carb veggies
    • 30 grams of nuts (not the same ones as breakfast)
    • 30 grams of cheese
    • small portion of fruit
  • Dinner
    • Fish - salmon, cod, mackerel, sardines...
    • Low carb veggies
    • thirty grams of nuts (not the same ones as breakfast or lunch)
    • thirty grams of cheese - not the same one as lunch time.

As far as possible we try to avoid 'packaged' foods and the cheese and butter comes from non pasteurised sources. It works!

 
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