Cured nightime hypos???

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Cured nightime hypos???


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Old 01-18-2015, 13:00   #1
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Default Cured nightime hypos???

I have been on Lantus, Metformin and Januvia for quite some time. I quick drinking alcohol (again) about 7 months ago and subsequently have lost about 15 pounds, Even though I was down to only 4 units of Lantus at bedtime (at one time it was 12). I would awaken around 1 AM going hypo. Ate a couple of glucose tablets and other carbs if it was really low, say low 50's to 40's. Then try to get back to sleep.

I started pondering what to do.

First I discontinued the Lantus but would still have hypos. I lowered the Metformin dose to 1000mg in AM but only 500mg in the evening. Less hypos, but still had them. My understanding of Januvia is that it retards the liver from releasing glucose. So I discontinued the Januvia about 2 weeks ago and haven't had a hypo since.

I discussed this all with my doc, after this. ( I am more of a "ask for forgiveness rather than permission". kind of guy) and he said that he didn't have a big issue with this as long as I monitored my BS levels and adjusted if necessary. He also said never underestimate the benefits of losing weight. Even 10 pounds can make a difference.

My recent A1C was 6.9 and I want to bring that down some. My doctor is a believer that Hypos will cause more damage than Hypers (within reason).

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Trying to reduce my Carb intake (not easy).

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Old 01-18-2015, 13:16   #2
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My understanding of Januvia is that it retards the liver from releasing glucose. So I discontinued the Januvia about 2 weeks ago and haven't had a hypo since.
It's Metformin that works in the liver. Januvia causes the pancreas to release insulin (whether or not you need it, like, at night). I think it's the Januvia that was causing your hypos, not metformin.

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Old 01-18-2015, 13:22   #3
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Tim,

In my opinion, for what that's worth, you made the wrong decision on your strategy. (I see VeeJay is ahead of me.)

Lantus dosage can be controlled precisely but Januvia is an insulin stimulating drug. It's this latter item that can't be controlled. How much insulin will it cause to be generated? When and for how long?

Suggestion - dump the Januvia and if necessary re-instate your Lantus injection if you discover that your numbers are creeping up.


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Old 01-18-2015, 15:16   #4
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VeeJay and John are spot on - it's the Januvia causing the hypos. Metformin is deemed so safe and effective because it rests the pancreas from making insulin and coaxes the liver to release less glucose. Met also works on cells' insulin receptors to allow access to insulin already in the bloodstream.

As far as I've been able to determine, Januvia not only burns out the pancreas making insulin you don't need, but it and other DPP-4 inhibitors can be a trigger for prostate cancer, as well as stimulating metastasis in melanoma, ovarian and lung cancers.




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Old 01-18-2015, 21:08   #5
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Thanks for the input everyone. My plan was to start back on Lantus if my BS got too high. Not real interested in developing Prostate Cancer
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Old 01-19-2015, 09:17   #6
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Tim, I think that's a good decision.

Using insulin stimulation forces you to go high carbohydrate to avoid hypos and going high carbohydrate virtually guarantees hypers! Neither is a particularly good idea .

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Old 01-19-2015, 09:36   #7
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On top of what John said ... a habit of correcting high-carb hypers will earn you some over-compensatory hypos as well.

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Old 02-19-2015, 04:33   #8
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Quote:
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My doctor is a believer that Hypos will cause more damage than Hypers (within reason).
Lol, my doctor says that too, only more so. He said "I don't much care how high it [blood glucose] goes, as long as it doesn't get too low."

Unfortunately, it goes quite high.

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Old 02-19-2015, 09:21   #9
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Lol, my doctor says that too, only more so. He said "I don't much care how high it [blood glucose] goes, as long as it doesn't get too low."

Unfortunately, it goes quite high.
My definitions of hypo and hyper read something like this - the figures are pretty individual though
  • Serious hypo - will kill in hours (under 40) Needs urgent treatment
  • Minor hypo - uncomfortable (under 70) self correcting
  • Normal - that's where we want it (under 140)
  • Hyper - will kill in years (not going into DKA)
  • Serious Hyper (DKA) will kill in days. (head for ER)
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Old 02-19-2015, 09:27   #10
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And my contention is still that docs want us high, because they don't want us going life-threatening hypo, and dying on their watch. Looks bad on their résumés.



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