Lantus, Novolog, Metformin, Januvia...questions!

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Lantus, Novolog, Metformin, Januvia...questions!


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Old 04-26-2015, 14:30   #1
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Question Lantus, Novolog, Metformin, Januvia...questions!

I'm so glad I found this forum. I have spent a lot of time reading and learning, since starting insulin about a month ago.

Question: my doc stopped my glimepiride and started me on Lantus and Novolog. She continued the Januvia, and the DM Educator I went to said I should stay on it, too.

But reading here, it sounds like Januvia is a Bad Thing. Also, I will be 65 this year and my husband will be retiring so soon we won't have our good insurance and will have to figure out what to do with Medicare and supplemental, which worries me. I'm on a lot of meds and the costs would be awful without good insurance. So, being able to cut back on some prescriptions would be good.

Twice now, I've stopped the Januvia on my own, but then my BS really climbs...especially the FBS,which rises to the 160-175 range. While on Januvia, it was in to 110-130 range.

I'm supposed to be on 25u Lantus, 6u Novolog at brkfst (2-3 carbs) and 7u Novolog at L&S (4 carbs.) I actually eat 3 at L&D, but now I've had to increase the Novolog to 8 before L&D or my premeal BS goes too high.

Someone here posted that they quit Januvia and it made no difference,
but both times I tried stopping it my BS has gone up. I've been off of it for four days now, and my FBS was 175 this morning.

What changes would you make in the insulin? Should I increase the lantus? I know to increase in small increments, but is there a point at which its just too much? Are there people who simply cannot get off the Januvia, or can it all be managed with the insulin doses? I do know how to count my carbs very carefully, BTW.

I'm not due back to the DM Educator until summer, and don't want to go back earlier. And anyway, the educator recommends Januvia, Victoza and Byetta--says the local endochronologists here really like them and also warn about tight BS control. I was happy when I was keeping my FBS and premeal BS around 80-100, but she said that it was dangerous (risking hypos) to keep it so tight...and said that with repeated hypos, one is at risk for early dementia. I've found research that concurs.

She says 160-180 is fine....but after reading books by Ruhl and Bernstein (sp?) I still want better control than that. Then again, I can get down to 66-70 and not feel it, so maybe she is right. I used to feel really crummy at 80, but since starting to be MUCH more careful with carbs (since starting insulin--which was a big wake up call!) I don't sense myself going low nearly a much. I do test 7-8 times a day.

Sorry for this long-winded post.

Comments? Suggestions? Should I just keep upping the Lantus? Give it up and add the Januvia back? Thanks so much!!!

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Old 04-26-2015, 14:42   #2
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I'm sorry to say that I can't really help on dosage management but I would echo the sentiment that you've already picked up. I struggle with the logic of using a drug to force your own body to generate insulin (in an uncontrolled amount and timescale) and in addition inject insulin.

In managing insulin I think it is hard to beat Dr Bernstein's "Law of Small Numbers" but built into that is the idea that you know exactly how much insulin you are taking. You can't achieve that with Januvia in the equation.

I've also have to ask you to clarify what you mean by "2-3 carbs". Do you mean 2 to 3 grams of carbohydrate or 2 to 3 carbohydrate units? (of 15 grams each).

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Old 04-26-2015, 15:06   #3
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Quote:
"I've also have to ask you to clarify what you mean by "2-3 carbs". Do you mean 2 to 3 grams of carbohydrate or 2 to 3 carbohydrate units? (of 15 grams each).

Thanks for your reply. Sorry I wasn't clear. I'm using 12-15 grams CHO per "carb" unit. I know studies show that people tend to over/under estimate, but I've used this for years and do know the basic foods well, but also read labels carefully and look up items I don't know.

Forgot to add that I did read "Think Like a Pancreas" and have read (and printed off for my DM notebook) the Law of Small Numbers. I love, love, love this forum, and how it has directed me to many excellent resources!

Roxanne


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Old 04-26-2015, 15:16   #4
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Quote:
Quote:
Originally Posted by rnr1 View Post
"I've also have to ask you to clarify what you mean by "2-3 carbs". Do you mean 2 to 3 grams of carbohydrate or 2 to 3 carbohydrate units? (of 15 grams each).

Thanks for your reply. Sorry I wasn't clear. I'm using 12-15 grams CHO per "carb" unit. I know studies show that people tend to over/under estimate, but I've used this for years and do know the basic foods well, but also read labels carefully and look up items I don't know.

Forgot to add that I did read "Think Like a Pancreas" and have read (and printed off for my DM notebook) the Law of Small Numbers. I love, love, love this forum, and how it has directed me to many excellent resources!

Roxanne
This is confusing, seeing my name under a post I didn't write. I assume your name is Roxanne too. WE don't use carb units like you will be taught in a "nutrition class". I count all carbs, half the protein (as Dr. B suggests in his book) and ignore the fiber. I choose not to use sugar alcohols as they upset my digestion in a negative way. Your doc should have suggested a I:C (insulin to carb ratio) to use with meals, and an insulin sensitivity factor (which he probably gave you a sliding scale). After awhile we need to learn how to tweek our own insulin. I was lucky that my endo allows me to send him numbers every 3 days in which he tells me to up or lower the lantus or change the I:C ration.

I dumped all diabetic medication and just use insulin. It makes it simpler to decide how much without quessing what the other meds are doing. You will eventually get all this down to a science. The nurses and doctor's were shocked I knew exactly how much insulin I needed to bring blood glucose down to 100.

Blood Sugars over 140 causes damage, so you want numbers at least below this at all times.

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Old 04-26-2015, 15:18   #5
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I think you need to cut back on your carbs, and get your dosage down, just as the "chorus" here advocates.

Grams are a better unit of measure than so-called "units". Too easy to eat too many, while telling yourself that you are fine.

This is not medical advice.

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Old 04-26-2015, 15:54   #6
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Oh my goodness. WAY too many carbs. You will NEVER be able to control your numbers that way. Injected insulin comes in at a much different rate than natural insulin. I was DX'd a year ago and was eating 15-20 c per meal and using 7-12 units. My BS was all over the place. I widdled all my carbs down to about 5 per meal, all green veg carbs and I now take 1 -1.5 units per meal. My lantus went from 5 to 2. I had lots of highs and lows and bopping around. Now I stay between 80 and 100 MOST of the time. I eat lots of salads or romaine lettuce wraps topped with some protein and fat. I eat the same size meals all the time. I use the same plate as my measuring cup. I just vary my proteins and fats. You will find it VERY difficult to steady your BS with that many carbs as well as grains, starch, fruit, sugar, juice etc. Can you aim for 20 carbs a DAY? That is the only way I could avoid the roller coasters.

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Old 04-26-2015, 15:59   #7
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Thanks for the clarification. If I may sum up, over the day you eat around 8 to 9 units. In my terms that's equivalent to somewhere between 96 and 135 grams of carbohydrate?

That does suggest to me that were you to cut back on the carbohydrates, you would need to do several things about your medication. First, consider the elimination of the random factor in the medication - the stuff called Januvia. This will reduce the risk of nasty hypos as you bring your carbohydrate load down.

Next, examine your post meal numbers and see whether given a reduction in the carbohydrates you can reduce or even eliminate the bolus of Novolog that you are using.

Finally, look at your morning fasting figures. As you improve your post meal numbers you should find that your need for Lantus will also reduce. But take that gently. Don't suddenly decide to half the dose - take it down a couple of units at a time. The advice I got back in 2010 was to reduce my dose by 2 units whenever I went three days running below 80 mg/dL. So, I'd suggest applying a rule like that to your own approach.

But to start, do explore How to Lower Your Blood Sugar for a step by step suggestion of the routine.

Good luck.

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Old 04-26-2015, 17:26   #8
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Thank so much, everyone, for your replies. I am always learning, through this site, as well as through the reference books recommended here. I'm going to try to continue staying off the januvia, cut my carbs, and fiddle with the Lantus and Novolog. I appreciate all of you time in answering my questions!

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Old 04-26-2015, 18:52   #9
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Quote:
Originally Posted by rnr1 View Post
Thank so much, everyone, for your replies. I am always learning, through this site, as well as through the reference books recommended here. I'm going to try to continue staying off the januvia, cut my carbs, and fiddle with the Lantus and Novolog. I appreciate all of you time in answering my questions!
Just be very careful. Cutting carbs will mean less insulin or you will have a hypo. Watch carefully please. I eat the way I do so I don't fear hypos. I love my salads and wraps so not a big deal for me. Keeps the shopping list easy too. I could never find a way to eat carbs other than green veggies and get my insulin there at the same time so I just don't eat them anymore. Makes dosing and meal planning very simple. I have no idea how I would even attempt with Januvia. How would one gauge random insulin coming in. IF it were ME, I would do the LC and get off Januvia, but that's just me.

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Old 04-26-2015, 20:20   #10
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"You will find it VERY difficult to steady your BS with that many carbs as well as grains, starch, fruit, sugar, juice etc. Can you aim for 20 carbs a DAY? That is the only way I could avoid the roller coasters."

i again, I appreciate all of the great information here! But now I have a question. You said "...with that many carbs, as well as grains, starch, fruit, sugar, juice etc."

I am counting total carb exchanges per meal (all grains, starches,veggies, fruit, dairy) and also checking labels whenever possible for grams of carbs, to make sure.

When you mention 20 grams of carb a day, that would be so little: like one small apple for the whole day and not any other sources of carb. So are most of you here being that strict? This is a new concept to me, but I am here to learn!

If you are being that strict, are any of you seeing problems with long term ketosis?

Again--thanks!

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