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Discussion Starter · #1 ·
Hi,

Allow me to introduce myself.

I'm type 2, diagnosed 1994, at age 45. I'm too fat, but not real fat. I've been on insulin for a long time. I maybe could be on orals, but I feel I can get better blood sugar control on insulin. Byetta gives me violent diarrhea. I've tried metformin (Glucophage) several times. For some strange reason, it makes me very tired and depressed. I keep my total calories low, I exercise and have good eating habits. Maybe that's why I'm still alive, and have no complications I know of, but I still have type-2 diabetes and I have not been able to lose a lot of weight.

I have a question that might be difficult to answer. I'm hoping for some good advice.

I'm afraid my blood sugar control is not good enough. My HbA1C is usually 7.1 to 7.4%.

One of the reasons my bgs don't run lower is I'm afraid of going hypo, and I really don't like it. If I get down to 70, 60 or lower, I feel terrible for several hours. Occasionally, this happens unexpectedly. If I lose consciousness, there could be a 911 call, ambulance, big ambulance bill, loss of driver's license, etc. I really don't want to go there!

Lately, I've decided to try to follow a new rule: Don't eat until my bg is below 100, preferably below 90. Attempting to do so has given me some surprises. For example, if my morning fasting bg is 150, and I take 20 units of regular, my bg falls very slowly for about two hours and levels out around 110, then starts to go up again, even though I have not eaten anything. Yet if I inject 25 units instead of 20, the bg falls much more rapidly and will fall below 70 within three or four hours.

Lately, I've been using only Regular, avoiding long-acting. I've been testing many times per day, recording bg readings, meal times and amounts, and insulin injection amount and times.

It's becoming obvious that my blood sugar, insulin and food intake interact in complex ways. I suppose the arithmetic is a little different for each person. Exercise would make it even more complicated.

I wonder if there is some kind of mathematical formula, or some kind of calculator that would help me predict bg one, two, three or four hours later, if I entered insulin dose, bg reading and so on. I would want it to take into account the rate at which my blood sugar falls, at various starting bg levels, at various insulin doses, and so on.

Does such a formula or calculator exist? Maybe an web site? If so, how well does it work?

Hope you understand my question. I know it's kind of complicated.

Timborama
 

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You're playing with fire. I think what you want is an artificial pancreas. Stop counting calories & start counting carbs. Your diabetic body will thank you for it.

Welcome to DF. :)
 

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Regular's peaks and dips are waaaayyy too unpredictable for me to use it, errr, regularly. I only use it if I'm going to some event where I know I'll be eating a certain number of carbs in an hour or two. Then I can take it before I leave the house; then I don't need to worry too much about testing/shooting up during the event.

I find that a long-acting basal keeps me on a fairly even keel. I use fast-acting bolus for carby meals only, since (thus far) proteins and fats don't affect my levels.

Most of the time, I avoid carby meals, so I don't have to bolus. But when I do bolus, I like the fact that it works quickly, then goes away.

The basal/bolus combination prevents/corrects any spikes, and helps me keep a near-normal average without those pesky lows that attract the attention of the California DMV.
 

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Welcome to the forum :). I know how you feel about lows. I really dislike them, too. I was wondering about this statement you made....

Timborama said:
I've tried metformin (Glucophage) several times. For some strange reason, it makes me very tired and depressed.
Is this a documented side effect? I wonder if other people have experienced that, too?
 

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Discussion Starter · #5 ·
Welcome to the forum :). I know how you feel about lows. I really dislike them, too. I was wondering about this statement you made....

Is this a documented side effect? I wonder if other people have experienced that, too?
It is not listed as a side effect in the PDR. My doctor thinks I'm a hypochondriac, or nutty about medicine, but this is not true. I've taken many medicines without problems or anxiety.

I've stopped and started several times. After a few days off the metformin, I feel better again. A day or two after starting, I feel terrible again. I've tried starting at a low dose and gradually increasing. One or two other medicines have the same effect on me. Most don't. Maybe a genetic predisposition to depression or something.

If it were a common side effect it would probably be listed in the PDR. It might not be terribly rare, either.
 

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If you desire better BG control, try researching the basal/bolus approach along with counting carbs. Do you see a GP or an Endocrinologist for your Diabetes management?

There is a lot of excellent information on Bloodsugar101.com. You might find it helpful.
 

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I have a coworker who gets horribly weepy on metformin. There is nothing worse than being discounted as a hypochondriac!
 

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I have a coworker who gets horribly weepy on metformin. There is nothing worse than being discounted as a hypochondriac!
This may be a function of Metformin doing its job and lowering Blood Sugar.
 

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It's becoming obvious that my blood sugar, insulin and food intake interact in complex ways. I suppose the arithmetic is a little different for each person. Exercise would make it even more complicated.
It isn't very complicated, but those are the 3 things I always keep in mind. Physical activity, food counts, and insulin doses. I like to use the smallest amounts of basal insulin I can, and just use the rapid acting insulin to cover meals.

If I am going to be doing something physical, I don't want my rapid acting insulin to be active at that time. They only last 4 hours, so I can schedule activity around them.

It does take a bit of practice and care.
 

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I have a coworker who gets horribly weepy on metformin. There is nothing worse than being discounted as a hypochondriac!
I get this way on Ibuprofen/Naprosin. First time this happened I thought I was losing my mind.
 

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Discussion Starter · #12 ·
This may be a function of Metformin doing its job and lowering Blood Sugar.
Certainly not in my case. My sugars were well within the normal range when I was depressed on metformin. And I was quite depressed around the clock.

If I felt that bad all the time, I would kill myself within a few months. Normally, I don't have serious problems with depression.

I'm just guessing... But I'm guessing that there have been unexplained suicides on metformin. This is not so far-fetched. Acutane, an acne medicine caused an estimated 5,000 to 7,000 suicides during the ten years it was on the market.

If you don't get depressed on metformin, don't worry about it.

Far be it for me to give medical advice. If you think metformin might be causing depression, talk to your doctor about it. Your doctor might not believe you. The only way to find out is to discontinue the metformin for awhile. There are other ways to control blood sugar.

If I had to guess, I would guess metformin does far more good than harm.

Just my opinions.

But that isn't the reason I started this thread. If anyone desires further discussion of this topic, please start a new thread.

Timborama
 

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Discussion Starter · #13 ·
If you desire better BG control, try researching the basal/bolus approach along with counting carbs. Do you see a GP or an Endocrinologist for your Diabetes management?
I've tried basal/bolus. I am not an inexperienced insulin user. Far from it. I've temporarily discontinued basal/bolus because I want to be able to calculate more exactly how long it will take for my insulin to fall to about 90, given a given starting bg and dose of insulin R. (Assuming I've been fasting for several hours and it's been at least 4 hours since my last does of R.)

Taking basal insulin makes the calculation more difficult. Once I get the arithmetic right, I'll repeat the process while using basal.

The trouble is, the function that predicts the number of hours to arrival at bg 90 based on starting bg and insulin dose is not linear. If the dose of Regular is too small, I never get down to 90, or even close to it. If the dose of insulin is a little larger, it takes several hours for bg to fall to 90. (I get really hungry waiting for arrival at bg=90!) With a little more insulin, bg falls rather rapidly.

I'm not good enough at algebra or calculus to put together the formula that takes the non-linearity into account. Chances are, some smart doctor or scientist has published the formula. I thought someone here might know it.

With enough experimentation, I can kludge the calculation.

Seems to me, if I can arrange never to eat when my bg is above 90, I'll have better HbA1C and will need less total insulin per day. My insulin sensitivity would probably improve somewhat. I just have to be careful not to go hypo. Even if I get the math right, I'll have to test more often, particularly around the time I expect bg will be approaching 90.

Comments welcome.
 

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Discussion Starter · #14 ·
It's me, the OP, with a quick reply to myself.

I suppose insulin pumps use a formula like the one I'm talking about. Does anyone know what it is?
 

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Discussion Starter · #15 ·
I get this way on Ibuprofen/Naprosin. First time this happened I thought I was losing my mind.
This is a well-documented side effect of NSAIDs. It doesn't happen to most people who use NSAIDs, but it is far from uncommon.

Well-documented, but not well-known. Neither the manufacturers nor the FDA (de-regulated tool of the manufacturers) are trying hard to make the public aware of it. The depression can begin at any time, even if you've been taking it for years with no problem. Apparently, it can happen at any dose.

It also happens with proton-pump inhibitors, the drugs that reduce stomach acid secretion.

In addition, psychiatrists don't trust beta-blockers, medications used to lower blood pressure and regulate heart rhythm. For many years, they have been suspected of causing severe depression in susceptible patients. Internists and cardiologists like to prescribe them because they lower blood pressure reliably and probably do prevent some deaths in patients who have heart disease.

But please, if you're interested, start a new thread. I really hope to get more answers to my original question and this is off-topic.

Cheers, Timborama
 

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"With enough experimentation, I can kludge the calculation." NOT!

Sorry to rain on your parade, but at first the lower sensitivity is caused by the fat in your blood. Insulin stores both glucose and fat. So with the fat in your blood about half of the insulin is being used to store fat and about half being used to store glucose. After the fat has been cleared from the blood all insulin will now be used to clear glucose. This will make it appear that you are now twice as sensitive to insulin if you are just measuring glucose. To predict your apparent insulin sensitivity to glucose you would have to know how much fat is in your blood and you have no way of measuring that.

ColaJim






I've tried basal/bolus. I am not an inexperienced insulin user. Far from it. I've temporarily discontinued basal/bolus because I want to be able to calculate more exactly how long it will take for my insulin to fall to about 90, given a given starting bg and dose of insulin R. (Assuming I've been fasting for several hours and it's been at least 4 hours since my last does of R.)

Taking basal insulin makes the calculation more difficult. Once I get the arithmetic right, I'll repeat the process while using basal.

The trouble is, the function that predicts the number of hours to arrival at bg 90 based on starting bg and insulin dose is not linear. If the dose of Regular is too small, I never get down to 90, or even close to it. If the dose of insulin is a little larger, it takes several hours for bg to fall to 90. (I get really hungry waiting for arrival at bg=90!) With a little more insulin, bg falls rather rapidly.

I'm not good enough at algebra or calculus to put together the formula that takes the non-linearity into account. Chances are, some smart doctor or scientist has published the formula. I thought someone here might know it.

With enough experimentation, I can kludge the calculation.

Seems to me, if I can arrange never to eat when my bg is above 90, I'll have better HbA1C and will need less total insulin per day. My insulin sensitivity would probably improve somewhat. I just have to be careful not to go hypo. Even if I get the math right, I'll have to test more often, particularly around the time I expect bg will be approaching 90.

Comments welcome.
 

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Discussion Starter · #19 ·
Sorry to rain on your parade, but at first the lower sensitivity is caused by the fat in your blood. Insulin stores both glucose and fat. So with the fat in your blood about half of the insulin is being used to store fat and about half being used to store glucose. After the fat has been cleared from the blood all insulin will now be used to clear glucose.
ColaJim
Hello ColaJim,

That would explain the non-linearity.

On the other hand, the previous message seemed to encourage calculating my I:C ratio and my ISF. That's "insulin sensitivity factor," I believe. Surely, this could not be a complete waste of time.

And for that matter, insulin pumps must do calculations of this sort.

Obviously, bgs vs. insulin injected vs. carbs consumed versus time elapsed cannot be predicted precisely. If attempting multiple daily injections, also known as "flexible insulin therapy" I've got to be careful not to go hypo. Several ways to do that, seems to me.

--Don't be too aggressive when calculating insulin doses.
--Consider the tail end of the previous insulin dose.
--Adjust for recent exercise
--Adjust for time of day. I seem less insulin sensitive in the morning.
--Re-calculate insulin sensitivity now and then.
--If I plan never to eat unless sugar < 90 or 100, then test frequently after injecting.

Am I on the right track? Is there something I'm not getting?

Timborama
 

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Timborama

You are getting pretty close to understanding "the cussedness of nature" when in a static state ( no food eaten in the last 2 hours ). But when you eat a meal the gut signaling will increase your sensitivity to glucose. You will see from others that they list: insulin sensitivity 10 mg/dl per unit insulin which for me is about 2 grams of carbohydrate, then they also list carbohydrate to insulin ratio (C:I) as 10 grams carbohydrates to unit insulin which for me is about 50 mg/dl. This is caused by your intestinal signaling and may be the reason that mutilating one's intestines appears to "cure" T2DM.

In the next lesson I would show how your kidneys determine your IR but if I did the powers that be might ban me. :D

ColaJim

PS:
"And for that matter, insulin pumps must do calculations of this sort." NOT

An insulin pump is programed by the user. If it could monitor blood glucose and adjust its' output accordingly it would be an artificial pancreas. In this day and age the continuous blood monitors are far too inaccurate to be hooked directly to the pump.




Hello ColaJim,

That would explain the non-linearity.

On the other hand, the previous message seemed to encourage calculating my I:C ratio and my ISF. That's "insulin sensitivity factor," I believe. Surely, this could not be a complete waste of time.

And for that matter, insulin pumps must do calculations of this sort.

Obviously, bgs vs. insulin injected vs. carbs consumed versus time elapsed cannot be predicted precisely. If attempting multiple daily injections, also known as "flexible insulin therapy" I've got to be careful not to go hypo. Several ways to do that, seems to me.

--Don't be too aggressive when calculating insulin doses.
--Consider the tail end of the previous insulin dose.
--Adjust for recent exercise
--Adjust for time of day. I seem less insulin sensitive in the morning.
--Re-calculate insulin sensitivity now and then.
--If I plan never to eat unless sugar < 90 or 100, then test frequently after injecting.

Am I on the right track? Is there something I'm not getting?

Timborama
 
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