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I've been on Metformin ER 1000x2 for the last 7 years with A1C between 6.1 and 6.9, with moderately healthy diet and exercise (no carb counting etc.). Last year my A1C shot up to 8 so I got serious and this led me to BloodSugar101 and this forum.

So far the consistent message I here on this forum is that one should drive carb consumption down to as low as necessary as a first line of diabetes management. Now that I'm counting carbs, I find I can maintain a 100g per day diet or maybe 75g , but 50g or 25g seems extremely difficult.

Seems to me that all medications have side effects - EXCEPT insulin. I know that insulin improperly dosed can cause hypo, but for a T2, a basal insulin like lantus should be the safest option of all.. When I tried to ask my doc about it, all she would say is we only try lantus after exhausting all other oral medications.

She put me on 100mg Jauvia - It doesn't seem to do anything to me - no side effects, no good effects either - no change in FBG (130-150).

I find that I have a morning spike in BS for no reason at all... rising 20-30 points from 4:30 AM to 6:00AM and back down by 8:00AM

The rest of the day, 2 hr pp is between 145-160 and pre-meal between 100-115.

Seems to me if I could just take a lantus shot first thing in the morning, it should get my A1c down by a fair bit. My question is why is this not the first option after Metformin, and why is it not preferable to driving carb consumption down to levels low enough to be very difficult to maintain? What am I missing?
 

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This is entirely a personal view, based solely on the fact that historically, insulin for a type 2 was considered a last resort treatment. Needle phobia still rules to a great extent. BloodSugar101 discusses this Insulin for Type 2 Diabetes

Before the advent of meters, control using insulin was pretty hit and miss and "a pill" much easier to swallow and just as sloppy.

Now with big Pharma in charge, they make a lot more money selling their expensive pills that keep the patient on the roller coaster to complications than they would offering insulin dosed using the guidance of someone trained to follow the protocols of someone like Dr. Richard Bernstein (see Diabetes Solution) that might actually arrest the progress.

Again, an entirely personal view - if, and I do say if, I ever have to use more than my Way of Eating to manage my blood sugar, I'll be at the head of the insulin queue - nothing else.
 

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Discussion Starter #4
Thanks David... so would it be correct to state that a basal insulin like Lantus should always be a better choice compared to Januvia and all the other new medications being developed?
 

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The two drugs are targeted at different things. Lantus is a basal insulin, aimed at long term levels. Januvia is an insulin stimulating medication that helps to manage meal time spikes.

So the comparison should be with a fast acting insulin like Humalog and there I would agree with you 100%
 

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Welcome batman....

I have been diagnosed as a Type 2 for over 9 years. I initially was put on metformin and then after a couple of years my doctor put me on Januvia. I too initially had no effects, either bad or good! Then after a few months on it I started getting upper chest infections. At first I did not connect the dots, as these things would start out as a bit of congestion, but then within 24 hours they would turn into a full fledged upper respiratory infection that would only respond to heavy antibiotics. During the first two year of taking Januvia I had 4-5 of these episodes and prior to Januvia it was unusual for me to be sick like this. I did more research on side effects of Januvia, and then for the first time I found out that it was known to cause upper respiratory problems among many other problems....I stopped taking it that day, and never went back. I have not had any respiratory infections since that day! Problem solved....

The problem with all new drugs is that they have not been in use for years with proven track records amongst the general population. Many of the problems and side effects will not show up right away. Some side effects can become permanent problems....so when you find out about them it is to late!

Therefore I take my metformin and Lantus injections and will not take anything else period! Since I started following Low Carb High Fat I have been able to reduce my Lantus from 126u daily to 25u! My A1c is now at 5.8% LCHF has solved my medication problems.....I hope to be completely off of Lantus by the end of this year....

By the way you mention dropping your carb intake, but if you do, you must increase your fat intake or the LCHF model will not work and actually could be dangerous....hope you read Blood Sugar 101 website....knowledge is the key here!

Good Luck
 

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Discussion Starter #7
The two drugs are targeted at different things. Lantus is a basal insulin, aimed at long term levels. Januvia is an insulin stimulating medication that helps to manage meal time spikes.

So the comparison should be with a fast acting insulin like Humalog and there I would agree with you 100%
Hi John.. perhaps I should rephrase my question. If there are no permanent side effects to using a basal insulin like Lantus, why should I even try the fancy stuff like Januvia and others, given that they have possibly dangerous side effects? What is the benefit of trying the other drugs over basal insulins like Lantus and Levemir? The pens are pretty painless.
 

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Welcome batman....

I have been diagnosed as a Type 2 for over 9 years. I initially was put on metformin and then after a couple of years my doctor put me on Januvia. I too initially had no effects, either bad or good! Then after a few months on it I started getting upper chest infections. At first I did not connect the dots, as these things would start out as a bit of congestion, but then within 24 hours they would turn into a full fledged upper respiratory infection that would only respond to heavy antibiotics. During the first two year of taking Januvia I had 4-5 of these episodes and prior to Januvia it was unusual for me to be sick like this. I did more research on side effects of Januvia, and then for the first time I found out that it was known to cause upper respiratory problems among many other problems....I stopped taking it that day, and never went back. I have not had any respiratory infections since that day! Problem solved....

The problem with all new drugs is that they have not been in use for years with proven track records amongst the general population. Many of the problems and side effects will not show up right away. Some side effects can become permanent problems....so when you find out about them it is to late!

Therefore I take my metformin and Lantus injections and will not take anything else period! Since I started following Low Carb High Fat I have been able to reduce my Lantus from 126u daily to 25u! My A1c is now at 5.8% LCHF has solved my medication problems.....I hope to be completely off of Lantus by the end of this year....

By the way you mention dropping your carb intake, but if you do, you must increase your fat intake or the LCHF model will not work and actually could be dangerous....hope you read Blood Sugar 101 website....knowledge is the key here!

Good Luck
Thanks!.. I read Blood Sugar 101 (bought the kindle version). Which is why I'm not happy that my Doc is insisting on Januvia. She mentioned something else as a next step if Januvia doesn't work... so I'm thinking I don't want to take anything other than Metformin, Low Carb, exercise and basal insulin if necessary.

I'm trying to look at it scientifically...
Option 1... go real low on carbs and get my numbers down.
Option 2... keep carbs reasonable.. say around 100g per day and use Lantus/Levemir.

In the end, it seems to be a tradeoff between using a pen and quality of life... or is there some downside to basal insulin which makes it preferable to go extreme low carb as a first option?
 

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First off, I'm not persuaded that a carb content in the 50 gram range destroys the quality of life :)

However, more important is that high insulin doses bring their own issues.

If nothing else, it's almost impossible to match the big dose to the big surge in blood sugar that a higher carb meal delivers. So you go high, then you go low (or the other way up). Have a look at The Laws of Small Numbers - Diabetes Solution - Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site , an extract from Dr Richard Bernstein's book where he discusses his "Law of Small Numbers".
 

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I'm trying to look at it scientifically...
Option 1... go real low on carbs and get my numbers down.
Option 2... keep carbs reasonable.. say around 100g per day and use Lantus/Levemir.
Scientifically, there is no option 2. If you go deeper in your research into glycolysis you will come across AGEs (Advanced Glycation Endproducts). That should convince anyone on the benefits of low carbing, which 100gm/day isn't. Option 1 is natural, it's better for all round health, it's my only option.
 

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Being as how glucose is necessary for about only 5% of our cells and the body can convert amino acids to glycogen, no carbs are either necessary or preferable. Continuing to eat carbs (because we don't want to quit) and covering higher BG numbers with basal and/or bolus insulin is not wise. Insulin does more than just help transport glucose into the cells, and it's not always good stuff.
 

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You'll see in my other post to you... I just took myself off of levemir by lowering carbs and upping fat. I hate how levemir makes me feel... And that it increases my appetite. The other drug I'm on in addition to met is invokana... Kicks excess sugar out in your pee. Not sure how others here feel about it, but I'm happy with my dose, no side effects.
 

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I'm a T2 and its been a fight to find a doctor willing to prescribe insulin. They all want to start with Januvia and other stuff. I insisted that when Metformin doesn't cut it, I want the next safest drug and that's insulin.

I don't think my doctor is that unusual in that she would rather see me with high BG (~150) than what she sees as too low. So insulin is something to be afraid of in her book. But I'm with the others, stick to the law of small numbers and you should be okay.

Also maybe insulin doesn't get as much cute pharmacutical rep time as the new drugs. So it's more familiar to them? It's all seems silly to me.
 

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"I don't think my doctor is that unusual in that she would rather see me with high BG (~150) than what she sees as too low. So insulin is something to be afraid of in her book."

Be advised that the slow acting insulins like Lantus has a very low incident of causing 'lows'! Most doctors will start with a slow acting insulin, just for that reason. You have to watch out for using fast acting insulin that is taken right before you eat, those can cause dangerous lows and require the user to be well trained and diligent is calculating dosages based on eating habits.
 

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It's because your doctor is not paying for it. I think that's the prime reason. They often have no clue about the cost of these other drugs. Most don't appear to know that Walmart has generic insulin at WAY less cost. I think they figure that if you are willing to shell out for Lantus, you would happily shell out for this other thing that is not going to give you dangerous lows. If you have insurance, you have a deductible up front cost. BUT, if you have Medicare, you have a donut hole to be concerned about. You may get your Lantus for $60/month and then suddenly it's $600-800 a month when you hit the donut hole. Now, what do you do?

Ok..that said, my doc did have two things to say about it. He avoids giving insulin to those who live alone (due to the concern for lows). He also said many of his patients (including me) who either do not lose weight or can't keep it off gain weight on insulin. This is because insulin turns the loose glucose in the bloodstream into fat instead of funneling it off into urine. However, it sounds like combining low amounts of metformin and insulin may avoid this issue, so both the diabetes educator and I are researching that as an option.
 

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Scientifically, there is no option 2. If you go deeper in your research into glycolysis you will come across AGEs (Advanced Glycation Endproducts). That should convince anyone on the benefits of low carbing, which 100gm/day isn't. Option 1 is natural, it's better for all round health, it's my only option.
I agree that 100 gm/day isn't low carbing. Call it 'lowish' carbing. My daily ceiling is 90 gm/day and I know it's not low carb, but low carb, unfortunately for me, causes worsening acid reflux over time which affected my breathing.
 
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