unmanagable

[cooluck]

Hi.  I am a 40 year old male, 190 lbs, active and on low carb diet, who has been on insulin NPH BID 25 units for the past 2 years.  Prior to that I took oral medications only(all sorts, metformin, avandia, etc..) In October of last year my A1C was at 6.3.  Adjusting my insulin levels seemed to have no effect on my fasting blood gloucose level (typically in 130 range).  August of last year I was put on Tricor and added Diovan 160 in Novemeber, and have always been taking 1000mg of metformin twice a day.  Since November my blood sugar has become unmanagable (fasting in 150+ range).  Recently I stopped taking Diovan, because I noticed that it appeared that this whole thing started after i took Diovan.  I tested my blood sugar and my mornings results for two days were in the 130s and went up to 150 again, so I went back on Diovan per my doctor's insistence.
Then my doctor suggested about two weeks ago that I switch to Lantus (My A1c is at 7.2 now). I did that and no change.  I tried adjusting the amount, almost up to 50 a day, no change.  Yesterday he suggested that I inject Lantus U-100 twice a day. I am getting super frustrated with this whole deal.
Any suggestions would greatly be appreciated.

[JDRF-Team-LRS]

Hello unmanageable,
I hear your frustration.  I have a few suggestions coming from my experience as a long time Type 1 diabetic who's tried to keep fairly current on what's what.

As I read your posting, it seems as though you're being treated as a Type 2 which is similar to, but not exactly the same as Type 1.  Keeping your blood PRESSURE under good control is essential for all diabetics, so I'm glad you honored your doc's advice to restart those meds.  I'm assuming that Tricor is a statin and that it's being Rx'd for heart protection, tho' I don't know that med in particular.  The heart protection is also important for all us diabetics.


Now, onto your gradually increasing blood sugars.  It would be helpful to begin keeping careful records (I know it's a hassle) of what you're eating (estimate your portion sizes adn record everything that you eat) and to do extra blood tests to see patterns of before meals/snacks, 1 hr after, 2 hr after, and even 3 or 4 hours after again.  These records can help your endocrinologist or diabetologist figure out if you're experience insulin resistance (if you're overweight, you are) and/or delayed insulin response and/or insufficient insulin production.  Based on what's really going on, there ARE ways to treat those issues.

A good site for general Type 2 diabetes information is from the American Diabetes Association.  Their website is www.diabetes.org

Another place I highly recommend is a very interactive bulletin board sponsored by Joslin Diabetes Center.  There are MANY knowledgeable Type 2s, MANY who've had to endure some measure of "HEY! what's going on NOW???" before they found the right knowledge & treatment plans that work for them.  The website to get started there is:  
http://www.joslin.harvard.edu/managing/discussion.shtml

There are sooo many variables to managing diabetes and it is frurstating -- sometimes for long periods of time.  I hope this msg is a bit helpful for you, and that you'll check back here again, too because others will likely share their views.  In recent days there've been some posting from other Type 2s and you might find some additional help embedded in the responses to their questions.

Waddya think?

[cooluck]

I will check that site out.  I do keep a detailed log of my blood sugar levels (What I ate, what I did, etc..), and as I mentioned, I watch what I eat and I am not overweight and very active.
Thanx again

[JDRF Team SGG]

Most patients require only about 80% of their old NPH dose when they switch to Lantus, so the fact that you are having to INCREASE your insulin dosage seems to indicate that the root problem may be insulin resistance. The fact that you write that your weight is normal and you eat a low-carb diet seems to make this the only logical explanation for the constantly increasing glucose readings. You may want to do some reading on this problem and current treatments for it.

Also, you may wish to know that many diabetics who take Lantus choose to take it twice a day rather than once a day. Many simply split the dose in half and take half in the morning and half at night. Others take the larger dose in the morning and a smaller dose at night so as not to run into night-time hypoglycemic risks. The Lantus insuln lasts for ALMOST 24 hours, but does sort of peter out after about 20 hours. So a slightly elevated morning glucose number may be the result of its giving out a few hours before you awaken if you take your main dose every morning. I didn't know if you were aware of the fact that it can wear off in about 20 hours for some folks or not. This elevated morning reading is not a problem if blood sugar readings during the rest of the day are good.