Diabetic treatment options in light of new tests

[anandbharti]

I am 53 year old male diabetic and have been on insulin for the last 25 years. My current A1C is 7.5 . My average daily insulin requirement is about 80 units
A recent test showed the following results:
GAD - AB < 5 IU / mL
C-Peptide 2.6 ng/ml
I had fasted overnight for the tests.
In addition to diabetes, I also have radiation induced Hypothyroidism and take 125 mcg of Synthroid.
I also have heart disease with EF of 30%. Had CABG (2 vessels) 10 years ago and have an implanted defibrillator.
My recent lipid readings are
HDL 37 mg/dL
Triglycerides 62 mg/dL
LDL 80 mg/dL
Total Cholesterol 133 mg/dL

I take Crestor (20 mg) and Trilipix (135 mg) to control lipids.
I also take  metaprolol  (100 mg) , Lissinopril ( 10 mg), aspirin ( 85 mg) and Effient (10 mg)

That was my background history, now the questions.
1. Since my C-Peptide and GAD-AB indicate that I am not Type I diabetic, was it a mistake of my Drs to put me on insulin ? After diagnosis I was on diet therapy for 5 years and then on oral medication for only 1 MONTH followed by insulin
2. If I am Type II, then would a combination of insulin and oral medication work better in my case ?

Thanks.

[Super_sally888]

Ah, ok.  Still the C-peptide should be high given the FBS.
Keep working on the exercise side of things.

A fasting FBS of 164 is double normal.  You really should be getting it as close to 100 or a bit under if ever.

It doesn't matter how you do this, and insulin is truely a great tool to work with.

Keep up the learning and working to keep yourself well.

[anandbharti]

Hi , Once again thank you very much for your valuable suggestions. One correction on my part. The C-peptide range is 0.8 - 3.5 ng/lit. 23.5 was a typo !
Exercise definitely helps in reducing insulin demand. I can do better on that front.

[Super_sally888]

Hi,

The c-peptide of 2.6 (range of .8-23.5) with a fbs of 164 is actually very low in the range.  With a FBS of 164 (High) the c-peptide should also have been high (at top of range at least) if your pancreas is truely able to produce significant insulin.

A c-peptide of 2.6 should be associated with a fbs in the low 80s.

Still, metformin could be useful to try in addition to the insulin as it could help reduce insulin resistance.  Other things that help reduce insulin resistance are reducing weight (if overweight) and exercise.

[anandbharti]

Thanks for your response and suggestions.
Yes, I could be Insulin resistant. Before I started on pump therapy, five years ago, I used to take on average 140 IU per day with two injections.

I will ask my Dr about metformin. I know I will never be completely off insulin at this stage but if the islets are still active then I do want to reduce insulin resistance with metformin or other medications if possible. I hope I am making sense with this.

As regards to FBS, it was 164 when the reading was taken according to the report. The lab nurse had asked me to fast which I did. She took a set of blood samples and then I asked me to come back after eating. The report says non-fasting so there is some confusion.

The C-peptide range was 0.8 - 23.5  ng/liter

[Super_sally888]

What was the reference range for the c-peptide?  Also do you know what your FBS was at the time that the c-peptide was taken?

[Super_sally888]

Your current A1C of 7.5 is not particularly low.  It equals an average blood sugar of around 180.  Truely normal non-diabetic blood sugar will give an A1C in the range of about 4.3 - 5.0.

Ideally your A1C would be a bit lower if you can achieve this without having lows.  best way to do this is to reduce the amount of carbs you eat (iwth close monitoring as lowering carbs can also lower insulin requirements).

Considering you are on 80 units of inuslin a day (a pretty high dose), I strongly doubt that you should be on oral meds to replace the insulin.

Insulin really is the best medicine to control diabetes. Considering you are insulin resistant, the addition of metformin may be helpful on that side.

Do discuss with your doctor further and if you would like to get tighter control there are some good resources availabel (I recommend book "Diabetes Solutions" by Richard Bernstein.  Other books are "Using Insulin" and "Think like a Pancreas".

Hope this helps.

[anandbharti]

Thank you  for your post.
Needles are not a problem when one has been on insulin for 25 years. Besides, for the last four years I have been on a pump. No, my main concern is of taking insulin when my problem may be insulin -resistance.
The extra insulin may be causing fat deposition, microvascular damage etc.

To answer your question, my BG was nearly 25 mmol /liter or 450 mg/dL when the clinic I attended recommended insulin. As i said before that was 25 years ago and so my recollection is getting bit cloudy. I have also changed countries and doctors and so getting the original record is not easy.

I will talk to my current Dr regarding all this soon.
Once again thank you.

[diabetes86]

Insulin is the BEST drug therapy for for diabetes (not withstanding the needle)

what where your numbers before insulin, that will tell you if you needed insulin.

There is a lot of controversy over salfurides (SP) many feel that FORCING the pancreas to push out more insulin actually causes the pancreas to die sooner.

[anandbharti]

Thanks for a quick reply.
Unfortunately, the C-peptide test either was not available or the Doctor did not order it when I was first put on insulin 25 years ago ! They had me on oral medical for only a month before recommending insulin treatment.

Any comment you would like to make regarding a combination therapy (oral + insulin)  at such a late stage ? I obviously will be asking my current Doctor about this , however, I just wanted to see if there was anybody else in similar situation to mine.

[WaveRider]

Normally, the first step in treatment is oral medication, then dosage increases when patients fasting blood glucose and/or A1c levels elevate. Sometimes a combination of oral medications will be tried. When levels continue to elevate, the next step is to include insulin. Depending on the individual the doctor may remove oral medication and treat only with insulin.

Discuss your concerns with your treating doctor. In your case he/she has knowledge of your medical history [we don't] and can explain the reason/s for specific treatment plan/s. Good luck -