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One of our readers asked "Why is insulin only considered after oral medications have been found ineffective?" I think this is an excellent question. However, I'm not sure that I have a good answer.
An October 2008 study in Diabetes Care concluded that a six-month course of insulin therapy, compared with oral anti-diabetes drugs (OADs), could more effectively result in adequate glycemic control and improvement of pancreatic insulin producing cells in those who had new-onset type 2 diabetes with severe high blood sugar levels.
Type 2 diabetes is progressive, and the insulin producing cells in the pancreas deteriorate over time. There are an increasing number of children, teens, and young adults who are diagnosed with type 2 diabetes. They'll live longer with diabetes than others before them, and so will be more likely to develop severe insulin-deficiency that requires insulin replacement earlier in life.
Reasons why insulin might not be prescribed sooner if you have type 2 diabetes may include:
According to an April 2005 article in Clinical Diabetes, an A1C level of 9 percent or more signifies the need to take action to lower blood glucose. Numerous studies have shown that early intervention with insulin is more important than was previously believed.
So, I don't have a good answer to this reader's question. However, if your oral medication(s) are no longer helping you control your blood sugar, discuss the option of insulin as a next step with your provider. Taking insulin doesn't mean that you've failed to manage your blood sugar. Type 2 diabetes is a progressive disease, and if you have it long enough, chances are you may eventually need insulin.
Have a good week,
Nancy Klobassa Davidson, R.N.
Peggy Moreland, R.N.
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I have been taking metformin for several..years...recently changed to the extended (er). Started having leg pains at night extremely cold feet.
Last week I woke up with difficulty in breathing. Decided to not take the med, went to Doctor and after x-ray of lungs and electrocardiogram...Doctor agreed that I had had an reaction to the Metformin. Now wants me to go on Junevia , but see that it may have connection to cancer of thyroid, bladder and pancreas. What do I do ? Very concerned.
I have type 2,and was recently put on 2.5 mg,glimipiride in addition to 1000mg of metformin twice a day.this caused excess cramping and gas and a visit to the E/R. I quit the glimepiride till I can see my d.dr.tues..any comment......?
Phil: Good job getting your blood glucoses back under control. Discuss with your provider as to whether you should wait to start another medication as long as your numbers are back under control. It would be reasonable to give it a try.
I have had type 2 diabetes for a few years.
I have been able to keep my A1c level between 6-7
However last month my test revealed that my glucose level had risen to 353 and my A1c to 11.
Through diet changes, over the last month, I have found my morning glucose is 110-115 and evening 99-110.
I have lost 14 pounds.
I have seen my primary doctor and an endocrinologist and both suggested different types of oral medication in addition to the metformin ( 2 1000 mg pills daily)I am currently taking.
Should I start another medication or wait to see if my glucose continues to get lower?
Awareness is the first level of defense in the treatment of type 2 diabetes. We must make people aware of what this disease is and how to prevent it. http://dallasnaturaldoctor.com/type-2-diabetes-plano-chiropractor
Thomas: Thank you. The diagnosis of type 1 in adults over 30 is often mistaken for type 2 initially as syptoms often present similarly to those with type 2 diabetes.
Sandra: Occasionally, a physician will add metformin to someone who has been on insulin for a number of years. Metformin actually works on the liver, not the pancreas as the sulfonylureas do. Metformin works to decrease the amount of glucose released by the liver into the bloodstream between meals. Metformin can also help promote weight loss, reduce cholesterol and triglycerides. Some side effects are nausea, upset stomach, or diarrhea. rarely, it may cause a harmful buildup of acid (lactic acidosis). Have a good discussion with your provider as to why you need to take metformin.
Sharon: Excellent points! Thank you.
Bonnie: Both Nancy and I have read Dr. Richard Bernstein's book, "Diabetes Solution". If his program is working for you that is great!
If you read Dr. Richard K. Bernstein's book, "Diabetes Solution", you would be able to write a better article about the use of medication and insulin for diabetes type 2 patients who want to normalize their blood sugars. You totally misrepresented his views on the protocol he uses for meal planning to help normalize blood sugar and avoid complications.See http://www.mayoclinic.com/health/comments/MY01817_comments#post Perhaps you could actually call his office for the 2011 book and revise your article to actually add a paragraph explaining the use of insulin and diet versus medication and diet that has worked successfully for thousands of people who have benefited from not Richard Bernstein (the Canadian doctor recommending dangerous calorie levels) and Dr. Richard K. Bernstein (the diabetes doctor who is himself a type 1 doctor and expert in diabetes wound care and prevention of diabetes complications with a clinic in New York) My A1c went from 9 to below 6 in 3 months just following what I read and free monthly pod casts and my understanding endocrinologist. What worked for me was initially counting carbs of 12-24-24 to avoid sharp drops in glucose levels, a GLP1, and Glucophage. Then we dropped the count to 6-12-12. My hope is that in 2 months time when I see the endo again, I will be at normal glucose levels. You say that I have a progressive disease. Well, already my little toes have feeling again and peripheral double vision from nerve palsy is gone. There's
Am 74 been diagnosed Type 2 since I was 45(probably had it for years before discovered accidently) & had various pills (which made no difference )gave me bad dysentry.I have been on act rapid & protophane for a number of years & am a different person.before I had cystitis, tonsilitis ,pyelitis & cintinually on antbiotics.22 protophane @ night ,8 in the morning & 15 units act rapid per meal or according to what blood test is i have a chart made by diabetic Dr.
Part of the issue may also be a hold-over from decades of previous practice where the golden rule was oral meds first, until they don't work any more, then Insulin as a last resort. Years ago cost and Insulin availability were issues; cost is still a factor. Though supplies like Insulin pens and easier-to-use glucose machines have made Insulin therapy easier, it is still more complex than oral meds, especially when people have decreased eye sight, memory issues, or a poor understanding of diabetes and glucose control.
I hope someone answers Sandra's question.
Here's a different take on why insulin might be prescribed instead of oral meds. I was able to control blood sugars for 8 years by a combination of diet and exercise. My A1C crept up to the point that I needed to do more, and started taking metformin, which didn't seem effective, and then metformin plus glipizide, which also didn't work. I went to an endocrinologist and had some blood work done, and was told that the probable reason for ineffectiveness of the meds was that I didn't have Type 2 to begin with, but rather Type 1 that in some cases progresses very gradually and is often misdiagnosed as Type 2. I now take humalog as needed with food and lantus (12 units) at night.
Should you be put on metformin if you have been taking insulin for
over 25 years? Currently taking humalog on a sliding scale three times
a day and lantus (17 units) at night. Doctor has recently added
metformin - I think it is useless as the pancreas is no longer functioning
so it cannot be stimulated. Will it do more harm than good? I fear
heart damage as I already have congestive heart failure. Should I
be concerned? I am a Type 1 diabetic.
Interesting article! I am T2. Although I would not want to be tied down with an insulin regimen, it seems healthier than dealing with drug side effects. My doctor prescribed Actos, which I took for about three months until I got my lifestyle under control. Now it's said to cause breast cancer! I think lifestyle options should be given to new patients as well as drug options. I realize some people aren't motivated, but those who are deserve the chance.
My A1c was 13 or so at diagnosis almost 20 years ago and now it's 5.1 - 5.3 consistently.
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