Hi. My husband was recently diagnosed with diabetes. He is 47 and overweight. His A1C showed an average of 319. The doc started him on 13 units of Lantis, which doesn't seem to be doing a thing. Today, he raised it to 28 units of Lantis. We have a doctor friend who threw a fit and said that my husband should have been started on oral meds. The doctor we went to said that oral meds only work is your blood sugar is under 200. I am so confused. I thought we went to a good doctor who specialied in diabetes care. What should my husband have started on? oral meds or insulin? He has had 3 nightly insulin injections of 13 units, with fbs of 242, 258, and 221 for the 1st, 2nd, and 3rd days respectively. Can anyone help with my confusion? I don't even feel knowledgeable enough to talk to the doctors about what he needs! Thanks!

Hi! I've been in a similar boat as your husband. I was diagnosed with T2 a little over a month ago and was started out on Glucophage (metformin) 1000 mg twice a day. Then it was changed to ACTOplusMet (Actos & metformin) twice a day. Next, Glucotrol XL was added to the ACTOplusMet. My blood sugars have continued to stay in the 300 - upper 400 range. (By the way, all these are oral meds.) Finally today, they put me on insulin. As for the Lantus, it is a longer acting insulin without much of a peak and they said it wouldn't work for these BGs in bringing them down and I needed something that is faster acting. So, they put me on Humalog mix 50/50 pen. Still waiting for pharmacy to fill it, so I don't know how it's going to work on me yet.

I do believe the diabetes specialist in what I was told today because I work in a hospital (nurse) and have talked with several others in the healthcare field and they have all said the same as what I was told today.

Thanks for your reply. The physician increased his Lantis from 13 units to 28 units and he had his first dose of 28 units last night. His fbs this morning was 266, though. It doesn't seem to make sense. With 28 units, it's higher.

He may also need something that is short acting to cover his meals.

After the doctor increased hhis Lantis from 13 units to 28 units, his fasting blood sugar Sat morning was 266, which was the highest reading yet. I don't think this doctor tested his blood insulin levels, which were high the last time we had them tested. If his blood insulin levels were high, should he be on something like Glucophage instead of insulin? Thanks!

... If his blood insulin levels were high, should he be on something like Glucophage instead of insulin? ....
High insulin levels mean that he is insulin resistant, which is the underlying problem with type 2 diabetes. While injecting insulin might reduce blood glucose levels, it won't reduce insulin resistance. If anything, it will aggravate it. Insulin sensitizing drugs may help him live with his insulin resistance. But the only way to reduce it is to cut carbohydrate from the diet, get lots of exercise, lose weight and build muscle.

Has his doctor recommended seeing a registered dietician for advice on meal planning and carbohydrate management? Has he recommended an exercise program?

If his A1c showed an average bg of 319, (11.2%), then his doctor probably wants to get his numbers down as quickly as possible. Oral medications take a while to work and, meantime, damage is being done. An average of 319 means that his blood sugar levels are running even higher than that at times.

And, frankly, I would take the word of a doctor who specializes in diabetes care over the word of a doctor who doesn't specialize in diabetes any day!

Ruth

Thanks for the replies. His doctor increased his Lantis to 32 units daily, and added Glucophase, 1000 mg twice a day, along with Actos at bedtime. His fasting is down around 160 for the past 3 days now. He is eating more nutritiously, and I have been able to get him on the treadmill for a few minutes a day. I know it will take more than that, but at least it's a start. I just don't understand why the doctor increased his Lantis when it didn't do anything to start with, and when the tests showed that his insulin levels are high. Does this make sense?

Yes it does make sense. If his fasting blood sugars are running that high, it means that his blood sugar levels are up ALL the time. Lantus is a "basal" insulin, which is given once (or sometimes the dose is split in two) a day and works to keep the blood glucose levels down even if you don't eat.

As he responds to the glucophage, he may have to reduce the dose of Lantus. Time will tell.

Ruth