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Old 08-03-2012, 09:03 PM   #1
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Which is the best medication?

Hi guys. I'm a Type II diabetic and I was wondering if there was any medication aside from insulin that doesn't have upset stomach as a side effect? Every medicine I've ever taken has done this and due to the inconvenience, I would stop taking it. I am being prescribed Januvia now and see it as a side effect to. Is there anything?

 
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Old 08-04-2012, 03:17 PM   #2
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Re: Which is the best medication?

Well, metformin can cause digestive problems, but many people on these boards have told me that if they start it at a very low dose (as low as 250 MG once a day), and increase it very gradually, their digestive tracts get used to it and they can get to a therapeutic dose within a month or two, at the most.

There is another class of oral medications, called sulfonylureas, which act by forcing the beta cells to produce more insulin. They can indeed lower your blood glucose levels, but they can also cause low blood sugar and, the biggest reason not to use them IMHO, is that they can cause your insulin producing cells to burn out faster, thus causing you to go on insulin sooner.

On the other hand, while using insulin has its problems, for sure, it can give you much better control and much greater flexibility in what you eat.

If I were in your position, I think I'd try the metformin again. Ask your doc to prescribe 250 mg pills, and take them once a day for a week or so, then increase to twice a day, then increase one of the doses to 500 while keeping the other dose at 250, then increase to 500 twice a day, etc. The amount of time you need to stay at one level with vary from person to person, but if you start getting stomach issues right after you've increased the dose, back off to the previous dose for another week, then try to increase it again. It make take you a couple of months to get up to a therapeutic dose but it's better than never getting your blood sugar controlled at all.

Another thought: If all else fails, you can perhaps try a very low dose of metformin or one of those other insulin-sensitizing drugs and combine it with a sulfonylurea. That may make it possible for you to use less of each; thus perhaps eliminating the side effects of each.

Ruth

 
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Old 08-09-2012, 06:50 AM   #3
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Re: Which is the best medication?

So I went to the doctor, and they gave me the choice of either continuing with oral meds or to take insulin. I chose insulin.

That aside, I was just wondering something. How far apart should insulin shots be taken? Since I usually don't eat breakfast, I'm to take it three times a day. Two fast-acting shots for lunch and dinner and one slow-acting one before I go to bed. For each shot, it's set to 6 units (I have an insulin pen).

The problem is that sometimes, I get home later than I'd like, which means I'll end up eating later. For instance, it's nearly 11:00 pm now, and I haven't had any dinner yet. I sometimes go to bed at 1:00 or 2:00 am. If I were to take the fast-acting shot at 11:00, would it be too soon to take the long-acting one at 1:00?

 
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Old 08-12-2012, 10:32 PM   #4
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Re: Which is the best medication?

Exactly which insulins is your doctor prescribing? There's fast-acting and rapid-acting, which are different. I'm assuming the slow-acting insulin will most likely be either lantus or levemir, yes? Can't give you more advice unless I know which "fast-acting" insulin you'll be taking.

But in any case, I would highly recommend learning how to count carbs, and then, working with your doctor, figure out your insulin-to-carb ratio, at which point you can fine-tune your insulin injections. Hardly anyone works on a set amount of insulin for each meal any more and doing so is likely to lead to either post-meal highs (because it's not enough insulin for what you're eating) or post-meal lows (because it's too much insulin for what you're eating.) And using rapid-acting insulin along with counting carbs gives you much greater flexibility in what and when you eat.

If you're taking levemir or lantus, it really doesn't matter all that much when you eat, as both of those insulins have an even action time and are geared to meet just your basic metabolic needs. Theoretically, you could fast all day on either of those insulins.

Just know that there's a learning curve re going on insulin, and it's going to take some time to get it all fine-tuned. In the short run it's probably going to be a pain in the neck; in the long run, I think you'll be much happier on insulin than on oral medication.

Oh, and one last thing...make sure you always have your blood glucose meter and some fast-acting carbs (glucose tablets or hard candies) with you AT ALL TIMES! You can have some serious lows on insulin, especially when you first start and while you're trying to get it fine-tuned for your own individual needs. If you feel weird, shaky, or spacey, test your blood sugar and if it's below 70, take 15 grams of carbs (usually 3 hard candies), and test again in 15 minutes. If you're still low, treat again, but you probably won't have to treat more than once. If you have a low and it's going to be more than an hour before a meal, then also have something with protein in it (I keep packaged peanut butter crackers handy).

Ruth

 
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Old 08-16-2012, 08:37 PM   #5
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Re: Which is the best medication?

Sorry I took such a while to reply to this. On vacation from work (so needed), so I haven't been online as much. I have to use the Lantus Solostar pen. For the day, I use the Humalog Lispro pen. Lantus is slow-acting, Humalog is fast-acting.

That aside, I know I'll be happier on insulin. I already am. As I mentioned in my first post, I requested to go on insulin because I was sick of oral medications and ending up in situations where I would stop taking them because of how screwed up my stomach gets, which would hinder me from doing normal day-to-day activities. I didn't have a reg doctor back home and when I did go to the doctor, and told this particular one of my situation....she still wanted me on oral medications. I then told her (and doctors of the past), "My stomach cannot handle those types of medications!" But no, they kept throwing pills at me. Even after taking it for a long time, the side effect of the upset stomach never went away. Even as a kid, I always had problems with my stomach (way before I was diabetic, mind you). I just have a sensitive stomach, I suppose.

For the most part, all that you said there I already knew since I've been diabetic since about 2002. My father's a Type I diabetic and has to use insulin, and he would carry around those tablets just in case it drops too low. When I was first prescribed the insulin, I went and bought some hard candies since I already knew about this. Now, the insulin stuff I didn't, fully. I guess it is definitely a learning experience.

The carb-to-ratio thing is interesting, though. I am keeping a chart thing here, and I'm supposed to go back to get checked up on next Wednesday. I'll see what the doctor says then or if she'll suggest putting up the dosage or lowering it, etc.

My numbers are still pretty out of whack. The lowest it's been has been 141, the highest, 375 (after a meal), and no, these numbers weren't done in the same day or anything.

Last edited by ssjup81; 08-16-2012 at 08:43 PM.

 
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Old 09-11-2012, 09:49 PM   #6
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Re: Which is the best medication?

Hi again guys. Since starting the insulin a month ago, my levels are still a bit nutty, but when doing my HbA1c was 13.3. Itís gone down to 12.4 after a month. Iím really glad about that and hope to someday reach my goal of 7 at least. Some day. Iím trying my best, but know I can do better.

 
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Old 09-14-2012, 03:08 PM   #7
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Re: Which is the best medication?

That's a pretty good improvement in just a month, so at least you're moving in the right direction.

From what you posted before, it doesn't sound as if your doctor is all that supportive of you being on insulin. If that's the case, you may want to find a specialist (endocrinologist) who is more supportive. Since you've been put on Humalog and Lantus, you can get even better control if you learn to count carbs. Usually you'd also see a Registered Dietician to learn how to count carbs, and then you'd work with your endocrinologist to work out your insulin-to-carb ratio. That means, how many units of insulin to how many grams of carbs. For example, my insulin-to-carb ration is 1:9, so I take one unit of Humalog for every 9 grams of carbs I eat. The other thing you'd work out with your endo is your correction factor; that is, how many points will your blood sugar drop if you take one unit of insulin. Mine is 1:30. So this means if my blood sugar is too high two or more hours after eating, I subtract my goal level (mine is to be below 150 at the two hour mark) from my actual bg and take insulin accordingly. If my post-prandial bg was 285 for example, I'd subtract 150 from 285, which is 135. I'd then bolus 4.5 units to bring my blood sugar down to where it should be.

All of this does take some effort and it's a pretty steep learning curve at first, but it's worth it because then you're not walking around for hours and hours every single day with high blood sugars. I'm on an insulin pump, which makes it easier because my rates are programmed in, so all I have to do is input carb grams and blood glucose tests and the pump does all the figuring for me, but I know of many people who do this without a pump. Most of us who religiously test and count carbs are able to keep our A1c's down to 6.5 or even lower, and the more normal your average blood glucose levels are, the less harm is being done to the body.

I'd guess the first thing to do, in your position, would be to learn how to count carbs and have your doctor figure out your insulin-to-carb ratio (it may take a bit of tweaking at first), so you can bolus for what you're eating, instead of just bolusing the same amount for every meal. That alone will help reduce your A1c quite dramatically.

And kudos to you, ssjup81, for not being afraid to go on insulin. It's probably going to turn out to be the best thing you've ever done for yourself!

Ruth

Last edited by SamQKitty; 09-14-2012 at 03:11 PM.

 
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Old 09-15-2012, 04:03 AM   #8
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Re: Which is the best medication?

Quote:
Originally Posted by SamQKitty View Post
That's a pretty good improvement in just a month, so at least you're moving in the right direction.
Yeah, I was really happy about it! I still find it bad that I had to come to Japan to get any real treatment. Back home, I never had that luxury due to lack of insurance and hence my sporadic visits and out of control A1c numbers. A few years ago, my highest was at about 11, so when checking it in late July for my health check (mandatory here) and seeing 13.3, I was beyond shocked. lol
Quote:
From what you posted before, it doesn't sound as if your doctor is all that supportive of you being on insulin.
No, and I should've specified better. I was talking about the last doctor I saw before moving out here. She wasn't supportive of putting me on insulin even though I insisted on it and told her my history with oral medication and how my levels are out of control because I always stop taking the meds and have for years at a time. The medication she put me on at that time also upset my stomach. The thing is, they also did an A1c test on me (also at my insistence). Unfortunately, not much was done about it. They had to have seen how high it was and would've called me to let me know or to reschedule an appointment. Nothing.
Quote:
If that's the case, you may want to find a specialist (endocrinologist) who is more supportive.
I went to an endocrinologist one time last year. Boy was that expensive (no insurance), and she was talking about trying out insulin. I went because I wanted to get my hormones and thyroid levels checked out.
Quote:
Since you've been put on Humalog and Lantus, you can get even better control if you learn to count carbs.
I have no idea how to count carbs anymore. I did that when first diagnosed and I did go to one here (in Japan) and they were telling me how much of each type of carb I can have, etc. For me it's just easier not to, especially when it comes to fruits. I love them too much. lol
Quote:
Usually you'd also see a Registered Dietician to learn how to count carbs, and then you'd work with your endocrinologist to work out your insulin-to-carb ratio. That means, how many units of insulin to how many grams of carbs. For example, my insulin-to-carb ration is 1:9, so I take one unit of Humalog for every 9 grams of carbs I eat. The other thing you'd work out with your endo is your correction factor; that is, how many points will your blood sugar drop if you take one unit of insulin. Mine is 1:30. So this means if my blood sugar is too high two or more hours after eating, I subtract my goal level (mine is to be below 150 at the two hour mark) from my actual bg and take insulin accordingly. If my post-prandial bg was 285 for example, I'd subtract 150 from 285, which is 135. I'd then bolus 4.5 units to bring my blood sugar down to where it should be.
That's interesting. Wish I could've learned that stuff. I wouldn't even know how to do that here.
Quote:
I'm on an insulin pump, which makes it easier because my rates are programmed in, so all I have to do is input carb grams and blood glucose tests and the pump does all the figuring for me, but I know of many people who do this without a pump. Most of us who religiously test and count carbs are able to keep our A1c's down to 6.5 or even lower, and the more normal your average blood glucose levels are, the less harm is being done to the body.
Very nice. Too bad I probably wouldn't be able to use an insulin pump. My job is an English teacher at a language school. If I worked at just the language school, I probably could use an insulin pump, but my mornings are spent at a Japanese kindergarten (age 2 - 6), which would has me moving around most time and playing with the kids. It'd probably come loose constantly.
Quote:
And kudos to you, ssjup81, for not being afraid to go on insulin. It's probably going to turn out to be the best thing you've ever done for yourself!

Ruth
Thanks. ^^ I was told that here, apparently, the doctors listen to the patients. When I explained my situation about wanting to try insulin back home and how rare it was for me to go to a doctor period and how the last doctor I saw treated me, knowing that I'd been diabetic for ten years and how my levels were beyond out of control and needed to get better control over them and how anything with Metformin in it hurt my stomach and how I had a history of stomach probs way before I even was diagnosed going back to childhood, they were surprised they didn't go with my wishes of just trying insulin. I go back for a check up next month.

Last edited by ssjup81; 09-15-2012 at 04:31 AM.

 
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Old 09-15-2012, 04:20 PM   #9
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Re: Which is the best medication?

Hi again,

Didn't realize that you're living in Japan now. How very interesting! "I have no idea how to count carbs anymore. I did that when first diagnosed and I did go to one here (in Japan) and they were telling me how much of each type of carb I can have, etc. For me it's just easier not to, especially when it comes to fruits. I love them too much. lol" I would imagine that you could get a carb-counting book on Japanese food and use that. The thing is, even if you eat a lot of fruit (or potatos, or rice, etc.) or anything that is high-carb, if you can figure out the amount of carbs, then you can bolus the right amount of insulin to keep your blood sugar from going too high after meals or snacks. Yes, there definitely IS a high learning curve, but after a while, one gets pretty good at remembering the carbs in the foods one eats most often and then you don't have to keep looking everything up.

As for the insulin pump...it doesn't matter how active you are. The pump itself can sit in a pocket of your clothes, and you can tuck the tubing into your pants. The part that is attached to the body is very small, and you can attach anywhere that you can use a syringe...so abdomen, thighs, upper buttocks, back of arms, etc. Heck, they even put infants and toddlers on insulin pumps now, and you know how active they are! In 10 years of being on a pump, I've only pulled my site out twice.

But of course, before you can use a pump you must learn how to count carbs. Actually, you can do that on your own...just shop around and see if there are any books available to you. There are some excellent books on the market that cover just about any food known to mankind, so I would imagine there'd be one that covers Japanese fruits and vegetables, etc.

Meanwhile, hopefully your A1c will get even better now that you're on insulin even if you don't count carbs or pump. Hopefully your doctor will help you adjust your doses so that you can get your A1c down without also having too many lows.

Ruth

 
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Old 10-17-2012, 07:02 PM   #10
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Re: Which is the best medication?

Onglyza doesn't upset my stomach, but DOES have a laxative effect. Other than that, only side effect is headaches.

 
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