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    Old 02-20-2005, 07:25 PM   #1
    lil_miss_bad
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    Question Going off of insulin

    Can a type two diabetic go from insulin back to pills?

    The reason I am asking is this: I am currently on insulin. I am 23 and have been diabetic since I was 19. I was put on insulin quite frankly because I asked to be put on it because I thought it would be easier to control my diabetes while eating more of the foods I want.

    What I am finding now is, I cannot lose weight. I am currently on the Atkins diet, which has worked wonders for both my energy levels AND my blood sugars. I am religiously between 4 and 7 all the time (7 is usually after I have had a meal), so my diabetes is in good control under atkins.

    The problem is I cannot lose any weight. I have been reading various articles that say that metformin help people to lose weight. Along with my diabetes, I have poly cyctic ovarian syndrome -- and studies have indicated that metformin helps people with PCOS lose weight.

    So, what I'm wondering is: could I go back to the metformin? Even if I miss a dose of insulin here and there (doesn't happen very often -- I've once or twice fallen asleep early in the evening without taking my NPH) my sugars are normal as can be.

    I really don't want to be a "fat" diabetic anymore...or for that matter I don't want to be "fat" in any sense anymore.

    Sorry for the long post!

    Thanx,
    -LMB

    Last edited by lil_miss_bad; 02-20-2005 at 07:28 PM. Reason: typo

     
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    Old 02-21-2005, 07:14 AM   #2
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    Re: Going off of insulin

    Hello,
    I am type 2 and started using insulin about 4 months ago. I have done nothing but gain weight since I started using it! I think what the problem is, is that it makes you hungry. I was not overweight when I was diagnosed with diabetes 3 years ago and have never been overweight in my life. I now am about 20 pounds overweight from changing my diet and taking drugs.

    As far as taking metformin to lose weight........ I also take metformin right now. This is what I started taking when I was first diagnosed. I lost a little weight the first month, but then it stopped working. <I think it was from the shock of the diagnosis> I don't know how this got started <losing weight from metformin> or anyone who has lost weight from it.

    I understand your frustration. My numbers have been pretty good since taking the insulin, but the nonstop hunger and cravings for sugary sweets is killing me. So this means that I probably won't die from diabetes but I will die from a heart attack from being fat and miserable.

    I think about this everyday and I have no solutions. I have thought about just stopping ALL drugs and seeing if i could just eat normally like I use to, but I figure my numbers will go sky high again. I try to diet every day of my life and can never last more than 3 days. I think the insulin constantly works on your brain telling you to eat, eat, eat.

    My husband told me he can't imagine having to take a drug that makes you hungry. It's hard enough to lose weight.......

    If you have any ideas please let know.

    Frustrated here, Kat

     
    Old 02-21-2005, 10:16 AM   #3
    CobaltBlue
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    Re: Going off of insulin

    LMB,

    One problem that is common in individuals with PCOS is impaired thyroid function. Perhaps, that could be one of your difficulties w/r/t losing weight?

    As for coming back off of insulin and onto metformin--the answer is that it all depends--which is not the answer you would like to hear...

    If your beta cells are underproducing insulin, or not producing insulin, then you will need insulin, regardless. If your beta cells are still functioning (enough production of insulin), such that if you lost weight, and such that your insulin senstivity became increased through that oral med and/or with increased exercise, then yes, you could come off of insulin.

    I am not able to give you the full answer on that, though, because really those are things that would be specific to you and your case, and you might want to ask your physician. You could ask those very questions from above: 1) how is my thyroid function, 2) is my diabetes related to insulin resistance, pancreatic in nature, or a combination of both?

    Finally, if the diet works for you and you can follow it and keep the weight off, then great. It sounds like you like Atkins, but I hope that you remain open to alternatives. I don't want to say much other than I am not really a fan of that approach, though I do understand that it works for some--just not for me. An ongoing study of people who have lost weight, and kept it off (30 lbs plus) for 3 years or more indicates clearly a number of things. The first, is that it needs to be a lifestyle modification and behavioral change in eating habits. The most startling result, however, was the type of "diet" the participants followed: 95% controlled calorie, low fat, and less than 3% with a low carbohydrate, or Atkins based approach.

    Quote:
    Originally Posted by KatakaNiki
    So this means that I probably won't die from diabetes but I will die from a heart attack from being fat and miserable.
    Actually, I have been there and tried that approach (I was 35 at the time) . I lived, and fixed my weight and misery issues. The heart attack was the only thing that did motivate to fix the real problem behind my diabetes. I played the game with diet alone, and no exercise. It nearly cost me my life and I really thought I was getting away with something. I do hope that you find a way to help reduce your risk, and that you not take the same risks I did.

     
    Old 02-21-2005, 04:34 PM   #4
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    Re: Going off of insulin

    Thanx for the input, guys

    I'm pretty sure my beta cells are still working -- although I base that off the fact that I've only been diabtic for 4 years (I know this because I would be sent for blood glucose test every year since both type two and one is VERY common in my family -- so my fasting BS went from 7 one year, to 11 the next). When I was first diagnosed my doc went on vacation and sent me to another GP, and he told me that young people, regardless of their type of diabetes, will go on insulin under him. My other doc put me on metformin, but then advandia because I found I was tired while on the metformin (although it's probably because I wasn't eating properly rather than the metformin itself), and then I asked to go on insulin because I thought it would be the easy way out. Now I realise that that was a really stupid reason to go on it. I should have stayed on pills as long as I could. Let's just say I've grown up and realised that my health is more important than taking the easy way out.

    Anyway, I have my suspicions that the diabetes and insulin resistance is in part to the PCOS, so *hopefully* I'm more insulin resistant than not producing enough insulin.

    I think a referral to an endochronologist is a good idea -- last time I saw one for my PCOS I was given a prescription for metformin -- at that time though I thought it was because of my diabetes. Today I'm much more informed!

    Again, thanx a lot for the replies

    Ubernier -- I'm very open to all kinds of "diets" (I hate the word "diet," don't you?). I'm giving atkins a whirl right now because it's pretty close to my regular eating habits (what I like to eat and such). I don't really miss the breads, and pastas, etc... because they don't really agree with my digestive system. We'll see where this goes, and if it doesn't work out, I"ll try something new

    Best of luck, Kat!!! I know cravings are terrible! The way I've gotten rid of one was by taking some unsweetened chocolate (one square -- it should be the pure, unsweetened chocolate) and sweetened it with a bit of splenda (and some sugar twin) and a little bit of "just peanuts" peanutbutter and a tiny bit of cream and melt it in a small pot. Then I put it in a pan sprayed with some cooking spray and put it in the freezer until it hardens. It's makes quite a lot and really helps with the sugar cravings (mainly because I find splenda tastes just like sugar -- actually I like splenda better!) It's not exactly low in fat, but it shouldn't have a HUGE affect on your blood sugars

     
    Old 02-21-2005, 06:29 PM   #5
    Rick49
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    Re: Going off of insulin

    ...If your tpye two diabetic and also taking insulin? Sounds like a double dose of insulin to me. My understanding of type two diabetes is that the pancreas secretes too much insulin because the insulin isn't as effective as it should be. Hard for me to imagine a doctor ok'ing such a thing but I am new to this.
    ...I highly recommend that you find a site that explains carbohydrate metabolism to substantiate what I'm about to say so here goes. Insulin controls high glucose levels by turning glucose into glycogen. If the glycogen levels continue to increase, the glycogen will eventually turn into fat. when blood sugar levels start to drop from the insulin two things have to happen to keep the blood sugar from falling too low. Either we have to eat or the Pancreas Secretes Glucagon. The glucagon changes the glycogen back into glucose.
    ...There's a catch however, if there is still insulin in the blood stream, the pancreas will not secrete glucogon so your either left with waiting for the adrenal gland to raise the glucose levels or you have to eat. As you can see, if your always in the mode of making fat, it's going to be very hard to lose any.
    ...A low Glycemic index diet can alliviate the hyperinsulinemia and hyperglycemia if you are insulin resistant. The atkins accomplishess the same thing by restricting all carbs and not just the high glycemic ones.
    ..Anyway, type two diabetes usually means that your insulin resistant and are hyperinsulinemic. That's a big Usually, as there may be other conditions for type two diabetes that I don't know about. That's where it is imperitive for everyone to know their disease or condition. It also helps to know how the metabolism works or it's easy to get stuck in the trap of always making fat which makes it impossible to lose any.
    ...Research, research, research...
    later,
    Rick

     
    Old 02-21-2005, 07:42 PM   #6
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    Re: Going off of insulin

    Hi Rick,

    What I have been told by my diabetes educator, is that, type two diabetics overproduce too much insulin in the beginning stages (say the first 10 years)that they need, and then after that the pancreas gets so overloaded that it stops producing any insulin, unlike type one diabetics who produce insulin, but their immune system attacks it (I hope I got that right!). Anyway, type two diabetics eventually need insulin shots because they have no insulin left for medications to sensitise (which is the aim of a lot of diabetic medications)

    I was actually surprised myself that it was so easy to be put on insulin, but I know a lot of doctors who are of the opinion that young people should be on insulin regardless. All I know is 19 is a pretty young age to get type two diabetes

    Anyway, thanx for the info! It pretty much sounds like I was put on insulin too early, and *hopefully* it is possible for me to go back on pills.

    I've grown up a lot and I've realised that sometimes the easy way out is not the smartest or best thing for my health.

    LMB

    Last edited by lil_miss_bad; 02-21-2005 at 07:45 PM.

     
    Old 02-22-2005, 04:28 AM   #7
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    Re: Going off of insulin

    LMB,
    ....Please make sure you verify everything I've said. I'm insulin resistant and the excess insulin was causing problems with an inner ear disorder I have. I've done a lot of searching on the internet to find all this information and like I said, I'm very new at this. Based on everything I've read about insulin resistance, I asked my doctor what the difference was between insulin resistance and type two diabetes and he said that there's no difference in the disorder, you just have to have a certain glucose reading (200 I believe) to be classifies as insulin resistance. So based on my knowledge so far, I have the same metabolic disorder as type two diabetes but have yet to reach the severity to be diagnosed with type two.
    ...As I mentioned in my other post, I went on the Low GI diet and got remarkable results. The whole focus of this treatment is to slow down the rate of metabolism of carbohydrates, which reduces the spike in blood glucose, which then reduces the spike in insulin. The Low GI diet works by telling you which carbs spike the blood sugar and which ones don't and all points inbetween. Of course it's carbs that spike the blood sugar and resulting insulin release, so a reduction in carbs like the Atkins would have the same effect.
    ...The pills that are given for type two diabetes is Metformin ( again, I haven't taken them and this is all based on what I've learn from type 2 friends of mine and from reading). I believe Metformin works on the same principle of slowing down the metabolism of carbohydrates.
    ...PCOS, as some one mentioned is also a result of excess insulin levels as can be hypertension. Since being on this diet, my blood pressure has gone from 130/80 to 110/75 and my tryglycerides have dropped from 350 to 97. My HDL cholesterol has finaaly rose to 40 which is normal for the first time in 15 years. So you may see other benefits of a Low GI diet or atkins diet.
    ...A friend of mine at work, who is type two diabetic, listened to what I was saying about the low GI diet and also tried it. He also had the same effect with tryglycerides, blood pressure, and cholesterol. His doctor has also cut back on the amount of the Metformin he is taking, so I believe there's some benefit to trying these diets. An important thing to keep in consideration when changing diet is to make sure you don't eliminate your sources of the different vitamins and minerals. That's the only problem that I have had is that when I reduced the amount of potatoes in my diet, I also reduced the amount of potassium I was getting, so I had to find other foods high in potassium.
    ...When I went on the diet i lost about 20 lbs. I believe that was from getting out of the mode of making fat all the time from the excess insulin. Now I am trying to lower my weight some more by lowering my caloric intake, so I will keep you posted on how that goes.
    ..Another important note would be to find a doctor that understands all this. My doctor highly recommends this diet and my friends doctor was concerned that it was a fad diet. So there are lot's of uniformed doctors out there that aren't keeping up with the research out there. Dr Jenie Brand-Miller did most of the research on the Low GI diet.
    Later,
    Rick

     
    Old 02-22-2005, 05:52 AM   #8
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    Re: Going off of insulin

    Well all I know is that I am a type 2 diabetic and I have a hard time keeping my BS down with any drug or insulin. My endocrinologist tells me that my body makes plenty of insulin on its own. If I didn't use insulin, my numbers would be really high. AND I have to use a lot of insulin to get it to even work.

    I have tried Atkin's type diets and they make my BS go up if I don't eat carbs. Exercise also makes my BS go up. When I wake up in the morning it is up no matter how much I increase my night time insulin. I seen to do best with I eat small portions of food and a small amount of carbs with about 6 meals a day.

    My numbers and A1c are better since using the insulin, but adding the extra weight is not good. My A1c is better but my blood pressure is not. I am gaining about 3 pounds a month since starting the insulin and my blood pressure keeps going up so I have to also increase my blood pressure medication. It is a vicious cycle.

    Kat

     
    Old 02-22-2005, 06:26 AM   #9
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    Re: Going off of insulin

    Rick,

    Are you talking about a specific low-glycemic diet or just generally incorporating low glycemic foods? I have a book here called "The G-Index Diet". Maybe I should take another look at it and give it a try. I collect diet books. LOL None of them work....... Kat

     
    Old 02-22-2005, 07:12 AM   #10
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    Re: Going off of insulin

    Kataka,

    Only part of the equation is diet, and as you lose weight and exercise, you will find that the diet limitations will be lessened. The diet that Rick described is a good start, but what is the most important factor to a type II in early stages of development is to up the cellular insulin sensitivity--and that involves maintenance of exercise--and that is where so many fail to do enough.

    If you are making plenty of insulin on your own, then you are in a state of hyperinsulemia, and if your plasma glucose is elevated, you are also in a hyperglycemic state. Those two together create the largest risk for complications.

    I would suggest taking a look at some other books related to diabetes, some suggest Bernstein's diet solution--but I have only glanced through that one. One that has sound advice, which if followed will control type II/IGT in most people is written by Julian Whitaker and entitled "Reversing Diabetes."

    Too often, the problem is not one of knowledge, unfortunately, it is one of following through and doing those things to prevent complications. It was never meant to be easy for many of us. I understand that all too well.

    Quote:
    Originally Posted by Rick49
    Since being on this diet, my blood pressure has gone from 130/80 to 110/75 and my tryglycerides have dropped from 350 to 97. My HDL cholesterol has finaaly rose to 40 which is normal for the first time in 15 years. So you may see other benefits of a Low GI diet or atkins diet.
    Rick, it will be interesting to hear how much more things improve with you as you continue. In my own case, by bp was 170/112 uncontrolled before I took 3 meds. Now it is 100/60 most of the time. My TG were once 638 mg/dL, and now, they range from 30-47 mg/dL. My HDL was once 25, and has been as high as 70 mg/dL, with a total 143 m/dL cholesterol. I once took Amaryl after diagnosis with a fasting glucose of 348 mg/dL. I now take no medications for diabetes, my HbA1c ranges from 4.7-4.8% and fastings are in the low 80 mg/dL range, post-prandial never exceeds 120 mg/dL at any time.

    Three major factors that allow this: 1) Exercise of 45 min or more daily (cardio), 2) Weight loss of 70 lbs from 225 to 155 lbs, 3) Controlled diet. However, diet is less critical now.

     
    Old 02-22-2005, 08:48 AM   #11
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    Re: Going off of insulin

    Quote:
    Originally Posted by KatakaNiki
    Rick,

    Are you talking about a specific low-glycemic diet or just generally incorporating low glycemic foods? I have a book here called "The G-Index Diet". Maybe I should take another look at it and give it a try. I collect diet books. LOL None of them work....... Kat
    Kat,
    ...One thing I have noticed regarding diabetes is that there's a lot of press about insulin but little about Glucagon. The two are supposed to work together to regulate our blood sugar. As long as the serum levels of insulin is high, then the glucagon phase never kicks in. As far as I know, exercise is the only way weight loss can be accomplished as long as serum insulin levels are high.
    ...A diet of Low to medium glycemic index foods turned my system around without the exercise. I think it's going to be personal for each person depending on their reaction to carbohydrates. For a person who is really sensitive it may be a combination of eating low index foods only in smaller quantities, more frequently as it sounds you may have started. And of course it may even require one of the drugs like metformin to get there. Sounds like Cobalt blue has the info there.
    ...One thing in your description that sounds interesting is the fact that you BS is up even after extended fasts. Even without insulin, our BS should come down as we burn the sugar for fuel. If the Glucagon isn't there to replinish the supply, it is my understanding that the adrenal gland releases cortisol and adrenaline to convert the glycogen and fat back into glucose.

    Cobalt,
    ....Can a hyperactive adrenal gland make one hyperglycemic and hyperinsulinemic? I would think one would have the symptoms of reactive hypoglycemia if this were the case. It was actually the reactive hypoglycemia that got me on the trail of this carb metabolism.
    Rick

     
    Old 02-22-2005, 09:22 AM   #12
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    Re: Going off of insulin

    I think the reason my BS goes up if I don't eat carbs is that my body thinks I am going to go low and it kicks in some glucose for me and then my body can't handle any extra sugar and so my levels go up.

    And the same thing happens when I exercise. My body kicks in some sugar because it thinks I am going to go low and hence the rise.

    I have found 2 things that help. First I have to exercise in the afternoon or evening. I can't exercise in the morning because my BS is already high at that time and it will make it worse. This is hard for me because I have my most energy in the morning and lack motivation by evening.

    The other thing is I think the amount of food you eat is more important or just as important as what you eat. If I eat small amounts of food I seem to do better. Kat

     
    Old 02-22-2005, 09:33 AM   #13
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    Re: Going off of insulin

    Rick,

    Regarding the adrenal gland and it's linkage to states--I don't know offhand. You are probably more up on that area of this equation; I guess that makes sense since each of us tries to research the areas that impact us the most. I have a better knowledge of the lipoprotein effects and part of the equation (factors that affect it) rather than all of the factors that come into play with insulin/glucagon actions and influencing factors. Because my plight (metabolic syndrome, etc.) I try to keep up with that. My hypoglycemic states were only a result of oral meds, and gaps between the lunch to dinner meal.

    Kat,

    If you can break the cycle, as Rick described, or like I did, then the results will come. The most important thing is getting over that hump and moving in that direction. What you are indicating is that weight gain, in you, corresponds to elevated blood pressure. Almost as sure will be weight loss, and drop in bp.

    Oh yes, sometimes in extended fasts, when you are type II, yes, the glucose level will rise. Mine did also. I guess one analogy would be think of your system's response as slowed/delayed with what it should be. Over time, your body begins to "equilibrate" or "normalize" with a blood glucose level that is higher than what it should be. This continues until a point where the pancreas fails to keep up, the beta cells cease to function, and then your sugars go extremely high. If you think of a way that a drain might clog (sorry for the weird analogy), the more gunk in the drain is similar to what is going on with increasing insulin resistance. The water can still pour in routinely, off and on, at a particular rate. In your case, suppose you shut off the faucet, but water still continues to pour out and there is a delayed shut off.

    When the drain is new (insulin sensitive state), the faucet comes on and water flows in and is removed as fast as it appears in the sink.

    As the drain becomes clogged (beginning of insulin resistance), the faucet comes on and some water drains, some is backed up, but given enough time with the faucet shut, the water drains out slowly. (This would be the beginning stages).

    Finally, the drain becomes severely clogged, and the water fills the sink and overflows....and one day the faucet breaks. OK, so the analogy is bad here...

    Controlling diet, and glycemic levels of foods is analogous to a better controlled flow of water, which will help.

    Losing weight, might be analogous to clearing some debris from the pipes, or perhaps adding another channel for the water to flow.

    Exercise--that would be like adding Draino or a taking a plunger to the pipe to clear it.

    What will minimize the delayed response and keep the fluctuations down to a minimum is keeping your weight down. In that case, the effect of exercise and eating will be more immediate, the spike should be better controlled and less prolonged.

    Bringing the HbA1c down with insulin usage is good in it's own way, but keeping tight control will minmize the damage and complications years from now.

     
    Old 02-22-2005, 11:58 AM   #14
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    Re: Going off of insulin

    CobaltBlue,
    I like your analogy. But my question is how do you break the cycle? I have tried just about every different way of eating and nothing works for me anymore and I have more or less just given up and started relying on insulin to keep it down as much as possible. And so I keep gaining weight.

    I have tried Dr Bernsteins, Atkins, and Schwartzbein <sp> and all of those will raise my BS. I can't take watching my sugars rise and after a week will give it up. I always wondered if I stuck with the low-carb if it would eventually come down. While I was on these diets I would search and ask questions if anyone else had heard of your sugars being high while on these type diets and noone had heard of it. Kat

     
    Old 02-22-2005, 01:55 PM   #15
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    Re: Going off of insulin

    Quote:
    Originally Posted by KatakaNiki
    CobaltBlue,
    I like your analogy. But my question is how do you break the cycle? I have tried just about every different way of eating and nothing works for me anymore and I have more or less just given up and started relying on insulin to keep it down as much as possible. And so I keep gaining weight.

    I have tried Dr Bernsteins, Atkins, and Schwartzbein <sp> and all of those will raise my BS. I can't take watching my sugars rise and after a week will give it up. I always wondered if I stuck with the low-carb if it would eventually come down. While I was on these diets I would search and ask questions if anyone else had heard of your sugars being high while on these type diets and noone had heard of it. Kat
    Sorry for intruding, but have you seen an edocrinologist yet? Hopefully that was the correct spelling.
    Rick

     
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