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Posted: 3/13/2005 3:10:00 PM EST
As a type 2, I took the education classes, and know what I should be doing. Unfortunately, I'm also a slacker.

So, my question is, would taking insulin shots on top of what medicine I take (glucophage, 1500mg Ext release) help me or not. I'm told my pancreas makes enough insulin, but my body uses it so terribly, I always have elevated levels, (above 250 almost all the time). Would taking a slow of fast acting insulin help relieve some of the work my pancreas does, or could it tell my pancreas to stop making insulin. This is what I am worried about. If I take insulin injections, can the pancreas just stop making it, causing me to need to continue for ever, as opposed to when I can slim down enough to not need the meds anymore. (I know, some folks always need them).

My blood sugar levels are always high (although I feel ZERO effects of this, never new I had till I took a physical), and the pills don't seem to do shit.

I would like the top part answered by someone who is an actual MD.

This part, if you got an answer, I want to hear it, please. Does anyone know of any alternative or herbal supplements that can help with high blood sugar. I've heard chromiam picolonate can help, but are there any others?

Thanks all for any help.

TXL

Link Posted: 3/13/2005 3:14:03 PM EST
I asked my Chiro (DC) and he said that when 'you were born your spine was twisted up...and that's why you are going to die'

Wait, that's what he said about every single condition, incluuding heart problems and cancer.

I told him I didn't want to hear any bull shit from a back massage guy and to shut up and get back to work, which is why I am the only chiro patient with visits left on my insurance plan who was fired by a DC. I got a 'don't come back' letter and everything.
Link Posted: 3/13/2005 3:20:40 PM EST

the pills don't seem to do shit.

Then talk to your doctor about trying a different drug. Glucophage didn't help my wife at all either.z
Link Posted: 3/13/2005 4:18:04 PM EST
[Last Edit: 3/13/2005 4:20:07 PM EST by Atencio]
+ 1 on the Glucophage. There are a host of other new drugs such as Starlix which stimulates insulin production differently from Glyburide. There are insulin sensitizers such as Avandia and Actos. There is also Prandin which is another type of stimulator.
Exercise and weight loss is still the best treatment. Remember that stress and being sick can raise your blood glucose levels so act to reduce those also.

edit: by the way, I am not a nurse, not a doctor. So take that for whats it worth, which really isnt a whole lot when you think about it.
Link Posted: 3/13/2005 4:32:01 PM EST
A non-medical help for type 2 diabetes is cinnamon. About 1 teaspoon per day worked wonders for me while in conjunction with glyburide, glucophage and avandia. Be very careful with Avandia as it has some nasty side effects.
Link Posted: 3/13/2005 4:45:11 PM EST
lose weight and your type 2 DM will decrease in severity
Link Posted: 3/13/2005 4:54:45 PM EST
I'm not a doctor but I have Tyoe 2 diabetes.

It seems like you are looking for a drug that will make your blood sugar go down. Drugs are only a part of the treatment for your diabetes. You must eat correctly along with the drugs or you are not helping yourself.

To lower you blood sugar, follow a low carb diet such as Atkins, South Beach, Sugar Busters, etc. and get some exercise.

I no longer take any medicine, and I was in a similar situation.
Link Posted: 3/13/2005 5:46:09 PM EST
I, too, have DMII, but I suffer more from 'dawn effect' than daytime blood sugar excesses. One of the disadvantages of metformin (Glucophage's generic name) is that many patients develop a resistance to it over time and it becomes less effective. I believe that when you're taking about 2000 mg of glucophage a day and your sugar is no longer 'controlled', that they change to another medication.

My average blood sugar reading is 143 over the last 90 days, and I'm taking 500 mg of metformin twice a day, 5mg of glyburide once a day and two herbal supplements, 1200 mg of Cinnamon and something called glucobiotic supreme which is a combination of the 'usual' metabolic supplements along with a probiotic supplement (not specified, but most likely acidophilus and bifidum). Without the cinnamon and glucobiotic supreme supplements, my sugar was 182 on average.

Diet and exercise are important, but they make changes very slowly.

From my reading, I've come to the conclusion that losing weight canl INCREASE your blood sugar levels due to the effects of fat metabolism, so the all inclusive statement that "diet and exercise will reduce your blood sugar" is too simplistic to be literally true. As general statements, and as a description of the long term effects, they are probably true, but some people simply don't react the way that the doctor's prejudices say they will.

It is important for you to work with your physician and endocrinologist to determine the best course of treatment for you. If you can't adjust your lifestyle to fight the disease, then you will have to live with the results. A former doctor told me when I was first diagnosed with DMII that I could eat anything I wanted, but everything had a cost. That slice of pie might cost me my toes. That ice cream might cost me my eyesight. I had to make the decision about what was most important to me. If my eyesight, heart or legs weren't important enough to change my lifestyle, he could help me some with medication, but eventually it would come down to the fact that I would pay for my excesses with food with my health. His prejudice against anything that he didn't know or think of himself was the reason I fired him and found another physician in that city.

Now for the usual disclaimer. I am not a doctor and I am describing only my own experience. Consult your own physician for any and all medical advice you may need.

Tachyon

Link Posted: 3/14/2005 7:54:28 AM EST
btt for the Doctor part of the q.

Thanks all to those who replied. I am pretty sure that my best bet is just to lose the weight, but until then, I would still like to know about the insulin option.

TXL
Link Posted: 3/14/2005 8:05:57 AM EST
Not an MD, but also have Type II.

Cinnamon has been found to reduce FBGs 18-29% with as little as 1 gram/day. I take 500mg with breakfast and another 500mg with dinner - began in November, and my sugars have dropped significantly. My FBGs went from 105-110 to 85-90 since taking it. I'm also on 1000mg Metformin 2x/day. Per the published study (below), the clinical trial was for 6 weeks - my FBGs started dropping within a few weeks.

Most grocery stores around here don't carry cinnamon in the capsule form, but Walmart has them - I think it's like $4 for 300 (500mg) capsules.

Info on cinnamon:

www.newscientist.com/article.ns?id=dn4413

care.diabetesjournals.org/cgi/content/full/26/12/3215

HTH
Link Posted: 3/14/2005 8:07:00 AM EST
[Last Edit: 3/14/2005 8:07:33 AM EST by cmjohnson]
Link Posted: 3/14/2005 8:07:02 AM EST
Interesting, never heard of the cinnamon angle before.
Link Posted: 3/14/2005 11:27:10 AM EST
[Last Edit: 3/14/2005 11:31:14 AM EST by juslearnin]
I am an MD, but only an ER MD, so I don't deal with long term management of diabetes. The way I think about diabetes is this: the cells in your body need insulin in order to allow sugar to get inside. Your pancreas is designed to produce the insulin required. In type II diabetes, the pancreas is still producing insulin, but the amount produced is not enough. This is ususally for two reasons. The first is that usually type II is associated with being overweight. There are too many cells requiring insulin for the pancreas to keep up. Think about it this way: Say you build a sprinkler system for your yard. You don't have good water pressure, so you calculate the resistance in the pipes for your system, and you buy a pump for it. Then your neighbor decides to tap into your system one night to water his lawn. All of the sudden, the pump which was perfectly adequate for your yard can't keep up, and nobody has good pressure. Our bodies were designed to be within a certain weight range in order to function, and when they get outside this range things don't work right.
There is a second aspect as well. People with type II diabetes also have higher insulin resistance. This means that the receptors on their cells do not bind insulin as well as someone without diabetes (or they may bind the same but have less of an effect). The net result is that more insulin is required per cell than in a person without diabetes. As far as I know, noone is sure why this is. Almost all of the time, if the person loses weight and gets down around their ideal weight range they will no longer need medicines, as their pancreas will be able to keep up. I am not sure if the insulin resistance goes away, or if they just get to a level where the pancreas is able to produce enough insulin, but either way weight loss will usually cure diabetes.
As noted above, there are several different ways to fight the elevated blood sugar with diabetes. There are four basic strategies:
1. Lower peak glucose levels- these drugs (acarbose and miglitol) slow the rate at which your body absorbs sugars from your intestines. They decrease the "spike" of sugar which normally happens after eating, and kind of smooth it out to a more gentle curve. The thinking is that the pancreas can produce less insulin but over a longer time period to compensate. These drugs tend not to be very powerful, and only work with someone who has mild diabetes, or in combination with other meds.

2. Stimulate the pancreas to produce more insulin- (sulfonureas and meglitinides) These drugs stimulate the pancreas to produce more insulin. They are very successful- to a point. The pancreas can only be pushed so far, and eventually demand again outstips supply. These are the drugs used most commonly for type II diabetes.

3. Increase sensitivity of receptors to insulin- (Metformin and thizaolidinediones) These drugs make the receptors more sensitive to the available insulin. There were some problems with the first thizaolidinedione on the market, and it was pulled. This class is fairly new, and expensive, and I am not too familiar with it. Here again, the problem becomes that eventually the pancreas may not be able to keep up.

In managing type II diabetes, a Dr can use one or more of the above meds to try to lower levels. At some point, however, if you are unable to get sugars down, the final solution is to just inject insulin- supplementing what the pancreas makes.

Is there an advantage to using these drugs in combination with insulin? I am not sure that has been proven. It seems logical that if you are on one or more of these above drugs it will decrease the amount of insulin you need to inject, but I am not aware of any studies which show an advantage to this. However, I am not a primary care MD and am not up on this literature. I do know that the current trend is to use one or more of the above medicines in combination with insulin if the oral meds cannot manage the sugar alone.

In your case specifically- it is very important that you lower your sugars. Running in the 200s all the time is setting you up for some very bad things- loss of your vision from diabetic retinopathy, possible renal failure and the need for dialysis, and much higher risk of heart attack and stroke. It is VERY IMPORTANT that you get your sugars down even though you don't have symptoms. Talk this over with your MD and determine the strategy he/she has for controlling your diabetes, and keep at it until your sugars are in the normal range. It would make sense in my mind to add another oral medicine from another class and see what your sugars do. If this is not enough, then add a medicine from the third class. It will be much easier for you if you are able to control it with pills instead of going to shots. If the combinations do not work, then you may need insulin, but I don't think you have exhausted your other options yet. If your MD is not aggressive in trying to control you diabetes, find another one. You do not want to end up paralyzed from a stroke prematurely, or on dialysis because you waited too long. Hope this helps, and good luck. By the way, weight loss and exercise will help, but you need much better control right now.
Link Posted: 3/14/2005 12:00:03 PM EST
Don't you hate it when you know the answers you are gonna get, know they are right, and still don't want to man up and do what's necessary?

Thanks for all the replies guys. Will be visiting my Dr. again very soon to talk about other meds.

TXL
Link Posted: 3/15/2005 7:38:19 PM EST

Originally Posted By juslearnin:
There is a second aspect as well. People with type II diabetes also have higher insulin resistance. This means that the receptors on their cells do not bind insulin as well as someone without diabetes (or they may bind the same but have less of an effect). The net result is that more insulin is required per cell than in a person without diabetes. As far as I know, noone is sure why this is.



juslearnin - great post. FYI, the Joslin Diabetes Institute (affiliated with Harvard) announced on January 30 that they have discovered the trigger for Type II - low-grade inflammation of the liver, and that it may be treatable with an already existing low-cost medication (salsalate). joslin.org/news/masterswitchtype2.shtml.

Txlewis - he's also very correct in that you need to get it under control. Varying reports say that neuropathy occurs whenever blood sugars are in excess of 140-200 - they keep revising the numbers downward, but having numbers like yours are setting yourself up for trouble later. I never felt any problems when I was diagnosed last September, and my bs was 429. I now have an A1c of under 6. Read up on low-carb diets, or go to a nutritionist. It can really suck for some poeple - luckily, I have naturally low cholestorol, and eat lots of meat and cheese....my BBQ'ing skills have improved significantly in the last six months, and I thought I was pretty good before!

IM me if you want some suggestions. Good luck in controlling your condition!
Link Posted: 3/15/2005 7:41:43 PM EST

Originally Posted By TxLewis:
Don't you hate it when you know the answers you are gonna get, know they are right, and still don't want to man up and do what's necessary?





All the damn time. Most of the misery in recent memory has in some way or another stemmed from this damned disease.
Link Posted: 3/15/2005 7:42:39 PM EST

Originally Posted By Happyshooter:
I asked my Chiro (DC) and he said that when 'you were born your spine was twisted up...and that's why you are going to die'

Wait, that's what he said about every single condition, incluuding heart problems and cancer.

I told him I didn't want to hear any bull shit from a back massage guy and to shut up and get back to work, which is why I am the only chiro patient with visits left on my insurance plan who was fired by a DC. I got a 'don't come back' letter and everything.



Love it.

Chiros are quacks.
Link Posted: 3/15/2005 7:52:57 PM EST
Link Posted: 3/15/2005 9:36:30 PM EST
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