Re: Re: My menu and numbers

April 22, 2005

At 02:59 PM 4/22/2005, you wrote:

>What's the advantage of taking less insulin if your body needs it?

>Economic?

>

>The only reason I could think of for a type 2 to take another med

>besides insulin -- and that would only apply to metformin - is to reduce

>insulin resistance.

>Vicki

My thoughts exactly... why take another med, at an additional cost, with

gut related problems, just to lessen the amount of insulin? It's cheaper

for me to get the script for the needed amount of insulin than to get two

scripts.

BTW on the eyesight thing... I did notice changes when my bgs were way up.

Those would go away when I got things back to " normal " What I didn't

realize is that my " normal " was high enough that when I got down into

non-diabetic levels (mostly), my vision improved even more. It was a

pleasant surprise!

Rick

April 22, 2005

At 02:59 PM 4/22/2005, you wrote:

>What's the advantage of taking less insulin if your body needs it?

>Economic?

>

>The only reason I could think of for a type 2 to take another med

>besides insulin -- and that would only apply to metformin - is to reduce

>insulin resistance.

>Vicki

My thoughts exactly... why take another med, at an additional cost, with

gut related problems, just to lessen the amount of insulin? It's cheaper

for me to get the script for the needed amount of insulin than to get two

scripts.

BTW on the eyesight thing... I did notice changes when my bgs were way up.

Those would go away when I got things back to " normal " What I didn't

realize is that my " normal " was high enough that when I got down into

non-diabetic levels (mostly), my vision improved even more. It was a

pleasant surprise!

Rick

April 22, 2005

Well I do remember reading somewhere quite awhile ago that Metformin &

Insulin together worked better, for some people, than insulin alone. I

can't remember where it was I read this--prob Diabetes in Control or

WebMD. I will see if I can find it later. YMMV

cappie

Greater Boston Area

T-2 10/02 1/05 A1c: 5.4 = 115 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, Coq10, B12, ALC, Vit C

Cal/mag, low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 20 mg, Enalapril 10 mg

4/05:140 lbs (highest weight 309),

5' tall /age 67,

cappie@...

April 22, 2005

Well I do remember reading somewhere quite awhile ago that Metformin &

Insulin together worked better, for some people, than insulin alone. I

can't remember where it was I read this--prob Diabetes in Control or

WebMD. I will see if I can find it later. YMMV

cappie

Greater Boston Area

T-2 10/02 1/05 A1c: 5.4 = 115 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, Coq10, B12, ALC, Vit C

Cal/mag, low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 20 mg, Enalapril 10 mg

4/05:140 lbs (highest weight 309),

5' tall /age 67,

cappie@...

April 22, 2005

Well I do remember reading somewhere quite awhile ago that Metformin &

Insulin together worked better, for some people, than insulin alone. I

can't remember where it was I read this--prob Diabetes in Control or

WebMD. I will see if I can find it later. YMMV

cappie

Greater Boston Area

T-2 10/02 1/05 A1c: 5.4 = 115 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, Coq10, B12, ALC, Vit C

Cal/mag, low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 20 mg, Enalapril 10 mg

4/05:140 lbs (highest weight 309),

5' tall /age 67,

cappie@...

April 22, 2005

Rick, Just curious. What happened? Did you take a hiatus from diabetes

or what? Enquiring minds want to know, LOL. Sue

On Thursday, April 21, 2005, at 11:39 PM, Rick wrote:

> I just started insulin again about a month ago - Lantus at Bedtime,

> Humalog

> pre-meal. My Lantus at bedtime is currently 60 units, and I still don't

> think it's quite enough. I may need 25 more! :o/

> My last Hba1c (a month ago) was 10.4 (no throwing stones!!!). Since

> I've

> been keeping my bgs close to a hundred or slightly less, after

> bringing my

> morning bg down, I'm sure my next Hba1c will be significantly better.

April 23, 2005

Well, of course, you all know that I'm one happy UL user.

And of course, YMMV. Everyone who uses insulin needs to find the one

that works best for them, whatever that is.

However, having said that, I'll add that it is possible that those who

had a bad experience with it had incorrect dosing parameters.

Vicki (running and ducking)

Re: Re: My menu and numbers

>

> On 22 Apr 2005 17:05:13 -0000 diabetes_int writes:

>>

>> On Thu, 21 Apr 2005 20:19:37 -0700 " whimsy2 "

>> writes:

>> >

>> > If you give the Lantus a fair try and it still seems to be keeping

>> > you awake, you might consider trying Ultralente as your basal.

>

> I tried UL, twice. I have no idea why I was a gluton for punishment

> Twice

> but the rerun was worse than the first time and the first time was

> pretty

> bad.

> Over the years I have tried just about every insulin ever made and if

> they were betting on one insulin to drop like a hot potato, I would

> have

> voted for UL. The decision makers dropped Lente instead, so I would

> have

> lost that bet. And the hypos with UL were killers and I mean that

> literally.

>

>> Very few

>>

>> >

>> Or taking the Lantus earlier might help but IMHO UL is not the

>> alternative.

>>

> I hear scads of people take Lantus in the AM. I do not take it at

> bedtime

> but a couple of hours earlier, which fixed the problem I initially had

> with Lantus. Maybe type IIs have a different absorbtion rate than type

> Is, which helps with an AM dosing.

>

>> I sound like a broken record but Lantus was put out as the

>> alternative to NPH, not UL.

>

> Very true and you aren't a broken record, you are using the repeat

> button. I guess from time to time it has to be said, Lantus was ok'd

> by

> the FDA as a substitute to NPH, not UL. When someone is on NPH for a

> long

> time they learn how to work around it's peaks and except for the peaks

> NPH has fewer problems than UL IMHO.

>>

>> > doctors ever prescribe this -- it actually doesn't even need a

>> > prescription since it's an old insulin, and it's a lot cheaper

>> > than Lantus.

>>

>> Effectiveness should be th number 1 concern, not whether a

>> prescription is needed or the cost. If cost is a major factor then

>> NPH

> doesn't

>> require a script and cost is the same as UL. BUT, Lantus has great

>> advantages and regardless of the manufacturer's admonitions to not

> alter bedtime

>> dosing or amount of shots,

>>[snip]

> Cost unfortunately has to be a consideration for some people when they

> are on a fixed income or don't have prescription coverage from

> insurance

> but there are ways to get the meds one needs regardless of ability to

> pay. If the only option is to use an old insulin then I too would go

> with

> NPH. If cost is not an issue I would rather go through an extended

> tweaking process with Lantus than go with UL.

>

>> > It has a reputation as being unpredictable but IMHO, this is

>> >

>> And IMO, that is a valid reputation. And it is, for many, more than

>> just unpredictable.

>

> I'll drink to that. For the few who successfully use UL, this is a

> good

> example of YMMV. This repeated sales pitch for UL that you don't need

> a

> prescription and it costs less makes me feel like someone is trying to

> sell me a Yugo. Remember them? They were cars made in I think

> Yugoslavia

> (probably why they had the name Yugo). They were so cheap many people

> didn't need to take out a loan to buy one but they were terrible cars

> that cost a bundle to make usable. While cost and a need for a

> prescription might be a consideration for some in deciding what

> insulin

> they should use, UL is not the only consideration for these two

> factors

> and the bottom line should be what works best for the user.

>

> [more snipping]

>

>> Try spliting the dose or taking it in the morning or checking to see

>> if it works the whole 24 hours and with time and a little patience

>> you

>> might overcome some if not all of the problems you are now having. No

> two

>> DMers are the same and you have to figure out what is best for you,

>> regardless of what the doctor, or the Lantus says.

>>

> I might add making changes slowly and giving several days with each

> change to see if the changes work.

>

>> > because most doctors don't understand how to use it to best

>> > advantage, i.e. twice a day, 12 hours apart.

>

>> This is what works for you Vicki and that is great that you found a

>> way to use UL but the problems, generally with UL is not that the

>> doctors don't understand it.

>

> Maybe most doctors DO understand how to use UL and that is why they

> don't

> prescribe it.

>

>> With time and Novo bringing out detemir and

>> then Eli Lilly bringing out their version you will probably find that

> UL will

>> be discontinued like Lente was discontinued and the animal insulins.

>> When that happens you will find a way to work with Lantus or Detemir

>> or

>> whatever they name Lilly's alternative.

>>

> We have entered a new era in DM control and UL is not in the insulin

> companies plans for the future and with time it will not be in the

> DMers

> plans for the future either. When human insulin was introduced some

> people claimed that we shouldn't use the new fangled insulin because

> it

> made DMers hypo unaware. Their cry was " use what you know " . Their

> campaign didn't work and both novo and eli lily dropped animal

> insulins.

> A small company in the UK bought the rights to produce animal insulin

> but

> I think they quietly went out of business. For all the yelling and

> cries

> of doom and gloom, there just wasn't enough call for the old

> insulins.

>

>>

>> >Also, it takes some

>> > experimentation to get the dosing correct.

>>

>> No matter what insulin you choose, it takes some experimentation to

>> get the dosing correct. It's the side effects that become the

>> problem.

>

>> I get excellent basal control with it, as do quite a few others

>> here.

>>

> I know of two other people who use UL and are on this list. I would be

> interested in knowing just how many list members do use UL..

>> >

>> I know of two other people who use UL and are on this list. I would

>> be interested in knowing just how many list members do use UL.

>>

> I sure would like the UL users on this list to raise their hand. I

> would

> be surprised if there were large number.

>

April 23, 2005

Well, of course, you all know that I'm one happy UL user.

And of course, YMMV. Everyone who uses insulin needs to find the one

that works best for them, whatever that is.

However, having said that, I'll add that it is possible that those who

had a bad experience with it had incorrect dosing parameters.

Vicki (running and ducking)

Re: Re: My menu and numbers

>

> On 22 Apr 2005 17:05:13 -0000 diabetes_int writes:

>>

>> On Thu, 21 Apr 2005 20:19:37 -0700 " whimsy2 "

>> writes:

>> >

>> > If you give the Lantus a fair try and it still seems to be keeping

>> > you awake, you might consider trying Ultralente as your basal.

>

> I tried UL, twice. I have no idea why I was a gluton for punishment

> Twice

> but the rerun was worse than the first time and the first time was

> pretty

> bad.

> Over the years I have tried just about every insulin ever made and if

> they were betting on one insulin to drop like a hot potato, I would

> have

> voted for UL. The decision makers dropped Lente instead, so I would

> have

> lost that bet. And the hypos with UL were killers and I mean that

> literally.

>

>> Very few

>>

>> >

>> Or taking the Lantus earlier might help but IMHO UL is not the

>> alternative.

>>

> I hear scads of people take Lantus in the AM. I do not take it at

> bedtime

> but a couple of hours earlier, which fixed the problem I initially had

> with Lantus. Maybe type IIs have a different absorbtion rate than type

> Is, which helps with an AM dosing.

>

>> I sound like a broken record but Lantus was put out as the

>> alternative to NPH, not UL.

>

> Very true and you aren't a broken record, you are using the repeat

> button. I guess from time to time it has to be said, Lantus was ok'd

> by

> the FDA as a substitute to NPH, not UL. When someone is on NPH for a

> long

> time they learn how to work around it's peaks and except for the peaks

> NPH has fewer problems than UL IMHO.

>>

>> > doctors ever prescribe this -- it actually doesn't even need a

>> > prescription since it's an old insulin, and it's a lot cheaper

>> > than Lantus.

>>

>> Effectiveness should be th number 1 concern, not whether a

>> prescription is needed or the cost. If cost is a major factor then

>> NPH

> doesn't

>> require a script and cost is the same as UL. BUT, Lantus has great

>> advantages and regardless of the manufacturer's admonitions to not

> alter bedtime

>> dosing or amount of shots,

>>[snip]

> Cost unfortunately has to be a consideration for some people when they

> are on a fixed income or don't have prescription coverage from

> insurance

> but there are ways to get the meds one needs regardless of ability to

> pay. If the only option is to use an old insulin then I too would go

> with

> NPH. If cost is not an issue I would rather go through an extended

> tweaking process with Lantus than go with UL.

>

>> > It has a reputation as being unpredictable but IMHO, this is

>> >

>> And IMO, that is a valid reputation. And it is, for many, more than

>> just unpredictable.

>

> I'll drink to that. For the few who successfully use UL, this is a

> good

> example of YMMV. This repeated sales pitch for UL that you don't need

> a

> prescription and it costs less makes me feel like someone is trying to

> sell me a Yugo. Remember them? They were cars made in I think

> Yugoslavia

> (probably why they had the name Yugo). They were so cheap many people

> didn't need to take out a loan to buy one but they were terrible cars

> that cost a bundle to make usable. While cost and a need for a

> prescription might be a consideration for some in deciding what

> insulin

> they should use, UL is not the only consideration for these two

> factors

> and the bottom line should be what works best for the user.

>

> [more snipping]

>

>> Try spliting the dose or taking it in the morning or checking to see

>> if it works the whole 24 hours and with time and a little patience

>> you

>> might overcome some if not all of the problems you are now having. No

> two

>> DMers are the same and you have to figure out what is best for you,

>> regardless of what the doctor, or the Lantus says.

>>

> I might add making changes slowly and giving several days with each

> change to see if the changes work.

>

>> > because most doctors don't understand how to use it to best

>> > advantage, i.e. twice a day, 12 hours apart.

>

>> This is what works for you Vicki and that is great that you found a

>> way to use UL but the problems, generally with UL is not that the

>> doctors don't understand it.

>

> Maybe most doctors DO understand how to use UL and that is why they

> don't

> prescribe it.

>

>> With time and Novo bringing out detemir and

>> then Eli Lilly bringing out their version you will probably find that

> UL will

>> be discontinued like Lente was discontinued and the animal insulins.

>> When that happens you will find a way to work with Lantus or Detemir

>> or

>> whatever they name Lilly's alternative.

>>

> We have entered a new era in DM control and UL is not in the insulin

> companies plans for the future and with time it will not be in the

> DMers

> plans for the future either. When human insulin was introduced some

> people claimed that we shouldn't use the new fangled insulin because

> it

> made DMers hypo unaware. Their cry was " use what you know " . Their

> campaign didn't work and both novo and eli lily dropped animal

> insulins.

> A small company in the UK bought the rights to produce animal insulin

> but

> I think they quietly went out of business. For all the yelling and

> cries

> of doom and gloom, there just wasn't enough call for the old

> insulins.

>

>>

>> >Also, it takes some

>> > experimentation to get the dosing correct.

>>

>> No matter what insulin you choose, it takes some experimentation to

>> get the dosing correct. It's the side effects that become the

>> problem.

>

>> I get excellent basal control with it, as do quite a few others

>> here.

>>

> I know of two other people who use UL and are on this list. I would be

> interested in knowing just how many list members do use UL..

>> >

>> I know of two other people who use UL and are on this list. I would

>> be interested in knowing just how many list members do use UL.

>>

> I sure would like the UL users on this list to raise their hand. I

> would

> be surprised if there were large number.

>

April 23, 2005

On Sat, 23 Apr 2005 11:40:13 -0700 " whimsy2 " writes:

>

> Well, of course, you all know that I'm one happy UL user.

>

Ah, but Vicki only one vote per customer and you were #1 on our talley

sheet, so it's still 4 UL users. Of course it is always nice to be #1.

:-)

April 23, 2005

On Sat, 23 Apr 2005 11:40:13 -0700 " whimsy2 " writes:

>

> Well, of course, you all know that I'm one happy UL user.

>

Ah, but Vicki only one vote per customer and you were #1 on our talley

sheet, so it's still 4 UL users. Of course it is always nice to be #1.

:-)

April 23, 2005

On Sat, 23 Apr 2005 11:40:13 -0700 " whimsy2 " writes:

>

> Well, of course, you all know that I'm one happy UL user.

>

Ah, but Vicki only one vote per customer and you were #1 on our talley

sheet, so it's still 4 UL users. Of course it is always nice to be #1.

:-)

April 23, 2005

At 06:13 PM 4/22/2005, you wrote:

>Rick, Just curious. What happened? Did you take a hiatus from diabetes

>or what? Enquiring minds want to know, LOL. Sue

>

>On Thursday, April 21, 2005, at 11:39 PM, Rick wrote:

>

> > I just started insulin again about a month ago - Lantus at Bedtime,

> > Humalog

> > pre-meal. My Lantus at bedtime is currently 60 units, and I still don't

> > think it's quite enough. I may need 25 more! :o/

>

> > My last Hba1c (a month ago) was 10.4 (no throwing stones!!!). Since

> > I've

> > been keeping my bgs close to a hundred or slightly less, after

> > bringing my

> > morning bg down, I'm sure my next Hba1c will be significantly better.

Hi Sue...

It will make the most sense if I give a brief history... )

Diagnosed T2 in Jan '99. A review of old health records turned up high bg

as early as '92 (no one ever pointed it out)

Diet & Exercise controlled until foot surgery in early 2001. A few months

after surgery, the same foods (low carb) started driving my bg's up.

Went to doc in June '01 and stared oral meds. After several months of

minimal effect, I went on Lantus and Humalog (stayed on Avandia, dropped

GlucophageXR).

Did very well on Lantus/Humalog throughout rest of '01 and into '02. Around

May of '02 I started aggressive weight loss program. Lost about 65 lbs.

Back on Diet and Exercise and was able to drop insulin and Avandia.

Stayed off all meds through balance of '03 and into '04. In May of '04 I

had a second foot surgery. D & E continued to work well until late fall. My

numbers started going up again. I did not go to the doc again until March

of this year. I was concerned as my numbers were getting really high -

fastings in the 200's, postprandial 200's, 300's sometimes 400's. Enough is

enough! Back on insulin!!!

As I reflect on my situation, it seems that both times I have had really

high numbers have come some months after surgery. It surprises me that the

numbers don't go up significantly closer to surgery. The only thing I can

see is that following my surgeries, I usually cannot walk aggressively for

a number of months. Since power walking is my main form of exercise, I'm

sure it's related.

At any rate, I'm back on insulin for as long as it takes. I have no problem

with taking it. I still try to keep my carbs in the low to moderate range

(50-75 a day). I's nearly impossible for me to consistently have fewer

carbs than that with all the people in this house - me, wife, 3 kids, 1

granddaughter most days,1 full time foster-care guest, another one

part-time - gee... did I miss anyone???

I've been walking again so we'll see if 1) I can eventually drop insulin,

or 2) I'll wear out my foot and need another surgery and start it all over

again!!! )

Rick

April 23, 2005