How do you know when you need to switch to insulin?!


Question: How do you know when you need to switch to insulin.?
I have had Diabetes for 2 years and I have been on Metformin 500mg, at first it was 2 times a day, now 3 times a day. My sugars have not been very good and I am trying to gain weight so that does not help. How do I know if it is time to switch to Insulin.? I know I have to see a doctor for that, but I just want to know if it is possible to tell.Health Question & Answer


Answers:
The doctor will increase your dose. You are at the starting dose and it can go quite a bit higher. He'll probably have you increase to 1000 mgs for one meal per day and see how it works before doing anything else. They have to increase the dose a little at a time because it can cause stomach problems if they raise it too quickly.

If you get stomach problems or diarrhea, take some sugar free yogurt with your Metformin, just before each meal. It helps. Danone makes a good one that is low in carbs, it says No Sugar Added, but still tastes good and it works. Follow it with a glass of water, then eat your meal.

When you reach the maximum dose of metformin, if you're still not getting good control, and still losing weight, they may put you on insulin or they may want to add more oral drugs. The other drugs can have some nasty side effects and aren't as safe as metformin.

However, you can ask to try insulin instead of waiting for things to get worse.

I recommend that you look into Lantus insulin. You take it once a day. Lantus is a basal insulin. That means that it has no peak and works in the background. You would still need your metformin for meals, to deal with the carbs you eat, but the Lantus would bring your blood sugar under control, and help you get your weight back too.

You could add a mealtime insulin later on if the combination of Lantus and Metformin isn't enough.

Good luck!


NOTE to Gary - uncontrolled high blood sugar causes weight loss in some people. This is why she is trying to gain weight.

Not every type 2 is overweight.Health Question & Answer

There are medical reasons not to go on insulin until you absolutely have to. I think you are worrying prematurely. Metformin may even precipitate weight loss. Your doctor may first try another drug or adding a second OHA to your regimen. You will have a hard time gaining weight with your sugars running high . Please see your doctor for medication adjustment and monitoring. And, calm down.

Try eating more water-soluble fibers, low glycemic foods and drinking glucerna /glucerna snacks to gain weight while controlling blood sugars. See google for low glycemic food lists. Be careful however if the doctor changes your medication as glucerna products and the dietary regimen I just recommended may lower your sugars dramatically. Metformin by itself will not cause hypoglycemia.Health Question & Answer

Registered DietitianHealth Question & Answer

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