I saw this, this morning on the Diabetes in Control Web site. This is the gist of a joint recommendation from the American Diabetes Assoc, and the European equivalent. As I mentioned on my training log, most of this was conspicuously true two or more years ago. Adam Campbell and others drew my attention to Web sites which were close to these recommendations. I just added 2 and 2 together, and ended up putting myself on over the counter insulin over a year ago.
Quote:
Step 1 is lifestyle intervention and use of metformin because of its effect on glycemia, absence of weight gain or hypoglycemia, good tolerability profile, and relatively low cost. Lifestyle changes should aim to improve glucose levels, blood pressure, and lipid levels, and to promote weight loss or at least to avoid weight gain. As tolerated, metformin should be titrated to its maximally effective dose at 1 to 2 months.
Step 2 is to add another medication, either insulin or a sulfonylurea, within 2 to 3 months of starting step 1 or at any time when target hemoglobin A1c level is not achieved or if metformin is contraindicated or poorly tolerated. For patients who have hemoglobin A1c level of more than 8.5% or symptoms secondary to hyperglycemia, insulin is preferred, typically a basal (intermediate- or long-acting) insulin.
Step 3 involves further adjustments by starting or intensifying insulin therapy with additional injections that might include a short- or rapid-acting insulin given before selected meals to curtail postprandial hyperglycemia. Insulin secretagogues (sulfonylurea or glinides) should be discontinued, or tapered and then discontinued, once insulin injections are started.
The tier 2 algorithm consists of less well-validated therapies that may be considered in selected clinical settings, such as in patients with hazardous jobs that would make hypoglycemia particularly dangerous. In these patients, adding exenatide or pioglitazone may be considered, although rosiglitazone is not recommended.
Forgot to add kudos on the insulin and on recognizing that diabetes is a self managed condition not a dr managed one. I'm not knocking dr's it's just there's only so much they can do.
Since you said OTC insulin I'm assuming you're doing N and R? Double kudos if that's the case. I hated those. I much prefer the analogues even if they are more expensive and need an RX.
Hi Dianas - I started with Regular insulin, and then went to my second doctor. He switched me to Lantus which worked for about 6 months, then I had to add Regular back in. He and my next doctor both wanted far higher/higher BGs than I was willing to settle for. We have a community clinic which I am going to now.
I do have Lispro now, just started using it. So far I am finding that I like Regular for my bolus dosing. It has a nice profile to cover meals, and is slow coming on so you don't have to pay a whole lot of close attention to timing. Currently my BGs average a little below 90.
Hi Dianas - I started with Regular insulin, and then went to my second doctor. He switched me to Lantus which worked for about 6 months, then I had to add Regular back in. He and my next doctor both wanted far higher/higher BGs than I was willing to settle for. We have a community clinic which I am going to now.
I do have Lispro now, just started using it. So far I am finding that I like Regular for my bolus dosing. It has a nice profile to cover meals, and is slow coming on so you don't have to pay a whole lot of close attention to timing. Currently my BGs average a little below 90.
If I remember correctly you prefer low carb eating. I forgot about that. In that case the R would probably do better for you than the rapid insulins. Although I think Lantus wins hands down over NPH any day. I found N to have too much day to day variation and an unpredictable peak.
That's too bad about the dr's. Most of the ones where I live are pretty aggressive with their blood sugar control recommendations. I'm glad you found someone who will work with you.
Today was a fasting day, and I woke up with BGs a little high, so thought it would be a good time to test Lispro. Two days ago it didn't seem to do anything, so I took a couple extra units - measured every hour for 5 hours - almost NO effect again! I think I will try once more, and use a syringe so I know for sure that it is injecting. The pen was a sample so I am not out any money. Odd.
NEW ADA type 2 diabetic guidelines
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