Medication and Insulin

 

Questions and Answers

Q: I have type 2 diabetes and have been on insulin for a year now. I have lost some weight and my A1C has dropped from 9.5 to 6.5 but I am having a lot of lows ranging from upper 40's to 60's. I am wondering if maybe I might be able to get off insulin. I feel that my oral med is starting to work better now that my beta cells have had a rest. Can that be true? 
A: Yes, your cells are also in a better position to uptake glucose from the bloodstream now that you have decreased body fat. You should see your physician ASAP to get this adjusted. 40's are a dangerous range to be in. He/she may start weaning you off insulin, watching your levels along the way.

Q: How much is blood sugar decreased for every unit of novolog insulin?
A: A starting point is to consider that one unit of insulin will lower the glucose 50 points. This can vary from 30-100 points, depending on one's insulin sensitivity, exercise habits, food choices or other variables. Time will tell for you as you test and track your numbers to see if a pattern evolves.

Q: What medication is used to replace metformin when liver enzymes are high and the endocrinologist discontinues this medication?
A: Much will depend on the advancement of your diabetes and other medications you might be taking. Your physician might choose a meglitinide such as Prandin or an alpha-clucosidase inhibitor such as Precose. Insulin would be another choice. There are other meds and newer ones always in the mill. Some physicians keep their patients on Metformin if the enzyme levels are not too high. If your numbers are not too high and you are otherwise healthy, focus on lifestyle management. Losing body fat, if needed, can help to get things under control.

Q: My bottle of insulin will expire next month. Can I still use it or do I need to throw it away?
A: Expiration dates usually have a grace period. If stored properly, you should be fine. I would assume that your insulin would also be used up sometime around the expiration date. Just to be sure, inquire from your pharmacist or source of your insulin what they advise.

Q: A lot of times I’ll forget to take my insulin before eating, especially when I go out to eat. Does it help any to take the shot after I’ve eaten?
A: Yes, if you are referring to short acting insulin. Of course, this will depend on how long after eating you are referring to. Your food may peak an hour after eating, especially if you ate carbs. I suggest you work out a scale or insulin adjustment schedule with your physician. Generally, 1 unit of insulin is geared to lower 15 grams of carbs. It may take a few guided trials for you to learn how your blood sugars respond to insulin taken post-meal.

Q: When injecting insulin, are you supposed to rotate within the site or rotate sites? 
A: You can do both. The best injection site is abdominal, rotating at least an inch away from the navel. The second best site is the “pinch” of the upper arm. Thighs can be used prior to sleeping. It is best to spend at least a week rotating in one area before moving on. If you can stay with the abdominal area, that would be ideal.

Q: Is it more effective if I take my insulin in the morning instead of the evening like I do now?
A: This depends on the type of insulin you are on. If it is a basal insulin, it is often suggested to be taken at night. Even though there is not a peak with basal insulin, it cannot perfectly mimic our physiology; some get better control with the night time dose. Sometimes, it is trial and error to see whether morning or evening works better; sometimes both an a.m. and p.m. injection get better control. Check with your physician to determine when the best injection time is for you.

Q: I am going to have to switch my insulin because Novo Nordisc is taking their Novolin N and R products off the market. I am not sure the pen is the best for me because once my insulin peaks my blood sugar drops very quickly. Do you have any suggestions for insulins I should research and ask my doctor about?
A: Have you and your physician discussed using a basal insulin to better balance those peaks and valleys that can occur with intermediate acting insulin? I would assume your physician is abreast of the changes and would begin to have an alternative plan for you. When switching insulin, it may take some closer management for a time as no two companies have the exact same formula. If one is accustomed to taking the R separately, a combo pen is not the best substitute for reasons you note; the control cannot be as exact since combo pens are set ratios.

Q: At my last appointment my doctor said to take 1 or 2 doses of metformin as necessary. If I take just one pill, my morning and evening readings are 100-120. If I take two pills, the readings are more in the 80-110 range. Is it better to eliminate some medication at the expense of higher readings?
A: If you are actively following a healthy lifestyle and losing weight if that is part of your program, the single dose may be just fine in the short run while you see lifestyle interventions achieve some more lowering. If you don't exceed 120 daytime, that is great! If you have no other cardiac conditions, then the single dose may be preferred. Be sure your physician gives you glucose levels to target.

Q: I am on metforim for type 2 diabetes. It has improved my glucose levels from but I am wondering if this is too much medicine and if it might cause kidney problems!?
A: All medications have potential side effects. When on metformin, you should be getting you liver enzymes checked every 3 months, at least initially making sure you are stabilized. This is a great time for you to truly start a Healthy Lifestyle Plan, working towards reducing excess body fat if that is an issue. It is possible to reduce/stop medication and there are those who have successfully been able to keep blood sugars in range without medication. Get whatever assistance you need here if you are unclear about whole foods eating and an active lifestyle. There are nutritional supplements that are also helpful. What is best for you will depend in part on any other health conditions/medications you may be taking. With patience, focus, and time spent to learn about your condition, you should certainly make progress.

Q: Does injecting insulin into the stomach cause additional fat to accumulate there?
A: Fat deposits do tend to increase where one has the greatest aggregation of fat cells, which for many, is in the belly. The increase would come if one is gaining body fat.  Insulin does have a job of depositing the byproducts of both protein and fat digestion into the cells, along with glucose: the end product of carbs.  If your caloric intake exceeds your activity output, you will gain fat and it will most likely show up in the belly.  What one may experience is some hardening of the tissue in the belly if injections are administered over a long period and are not routinely rotated in the area.  Still, abdominal injections are the most effective.

Q: I have had type II diabetes for 15 yrs. I have been working very hard at diet and exercise and have lost 20 pounds. Three months ago my A1C was 6.8. and now it is 7.9. The doctors want to put me on insulin now. Is there any other oral meds that I can take before I have to go this route? Right now I am taking Metformin 1000mg 2x a day, Glyburide 5mg x 2 twice a day and Avandia 4mg 2 x a day. 

A: At this point, they have about maxed you out on your existing oral medications. I think going on a term of insulin would be wise, in order to give your insulin producing cells a rest and possibly regroup a bit. People have "needle fear", but when done in the fat of the belly, insulin injections are not painful. Insulin is generally less toxic to the system and has fewer side effects than the oral meds you are taking. Try to get back in that good control you were in, and remain very diligent about lifestyle. Learn carb counting initially and, in time, you will begin to know what affects you and what doesn't. As you continue to lose body fat and become leaner, you may find yourself needing less insulin. Keep a fish/veggies diet focus, and you will achieve faster results. You may need a tune up with a knowledgeable diabetes educator/nutritionist if unclear about whole foods eating and truly nutrient dense foods.

Q: Is it possible for someone with insulin resistance to take too much insulin? I am finding it necessary to gradually increase my daily injections of Humalog 25/75 to have satisfactory blood glucose readings.
A: Pre-mixed insulin cannot give the same fine tuning control that taking baseline/meal insulins separately can. I would assume you are getting low blood sugar reactions? Speak with your physician if this is the case. If you are willing to take your insulins separately, then you should be able to calibrate with your meals more effectively. This will mean learning to count carbs, which is good knowledge to have regardless.

Q: When on an insulin pump, is it alright to eat anything you want? My teenage stepdaughter who is visiting us right now eats more sugar than I've ever seen anyone eat and when I asked her about her sugar intake, and her response was, "It doesn't matter, I have the pump".
A: It certainly does matter how one eats with or without the pump and, in general, with or without diabetes. A pump does allow for a bit more leeway, but not a total sugar binge. In general, more teens are surfacing with conditions never before seen until later stages of life: high lipids, blood sugars and irritable bowel, to name a few. If she is to be living with you, then you would need to become more “proactive”. It may be that if you don’t see her that often that she is “playing” you like a substitute school teacher, getting away with whatever she can while she can. Be very clear about how she normally eats, and what her education and support is. Perhaps you might just consider bringing only healthier foods into the house. If you and others are eating the sugary foods, she, like any 13 year old, does not want to feel “abnormal”. Nothing like a good example to set the stage for change.

Q: I take novolog 70/30 before breakfast and dinner. My bedtime blood sugar reading can go as low as 37 but then, first thing in the morning, I am up into the 200's and 300's. Do I need to switch my insulin?
A: I would suggest you discuss with your physician about switching to basal and mealtime insulins, which would mean more injections, but better control. In my experience, many folks require more insulin in the morning, because hormones kick in around dawn and tend to elevate blood sugars first thing in the morning. A basal insulin, taken once a day, gives you a better steady "trickle", then depending on the time of day and the meal, injections in different amounts help to give better control. This is where learning to count carbs, based on 1 unit insulin for every 15 grams of carbs, is a place to start. Over time you can fine tune the amounts once you know the composition of your meals and have a good handle on what you are eating and how much. This may take some homework for awhile, but is well worth it in the long run.

Q: What does it mean when a person has high insulin levels? Is this bad and what can it cause?
A: High insulin levels are often the result of years of less than desirable lifestyle habits such as poor food choices. Refined foods, especially carbs, produce sugar very quickly in the body, resulting in the pancreas secreting insulin to meet the demands of removing sugar from the bloodstream. In time, the insulin secreting cells get tired and stop working effectively.

Q: Could taking an anti-fungal medication cause my blood sugar levels to go too low? I have a toenail fungal infection and was prescribed Lamisil tablets. After 7-10 days of starting the Lamisil, my glucose levels started going very low and I had to reduce my insulin significantly to avoid hypo's. The problem is that although my readings are within a good range, have become extremely tired and have no energy.
A: You may be responding to the rapid shift in blood sugar levels, which can be fatiguing. You should adapt. If not, and nothing else has changed in your management, then it may be the medication. Ask your physician about this. As for dealing with future recurrences of the fungal infection, it may help to keep a good amount of fiber in your diet, drink lots of water, take a minimum a high quality multivitamin that suggests 2 pills/day, and one-two courses (bottles) of a probiotic which contains live bacteria that you find in yogurts.

Q: Is Glucovance causing my blood sugar to go too low? Since I have lost weight, my blood sugar goes as low as 70, which makes me very sweaty and faint.
A: The good news is that you probably don't need the medication now! Your efforts are paying off. You may be over medicated which could be dangerous by causing very low blood sugar levels. Notify your physician immediately to start cutting back with the goal to be total elimination of the medication.

Q: Is my blood pressure medication causing my blood sugar level to drop drastically each morning after I take it?
A: If you have not changed anything else in your diabetes management, you are most likely being affected by the blood pressure medication. Certainly your physician should be notified, and either recommend a medication change, and/or lower your diabetes medication.

Q: What could happen if someone were misdiagnosed as having diabetes and took insulin but didn't need it?
A: If a person doesn't need insulin, and is injected with it, there's a strong possibility of getting a very low blood sugar reaction, depending on the insulin dosage and the amount of food eaten. I personally have never heard of someone being misdiagnosed with diabetes. Before a person is started on insulin, a diagnosis of diabetes is clear via lab tests, and usually, blood sugars are high even with oral medications and lifestyle changes. In and of itself, insulin is not generally damaging.

Q: Can anti-inflammatory medications increase my blood sugar levels? I have been taking 600mg Ibuprofen 3 times a day and my sugar levels are the highest they have ever been.
A: Most likely the inflammation itself is the first cause of blood sugar rise. NSAIDs (non-steroidal anti-inflammatory drugs) as a group are hard on the digestive tract over a long haul; this may affect your metabolism at some level. If this is short term for you and not a chronic treatment, you should return to better control as the inflammation subsides.

Q: I have type 1 diabetes and am wondering if I can take steroids for about 2 months?
A: Taking steroids is never considered without risk and I would strongly suggest you do not unless advised by your doctor for medical reasons. You can most likely expect the steroids to cause a rise in your blood sugars. Steroids when taken as a prescription often induce secondary diabetes. I am assuming that you are inquiring about steroids for muscle building. As an alternative, you may want to try a microfiltered whey protein powder w/o preservatives, sucralose, or other additives in it. This should be done under nutritional supervision to ensure a good dietary balance. Close monitoring of blood sugars is necessary.

Q: Is an increase in the amount of insulin that I require a sign that my diabetes is getting worse? I have been a diabetic going on 18 years and most of the time my blood sugar has been anywhere from 200 to 450. When I was first diagnosed, I took 5 to 10 units of insulin but now I take 15 units to 50 units depending on how high my sugar is.
A: In general, long standing diabetes where blood sugars run high can invite complications. Are you under close care of your physician where you are monitored every 3 months? High blood sugars may to due to many factors. Once diet/lifestyle are truly being well managed and blood sugars are still labile, it may be that forms of neuropathy have taken hold. Please do visit your concerns with your physician.

Q: What medication can be taken by a type 2 diabetic with leg ulcers, to offset arthritic pain in the foot?
A: This is a question for your physician. One has to always be aware of drug interactions, depending on your other medications. Better healing is connected to how you eat and if you are taking any nutritional supplements. If there is room for improvement in the health of your lifestyle, I suggest you get some guidance from a nutritionist /diabetes educator. You sound as if your conditions have progressed; it is important to do what you can to slow any further degeneration. A vitamin B-complex may be helpful, as well as fish oil capsules. Certainly taking a high quality multivitamin would be a basic start.

Q: Is my doctor correct to put me on Byetta for the principle reason of improving beta cell production and longevity? I am resistant to going on it because of the fact it has to be injected and I don't want the side effects of nausea, gastric upsets, etc.
A: As with any approved medication, it is only as effective as what we know of it to date, and every person does not respond to each medication the same way. It may be that your doctor's objective is to discharge you from one or more of your current medications, to Byetta. That is a decision the two of you must arrive at. It is always a good goal to strive towards medication dosage reduction. Perhaps this may occur with a proposed change. All medications do come with warnings.

Q: Do you agree that although lab standards say I am right in the middle of "normal range values" with a C-peptide at 2.5, half my B-cells are gone? What would be an optimal C-peptide score? My current A1C is 5.9.
A: A normal fasting level of C-peptide is 0.78-1.89 ng/mL. At 2.50 I don't know of the correlation to amount of beta cells remaining. If you stay at that level, your lifestyle is managed well, and your blood sugars stay fairly consistent to reflect your 5.9 A1C, I'd say you are on a quality life path, doing what you can with what is in your control. Insulin and C-peptide are jointly secreted, with C-peptide being used as a clinical monitor of your body's insulin production. Direct measurement of insulin is difficult because it is rapidly removed from the bloodstream. This may make it difficult to rely on C-peptide to accurately measure insulin levels at the time of testing. C-peptide is not an average measurement as is the A1C, (the A1C is the average level of blood sugar over 3 months). They are 2 separate values, and reviewed independently.

Q: Could I have gotten diabetes from taking prednisone? I am 39 and was diagnosed with diabetes about a month ago, all my symptoms (thirst, frequent urination, dry mouth etc.) started after having 2 steroid shots for a sore throat and then I was on prednisone for my back. My sugar was over 425. Now in the morning it is around 103-120. After meals it is 148-193. How long will it take to get normal?
A: I wish I could give you a definitive answer, but I can't. Yes, prednisone can be a trigger for diabetes, and with following a healthy lifestyle, diabetes can be resolved to more normal blood sugars. Certainly, you are reporting much better blood sugars, in the pre-diabetes range. I suggest you discuss this with your physician, and if needed, be referred to an endocrinologist for some more definitive answers regarding the endocrine system and what may be manifesting with you. If you have a family history of diabetes, the prednisone may very well have been your trigger, particularly if you weren't following a healthy lifestyle. Time will tell; good lifestyle management is a "must."

Q: What is the recommended ratio of long term insulin vs. short term to make up the total insulin requirements for the entire day?
A: Textbook starting point may be 2/3 long acting, 1/3 short or rapid acting. There are formulas to further refine the breakdown. Individualizing each person's therapy is always the key, based on accurate blood sugar records. Seeing your daily numbers lets you know how well your program is doing and where adjustments need to be made. Remember: no two people with diabetes follow identical management patterns.

Q: Why do my insulin injections hurt so much? No other diabetic that I have ever met has experienced this as I have.
A: Have you spoken with your physician about this? It could be that you have a degree of autonomic neuropathy, where you are becoming very "nerve sensitive". There are topical cayenne based creams that may help. Maintaining a high nutrient dense food intake is important; a nutritionist knowledgeable in vitamin/mineral supplements would be your best source.

Q: Is there a correlation between the Metformin and hair loss?
A: Hair loss is not typically listed as a possible side effect with Metformin, but can occur due to stress. Diabetes itself can trigger hair loss. Often a good vitamin/mineral therapy course will begin the correction; B vitamins especially are needed for a more balanced metabolism. You may want to see an endocrinologist about this if it persists. Meanwhile, start eating a truly nutrient-dense diet coupled with exercise. The fewer stresses you have, the more balanced your system will become, and perhaps you will achieve normal blood sugars without the aid of medications.

Q: Why is my 13 year old son suddenly getting up in the middle of the night with low blood sugar? He eats at exact times and makes sure I do the insulin or check it to make sure that it is accurate. He uses Humalog and Humulin N.
A: This is due to the peak times of his insulin. It sounds like he needs that dose lowered, which is a good thing. Have you discussed this with his physician? It may be that a switch to a long-lasting insulin like Lantus would be better for him; it certainly is worth exploring.

Q: Is my diabetes medication causing headaches? I'm not sure if it is my new medication (metformin) or high blood sugar, but I have been getting these horrible headaches that stop me from doing anything all day long. My blood sugar ranges from 130-160. Sometimes it is 100 but it seems like when it is closer to 100, my headaches are even worse.
A: It does sound like you are reacting to the medication; side effects the first 2 weeks are not uncommon. If this persists, you may need a medication change. You should also let your physician know. It will take some time and patience on your part to accept and understand your diabetes. Each person responds differently. Do not be timid to ask for guidance. I suggest you seek out a diabetes educator, classes, or some other support group to help you along. Paying close attention to your total lifestyle is key to good management, and possibly reducing or eliminating the need for medication.

Q: Does insulin cause weight gain? I have been on insulin for 4 months and injecting in my stomach and now my stomach has gotten bigger.
A: Insulin can contribute to weight gain which is one good reason for working on maintaining a healthier lifestyle as much as possible. Weight gain is sometimes also seen when one experiences low blood sugars from too much insulin, and eats more to compensate. With patience and adjustments, insulin requirements can be arrived at. I suggest you get assistance with your diet and carb counting if you haven’t already.

Q: What kind of medications are used to treat pre-diabetes?
A: The best “medication” is be as active as you possibly can and follow a healthy, whole foods eating program. Medications are never the magic answer and should only beconsidered when truly needed. A strong focus on lifestyle changes - which usually means losing fat and becoming leaner - can serve to keep most folks under control.

Q: What do you know about a new “I-Port” that can be implanted into a person with diabetes to give insulin?
A: Check out the web site for more information. This just involves inserting the dome shaped port onto the injection site via a needle guiding a tiny cannula (tube) into your subcutaneous tissue, where it remains for 3 days. This is similar to the set ups for insulin pumps. For those doing multiple daily injections, this may reduce them by as much 90% in a month.

Q: My doctor wants to put me on Byetta, for the principle reason of improving beta cell production and longevity. Do you agree that although lab standards say I am right in the middle of "normal range values" with a C-peptide at 2.5, half my B-cells are gone? What would be an optimal C-peptide score? Would Byetta actually do what the doctor says: to help maintain B-cell integrity and functionality? I am resistant to going on it because of the fact it has to be injected and I don't want the side effects of nausea, gastric upsets, etc. My current A1C is 5.9.
A: A normal fasting level of C-peptide is 0.78-1.89 ng/mL. At 2.50 I don't know of the correlation to amount of beta cells remaining. If you stay at that level, your lifestyle is managed well, and your blood sugars stay fairly consistent to reflect your 5.9 A1C, I'd say you are on a quality life path, doing what you can with what is in your control.

Insulin and C-peptide are jointly secreted, with C-peptide being used as a clinical monitor of your body's insulin production. Direct measurement of insulin is difficult because it is rapidly removed from the bloodstream. This may make it difficult to rely on C-peptide to accurately measure insulin levels at the time of testing.

C-peptide is not an average measurementas is the A1C, (the A1C is the average level of blood sugar over 3 months). They are 2 separate values, and reviewed independently. As to your question regarding Byetta, I don't have an answer for that. As with any approved medication, it is only as effective as what we know of it to date, and every person does not respond to each medication the same way. It may be that your doctor's objective is to discharge you from one or more of your current medications, to Byetta. That is a decision the two of you must arrive at. It is always a good goal to strive towards medication dosage reduction. Perhaps this may occur with a proposed change. All medications docome with warnings.

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