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Changing meds

Pam123

Pam123

Well-Known Member
Relationship to Diabetes
Type 2
Having been a member here since I was diagnosed 18 moths ago
Ive noticed a lot of people who are T2 are on insulin and remain on it long term.

I have been on Basel now for 18 months and dont intend changing it seams from what I read that a lot of people are being asked to change, I have just had the usual medication reviews by the pharmacist.

Apart from the usual blood tests, I don’t see the DN apart from a couple of visits when first diagnosed she is an idiot, has no idea what she is doing, the GP who is the diabetic lead ive only seen a few times, hasn’t said anything about changing my medication just wondered why they do it in my book if it works don’t change it.
 
I think what you said about “if it works, don’t change” is very true. Unless you have a problem that you want to address then I wouldn’t see any need to mess about with changes.

If on the other hand you are finding things too restrictive with your current regime, for example, then it would be worth exploring other options - maybe adding a bolus of rapid acting insulin before meals, so your regime would be basal-bolus which is used by a lot of people who are on insulin.

My GP health centre openly admit they haven’t got the skills and knowledge to manage people on insulin and are more than happy to refer us to the local hospital diabetes team. So if you feel some tweaks could be helpful for you then it may be worth asking your GP for a referral to your local hospital diabetes team? Otherwise, if all is good and you are happy then stay with what you are on currently.
 
However a referral to a hospital clinic might see them looking more closely at your situation and deciding that they would like you to come off insulin and try oral meds.
@Eternal422 Tony, you yourself nearly became victim to this very recently.
 
I think it it easy to make the assumption that changes in meds are for health reasons.
Sadly, there are other reasons such as
- availability - there has been a long and growing list of medications (including some insulins) that are in short supply. In these situations, it may be necessary to change your prescription to something easier to get hold of.
- financial - there are some common insulin that have recently come out of their patent protection period (there is probably a better official term for this) allowing other manufacturers to make "biosimilar" alternatives. Some people are finding their prescription changing to these cheaper options. For many, this is fine but some people find there are issues with teh biosilimars.
 
rebrascora said:
However a referral to a hospital clinic might see them looking more closely at your situation and deciding that they would like you to come off insulin and try oral meds.
@Eternal422 Tony, you yourself nearly became victim to this very recently.
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Yes, I did wonder about that being a possibility. I guess it depends on whether @Pam123 feels some change would be beneficial and therefore worth pursuing?

I still wonder if there is some drive to reduce costs and get people onto cheaper oral meds and off insulin if oral meds could control BG as well as insulin for the person. @helli, my change from Levemir to Abasaglar was due to the Levemir patent expiring and it being dropped by Novo Nordisk later this year. I do also wonder if the consultant’s attempt to put me on oral meds instead of insulin was also a bit of a cost cutting attempt. No idea why she ignored the fact my oral meds failed to do anything to control my BG some 18 years ago!

One thing I would say though is that the treatment plan must be a shared, agreed plan and not forced on the patient. The NICE guidelines clearly state this, but I don’t know anyone who has had to test this if they are being pushed down a path they don’t want.
 
Eternal422 said:
I think what you said about “if it works, don’t change” is very true. Unless you have a problem that you want to address then I wouldn’t see any need to mess about with changes.

If on the other hand you are finding things too restrictive with your current regime, for example, then it would be worth exploring other options - maybe adding a bolus of rapid acting insulin before meals, so your regime would be basal-bolus which is used by a lot of people who are on insulin.

My GP health centre openly admit they haven’t got the skills and knowledge to manage people on insulin and are more than happy to refer us to the local hospital diabetes team. So if you feel some tweaks could be helpful for you then it may be worth asking your GP for a referral to your local hospital diabetes team? Otherwise, if all is good and you are happy then stay with what you are on currentlyI have
Click to expand...
Eternal422 said:
I think what you said about “if it works, don’t change” is very true. Unless you have a problem that you want to address then I wouldn’t see any need to mess about with changes.

If on the other hand you are finding things too restrictive with your current regime, for example, then it would be worth exploring other options - maybe adding a bolus of rapid acting insulin before meals, so your regime would be basal-bolus which is used by a lot of people who are on insulin.

My GP health centre openly admit they haven’t got the skills and knowledge to manage people on insulin and are more than happy to refer us to the local hospital diabetes team. So if you feel some tweaks could be helpful for you then it may be worth asking your GP for a referral to your local hospital diabetes team? Otherwise, if all is good and you are happy then stay with what you are on currently.
Click to expand...
Eternal422 said:
I think what you said about “if it works, don’t change” is very true. Unless you have a problem that you want to address then I wouldn’t see any need to mess about with changes.

If on the other hand you are finding things too restrictive with your current regime, for example, then it would be worth exploring other options - maybe adding a bolus of rapid acting insulin before meals, so your regime would be basal-bolus which is used by a lot of people who are on insulin.

My GP health centre openly admit they haven’t got the skills and knowledge to manage people on insulin and are more than happy to refer us to the local hospital diabetes team. So if you feel some tweaks could be helpful for you then it may be worth asking your GP for a referral to your local hospital diabetes team? Otherwise, if all is good and you are happy then stay with what you are on currently.
Click to expand...
I am managing really well and have been fine for most of the time, only in the beginning after food I had high reading which I controlled with diet, I did ask in the beginning if I could have Bolus to help the DN one of the first of 2 visits said no as it might cause a cardiac event, total confused with that, and just did my own thing and learned from this forum which as been amazing.
 
Pam123 said:
it might cause a cardiac event
Click to expand...
Never heard of that. It could cause a hypo if you don’t need the bolus insulin or inject too much, but not heard about any cardiac problems. Might be worth querying with the GP? But if you are managing well as you say then there seems to be no need to look at changing anything.
 
I am right in the middle of this at the moment. Pretty recently diagnosed (6 Dec) and, as they thought initially I was T1 I have been on insulin and managing very well.

A recent appt with the consultant though has made it clear they very much want me to try oral meds. I am very conflicted by this as I have an ileostomy which means, if I do suffer from the common side effects of Metformin, it will be very unpleasant for me both medically and mentally.

However, the consultant is fairly confident I can push my diabetes into remission and this will happen quicker on oral meds than on insulin. She has a valid point also that unless I try them, I won't know whether they do give me side effects or not and made it clear if they do I can just stop them.

Insulin has its downsides too - not least the risk of hypos and it is not necessarily the best thing to be on long term if other medications do work.

So my take is I may as well give it a go and see if I can get off the insulin and push this thing into remission. I will give it my very best shot and if it works then it will be brilliant. As life changing as having the diagnosis in the first place. If it doesn't work then I can say I tried it and it didn't work out for me.

Yes, I am absolutely convinced that cost is a factor in her decision making but then oral drugs are a couple of £ a month and insulin is £40+ a month. Should I have the right to be stubborn and decide I want to stay on an expensive drug just because I am too scared to try something else? I don't know. In some ways I think I should, in other ways I think it is fair enough I should be asked to at least try the cheaper option. Particularly when that option may genuinely be the better route for me. The NHS is very very underfunded so perhaps patient choice does need to be balanced with cost.

I flit between being OK with the idea and trying to be positive and really hating the thought and think about fighting the decision!
 
Eternal422 said:
Yes, I did wonder about that being a possibility. I guess it depends on whether @Pam123 feels some change would be beneficial and therefore worth pursuing?

I still wonder if there is some drive to reduce costs and get people onto cheaper oral meds and off insulin if oral meds could control BG as well as insulin for the person. @helli, my change from Levemir to Abasaglar was due to the Levemir patent expiring and it being dropped by Novo Nordisk later this year. I do also wonder if the consultant’s attempt to put me on oral meds instead of insulin was also a bit of a cost cutting attempt. No idea why she ignored the fact my oral meds failed to do anything to control my BG some 18 years ago!

One thing I would say though is that the treatment plan must be a shared, agreed plan and not forced on the patient. The NICE guidelines clearly state this, but I don’t know anyone who has had to test this if they are being pushed down a path they don’t want.
Click to expand...
I avoid hospitals whenever possible because of my phobia, but do understand if I had to go then I wouldn't put my health at risk, but again my husband who is no longer on any diabetic meds, was messed about with the team at our hospital, long story but he was put on glyside sorry spelling, wasn't monitored never given a follow up appointment after being rushed it with a BS of 30 that was 4 years ago, I was given Lantus, when I was in with a kidney infection and sepsis, and I think a DKA, then dropped three weeks later DN who discharged me didn't even show me how to inject hubby did it and still does. sorry I need to get off my soap box
 
Pam123 said:
I avoid hospitals whenever possible because of my phobia, but do understand if I had to go then I wouldn't put my health at risk, but again my husband who is no longer on any diabetic meds, was messed about with the team at our hospital, long story but he was put on glyside sorry spelling, wasn't monitored never given a follow up appointment after being rushed it with a BS of 30 that was 4 years ago, I was given Lantus, when I was in with a kidney infection and sepsis, and I think a DKA, then dropped three weeks later DN who discharged me didn't even show me how to inject hubby did it and still does. sorry I need to get off my soap box
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Sorry to hear about how your husband was treated and I can totally understand your reluctance to go to a hospital. It’s such a shame how the standard and consistency of care varies so much across the country.
 
Eternal422 said:
Never heard of that. It could cause a hypo if you don’t need the bolus insulin or inject too much, but not heard about any cardiac problems. Might be worth querying with the GP? But if you are managing well as you say then there seems to be no need to look at changing anything.
Click to expand...
I got the impression she was trying to scare me, or sorry to be blunt just stupid, I will mention it to the GP when I go again
 
dannybgoode said:
I am right in the middle of this at the moment. Pretty recently diagnosed (6 Dec) and, as they thought initially I was T1 I have been on insulin and managing very well.

A recent appt with the consultant though has made it clear they very much want me to try oral meds. I am very conflicted by this as I have an ileostomy which means, if I do suffer from the common side effects of Metformin, it will be very unpleasant for me both medically and mentally.

However, the consultant is fairly confident I can push my diabetes into remission and this will happen quicker on oral meds than on insulin. She has a valid point also that unless I try them, I won't know whether they do give me side effects or not and made it clear if they do I can just stop them.

Insulin has its downsides too - not least the risk of hypos and it is not necessarily the best thing to be on long term if other medications do work.

So my take is I may as well give it a go and see if I can get off the insulin and push this thing into remission. I will give it my very best shot and if it works then it will be brilliant. As life changing as having the diagnosis in the first place. If it doesn't work then I can say I tried it and it didn't work out for me.

Yes, I am absolutely convinced that cost is a factor in her decision making but then oral drugs are a couple of £ a month and insulin is £40+ a month. Should I have the right to be stubborn and decide I want to stay on an expensive drug just because I am too scared to try something else? I don't know. In some ways I think I should, in other ways I think it is fair enough I should be asked to at least try the cheaper option. Particularly when that option may genuinely be the better route for me. The NHS is very very underfunded so perhaps patient choice does need to be balanced with cost.

I flit between being OK with the idea and trying to be positive and really hating the thought and think about fighting the decision!
Click to expand...
When people have other conditions which would be badly affected by side effects of a particular medication then that need to be taken into consideration when deciding on a suitable treatment plan. You should not feel pushed into a route you don't feel comfortable with. At least if you try the alternatives and it doesn't work for you, you have the option of going back to insulin so I would make that clear to them that you would want to do that.
 
dannybgoode said:
I am right in the middle of this at the moment. Pretty recently diagnosed (6 Dec) and, as they thought initially I was T1 I have been on insulin and managing very well.

A recent appt with the consultant though has made it clear they very much want me to try oral meds. I am very conflicted by this as I have an ileostomy which means, if I do suffer from the common side effects of Metformin, it will be very unpleasant for me both medically and mentally.

However, the consultant is fairly confident I can push my diabetes into remission and this will happen quicker on oral meds than on insulin. She has a valid point also that unless I try them, I won't know whether they do give me side effects or not and made it clear if they do I can just stop them.

Insulin has its downsides too - not least the risk of hypos and it is not necessarily the best thing to be on long term if other medications do work.

So my take is I may as well give it a go and see if I can get off the insulin and push this thing into remission. I will give it my very best shot and if it works then it will be brilliant. As life changing as having the diagnosis in the first place. If it doesn't work then I can say I tried it and it didn't work out for me.

Yes, I am absolutely convinced that cost is a factor in her decision making but then oral drugs are a couple of £ a month and insulin is £40+ a month. Should I have the right to be stubborn and decide I want to stay on an expensive drug just because I am too scared to try something else? I don't know. In some ways I think I should, in other ways I think it is fair enough I should be asked to at least try the cheaper option. Particularly when that option may genuinely be the better route for me. The NHS is very very underfunded so perhaps patient choice does need to be balanced with cost.

I flit between being OK with the idea and trying to be positive and really hating the thought and think about fighting the decision!
Click to expand...
I hope all goes well whatever you decide, I found to begin with I did get hypos, but with the help of my sensor and making sure I ate a little snack if I was low before sleep 90% off the time now I just get the odd hypo, personally I would not want any other options you say I believe the cost is factored in but if at any stage I do get asked to go on oral meds I'm afraid the answer will be no.
 
Leadinglights said:
When people have other conditions which would be badly affected by side effects of a particular medication then that need to be taken into consideration when deciding on a suitable treatment plan. You should not feel pushed into a route you don't feel comfortable with. At least if you try the alternatives and it doesn't work for you, you have the option of going back to insulin so I would make that clear to them that you would want to do that.
Click to expand...
I absolutely agree and my consultant did say if the oral meds don't work out then to stop them. She also made it clear it would be a managed transition so I won't be stopping the insulin to start the other meds either so I will still have insulin available for a time.

They did offer me 6 months with no changes at all to give me time to think about things as well however I may as well give it a go now to see.

As I say, remission has to be the goal and if meds other than insulin help achieve that more quickly then it would not make sense not to at least see if it does work for me. After all, I would rather not be on insulin to be honest - just the fear of side effects makes me cautious.

I will reiterate this when I see the DSN to put the formal transition plan in place and I have a question over potential issues with drug absorption caused by the ileostomy - I have all my meds as either liquid or 'melt in the mouth'. If they do not know then I will expect them to find out!
 
Liquid Metformin is more expensive and difficult to source so that might be one way of dodging it. Why can't they bypass Metformin anyway when there is a serious concern regarding your ileostomy and go straight to other meds like flozins or gliptins. Metformin has a relatively minimal effect anyway and I doubt you are suffering from much in the way of insulin resistance, so the only real benefit would probably be in suppressing liver output a bit.
 
rebrascora said:
gliptins. Metformin has a relatively minimal effect
Click to expand...
I'll be on a combo of gliptins and Metformin from what I was told.. My consultant was pretty adamant too that Metformin is effective.

We will see - as I say if it gets me off the insulin then fantastic, if it helps push it into remission even better. If it doesn't work then I'm in a much stronger position to stick with what we know does work.
 
Sorry to hear about the very difficult healthcare experiences you and your husband have been having in recent years @Pam123

Mostly the times med changes (eg different types of insulin) have been suggested to me have been when I’ve been discussing a problem I’ve been having, and a different insulin might work better.

The other ’med change’ conversation that I had was the recommendation to start on a statin, which I agreed to do when my QRISK score rose.

Best practice is for HCPs to discuss any possible changes in medication and therapy with you, take on board your views, and agree a way forward that you both think is for the best.
 
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