Curious about hba1c and medication reduction

[zoombapup]

Hi guys,

I'm wondering what your experiences are with having lower hba1c and how that altered your medications.

I'm currently coming back down towards the "normal" ish range and expect to be down significantly when I next see my DSN. Currently I'm on 2 metformin a day, 8ml? insulin once a day and gliclizade? once a week.

Seems to me, that with proper diet, I shouldn't really need all of those things at once. Given I'm aware and motivated to watch my BG levels now. But what would they cut from that list? Do any of you have any knowledge to share here? I guess the main ones I'd like to cut are the two injections (basal insulin and gliclizade), because I hate needles 😉

Apparently that insulin dose is very low anyway. So I'm hoping they're just going to drop that at least, but does it make sense to continue with the other meds in the same way if I'm within the normal range for hba1c when they do the next test?

Not asking for medical advice obviously, more curious how you're hba1c scores changed your meds over time (basically want to know how doctors tend to think).

Thanks for sharing.

 

[AJLang]

Those with Type 2 will give relevant advice but I think it's important to remember that your levels are currently coming down because you are on those medications. What are your levels like, i.e. specific numbers? Have you moved onto a low carb diet and increased your exercise?

 

[Felinia]

How long have you been Type 2 and what is your HbA1c history? Also do you have any other medications or health issues as that would also have to be taken into account. I can't comment but other more experienced people might be able to with the additional information.

 

[Drummer]

If you are in the normal range I suggest a heavy hint that glucose lowering medication is no longer necessary, and you could infer that you are now having to eat to be sure of not going hypo - which should of course be true.
One thing which would happen then, though, is that you are no longer eligible for free testing supplies.
If you are a type two, and a lucky one, a low carb diet should be all that is required. Many HCPs are convinced that tablets for life and a dismal death lie in store for type two diabetics, no matter what, but I am reading of people getting back to normal all the time now - normal blood glucose normal Hba1c, normal weight - even if they were on insulins and various tablets too.
I think the weekly injection is - something beginning with V - sorry, got a stinking cold and the head is full of cotton wool, but Gliclizide is a tablet - I think...

 

[zoombapup]

Those with Type 2 will give relevant advice but I think it's important to remember that your levels are currently coming down because you are on those medications. What are your levels like, i.e. specific numbers? Have you moved onto a low carb diet and increased your exercise?

I'm hovering around the 5.0 mark most of the time now. Goes up to around 5.7 in the early morning, but haven't been over that in the last 3 weeks or so. I am curious how much the medication alters this though. I'm in the 4.0-5.0 range a fair bit so maybe that would raise some if I had cut some of the insulin for instance? Not sure how each medication actually works to alter blood sugar levels in practice if I'm honest. But yes, on a low carb diet and increasing exercise (got myself a fitbit to track it too). Last hba1c was 71, but that was less than a month after diagnosis and I was pretty damn high then (140).

 

[rebrascora]

@AJLang is right in asking those questions. Have you dramatically modified your diet and increased your activity levels. If not then those medications will be responsible for any lowering of your BG levels so if you stop taking them then they will rise again. If you have cut right back on all carbs (not just sweet stuff) and perhaps lost some weight/fat and are getting fitter then it may be possible to come off the insulin but it will need to be done under the supervision of your team/nurse. If your BG levels are holding steady overnight then it is unlikely that they will take you off it or even reduce it. If the long acting insulin is not necessary then you would be seeing your BG levels drop too low (ie you would be going hypo) and your nurse would be only too keen to reduce it then. For information 8mls of insulin would be enough to fell a heard or elephants. I am guessing you mean 8 units.
@Drummer is right, Gliclazide is a tablet. I am not familiar with a once a week injection although I have heard it mentioned.

 

[zoombapup]

I think the weekly injection is - something beginning with V - sorry, got a stinking cold and the head is full of cotton wool, but Gliclizide is a tablet - I think...

The brand name is ozempic, so I might be wrong on the gliclizide thing, because I just remember it from the DSN at the hospital. Ah, its semaglutemide. I knew it was an "ide" 🙂

 

[rebrascora]

Sorry, I see you posted a response whilst I was typing my reply above.

 

[Drummer]

Those numbers are quite low - I think you can argue that you are at least entitled to adjust as you require rather than be on a set regime.
Sorry I did not notice the units - this cold is giving me that cotton wool feeling, and I'd be better off in bed.

 

[zoombapup]

Sorry, I see you posted a response whilst I was typing my reply above.

Out of interest, what are units of insulin measured in? I just have the number on the injector pen, so didn't think to ask. But yes, I assume its 8 units I'm taking once a day.

 

[rebrascora]

They are routinely referred to as "Units" for convenience although I believe they are 0.01ml each.... hence 8mls would be an enormous amount. A unit of insulin is a standard amount regardless of the insulin being used. So I use NovoRapid and Levemir and whilst each insulin has a different time profile once in your blood stream so it acts differently, they are both measured in the same unit but different numbers of units are needed for different reasons.

 

[Bruce Stephens]

Out of interest, what are units of insulin measured in?

They're just units, actually. One unit is 1/100 of a ml of U100 insulin (almost all insulin is U100 though other strengths exist).

 

[zoombapup]

They are routinely referred to as "Units" for convenience although I believe they are 0.01ml each.... hence 8mls would be an enormous amount. A unit of insulin is a standard amount regardless of the insulin being used. So I use NovoRapid and Levemir and whilst each insulin has a different time profile once in your blood stream so it acts differently, they are both measured in the same unit but different numbers of units are needed for different reasons.

That makes sense, so no, I'm not on 8ml (probably enough for a horse), but 8 units. Is that considered a lot or a little? I've no idea what the usual range is. This is apparently slow release as its dosed once a day. Think the term the DSN in hospital used was basal?

 

[rebrascora]

Yes that is correct, Basal insulin. It is quite a low dose but that doesn't mean you don't need it. I was on a course with a lady who had been Type 1 diabetic for 50 years and she only took 2 units of basal insulin and hypoed nearly every night although it turned out she had had the same injection gun for the whole time and it was no longer accurately dispensing the insulin. That said she is now using a modern pen and is using 3 units and managing her levels much better. 3 is a tiny dose but you need whatever you need, be that large or small. It is a fine balance and a change of just one unit can make quite a significant difference. If you were waking up below 4 most mornings that would indicate that your basal insulin probably needed reducing
Basal insulin deals with the glucose released by the liver when you are not eating... so through the night when you are sleeping it provides your body with a means of processing that glucose and providing your heart and lungs and brain etc with a steady supply of low level energy.

 

[DaveB]

Hi. Can you let us know your rough BMI? If you are a 'normal' T2 and if you low-carb you may well be able to stop the insulin and Gliclazide if the DN agrees. 8 units of Basal is quite low. What dose of Gliclazide are you on? If you have any excess weight you may have some insulin resistance which a low-carb diet will help with.

 

[zoombapup]

No idea for a BMI, but yes I'm overweight, so I'll be doing the low carb from now on. Apparently I'm not on gliclazide but instead on semaglutemide. That one is only 0.25 i think, once a week. So being overweight generally is insulin resistance? does that mean on the fat cell end? Trying to get a handle on what the insulin is doing to me long term. I guess if T1 patients take it forever it can't be all bad. But I'm not a fan of needles, so would like to get out of it someday.

 

[everydayupsanddowns]

Trying to get a handle on what the insulin is doing to me long term. I guess if T1 patients take it forever it can't be all bad. But I'm not a fan of needles, so would like to get out of it someday.

there is nothing inherently wrong with taking insulin if you need it. In T1 there is absolute insulin deficiency (the pancreas loses beta cells and there isn’t enough remaining production to cope). The situation in T2 is more complex - if you have insulin resistance you can’t use insulin properly, so the pancreas can need a helping hand with additional insulin (though this often means the T2 insulin dose is much higher). In other cases a T2 pancreas can ‘wear out’ over time through over production and need insulin replacement / MDI.

It would be interesting to know the thinking behind escalating you to both injectables so soon after Dx, and whether any antibody testing might help to support or rule out possible LADA (slow onset T1 later in life).

but whatever the thinking those levels are great (though perhaps a little precariously close to hypo range if your insulin needs change eg if you lose weight).

Best bet is to be up front with your clinic about wanting to ditch either or both injections and see what they say.

 

[zoombapup]

It would be interesting to know the thinking behind escalating you to both injectables so soon after Dx, and whether any antibody testing might help to support or rule out possible LADA (slow onset T1 later in life).

but whatever the thinking those levels are great (though perhaps a little precariously close to hypo range if your insulin needs change eg if you lose weight).

Best bet is to be up front with your clinic about wanting to ditch either or both injections and see what they say.

I suspect they started me on both injectables because my levels were massively high. When I was in the hospital (had bad keto-oxidosis) the doctor and the diabetic nurse had a bit of a conflab about what to give me and the nurse convinced the doctor that a low level basal insulin would be enough along with the semaglutemide, I figure the nurse understood what a control freak I am and knew I'd stick to the plan. The doctor wanted to give me more because of the really excessive levels I was at I think. So in the end I've gotten possibly more than I need now that I'm on a reasonable eating regime.

Totally agree though, I'll bring it up with the DSN/Doctor when I go for my next test in Jan and see what they say. I'm not so bothered about the metformin, but having to inject is a bit of a pain (although strangely I'm mostly ok with it now, just occasionally can't seem to stick myself and have to give it half an hour for my brain to relax before trying again).

I'll have to do some more study on the different types of impacts that insulin and our response can have, at least help me to understand some of the different pathways that alter the BG etc. I'm used to reading research papers, but reading papers on health makes my head spin a bit 🙂