Answered by: Dr. Mariela Glandt

It is wonderful you lost so much weight! Congratulations!

While liraglutide helps to increase insulin after the meals, it seems it is not enough in your case.  If the post meal spike is not too bad, you could ask your doctor about trying repaglinide (Prandin) or nateglinide (Starlix) with meals, which also lower blood glucose by stimulating the release of insulin from the pancreas. Any sulfonylurea should also help. These options are worth considering before you jump to insulin, since they might give you the extra insulin push, at least for a while.

Answered by: Dr. Mariela Glandt

Most of the risk that comes from eating too many sweets is associated with fact that eating a lot of sugar leads to weight gain, which in turn can lead to diabetes.  Having said that, there are studies that show, for example, that if you drink more than 2 soft drinks a day you are at increased risk of developing diabetes, regardless of the amount of weight gain.

When we say that type 2 diabetes is caused by genetics and lifestyle factors, it is in a way saying yes, there is a predetermined level of insulin production.  There are those lucky people who eat lots of sweets, but somehow their pancreas can compensate for this by producing more insulin, and hence keeping the sugars in the normal range. While there are others whose pancreas cannot respond to that kind of stress, and thus cannot produce enough insulin, and their blood sugar levels go up.  This is indeed preset mostly by genetic factors, and perhaps also by circumstances set in the mother’s womb.  If you have a history of diabetes in your family, try not to stress your pancreas too much! Keep to a healthy diet and exercise.

Answered by: Dr. Mariela Glandt

It is definitely true that being on oral medications reduces the amount of insulin you need, but you must find out why you were taken off the oral pills when you came into the hospital – were the doctors concerned about your heart, kidneys, or did they just want to manage your sugars as an inpatient with insulin, which is a very common scenario.  Once you know the answer then you will know if you can go back on the oral medication or not.

Answered by: Dr. Mariela Glandt

Usually if a treatment regimen is working, meaning there are no major hypoglycemias, no weight gain, and good HbA1c,  the practice is to continue with that regimen. However, there is no single right way to treat diabetes. There are often many different ways to control the condition. Perhaps there was something about treatment with Januvia that was making your doctor uncomfortable. You should ask him in order to understand his thought process, and his decision to change your medication. And do keep your doctor informed of your progress.  It’s very important that he know what’s going on.
 

Answered by: Dr. Mariela Glandt

There are several reasons that could account for the fact that taking
insulin injections can lead to weight gain.

The first reason is that before the person was taking insulin the body
was clearly in an insulin deficient state- meaning that the calories
he or she was eating were being wasted in the urine instead of being
stored in the cells.  Once there’s insulin around, if it’s in the
correct dose, all the nutrients will be stored, which leads to weight
gain.  The insulin is just restoring the normal balance. Just like
with anybody else without diabetes, in order not to gain weight we
have eat less and exercise.

The second reason  is that especially in the case of NPH insulin,
where the peak in insulin action happens without really having much
control over it, many patients will eat more than necessary just to
avoid a hypoglycemia. This weight gain is less drastic with glargine
(Lantus) and it seems that there’s even less weight gain with Detemir
(levemir).

Insulin may intrinsically lead to weight gain beyond what I have
mentioned, but it is not clear by what mechanism this might occur.
If you are having trouble you should consult your physician.

Answered by: Dr. Mariela Glandt

Nighttime hypoglycemia can certainly present like this. It happens much more with the older insulins like NPH, which have a peak in action, as compared to the newer long acting insulins like glargine (Lantus), or detemir (Levemir). Detemir does still have a peak, but not as much as NPH.
One easy way of finding out if you are having nighttime hypoglycemia is to set your alarm for around 3 am and you can check your sugars. The body is particularly sensitive to insulin in the very early morning hours, like 2-3 am. This means that the insulin that is present is more effective at lowering blood sugars. This could be compounded by a peak in insulin action, if you are taking something like NPH.