June 26, 2006

It's Always Something

Back in January after a lot of experimentation I learned that I could achieve near normal blood sugars using Ultralente insulin. There was only one catch. They've stopped making it. I found a couple pharmacies that still had a supply in their fridges and stocked up, figuring that since I only used a couple units a day, I could make the stash last for years.

Boy, was I wrong!

It turned out each vial lasted me about 6 weeks before it stopped working--usually because the stuff started to clump, but not always. I tried everything to keep the stuff alive. I kept the insulin in the butter compartment of the fridge with a thermometer making sure the temperature was right. I shook the vials very gently. I never reused a needle.

It made no difference.

So when it became clear that UL was not going to be a solution for me for much longer, I started checking out alternatives.

Lantus, alas, while it brought my fasting level down, caused my post-meal numbers to shoot up even higher than normal. Since I'd had problems with Lantus before (which is why I tried UL) I figure this is because of some kind of antibody problem. Since I am not ready for a 5 shot a day regimen, I bagged that.

Levemir caused my blood pressure to rise into the stroke zone. When I called the company, they claimed they'd never heard of such a thing but someone on an online diabetes board told me they had heard of someone else who experienced the same thing. I reported this to the FDA and moved on.

The endo suggested that since my main problem is with my post-meal blood sugars, I try using a fast acting insulin. Unfortunately, here again, when I tried an analog insulin, Humalog, I ran into a similar problem as with lantus. My numbers one hour after injecting were much higher than they were if I ate the same food without insulin and then I dropped low at three hours. After a couple days of testing Humalog my numbers in general started rising. Hmmm. Looks like antibodies for sure.

Since it looks like analogs aren't for me, I went back to Regular R insulin which is what I'd started with back in December. I found I could get it to work pretty well for meals if I raised the dose higher than what I'd been using before and timed it so that the insulin was injected 2 hours before the food would peak and then ate a little bit more carb at 3 hours after injection to mop up the last bit of activity.

I was just cheering up after 4 days of the new regimen--2.75 units of R at 10:30 and 4:30 with no basal, because I had not gone over 120 at all eating almost like a normal person, when I noticed that my fasting bg had gone up from the 89-91 mg/dl where it had been for months on UL to 103 the past two days.

I'd been hoping the first reading was a fluke. But it looks like the UL washed out of my body and fasting control will start to tank.

So on to the next option. I've avoided sulf drugs all these years because Dr. Bernstein warns they burn out beta cells and because research has shown that some of them increase the incidence of heart attack. However, it turns out that for some people with MODY very low doses (1/4 of the usual starting dose) work like magic. This is the case when the genetic defect is one that keeps the cells from secreting, rather than a defect in the insulin which I may or may not have.

Amaryl is one sulf that turns out not to affect the receptor on the heart that the older drugs did. So I figure it's time to see if a tiny dose of Amaryl will work better than the insulin. The big plus of that approach is that the insulin goes into the portal vein of the liver rather than into fat which may do more to keep blood sugars from rising. Plus, there isn't the problem of antibodies. My insulin dose kept rising all these past months which suggests antibodies are a factor.

The challenge will be to get a small enough dose. I'll start out with the smallest amount it is possible to divide the pill into and take it from there.

If that doesn't work, on to Byetta. If that doesn't work, well, back to the bolus R and accept that I can't normalize my fasting blood sugars.

Damn Lilly for discontinuing UltraLente!