July 3, 2006

The Amaryl Experiment

Leaving no stone unturned, I decided to try a very small dose of Amaryl after seeing posted on the Exeter MODY site what the correct dose would be for someone with the kind of MODY I've been guessing I have. (1/4 of the normal starting dose.)

My doctor had been wanting me to try it, and after assuring myself that Amaryl is, in fact, one of the sulfs that doesn't affect the receptors on the heart (since some sulfs cause the two and a half times more heart attacks in sulf-takers), I gave it a shot.

Being ultra conservative, I started with 1/8 of the starting dose, which involved complex manipulations with a pill cutter. Turns out you can turn 1/4 into 1/8 by turning the pill on edge. (Dr. Bernstein's warning about sulfs burning out beta cells seemed not to be a huge concern with a dose that was 1/64th of what most Type 2s take.)

It was an interesting and productive experiment. The Amaryl most definitely got me secreting insulin, and that insulin worked. That validated that I do seem to have the MODY I think I do, as an extremely strong response to tiny doses of Sulfs is a characteristic. It also answered the question of whether something is wrong with my own insulin molecule with a rousing "No!" (This makes it more confusing that my C-peptide was normal when my bg was over 200!)

That said, I'm not likely to take this stuff again, even though it worked scarily well.

I had stopped taking metformin for a couple days because the version the pharmacy gave me this month, from a different manufacturer, was making me nauseous all the time. Without metformin in my system, my bgs after eating had risen another 20 mg/dl. So to test the 1/8 mg of Amaryl, I ate a meal that contained the same amount of carbs--40 grams--that, the previous day, when eaten with 3.25 units of R was putting me in the 110s (6.1 mmol/l) after 2 hours. The 1/8 mg of Amaryl dropped me to 86 mg/dl (4.8 mmol/l) at 90 minutes!

This sounds good, but there was one deal-killing side effect. From the an hour after I took the Amaryl at 8 AM until I went to bed at 10 PM I was ravenously hungry--Eat everything you see and then eat more hungry. Shovel food into your mouth like a crazed lunatic hungry. The kind of hungry I was in the months before I got diagnosed with diabetes.

When I woke up this morning with a fasting bg of 111 and NOT hungry, I heaved a deep sigh of relief that the drug was clearly out of my system. It wasn't clear how long it lasted from the prescribing information, and I wasn't looking forward to another day like yesterday!

I'd read that sulfonylurea drugs packed weight on people. Now it is clear why! Intellectually I might like the much better control it could give me, but I could not live with that kind of hunger. Plus, I would have to live on starch and sugar to avoid hypoing and I also could not take this stuff with metformin, given that I was plummeting to the 80s after eating boatloads of carbohydrate at each meal. Metformin does such good things to my lipids and maintains my weight perfectly, so I don't want to give it up.

My total intake yesterday got up to 150 grams of carbs because otherwise I was sure I was going to hypo. At one point, I hit 190 mg/dl at 45 minutes and then dropped back very quickly to 100 and then back to the 80s at 2 hours.) Since Met drops me another 20 mg/dl I could easily end up in the 60s. A lot. I don't think I could get the pill splitter to do 1/16!

So back to the Regular insulin I go. No hunger, no ugly spike when I time it right, though not a lot of time spent in the 80s, either. But 90s works for me and I can achieve that consistently. It's a lot better than 120-140. Most importantly, if I'm not eating carbs, I just cut back or omit the insulin entirely (as I usually do for breakfast) and that's that.

That's what I call "Control!"