A very naive question: If a non-insulin dependent T2D has an upcoming large meal, is it possible for him/her to, for instance double their daily metformin dose? Or can/should they take a glucoside pill? Or?
I guess the underlying question is: is there a recommended way for a non-insulin dependent T2D to anticipate a large carb intake?
You can actually take insulin.
I know, can of worms there, but you could do it if you were careful.
Everyone “takes” insulin, one way or the other…
Maximum dose for metformin is 2550mg/day. As the most usual dosage is 1000 mg bid, it would be an overdose to double it.
I would think @Eric 's idea of supplemental insulin would be the best course of action. But most T2’s controlled on metformin would not have the slightest idea of how to initiate insulin therapy.
I would think that this is one of the biggest lifestyle problems confronting T2’s.
What am I missing: How is 2,000mg an overdose, if 2,550 is the max dose?
1000 bid = 2000mg a day. bid is medical speak for twice a day. So twice that would be 4000mg a day (or doubling a single dose would be 3000mg).
That’s what I’m on by the way, 1000mg bid or 2000mg a day. Seems to be the most common dose, since why not max it out if it’s working? I haven’t heard of people going above 2000mg/day.
This is what I’m on, too (2,000 mg/day extended release).
I think if I were a T2 I would stick to low-carb foods. I’m not sure how a T2 on medication only would deal with a big carb meal. Maybe doing some intense cardio exercise after eating to bring their BG back down?
The max dose is most often given to patients with polycystic ovary syndrome. If 2000mg/day is not working for a diabetic patient the doc will more likely go to a polypharmacy approach.
@Jen has it right, a non-insulin dependent T2 has only one choice, avoid high carbs or go high. If this T2 actually eats the high carb meal and end up high the only thing he or she can do is wait or like Jen said, exercise. There is no doubling up on T2 meds.
Shouldn’t it be that the question is about non-insulin-using T2s, not non-insulin-dependent? Bc in this case, a T2 could easily be non-insulin dependent (fine with control via diet/exercise/meds), but still have insulin for the occasional high carb meal. Seems like we reinforce the idea that T2s need to need insulin in order for it to be useful by referring to any of them who use it as insulin-dependent.
That sounds ideal but would that be a typical treatment approach?
(I honestly have no idea)
I don’t know, but it does seem that it is certainly possible for T2s to use insulin when not really insulin-dependent (it’s one of several possible treatment strategies), and from reading discussions on TuD, a number do use it at that point for very logical reasons.
I agree. That’s what I was saying. You could be someone who does not use insulin for most occasions if you were diet controlled, but occasionally use it for high carb or large meals.
It would be great if T2 not using had the training and access to insulin for high carb meals.
The problem is teaching dosing skill to someone that will only use it occasionally. Calculating a bolus is something that takes practice. Not saying it could not be done but would be difficult.
The average T2 does not see an Endo, good luck getting a GP to prescribe insulin for occasional use.
Of course, it’s all about costs, so I would think the most cost-effective way of doing it would be to do education groups for interested people, rather than seeing an endo on an individual level—say, diabetes educator-run group treatment sessions that taught the basics of using insulin and also had some follow-up sessions, as add on to GP management. Also in theory, it seems like Afrezza would be safer and easier given that it’s a.) not an injection, b.) less precise dosing required, and c.) less opportunity for persistent severe lows. But the only way insurance would cover that is if it made a notable difference in A1cs, so my guess is to qualify, T2s would have to have sub-optimal control prior to insulin therapy. Insurance probably wouldn’t cover rapid insulin or Afrezza for equivalent control in a less rigid way…(even though I would argue there are significant health benefits to that such as lower stress and reduced likelihood of burn out).
You can get Regular (R) insulin Novolin without prescription (in many states, not sure if it is available everywhere). That could help a T2 on occasion.
Then it’s up to the individual to learn it on their own, or in a group with help as Cardamom suggests.
I don’t think it’s as difficult or dangerous as many people think. As long as someone does not do something stupid, proceeds cautiously, and is willing to learn.
That’s why it’s not SOP.
No kidding, I mean if you have never taken any insulin before in your life, where would you start? I could easily see someone getting confused and injecting a large quantity of insulin.
Also I could see with Regular, it not doing much the first 90 minutes and the person figuring it wasn’t enough and injecting again…
Nothing is easy about maintaining control for a T2, especially if using diet and exercise even when orals are added. There is no room at all for error, you must be on your game 100% of the time to be totally effective. There is no magic pill that one can take when ya just gotta have that high carb meal. That’s why a lot of T2s fail, no one can always be perfect. It doesn’t get easier until bolus insulin is added but then who said insulin is easy, although it is a powerful tool.
The truth is that an occasional failure in control is not the end of the world, guano just happens. The trick is to keep them to minimum.
Wouldn’t insulin work? (Except it’s not a pill)