DIABETES 2 INSULIN QUESTION

[Jenny15]

Obviously, individuals should do their own research and make their own decisions.

I agree.

 

[ickihun]

@pollensa type2s take insulin to control their high bgs.
Insulin is given in cases where no other med or diet/exercise has been effective. High bgs kill. Just like too much insulin, injected or naturally produced, without a very busy liver can cause hypos and in no insulin produced diabetics this can cause coma and in some cases death.
Hypers are treated with insulin in all diabetics. Natural insulin or injected/interviened insulin. Ketones are only are caused by no insulin or not enough insulin.
Insulin saves lives! For type2s too.

I often remind myself I'm currently an morbidly obese insulin taker but alive. I'm working on being... not overweight but still being alive. More alive, if possible. (Work in progress.) Awaiting bariatric surgery to stop my health deterioating faster than it should do, due to 40+yrs of diabetes symptoms. I'm wrigged with hormone discrepancies in my fat filled body.
My priory is getting rid of fat to help my diabetes management - and other hormonal problems. Managing an insulin regime additionally to that.
The older I'm getting the more my body reminds me I'm only human. My younger insulin filled body was extremely strong, stronger than some men's body building capacities. Sporty but very muscle filled with fat attached. I've jogged with professional footballers and swam with athletes but due to a nipped S1 in my lower back and excruciating scatica I'm sometimes painkiller resistant. Like insulin resistant and many meds.
I'm on my 3rd course of antibiotics, this year. Luckily all worked for different infections. Bacterial from a very very curious toddler minded 5yr old who has learning disadvantages.
Maybe due to less energy from Iron deficiency and uncontrollable diabetes our home wasn't has bacterial free from my normal constant spraying and wiping. I know his school has struggled with their scarlet fever outbreak before we court anything.
It was inevitable I'd get something.

Fast forward me a few years and I should be far less fat filled, hormonal and much more mobile.
Far less resistant !!!!

However, I've been told I may still need insulin. We'll see.
I'll do my very best to see what my body needs.. .. extra insulin wise.
For me taking insulin isn't a chore. Just like brushing teeth or combing hair. I've done for pregnancies and now so I don't rot away. I don't mind taking my triple strength insulin to keep me awake and functioning.

 

[bulkbiker]

Ketones are only are caused by no insulin or not enough insulin.

You know that is simply incorrect...

 

[Jenny15]

Not being picky but you said this

"The only other ways to address high BG is to reduce carbs and/or add insulin. A person might do one or both of these things. If reducing carbs is not enough, then the only remaining option is insulin."

So are you saying that you can get a fasting insulin test done in NZ? That was what I was interesetd in..

It appears that you may have taken one sentence out of context. Next time I will be more specific to note I am talking about people like myself with medical reasons for considering insulin. I am not talking about newly diagnosed T2s who haven't tried dietary changes and the other BG lowering meds first. As you know, I have often posted about my view that for those people, dietary changes are likely to be the most effective first thing to try.

I do not know which insulin level tests are available in NZ, you can find out by googling it. I said people can get the tests they want, implying people in any country. There will some patients for whom this test is considered worthwhile by endocrinologists.

I also said in my post that I do not wish to get into a debate about this. I posted to correct some misinformation, that's all.

 

[Jenny15]

Just picking up on your post; at a presentation recently, a Consultant Endo stated that there are currently over 400 options for treating T2 diabetes, before including insulin.

Yes, 400 options, as opposed to 400 individual medications, but even so, that suggests to me that any route to insulin could be quite slow, unless it is established the individual is no longer producing much of their own, natural insulin.

Do people with non T1 or T2 diabetes always get diagnosed correctly (eg LADA and others) at the start?

The route to insulin isn't based on time spent getting there, it is based on clinical need. An example of this is the three levels of therapy intensification that are in the NICE guidelines. Insulin is not the first or second line treatment but it is meant to be considered as one of the options after those have not reduced BG to the agreed target range.

I think the 400 options figure probably included combinations of 2 or 3 things, eg dietary changes and two meds, for example. Specialists often use a rhetorical device like this to help their GP audience open their minds to using combination therapies more.

 

[bulkbiker]

I posted to correct some misinformation, that's all.

As did I.

 

[Jenny15]

@pollensa type2s take insulin to control their high bgs.
Insulin is given in cases where no other med or diet/exercise has been effective. High bgs kill. Just like too much insulin, injected or naturally produced, without a very busy liver can cause hypos and in no insulin produced diabetics this can cause coma and in some cases death.
Hypers are treated with insulin in all diabetics. Natural insulin or injected/interviened insulin. Ketones are only are caused by no insulin or not enough insulin.
Insulin saves lives! For type2s too.

I often remind myself I'm currently an morbidly obese insulin taker but alive. I'm working on being... not overweight but still being alive. More alive, if possible. (Work in progress.) Awaiting bariatric surgery to stop my health deterioating faster than it should do, due to 40+yrs of diabetes symptoms. I'm wrigged with hormone discrepancies in my fat filled body.
My priory is getting rid of fat to help my diabetes management - and other hormonal problems. Managing an insulin regime additionally to that.
The older I'm getting the more my body reminds me I'm only human. My younger insulin filled body was extremely strong, stronger than some men's body building capacities. Sporty but very muscle filled with fat attached. I've jogged with professional footballers and swam with athletes but due to a nipped S1 in my lower back and excruciating scatica I'm sometimes painkiller resistant. Like insulin resistant and many meds.
I'm on my 3rd course of antibiotics, this year. Luckily all worked for different infections. Bacterial from a very very curious toddler minded 5yr old who has learning disadvantages.
Maybe due to less energy from Iron deficiency and uncontrollable diabetes our home wasn't has bacterial free from my normal constant spraying and wiping. I know his school has struggled with their scarlet fever outbreak before we court anything.
It was inevitable I'd get something.

Fast forward me a few years and I should be far less fat filled, hormonal and much more mobile.
Far less resistant !!!!

However, I've been told I may still need insulin. We'll see.
I'll do my very best to see what my body needs.. .. extra insulin wise.
For me taking insulin isn't a chore. Just like brushing teeth or combing hair. I've done for pregnancies and now so I don't rot away. I don't mind taking my triple strength insulin to keep me awake and functioning.

I hear you. I, too have complex medical issues that seriously affect my quality of life and in some ways are even life-threatening. I hope you get your bariatric surgery soon and I will you all the best with the trials and tribulations of adjusting after it. You sound extremely well motivated and positive. You inspire me.

 

[ickihun]

You know that is simply incorrect...

Dietery ketones are due to not enough insulin to that nutrition filled body.
Insulin producing bodies only create ketones by..........
conning the body into thinking insulin doesn't need to be produced (lchf).
I thought @bulkbiker?

 

[Jenny15]

Not being picky but you said this

"The only other ways to address high BG is to reduce carbs and/or add insulin. A person might do one or both of these things. If reducing carbs is not enough, then the only remaining option is insulin."

So are you saying that you can get a fasting insulin test done in NZ? That was what I was interesetd in..

Actually, on re-reading the whole of my post, I now think it's perfectly clear that I was talking specifically about "some" T2s in this paragraph. I don't want to start repeating myself in every sentence just in case someone wants to disregard the first sentence of a paragraph. I will wait a bit longer in future before replying to posts like yours.

"There is a limit to how much some T2s can reduce their insulin resistance. The only other ways to address high BG is to reduce carbs and/or add insulin. A person might do one or both of these things. If reducing carbs is not enough, then the only remaining option is insulin."

 

[DCUKMod]

Do people with non T1 or T2 diabetes always get diagnosed correctly (eg LADA and others) at the start?

The route to insulin isn't based on time spent getting there, it is based on clinical need. An example of this is the three levels of therapy intensification that are in the NICE guidelines. Insulin is not the first or second line treatment but it is meant to be considered as one of the options after those have not reduced BG to the agreed target range.

I think the 400 options figure probably included combinations of 2 or 3 things, eg dietary changes and two meds, for example. Specialists often use a rhetorical device like this to help their GP audience open their minds to using combination therapies more.

Of course they don't. That is why I added the caveat about understanding natural insulin roduction levels.

Of course when I said options it suggests combinations, I would suggest. Furthermore I stated it "could be quite slow", not that it would be quite slow.

Personally, I would much prefer that my healthcare be delivered dynamically, based on advice from those with up-to-date, relevant expertise, than a static decision tree written at distance by someone who may not have any experience of diabetes.

At all times I state that these conclusions are for me. Having listened to advice, I would have evaluated the risks of any planned interventions for myself, and thereby I would have to live with my decision; however it turned out, just as I have in the past.

Others can make their own minds up, based on whatever research they decide to undertake. I have zero issue with that.

 

[TonyHancock]

I know the medical profession appears to recognise more than two types of diabetes and that seems logical to me. The problem I have is diagnosing on a symptom that can be caused by more than one "condition". To me if the pancreas is no longer able to produce enough insulin then that condition is nearer to what we currently refer to as T1 diabetes.

Having read Jason Fung's two "code" books recently I am more than a little concerned about too much insulin in my body. I haven't had an insulin level test but will discuss this with my GP when I get back to Australia in July. I would like to know what the current medical profession thinking is on Hyperinsulinaemia.

Diabetes is way to complex and illogical for me. In my logical mind if I have too much insulin in my system it seems wrong to increase that amount. (Like giving alcohol to an alcoholic as a treatment.) It seems to make sense that increased insulin only serves to force more glucose into fat cells and make losing weight harder. I'm not a medical professional and the number of variations with this dreadful condition sometimes blow logic out of the window.

There does not appear to be one size fits all, but I'd like the medical profession to get away completely from the term diabetes as a catch all and start to focus on identifying and treating the causes of high blood sugar.

 

[Guzzler]

The system we have at the moment does not screen for insulin resistance. This same system, in the main, promotes a T2 Diet that, in my opinion, promotes or prolongs the insulin resistance in some people. As I commented earlier, hyperinsulinaemia is not an optimal state and we sometimes see new members who have experienced the need to use rising levels of exogenous insulin without the benefit of the information that an insulin assay would show. Result? The patient cannot easily judge whether they have a high level of insulin resistance or whether they have a dearth of beta cells or they may never have been given dietary advice that may aid their condition.

This is where forums such as this one are invaluable. Not only for information and for support but for debate which is needed to clarify facts, to myth bust and to guage opinion.

 

[Jenny15]

Of course they don't. That is why I added the caveat about understanding natural insulin roduction levels.

Of course when I said options it suggests combinations, I would suggest. Furthermore I stated it "could be quite slow", not that it would be quite slow.

Personally, I would much prefer that my healthcare be delivered dynamically, based on advice from those with up-to-date, relevant expertise, than a static decision tree written at distance by someone who may not have any experience of diabetes.

At all times I state that these conclusions are for me. Having listened to advice, I would have evaluated the risks of any planned interventions for myself, and thereby I would have to live with my decision; however it turned out, just as I have in the past.

Others can make their own minds up, based on whatever research they decide to undertake. I have zero issue with that.

I agree with you, I wasn't trying to challenge what you said, just adding the issue of LADA and other types in for the benefit of readers who may be unfamiliar with that issue. As you probably know, often someone with LADA is treated as if they have T2, delaying treatment that will be more effective for them and prevent complications sooner.

I read a post here last night from someone whose A1c has been above 70 for two years because she was not given the right care or advice by her doctors and didn't know the information was out there, including this forum. She now has painful and potentially irreversible complications.

The route to insulin often is quite slow for those who really need it, and (speaking in general, not about your post in particular) if people believe T2s should not have insulin, then the journey is even slower than it should be for those people.

I totally agree with you here "Personally, I would much prefer that my healthcare be delivered dynamically, based on advice from those with up-to-date, relevant expertise, than a static decision tree written at distance by someone who may not have any experience of diabetes."

My own GP ticks all those boxes in terms of dynamic, up to date care. The 3 levels of intensification in the NICE guidelines aren't meant to be used as a static decision tree, and they were written by diabetes specialist endocrinologists. Draft guidelines are pored over by doctors and any other interested parties before being finalised.

I'm not defending every assertion made in the guidelines, because I haven't read them all in detail and I lack the expertise to even understand some of them. I realize drugmakers and others have a disproportionate influence on guidelines, which is bad for patients and taxpayers alike. But that is a separate issue IMHO.

 

[rab5]

I agree with you, I wasn't trying to challenge what you said, just adding the issue of LADA and other types in for the benefit of readers who may be unfamiliar with that issue. As you probably know, often someone with LADA is treated as if they have T2, delaying treatment that will be more effective for them and prevent complications sooner.

I read a post here last night from someone whose A1c has been above 70 for two years because she was not given the right care or advice by her doctors and didn't know the information was out there, including this forum. She now has painful and potentially irreversible complications.

The route to insulin often is quite slow for those who really need it, and (speaking in general, not about your post in particular) if people believe T2s should not have insulin, then the journey is even slower than it should be for those people.

I totally agree with you here "Personally, I would much prefer that my healthcare be delivered dynamically, based on advice from those with up-to-date, relevant expertise, than a static decision tree written at distance by someone who may not have any experience of diabetes."

My own GP ticks all those boxes in terms of dynamic, up to date care. The 3 levels of intensification in the NICE guidelines aren't meant to be used as a static decision tree, and they were written by diabetes specialist endocrinologists. Draft guidelines are pored over by doctors and any other interested parties before being finalised.

I'm not defending every assertion made in the guidelines, because I haven't read them all in detail and I lack the expertise to even understand some of them. I realize drugmakers and others have a disproportionate influence on guidelines, which is bad for patients and taxpayers alike. But that is a separate issue IMHO.

NICE guidelines are driven firstly by costs.

 

[Jenny15]

The system we have at the moment does not screen for insulin resistance. This same system, in the main, promotes a T2 Diet that, in my opinion, promotes or prolongs the insulin resistance in some people. As I commented earlier, hyperinsulinaemia is not an optimal state and we sometimes see new members who have experienced the need to use rising levels of exogenous insulin without the benefit of the information that an insulin assay would show. Result? The patient cannot easily judge whether they have a high level of insulin resistance or whether they have a dearth of beta cells or they may never have been given dietary advice that may aid their condition.

This is where forums such as this one are invaluable. Not only for information and for support but for debate which is needed to clarify facts, to myth bust and to guage opinion.

I agree generally with your comments. In your example of a T2 insulin user who has been misled about dietary advice and hasn't reduced their carb intake, who then finds this forum, what's to stop them informing their HCP about reducing their carbs, then responding to reduced BGs by gradually reducing their insulin dosing eventually to zero?

 

[Jenny15]

NICE guidelines are driven firstly by costs.

Obviously, since the NHS is funded by taxpayers. Cost isn't the only factor. Saving lives also comes into it.

 

[rab5]

Obviously, since the NHS is funded by taxpayers. Cost isn't the only factor. Saving lives also comes into it.

You seem to think that all these experts for each condition meet and discuss treatments under the NICE umbrella. That’s simply not true

They have 3 things they consider

Cost effectiveness is the cost per quality adjusted life year (QALY)

How much does the intervention cost
What is the extension in life
What is the quality of life during the above extension of life

Money is the lead driver. These bastards have turned down drugs for children on the basis they are too expensive. Indeed in my own personal life I have been at the wrong end of their disgusting behaviour

They are accountants first

 

[Jenny15]

You seem to think that all these experts for each condition meet and discuss treatments under the NICE umbrella. That’s simply not true

They have 3 things they consider

Cost effectiveness is the cost per quality adjusted life year (QALY)

How much does the intervention cost
What is the extension in life
What is the quality of life during the above extension of life

Money is the lead driver. These bastards have turned down drugs for children on the basis they are too expensive. Indeed in my own personal life I have been at the wrong end of their disgusting behaviour

They are accountants first

Happy to agree to disagree

 

[Indy51]

Personally, I don't think any type 2's should be prescribed insulin without having a c-peptide result that indicates loss of endogenous insulin production. No way would a GP be able to convince me to start insulin without such a test. Insulin therapy is known to increase the risk of CVD and other complications in Type 2 diabetics. Just one recent study:

https://www.ncbi.nlm.nih.gov/m/pubmed/28958751/

 

[rab5]

Happy to agree to disagree

Which bit do you disagree with