Insulin, Yea or Nay?

[type2newbie]

Hello. I have been type 2 since 2012 and have been taking combinations of metformin, gliclazide, trulicity and empagliflozin in varying doses and combinations over the years. I am currently taking the maximum dose of metformin and gliclazide plus one empagliflozin but my last hba1c was still 90. My diabetes nurse has said that my glucose level is dangerously high and she wants me to start insulin injections once per day. I'm a little wary of this because my understand was that once you start on it, there is no going back and I know my health is way more important but things like notifying the dvla and insurance companies is also something I've been thinking about.

Does anyone have anything which may help me to decide, one way or the other?

Thank you in advance

 

[Jaylee]

Hi,

As a T1. I wouldn’t knock insulin. Big fan of it.

However, (yeah, the “DVLA” every 3 years..)

Could there be any possible tweaks to your diet that could help dial back the BGs?

If you have tried everything? You have my best wishes on your decision.

 

[EllieM]

My T2 cousin is on insulin and loves it -he doesn't want to restrict his carbs. His T2 wife is also on insulin but has a lot more trouble with it.

Insulin users have a few more hoops to jump through as regards DVLA (and those hoops are significant if you are a lorry driver) but they never caused me any issues (left UK in 1999 but got license in 1979). Interestingly Australia required a letter from my GP every 2 years but New Zealand gave me a license for 10 years.

If it was me, I'd ideally want to know whether my insulin production had gone down (not uncommon in long term T2s) or just that my insulin resistance had gone up. If the latter then low carbing can help.

But if you don't want to take insulin and you haven't tried reducing carbs then that is an option that might help. And some people do come off insulin by reducing the carbs in their diet.

But yes, 90 is a high bg which is doing you no favours in the long term.

Good luck. whatever you decide to do. (And as a T1, like @Jaylee I'm a big fan of insulin).

 

[In Response]

As another person with Type 1, I have never had the choice about whether to take insulin but it has never got in my way.
I still travel, run, drive, cycle, have a stressful career, climb, hike, ...

If you are finding that all the type 2 drugs are not working for you, have you ever been tested for Type 1?

 

[Pipp]

Does anyone have anything which may help me to decide, one way or the other?

I am going to tag @lovinglife. Who, as someone with T2 diabetes, may be able to advise from her experience with insulin, and it not needing to use it permanently.

 

[JoKalsbeek]

Hello. I have been type 2 since 2012 and have been taking combinations of metformin, gliclazide, trulicity and empagliflozin in varying doses and combinations over the years. I am currently taking the maximum dose of metformin and gliclazide plus one empagliflozin but my last hba1c was still 90. My diabetes nurse has said that my glucose level is dangerously high and she wants me to start insulin injections once per day. I'm a little wary of this because my understand was that once you start on it, there is no going back and I know my health is way more important but things like notifying the dvla and insurance companies is also something I've been thinking about.

Does anyone have anything which may help me to decide, one way or the other?

Thank you in advance

What a question... A good one, but the answer depends wholly on... A lot of stuff.

Type 2's are usually insulin resistant, so we don't respond to insulin like a regular T1 would. Which is something that makes sorting our the right dosage for yourself maybe a tad more complicated.

You're on a ton of meds, and still high. So then the question becomes, what are you eating? (Not a rhetorical question, if you can be as detailed as you can, that'd be grand!). That high blood glucose is coming from somewhere. Is it food, because then going low carb might get you sorted, off (most, if not all) meds and insulin likely no longer in the picture... On the other hand, if medication for other conditions is putting your sugars up, like statins, steroids, antidepressants etc, insulin might be a solution, as you possibly don't have a whole lot of wriggle room for changes. And yes... If you are low carbing already, on a mass of medication and still hitting a HbA1c of 90, further investigation into your type would be useful. Lots of adult onset T1's are misdiagnosed as T2.

First thing's first though.

What're ye eating/drinking? And keep in mind I'm not accusing you of anything. The EatWell plate that's pushed on a lot of people still, would put me well over a HbA1c of 90 in no time at all. Heck... It did.

Hugs,
Jo

 

[lovinglife]

Hi @type2newbie & thanks for the tag @Pipp

I was on insulin for a short time at the start of my diagnosis as it was query T1 with a fasting BG of 28 - 32 and a HbA1c of 11.9 (that’s the old measurement of the HbA1c as it was nearly 14 years ago) I began reducing my carbs to 130g carb a day and was soon off the insulin and on maximum Gliclizide and Metformin, with the help of my GP I began to reduce my carbs further and reduce my meds accordingly until I went full keto with carbs at less than 20g carbs a day then I dropped all Gliclizide.

This works well for me now and I’m now diet only 14 years in. Like @JoKalsbeek says if you can maybe reduce your carbs - not just sugars but all carbs as they all turn to glucose in the body, if you can give us as much detail as possible of what you eat then we may be able to help you reduce your carbs.

Things that contain lots of carbs are all flour products such as all breads except specifically low carb, pasta white & wholemeal, pastry, also rice both white & brown, potatoes, below ground veg like carrots, parsnips except celeriac & swede/turnip. Most fruits are high in sugar

Things that are great for lower carb all meats, bacon, eggs, cheeses, cream, fish, above ground veggies, salads, berries such as strawberries, raspberries, blackberries, full fat Greek yogurt, butter, virgin olive oil, mayonnaise

The diet recommended by the NHS often isn’t the best one fit T2 diabetes, please ask as many questions as you like, it’s hard to get your head round such a big change and it takes time but members here have lots of low carb ideas, recipes etc that are more than delicious

 

[type2newbie]

As another person with Type 1, I have never had the choice about whether to take insulin but it has never got in my way.
I still travel, run, drive, cycle, have a stressful career, climb, hike, ...

If you are finding that all the type 2 drugs are not working for you, have you ever been tested for Type 1?

No, I have never been tested for type 1. I am seeing me Diabetes Nurse this afternoon, so I will ask her. Thank you for the suggestion.

 

[type2newbie]

What a question... A good one, but the answer depends wholly on... A lot of stuff.

Type 2's are usually insulin resistant, so we don't respond to insulin like a regular T1 would. Which is something that makes sorting our the right dosage for yourself maybe a tad more complicated.

You're on a ton of meds, and still high. So then the question becomes, what are you eating? (Not a rhetorical question, if you can be as detailed as you can, that'd be grand!). That high blood glucose is coming from somewhere. Is it food, because then going low carb might get you sorted, off (most, if not all) meds and insulin likely no longer in the picture... On the other hand, if medication for other conditions is putting your sugars up, like statins, steroids, antidepressants etc, insulin might be a solution, as you possibly don't have a whole lot of wriggle room for changes. And yes... If you are low carbing already, on a mass of medication and still hitting a HbA1c of 90, further investigation into your type would be useful. Lots of adult onset T1's are misdiagnosed as T2.

First thing's first though.

What're ye eating/drinking? And keep in mind I'm not accusing you of anything. The EatWell plate that's pushed on a lot of people still, would put me well over a HbA1c of 90 in no time at all. Heck... It did.

Hugs,
Jo

Thank you very much. I guess there is a little wiggle room on carbs, but not much as I don't do treats. I gave up smoking 4 years ago and gave up drinking 1 year ago. I also suffer from atrial fibrillation, hypertrophic cardiomyopathy, high cholesterol and high blood pressure, so my medicine cabinet is pretty full.

 

[type2newbie]

Hi @type2newbie & thanks for the tag @Pipp

I was on insulin for a short time at the start of my diagnosis as it was query T1 with a fasting BG of 28 - 32 and a HbA1c of 11.9 (that’s the old measurement of the HbA1c as it was nearly 14 years ago) I began reducing my carbs to 130g carb a day and was soon off the insulin and on maximum Gliclizide and Metformin, with the help of my GP I began to reduce my carbs further and reduce my meds accordingly until I went full keto with carbs at less than 20g carbs a day then I dropped all Gliclizide.

This works well for me now and I’m now diet only 14 years in. Like @JoKalsbeek says if you can maybe reduce your carbs - not just sugars but all carbs as they all turn to glucose in the body, if you can give us as much detail as possible of what you eat then we may be able to help you reduce your carbs.

Things that contain lots of carbs are all flour products such as all breads except specifically low carb, pasta white & wholemeal, pastry, also rice both white & brown, potatoes, below ground veg like carrots, parsnips except celeriac & swede/turnip. Most fruits are high in sugar

Things that are great for lower carb all meats, bacon, eggs, cheeses, cream, fish, above ground veggies, salads, berries such as strawberries, raspberries, blackberries, full fat Greek yogurt, butter, virgin olive oil, mayonnaise

The diet recommended by the NHS often isn’t the best one fit T2 diabetes, please ask as many questions as you like, it’s hard to get your head round such a big change and it takes time but members here have lots of low carb ideas, recipes etc that are more than delicious

Thank you very much. I am already on most of the things in you low carb list, but there is always room for improvement. My fasting reading first thing in the morning is usually between 18 and 22. I think one of the most important things I have learnt from some of the replies, is that starting Insulin is not a one-way street, which is what I previously thought. Maybe I should start the Insulin while I look at tweaking my diet and exercise routine, then maybe I will be able to follow your excellent example.

 

[type2newbie]

Hi,

As a T1. I wouldn’t knock insulin. Big fan of it.

However, (yeah, the “DVLA” every 3 years..)

Could there be any possible tweaks to your diet that could help dial back the BGs?

If you have tried everything? You have my best wishes on your decision.

Thank you for your response There may be a couple of tweaks I could make, but my fasting levels are still around 18-22, so not much I don't think. What do you need to do with the DVLA every 3 years? Just notify them that nothing has changed?

 

[JoKalsbeek]

Thank you very much. I guess there is a little wiggle room on carbs, but not much as I don't do treats. I gave up smoking 4 years ago and gave up drinking 1 year ago. I also suffer from atrial fibrillation, hypertrophic cardiomyopathy, high cholesterol and high blood pressure, so my medicine cabinet is pretty full.

I see. Mind you, carb cutting isn't about cutting treats, it's about cutting staples like bread, potatoes, corn, cereal and such... You'd be surprised how much of a "normal, healthy" diet consists of things that turn to glucose once ingested. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some in reducing carbs, just keep in mind that if you do cut those rather drastically, with the meds you're on, you're likely to hypo, so do be careful and test your heart out.

Statins and the like may not be optional for you, they're something you'll have to live with, but... If a change in diet doesn't do enough to change things up drastically, please, do get checked for one of the type 1 variants. You never know.

Hang in there and good luck!
Jo

 

[Jaylee]

Thank you for your response There may be a couple of tweaks I could make, but my fasting levels are still around 18-22, so not much I don't think. What do you need to do with the DVLA every 3 years? Just notify them that nothing has changed?

Basically fill out a restricted licence DIAB1 form (maximum of 3 years.) appertains to fitness to drive on insulin. You need to have hypo awareness. (Not getting an ambulance involved with loosing consciousness is a plus.)
“pass the jelly babies darling. I do believe I’m going low.” Don’t count a 3rd party help…
You will also need to meet the minimum legal eyesight standard too..

Then sign the form allowing DVLA to speak to your doctor. Eye scanning team or anyone else diabetes related..
(I always plan to see my people around 2 months prior to the licence end date. Keeps the reports, recent.)

There is also a legal obligation to sign that you will monitor your BG levels every 2 hours whilst in control of the vehicle.

Been filling this stuff out since 1986.

This might point you in the right direction..? https://www.gov.uk/diabetes-driving

 

[type2newbie]

I see. Mind you, carb cutting isn't about cutting treats, it's about cutting staples like bread, potatoes, corn, cereal and such... You'd be surprised how much of a "normal, healthy" diet consists of things that turn to glucose once ingested. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help some in reducing carbs, just keep in mind that if you do cut those rather drastically, with the meds you're on, you're likely to hypo, so do be careful and test your heart out.

Statins and the like may not be optional for you, they're something you'll have to live with, but... If a change in diet doesn't do enough to change things up drastically, please, do get checked for one of the type 1 variants. You never know.

Hang in there and good luck!
Jo

Bread and potatoes are my "treats". I'll take a look at the blog, thank you

 

[postinic]

I am Type 2 been using insulin for about 2years now slow & long acting 4 times a day, reason was my body decided it did not like metformin any more, I really do not have a problem using insulin & atm I self purchase libra 2 sensors & this has changed me a lot I have greater control on my blood glucose levels, there is a chance that I can get them on prescription now just waiting to see.

 

[type2newbie]

I am Type 2 been using insulin for about 2years now slow & long acting 4 times a day, reason was my body decided it did not like metformin any more, I really do not have a problem using insulin & atm I self purchase libra 2 sensors & this has changed me a lot I have greater control on my blood glucose levels, there is a chance that I can get them on prescription now just waiting to see.

My dog is diabetic too and I have to buy Libre 2 sensors for her. They only stay attached for 7-10 days, so it's pretty expensive at £50 per sensor

 

[type2newbie]

Thank you everyone for your help and guidance yesterday. I have decided to give the insulin a go and I'll be starting on 8 units once per day, from tomorrow. Sugars to be tested at least three times a day, and results to be reviewed every week by my diabetes nurse

 

[JoKalsbeek]

Thank you everyone for your help and guidance yesterday. I have decided to give the insulin a go and I'll be starting on 8 units once per day, from tomorrow. Sugars to be tested at least three times a day, and results to be reviewed every week by my diabetes nurse

Good luck, and may it bring you most excellent blood sugars!
Jo

 

[Ashintheuk]

Hello. I have been type 2 since 2012 and have been taking combinations of metformin, gliclazide, trulicity and empagliflozin in varying doses and combinations over the years. I am currently taking the maximum dose of metformin and gliclazide plus one empagliflozin but my last hba1c was still 90. My diabetes nurse has said that my glucose level is dangerously high and she wants me to start insulin injections once per day. I'm a little wary of this because my understand was that once you start on it, there is no going back and I know my health is way more important but things like notifying the dvla and insurance companies is also something I've been thinking about.

Does anyone have anything which may help me to decide, one way or the other?

Thank you in advance

Have you started to lose weight on the oral med regime ?. I was misdiagnosed as a T2, was on max dose metformin, saxagliptin and Dapagliflozin. My HBA1C was over 100 and I lost 2 stone in the 4 months without any dietary changes.
I would suggest you ask for a C-Peptide test to see how much of your own insulin is being made. The other test is the GAD65 antibody test which is for LADA, finally there is there genetic testing for MODY.
I went onto insulin about 5 years ago and it was by far the best thing I could do. I dropped all the other oral meds apart from lower dose metformin as it has other health benefits which I didn't want to sacrifice.

 

[type2newbie]

Have you started to lose weight on the oral med regime ?. I was misdiagnosed as a T2, was on max dose metformin, saxagliptin and Dapagliflozin. My HBA1C was over 100 and I lost 2 stone in the 4 months without any dietary changes.
I would suggest you ask for a C-Peptide test to see how much of your own insulin is being made. The other test is the GAD65 antibody test which is for LADA, finally there is there genetic testing for MODY.
I went onto insulin about 5 years ago and it was by far the best thing I could do. I dropped all the other oral meds apart from lower dose metformin as it has other health benefits which I didn't want to sacrifice.

I have put on weight since I was diagnosed back in 2012. I asked my Diabetes Nurse last week if she thought I could be Type 1 and she said, in her experience, I was not a "typical" type 1 diabetic. Once my units have been sorted, they said I will more than likely stop my gliclazide