Medication to insulin??

[macmaz]

I have been diabetic type 2 since 2000, managed first five years on diet only, then metformin which I really had problems with, changed to slow release metformin and glimepiride, now have probs with the metformin. Doc added canaglifozin low dose, not happy as it can have so many side effects. Taking only one slow release of metformin I can tolerate it better, plus the glimepiride and now the new one.BUT doc keeps mentioning insulin, I am so against it as have watched friends struggle on it. Any advice or tips please, I do watch my diet, eat healthily and walk, but due to arthristis am slowing down a lot.
Am not afraid of needles at all just the insulin. Many thanks.

 

[ziggy_w]

Welcome to the forum, @macmaz.

I really empathize with you. When first diagnosed, my Hba1c was extremely high and my doctor mentionend insulin on my very first visit. Tbh, this and the potential consequences of diabetes scared the bejesus out of me.

I will tag @daisy1 for some really helpful information for newbies. By tweaking diet a bit, most of us have been able to lower blood sugar levels quite a bit.

 

[Guzzler]

Hello and welcome to the forum. Tagging @daisy1 for you for some great advice offered to all newcomers.

I do not take bg lowering drugs so can't advise you about that, sorry, but if you could say a little more about your diet and whether you use a glucometer, your last HbA1c result then you will get lots more advice.

And lastly, I share your feelings about taking insulin.

 

[Guzzler]

Welcome to the forum, @macmaz.

I really empathize with you. When first diagnosed, my Hba1c was extremely high and my doctor mentionend insulin on my very first visit. Tbh, this and the potential consequences of diabetes scared the bejesus out of me.

I will tag @daisy1 for some really helpful information for newbies. By tweaking diet a bit, most of us have been able to lower blood sugar levels quite a bit.

Oops, sorry Zig, cross posting.

 

[Mep]

I have been diabetic type 2 since 2000, managed first five years on diet only, then metformin which I really had problems with, changed to slow release metformin and glimepiride, now have probs with the metformin. Doc added canaglifozin low dose, not happy as it can have so many side effects. Taking only one slow release of metformin I can tolerate it better, plus the glimepiride and now the new one.BUT doc keeps mentioning insulin, I am so against it as have watched friends struggle on it. Any advice or tips please, I do watch my diet, eat healthily and walk, but due to arthristis am slowing down a lot.
Am not afraid of needles at all just the insulin. Many thanks.

Hi Macmaz

It really depends on what your body is currently doing or not doing. You say you've had diabetes since 2000, so that's almost 17 years. I had diabetes for 12 years when I was placed on insulin beginning of 2010. I did diet control for 7 years and was placed on quite a few drugs for the next 5 years when they clearly stopped working after the 3 year mark. I insisted on getting the diagnostic testing done again which my endo agreed to. The result was the c-peptide test showed I no longer produce insulin I need. So I had no option but to be placed on insulin therapy. I've been on it ever since. It's not really hard once you get used to it. I did have my initial phobia about injecting myself, but got over that very quick.

I would suggest finding out first what your body is doing and once you know the answer you can decide with your doc what is the best treatment. Oral meds aren't going to work when you no longer produce insulin you need.... that was why I had no option. It was the best thing for me though as I've had better control since.

I wish you the best.

 

[SimonCrox]

Yes, as above, you have managed on tablets for longer than average which is a testament to your hard work.
You do not seem to have tried a gliptin; have you considered these tablets?
The canagliflozin and empagliflozin decrease risk of heart attack, stroke and kidney disease, but on cana (and no one is sure about empa), one needs to watch one's feet; the thrush is generally once per year, and not too bad, but at times can be awful and need to stop the cana; poorly contorlled diabetes and cana gliflozin have simialr risk of waterworks infection per year.
Insulin is not the only injection - there are the GLP-1 RAs. These work as well as insulin to decrease HbA1c, but help lose weight and do not cause hypos on their own. Also, liraglurtide (once per day) and semaglutide (once per week - just been approved by FDA so perhaps in UK in new year) avoid heart attacks and strokes which lixisenatide and exenatide do not.
So, a lot more choice than 15 years ago.
Best wishes

 

[macmaz]

Welcome to the forum, @macmaz.

I really empathize with you. When first diagnosed, my Hba1c was extremely high and my doctor mentionend insulin on my very first visit. Tbh, this and the potential consequences of diabetes scared the bejesus out of me.

I will tag @daisy1 for some really helpful information for newbies. By tweaking diet a bit, most of us have been able to lower blood sugar levels quite a bit.

 

[macmaz]

Thank you all for your replies, am writing down what has been said and will discuss with doc the info, it is a battle with the docs, never see the same one, might ask to go to local hospital for checks as doc just looked up in his book what tabs were suggested. My long term high is only 8.1in the old measure, but doc wants it to be seven .Do not the use the new measures!
My diet is good I live abroad half the year on and off,good Mediterranean diet, my only downfall is the odd cake or ice cream. Maybe my body just won't accept the metformin in higher doses, it will accept one tablet along with others mentioned. I do find it very depressing and after battling for seventeen years I am still determined not to resort to insulin. When first diagnosed back in 2000 a nurse kindly told me, it knocks ten years off yr life !! I was not amused , told her well my grandmother got to 84 As a diabetic when they did not even treat it! So I'll sign up for that thank you, quite a good age. thank you all again.

 

[LittleGreyCat]

@macmaz - what do you class as a healthy Mediterranean diet? [With only the occasional cake or ice cream.]

Many on here are on very low carbohydrate diets which has helped to keep BG levels under control.

Do you eat many carbohydrates?

 

[macmaz]

@macmaz - what do you class as a healthy Mediterranean diet? [With only the occasional cake or ice cream.]

Many on here are on very low carbohydrate diets which has helped to keep BG levels under control.

Do you eat many carbohydrates?

I have been diabetic type 2 since 2000, managed first five years on diet only, then metformin which I really had problems with, changed to slow release metformin and glimepiride, now have probs with the metformin. Doc added canaglifozin low dose, not happy as it can have so many side effects. Taking only one slow release of metformin I can tolerate it better, plus the glimepiride and now the new one.BUT doc keeps mentioning insulin, I am so against it as have watched friends struggle on it. Any advice or tips please, I do watch my diet, eat healthily and walk, but due to arthristis am slowing down a lot.
Am not afraid of needles at all just the insulin. Many thanks.

 

[macmaz]

A healthy Mediterranean diet includes, fresh fish, fresh vegetables, lots of salad, some fresh fruit, beans , pulses, chicken, lean meat, cheese, we grow our own veg and some fruit. Meat a few eggs, love them. I avoid pasta and rice , but of course sometimes. As much protien as possible.

 

[LittleGreyCat]

A healthy Mediterranean diet includes, fresh fish, fresh vegetables, lots of salad, some fresh fruit, beans , pulses, chicken, lean meat, cheese, we grow our own veg and some fruit. Meat a few eggs, love them. I avoid pasta and rice , but of course sometimes. As much protien as possible.

But of course sometimes?

So where are you on other carbohydrates? Bread, pizza, other pastries? Potatoes, parsnips? Cereals, especially for breakfast? Porridge?

Pasta and rice are just a small subset of the carbohydrate rich foods.

Just trying to get a feel if you are eating "healthy carbohydrates" or avoiding nearly all carbohydrates.

You also say "as much protein as possible". Too much protein and your body converts it to carbohydrate through gluconeogenesis which can make BG control harder. Fat can be your friend as an energy source.

The reason that I am asking is that you want to avoid insulin and there may be ways to change your diet which will keep you off it for a few years longer.

Have a look at the LCHF/low carbohydrate forum for some more ideas.

 

[SimonCrox]

Thank you all for your replies, am writing down what has been said and will discuss with doc the info, it is a battle with the docs, never see the same one, might ask to go to local hospital for checks as doc just looked up in his book what tabs were suggested. My long term high is only 8.1in the old measure, but doc wants it to be seven .Do not the use the new measures!
My diet is good I live abroad half the year on and off,good Mediterranean diet, my only downfall is the odd cake or ice cream. Maybe my body just won't accept the metformin in higher doses, it will accept one tablet along with others mentioned. I do find it very depressing and after battling for seventeen years I am still determined not to resort to insulin. When first diagnosed back in 2000 a nurse kindly told me, it knocks ten years off yr life !! I was not amused , told her well my grandmother got to 84 As a diabetic when they did not even treat it! So I'll sign up for that thank you, quite a good age. thank you all again.

Yes - I cannot get my head around new units having been using the old units for decades.
If one tablet of metformin is all you can take, you are not alone, and it is probably doing some good.
I thnk that one is entitled to a second opinion; I would also point out that all NICE guidance starts with a paragraph that a knowledgeable clinician works with an informed patient to reach an individual treatment plan - having to look it up in a book doesn't sound that great to me; I would however point out that GPs are just snowed under and cannot know everything in depth.
Best wishes

 

[ziggy_w]

A healthy Mediterranean diet includes, fresh fish, fresh vegetables, lots of salad, some fresh fruit, beans , pulses, chicken, lean meat, cheese, we grow our own veg and some fruit. Meat a few eggs, love them. I avoid pasta and rice , but of course sometimes. As much protien as possible.

Hi @macmaz,

Do you test your blood sugar after meals? If yes, how much of rise do you usually see?

Some foods can cause a rise for some diabetics, but not for others. Beans and pulses, for example, can be a problem as may some fruits. With respect to fruits, usually blackberries, raspberries and strawberries tend to work best for most. Also, starchy vegetables are often a problem. On another thread, I have just read that a poster observed a rise of 2 mmol after eating only one-third of one carrot.

If you take medication that increases insulin production, such as glimepiride, it is safest to talk to your GP before lowering the carb content of your food even more. It can be a very effective way of lowering blood sugars, however.

 

[daisy1]

@macmaz

Hello macmaz and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you need to and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 250,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.

Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.

 

[Daibell]

Hi. You shouldn't be afraid of insulin. When I was on the complete set of tablets for years and an ever higher blood sugar level my GP refused me insulin when I asked. The year following I was offered it and grabbed it. For me it was salvation and has been for the last 4 years. It is a nuisance rather than a problem. It has no side effects and if you put on weight with it you are eating too many carbs. Yes, you do need to inject 4 to 5 times day with the Basal/Bolus regime and test quite frequently to avoid hypos but you soon get used to that and the injections rarely hurt; the lancet is worse. Diabetes when on insulin and with reasonable control shouldn't really affect your life span (why should it?). So, as and when the tablets fail you then go for insulin (Basal/Bolus) with enthusiasm! BTW your diet sounds excellent. Bear in mind you may even be Late onset T1 and not T2. I was mis-diagnosed and so are may others. If so, insulin is inevitable.

 

[Resurgam]

Personally - I have given up on carbohydrates from highly starchy or sugary foods and have to confess to being totally smug about the lowering of my blood glucose to normal levels without any medication. It is only a year since I was diagnosed so I can't tell how it will go, but my hope is to continue unmediated control for as long as possible. I suspect that my long term low carb diet masked diabetes for a long time, and only the 'cholesterol lowering' diet I was put on caused the massive weight gain and the diagnosis.
If you are no longer producing insulin then you have no option, but it could be worth you trying to cut down on the carbs and see if you can squeeze a few more years without insulin injections.
One thing I found when I went back to low carb foods was how the pains in my knees and hip reduced - I was using walking poles a year ago, now I don't need them and can happily walk a couple of miles without any concerns. I do use them when on rough heathland, but I always did.

 

[Strachan1]

Yes, as above, you have managed on tablets for longer than average which is a testament to your hard work.
You do not seem to have tried a gliptin; have you considered these tablets?
The canagliflozin and empagliflozin decrease risk of heart attack, stroke and kidney disease, but on cana (and no one is sure about empa), one needs to watch one's feet; the thrush is generally once per year, and not too bad, but at times can be awful and need to stop the cana; poorly contorlled diabetes and cana gliflozin have simialr risk of waterworks infection per year.
Insulin is not the only injection - there are the GLP-1 RAs. These work as well as insulin to decrease HbA1c, but help lose weight and do not cause hypos on their own. Also, liraglurtide (once per day) and semaglutide (once per week - just been approved by FDA so perhaps in UK in new year) avoid heart attacks and strokes which lixisenatide and exenatide do not.
So, a lot more choice than 15 years ago.
Best wishes