Type 2 considering asking to go on insulin

[kjc2011]

Hi everyone I was diagnosed 5 years ago as type 2 and since then my HBA1C has always been high and I have let diabets rule me.
I suffer from high blood pressure, hypothyroidism high cholesterol and angina, for which I had a triple bypass 3 years ago and now waiting to see specialist regarding my last diabetic eye checks.
Basically, I want to take control of diabetes and not let it control me and I was wondering for some advice on insulin and your experiences, and if it will give me control back.
At the moment I am on a cocktail of medication for all the above, including maximum doses of gliclazide and pioglitazone. In general the gliclazide doesn't seem to do much in lowering BG's at breakfast time and then don't have any with my lunch and then only seems to do the trick with my evening meal, only rising by 1ml orless, for example I can be 4.8 before tea and then rise to 5.4 or can be 5.I then 6.2 pre meal.
Any opinions help and advice regarding insulin will be greatly appreciated before I go see my doctor tomorrow. I know thee os still a lot of hard work involved with insulin, but just want to take control and try to ensure my bloods are more stable as they can be all over the place, for example today I woke fasting at 6.2, then 8.9 after breakfast, then before lunch was 4.6 and then 2 hours post was 9.8 and that's with taking my morning dose of gliclazide and pioglitazone. Yesterday was pretty much the same fasting 5.4, post brekkie 12.4, pre lunch 4.0, post 6.6, pre evening meal 5.3 and post 7.6.
I know some of those numbers are within range, it's just the amount that they fluctuate and no real stability up and down constantly, but I mainly notice that they are mainly up after meals and my readings fasting and pre meal are all perfectly fine.

 

[himtoo]

Hi there

your numbers don't look bad -- ok maybe you could do a bit more with them -- but possibly it could be diet related -- if you are already controlling carbs then perhaps the step onto insulin could help.
Insulin comes with its own dangers though ( hypos)
have you had the opportunity to have this discussion with an endocrinologist ?
they would be your best source of medical advice.

all the best !!

 

[kjc2011]

Thank you for your advice @himtoo and @Galja I do understand that insulin comes with its own challenges and complications and I have been thinking about it lots recently. I have never had an acceptable HBA1C since diagnosis and have struggled for years. Most of the readings that I have posted are within range but the high reading of 12 is not a 1 off and also my readings post breakfast/lunch are usually in the 9s or above agree could be diet related. I feel diabetes has controlled me rather than me controlling it. I need and want to make changes for the better. My doctor mentioned insulin very briefly when I was last there for my last results but wasn't discussed fully. I made an appointment with him for tomorrow as thought lots about it over the past 7/8 weeks have a chat with him and see what he suggests.

 

[himtoo]

Insulin will definitely help with BG readings but just comes with the caveat of more testing and awareness

 

[Kristin251]

When I look at your numbers many seem high but more so I don't like the fluctuations. Those can cause just as many problems as slightly higher numbers.
Have you thought of cleaning up your diet a bit? Lowering carbs can go a long way. If it helps make a decision, I could never control BS eating carbs and taking insulin. A low carb diet was never a problem for me as I was very low carb for years before insulin. I was told to eat just 15-20 carbs per meal and bs was all over the place. I think people on pumps do much better with carbs and insulin. I on.y eat above ground veggies for carbs and allows me to take very small doses of insulin so I don't fear the hypos. They were scary. I guess what I'm saying is insulin isn't go to be the answe to your problem while eating lots of carbs from MY experience. I still had nasty swings. With low carb and I insulin I stay steady. It took awhile to find the right diet and doses and lots of hypos and hypers to get there but it can be done.

 

[kjc2011]

Hi @Kristin251 and thank you for your reply with your experiences. I try eat no more than 20g carbs per meal myself most of the time sometimes try and be lower. I'm finding that my main problems are breakfast always high afterwards even with 160mg gliclazide and then lunch im always a little high as no meds to take with lunch. Evening meals are not too bad as gliclazide seems to do its job there 5.3 and 7.6 yesterday and today 5.6 pre evening meal and then 5.9 2 hours post just a little bit of a big jump yesterday after evening meal but I know what caused that over did the carbs a little yesterday and had a forbidden slice of bread with my meal.

 

[Kristin251]

What do you normally eat for BF ? Lunch?

I have found through extensive finger sticking that I do. It tolerate any carbs for BF. And very little protein. It needs to be mostly fat even with injected insulin. Most of us are most insulin resistant in the morning when all the hormones are waking up such as adrenaline and cortisol.

My typical meal plan is
BF 1/2 avocado smashed with sea salt and celery
L 10g protein with mayo on a lettuce wrap and 1/4 avocado. Some celery and radish
D is 2 oz protein on either a lettuce wrap or salad with either mayo or olive oil and a small serving of random veggies.
Snacks are a few nuts or olives
I also require a bedtime snack to allow me to sleep so it's a glass of red wine and a celery stick with a swipe of peanut butter

At some point along this journey protein started effecting me more and more so I don't eat slabs of it anymore

BF was always the hardest meal to get right and if I don't get it right I'm messed up all day. The guacamole and celery seem to be most consistantly the best.

Maybe if you're eating carbs at BF they should be saved for later in the day. I take the same insulin doses for all my meals but I can ramp up protein and veg as the days goes on. I still spike after BF more than any other meal and it is the smallest meal for the day. By spike I mean from 85-95 or 100 so not really q spike but the other meals I stay almost exactly the same.

 

[kjc2011]

Bf is usually a small amount of porridge or a few strawberries in natural Greek yoghurt lunch was usually a Sandwich but now changed to either a few ryvita crackers with cheese or a ham/ chicken salad. I find breakfast really hard. With a time limit during the week due to work its hard to cook but weekends do a lot with eggs boiled scrambled omlettes. Can tolerate small amount carbs with evening meal such as potatoes rice pasta as my gliclazide seems to be most effective and cope with carbs better then, but not too many as found out last night just a little to much and a big jump in numbers

 

[Kristin251]

Most cannot tolerate porridge especially in the morning. Do the eggs give you better readings on the weekend ? You could hard boil eggs and keep in the fridge. Either eat plain or mix with mayo. You could eat with celery. Could be done the night before. Do you like avocado? I would ditch the carbs at BF for sure and even the crackers at lunch and stick with the salad. I found meals that work at different times of day and stick to them. Always same BF and macros at lunch, switching up proteins but dinner is what I'm in the mood for and get random numbers but it's never carby. Maybe just more veggies. Still random numbers.

There are plenty of BF foods that work well and low carb. Carbs at BF is the worst time for them in my experience. Left over dinner. We never have any though hahah. Egg salad, chicken/ turkey salad etc. many can be made the night before. Grab and go. Seems weird at first but then it seems normal.

 

[kjc2011]

Just an update on my doctors appointment today. He has changed my BP medication so pick my new ones up from the chemist tomorrow. I also discussed I sulin with him. He agrees that it may help, but also said my next HBA1C is due in around 6 weeks, so feels that we should wait and see what the results of these are first as only just started taking the max dose of gliclazide, at the beginning of April, which I can see where he's coming from and makes sense. Thanks for your opinions and sharing g experiences and will keep you updated.

 

[Brunneria]

Can i ask if you weigh and accurately calculate the number of carb grams you eat in every meal?

The reason i ask is because you would need to do that when injecting insulin, so it would be a kind of practice, giving you a sense of the extra amount of work needed for insulin.

Plus... It looks to me as if you may simply be overloading your body with carbs - or of carbs of a type you cannot tolerate.

My body can't tolerate ANY carbs first thing in the morning - oats and bread are a disaster. Then, like you, my ability to cope increases as the day lengthens and my insulin resistance drops.

Now, i completely acknowledge that we don't all want to drop bread and carbs from our eating. But choosing between insulin AND porridge, or no insulin and hamandcheese for breakfast would be a very easy choice for me.

 

[AndBreathe]

Just an update on my doctors appointment today. He has changed my BP medication so pick my new ones up from the chemist tomorrow. I also discussed I sulin with him. He agrees that it may help, but also said my next HBA1C is due in around 6 weeks, so feels that we should wait and see what the results of these are first as only just started taking the max dose of gliclazide, at the beginning of April, which I can see where he's coming from and makes sense. Thanks for your opinions and sharing g experiences and will keep you updated.

KJC - Could I ask you why you want to take insulin? Is it because you don't like your numbers, or because you think it will be easier to achieve control, using insulin, rather than your current regime and meds, or are you struggling with your diet and deep down want to eat more carbs? Of course, it could be something else.

 

[Mars1946]

Hi Kristin

As I know you use Lantus as basal insulin. It is a long acting insulin type , but it is impossible to obtain an invariably level all 24 hour. I know that in the lantus and levemir the "product synopsis" postulate that this insulin types are long acting and have a actions time of 24 h, but it is not true.

On the morning the background insulin in the body is low. That is the reason why people with T2DM have a problem on the morning if they digest carbohydrates. This problem can be solved if you take a dose of quick acting insulin type, like Novo Rapid.

The better solution is to change Lantus to Tresiba. Tresiba is a true long acting insulin. It is active for 42 h. I take Tresiba self and I do not experience problems on the morning. I use on the morning Novo Rapid to.

You write that your diet is of low carbo. It is not good if you have T2DM or LADA. If you really have LADA ( it can be verified by test for GAD-65 and C-peptide) you can develop with the time cetoasidosis.

The optimal diet for people with T2DM is to prepare meals with nutrients who have a GI (Glycemik Index) under 50 and GL ( Glycemik Load) under 10.

You must eat carbs for the reason of the biochemical process Krebs Circle and the Biological Respirations Chain . In this process the glucose and the fat are catabolised to CO2 an H2O.

If you do not have carbs in your blood, then this process produces Ketone with negative consequences for you.

I wish to you a good healt

 

[Brunneria]

Hi Kristin

As I know you use Lantus as basal insulin. It is a long acting insulin type , but it is impossible to obtain an invariably level all 24 hour. I know that in the lantus and levemir the "product synopsis" postulate that this insulin types are long acting and have a actions time of 24 h, but it is not true.

On the morning the background insulin in the body is low. That is the reason why people with T2DM have a problem on the morning if they digest carbohydrates. This problem can be solved if you take a dose of quick acting insulin type, like Novo Rapid.

The better solution is to change Lantus to Tresiba. Tresiba is a true long acting insulin. It is active for 42 h. I take Tresiba self and I do not experience problems on the morning. I use on the morning Novo Rapid to.

You write that your diet is of low carbo. It is not good if you have T2DM or LADA. If you really have LADA ( it can be verified by test for GAD-65 and C-peptide) you can develop with the time cetoasidosis.

The optimal diet for people with T2DM is to prepare meals with nutrients who have a GI (Glycemik Index) under 50 and GL ( Glycemik Load) under 10.

You must eat carbs for the reason of the biochemical process Krebs Circle and the Biological Respirations Chain . In this process the glucose and the fat are catabolised to CO2 an H2O.

If you do not have carbs in your blood, then this process produces Cottons with negative consequences for you.

I wish to you a good healt

I defer to your greater knowledge of insulin, but I completely disagree with your dietary advice.

I eat low carb, I am T2. I avoid all medication by eating very low carb, I have great energy levels and have no liklihood of ketoacidosis. My blood glucose levels are now normal (below pre-diabetic) and I feel great. I do have ketones, but they are from nutritional ketosis and my body and brain work excellently on them. They are at a level that benefits me, and are no risk of tipping into ketoacidosis.

When I tried eating a low glycaemic index diet I felt dreadful and far less healthy than now.

 

[Mars1946]

I defer to your greater knowledge of insulin, but I completely disagree with your dietary advice.

I eat low carb, I am T2. I avoid all medication by eating very low carb, I have great energy levels and have no liklihood of ketoacidosis. My blood glucose levels are now normal (below pre-diabetic) and I feel great. I do have ketones, but they are from nutritional ketosis and my body and brain work excellently on them. They are at a level that benefits me, and are no risk of tipping into ketoacidosis.

When I tried eating a low glycaemic index diet I felt dreadful and far less healthy than now.

Hi Brunneria

You have a T2DM. Your pancreas is not affected of the immune system destroying your beta cells.

Kristin write she has LADA. This diagnose is not accepted off the WHO because this disease has not an ICD 10 code.

An expert committee of the ADA with its etiologic diagnostic criteria, has recommended dividing T1DM into type 1A (immune mediated) and type 1B ( other forms of diabetes with severe insulin deficiency). I do not know, but perhaps LADA is the same as T1DM type 1A???

Experts in the Diabetologi, test for LADA with blood analyses for , GAD-65 and C-peptide. If GAD-65 is >20 it indicate for anti bodies for beta cells. Low C-peptide indicate low endogen insulin. The person is going to become T1DM.

I write about ketone to Kristin because she inform that she has LADA.

"You must eat carbs for the reason of the biochemical process Krebs Circle and the Biological Respirations Chain . In this process the glucose and the fat are catabolised in the mitochondria to CO2 an H2O and there is produced ATP". ATP are the molecules who give energy to all biochemical processes. If you have T2DM and you do not eat lot of carbs, then because insulin has defect on the liver to inhibit glucose production , the liver start the gluconeogenese and convert proteins from your muscle to produce glucose. People with T2DM do not become DKA because they have endogen insulin. DKA is a fare more characteristic feature of T1DM than of T2DM, but it may be seen in persons with T2DM under conditions of stress such as occur with serious infections, trauma and cardiovascular or other emergencies.

I do not know how much you know about GI, but you can find it in the Australian site about GI.

Low GI means your digestive tract absorbs the carbs very slowly and the insulin has time to bring them safe on there places. Your blood glucose do not go very high and you can avoid hyperglycaemia.

Have a nice day

PS Remember, the Diabetes has many stage. Your T2DM is on the beginning, but it develops every day. Diabetes is the "Silent killer", and if you do not treat it correct, then the problems will develop.

 

[Brunneria]

Hi Brunneria

You have a T2DM. Your pancreas is not affected of the immune system destroying your beta cells.

Kristin write she has LADA. This diagnose is not accepted off the WHO because this disease has not an ICD 10 code.

An expert committee of the ADA with its etiologic diagnostic criteria, has recommended dividing T1DM into type 1A (immune mediated) and type 1B ( other forms of diabetes with severe insulin deficiency). I do not know, but perhaps LADA is the same as T1DM type 1B???

Experts in the Diabetologi, test for LADA with blood analyses for , GAD-65 and C-peptide. If GAD-65 is >20 it indicate for anti bodies for beta cells. Low C-peptide indicate low endogen insulin. The person is going to become T1DM.

I write about ketone to Kristin because she inform that she has LADA.

"You must eat carbs for the reason of the biochemical process Krebs Circle and the Biological Respirations Chain . In this process the glucose and the fat are catabolised in the mitochondria to CO2 an H2O and there is produced ATP". ATP are the molecules who give energy to all biochemical processes. If you have T2DM and you do not eat lot of carbs, then because insulin has defect on the liver to inhibit glucose production , the liver start the gluconeogenese and convert proteins from your muscle to produce glucose. People with T2DM do not become DKA because they have endogen insulin. DKA is a fare more characteristic feature of T1DM than of T2DM, but it may be seen in persons with T2DM under conditions of stress such as occur with serious infections, trauma and cardiovascular or other emergencies.

I do not know how much you know about GI, but you can find it in the Australian site about GI.

Low GI means your digestive tract absorbs the carbs very slowly and the insulin has time to bring them safe on there places. Your blood glucose do not go very high and you can avoid hyperglycaemia.

Have a nice day

PS Remember, the Diabetes has many stage. Your T2DM is on the beginning, but it develops every day. Diabetes is the "Silent killer", and if you do not treat it correct, then the problems will develop.

Considering the number of type 1 and LADA diabetics who post on this forum, and who have excellent blood glucose control while using low carb or very low carb diets, I continue to strongly disagree with your diet advice.

Low Glycaemic Index eating is a perfectly valid way of eating. However, it is not necessary, or superior, just one choice. I tried it, and found that my T2 did degenerate. So I switched to very low carb and have now felt better for 2 years, with no deterioriation.

So I will also take issue with your belief that T2 is automatically degenerative. This is old thinking and is increasingly being disproven for some forms of T2 (of course there are many different sub-types). I can give you a long list of references to studies and dietary options which provide the data on this, if you like.

 

[Bluetit1802]

@kjc2011

I think if you space out your daily carb allowance differently you will see a big difference in your fluctuations. Your before readings are superb.

Personally I can't eat any carbs for breakfast. It is protein and fat only. I am Type 2 unmedicated.
I eat a few for lunch along with more protein and fat
I eat the majority of my allowance at evening meal, again with protein and fat
I don't have any other meals or snacks.

This works for me and keeps me more or less level all day and night. (maximum peak post meal is about 1.5mmol/l and that is the peak, not the 2 hour reading, and is more often than not around 1mmol/l. I am usually lower after breakfast than before. It took me over a year to realise I couldn't manage any carbs for breakfast. I thought it was dawn phenomenon kicking in but as soon as I dumped the Greek yogurt and berries and swapped to a boiled egg it all came right for me.

Why not give it a try and see what happens?

 

[Mep]

@kjc2011 - If the oral meds are not working you will get high sugar readings most of the time. When they stopped working for me I was getting readings over 7 all the time. My endocrinologist finally agreed to run the diagnostic tests on me again (GAD and c-peptide) and the c-peptide showed I hardly produce any insulin... so I have insulin deficiency due to beta cell damage (definitely not type 1 though). I have to be on insulin now and have no choice about that. If you find yourself in the same position you will have no choice. Although I understand docs can also put you on insulin to help get control too. I guess it will depend on what your hbA1c result is as to whether or not your doc thinks it is worthwhile. I definitely have had more hypos on bolus and basal insulin treatment. I wish you the best.

 

[Bluetit1802]

@Mars1946

I cannot agree with your thinking that a low GI diet is better for T2s than a very low carb diet. It is one diet that works for some people, most likely those with medication to help. The diet that works for the majority is low carb or very low carb. There are many success stories on this forum from low carb eaters. Many have reduced their need for meds, many have come off meds completely, and many have never had meds. I'm one of them. I have good control with minimal fluctuations and have maintained this control - in fact better than maintained it, I continue to improve it.

I did try the low GI approach initially - diligently. It didn't work despite careful counting of the GL, which needs a maths degree.

Carbs are carbs, and they all convert to glucose, no matter what the GI/GL may be. It may take a bit longer, but the glucose still arrives in the blood stream at some point and in my case kept my levels raised for longer. I find that fat with fewer carbs works much, much better.

As low carbers see these improvements test after test and reach non-diabetic levels, and maintain these, then how can you say it is automatically degenerative? That is a phrase often used by our GPs and nurses - because the vast majority of their patients do degenerate, most often because they are still eating carbs and expecting their medication to do the work for them. (Obviously there will be some that degenerate for other reasons)

 

[Mars1946]

Dear Brunneria
You are in your right to believe what you wish. People says " Believing can move the mountains".
I have to T2DM. On the onset of my T2DM I have used the same nutritional technique like you.
With the time I have been wise and my knowledge about Diabetes to day is on the top.
The truth is: If a person has Diabetes, then low carbohydrate intake is not recommended. Please ask your doctor or dietician about theirs opinion. Your T2DM is on the beginning. You shod eat hefty diet and make exercises and use medication with Metformin. Later when your DM progress then your doctor can inform you what you shod do.
I told you what is the problem if you do not intake normal amount of carbohydrate.
Your need of KCalories is: Your weight multiplied with 24 , ( uncorrected for thermo genesis and conversions), but it is OK.
It is according to the biochemical concept about BMR (Basal Metabolic Rate)

This KCalories you shod distribute on this way:

1. 40% on carbohydrate (Dietician say 55%)
2. 30% on fat (Dietician say 25%)
3. 30% on protein (Dietician say 20%)
Every gram carbs and protein give 4 KCal.
Every gram fat give 9 KCal.

Moreover you shod choose nutrition's with GI lover than 50. It is all for now.