Confused!!

[LittleGreyCat]

Is the change to basal-bolus regime something the GP can do, I didn’t like to ask the doctor as he wanted me to come of the insulin altogether but I wasn’t comfortable with having another medication change. I will ask the nurse tomorrow but I’m so confused right now, I always seem to come out of doctors appointments with more question than I go in with.
What job does the metformin have working along side the insulin?

Not sure that you have had a specific reply to this.

One thing Metformin does is help to reduce insulin resistance.
Therefore it can be prescribed both T1s and insulin dependant T2s to make the injected insulin more effective at lowering blood glucose levels

 

[JoKalsbeek]

Thanks for all this information, it is useful reading actual people going through experiences rather than just reading from the websites.
A lot of the confusion comes from the fact that when the results first came back as type 2 the nurse said that I wasn’t producing enough insulin so another test had to be done, result still came back the same. Then 6 weeks later I see the diabetic doctor and he tells me that I’m insulin resistant and producing too much insulin? (Which is it??). Because of this the wanted to take me off the insulin and onto gliclazide but that may not work as was equivalent to the amount of insulin I was injecting and the metformin wouldn’t be strong enough so WHY 6 weeks after telling me that do they want to put me into metformin and off the insulin??? The diabetes needs to be under control before they will change my other meds to methotrexate but I’m worried that the metformin on its own will imbalance the diabetes and put me back to square one. Do I try this and just not think about the other meds for now?? If the metformin doesn’t work then try something else then possibly back on insulin anyway? Or stick with the insulin because I know it works and starts the other meds then if they stabilise the psoriasis then think about coming off insulin? I have so many doctors, consultants and nurse all telling me something slightly different and not communicating amounts themselves?? The good thing is that I phoned my surgery to make an app with the diabetic nurse and when I explained to them that the hospital has just referred me back to the surgery they pulled my GP app forward so am seeing him next week.

Oh my, that IS a lot of confusion! I don't have the answers for you, alas, I just have a few components that might make things a little clearer... Or not. I dunno. I'm a little surprised you haven't been put on the methotrexate yet, as the other meds may be causing problems with the T2. Hmm. As for Gliclazide, it forces you pancreas to make more insulin. So rather than you injecting it, you'd be making your own. But there's quite a bit of contradition about how much you're making yourself... If you're making very little, it could be that your pancreas is exhausted. (Forcing it with gliclazide, I don't know how wise that would be, but then, I wasn't on the stuff for more than a month or so.) It happens, if you've been putting out large amounts of insulin (and becoming insensitive to it in the process), and it just can't keep up anymore. Thus, it is possible to be both insulin insensitive and not making a whole lot of it anymore. So it's a bit of a puzzle, as long as people aren't giving you straight, and non-contradictory answers. I can only imagine how frustrated you must feel right now.

Write down what others have said, and tell your GP all the contraditions you're getting. Then get a print-out of all your testresults and have him explain every single one to you. (No just so you know what they are, but so he/she can't skip over anything and miss something crucial!) You want to know where you're starting from, and maybe it'll make some sense out of the chaos you've been served lately. You can't be expected to figure all this out on your own. T2 is complicated enough without co-morbidities, ans you shouldn't be left flailing like this. I'm glad your appointment was moved up.

 

[Jackie0022]

Oh my, that IS a lot of confusion! I don't have the answers for you, alas, I just have a few components that might make things a little clearer... Or not. I dunno. I'm a little surprised you haven't been put on the methotrexate yet, as the other meds may be causing problems with the T2. Hmm. As for Gliclazide, it forces you pancreas to make more insulin. So rather than you injecting it, you'd be making your own. But there's quite a bit of contradition about how much you're making yourself... If you're making very little, it could be that your pancreas is exhausted. (Forcing it with gliclazide, I don't know how wise that would be, but then, I wasn't on the stuff for more than a month or so.) It happens, if you've been putting out large amounts of insulin (and becoming insensitive to it in the process), and it just can't keep up anymore. Thus, it is possible to be both insulin insensitive and not making a whole lot of it anymore. So it's a bit of a puzzle, as long as people aren't giving you straight, and non-contradictory answers. I can only imagine how frustrated you must feel right now.

Write down what others have said, and tell your GP all the contraditions you're getting. Then get a print-out of all your testresults and have him explain every single one to you. (No just so you know what they are, but so he/she can't skip over anything and miss something crucial!) You want to know where you're starting from, and maybe it'll make some sense out of the chaos you've been served lately. You can't be expected to figure all this out on your own. T2 is complicated enough without co-morbidities, ans you shouldn't be left flailing like this. I'm glad your appointment was moved up.

The dermatologist nurse said when I asked the question that there wasn’t any link between the psoriasis and the diabetes!!

 

[Freema]

I know that type 1 and type 2 are two very different conditions/ diseases, but initially, the doctors and nurses sometimes can figure out what kind of diabetes a person has... in this case it seems they are now convinced that the OP is a type 2 diabetic and not a type 1 as initially diagnosed as

 

[JoKalsbeek]

The dermatologist nurse said when I asked the question that there wasn’t any link between the psoriasis and the diabetes!!

https://www.webmd.com/drugs/2/drug-...al/cyclosporine-oral/details/list-sideeffects <-- it does list high bloodsugars. Not all leaflets mention it, and I'm assuming you can't read the Dutch one I found, but it is something that rarely happens. And then there's this, linking psoriasis to insulin resistance: https://www.medicalnewstoday.com/articles/323744.php
Remember, you're talking to someone who is specialised in only ONE condition... They don't know anything about others, so the impact of one on the other might be a mystery to them.

 

[HSSS]

The dermatologist nurse said when I asked the question that there wasn’t any link between the psoriasis and the diabetes!!

Depending on her experience and level of expertise and the further study she has undertaken she may or may not know. Sadly not all nurses working in specialist departments have anything like the level of knowledge you’d hope for and assume. Some do and some don’t. Insulin resistance certainly has some grounds for linking the two. As unpleasant as psoriasis is the diabetes is in my opinion the greater risk to your health. I’d be getting the diabetes sorted then returning to the psoriasis if they have to be done one at a time. (Do they?)


Jo has given excellent advice about getting the dr to go through it all.

For what it’s worth at my last review with a nurse she used the line ”not enough insulin”. I questioned that and asked but surely as a type 2 I have huge amounts of insulin but I just can’t use it as I’m insulin resistant. She said “well yes” so I said but that’s totally the opposition of what you just said. Her reply. ”oh well, its just wording! So sloppy explanations can lead to a great deal of misunderstanding.

“Not enough” could be an absolute not enough and obviously needs supplementing as there’s no other option. (Eg type 1 or typically in the later stages of type 2) or it could mean there’s not enough of it to do the job because it doesn’t get used properly (insulin resistant) so mega doses are needed to forced it to work by sheer weight of numbers. So a relative “not enough”. They are quite quite different. From what your specialist is saying the latter seems more likely. And if so becoming less insulin resistant is the key that way your own insulin will be enough - once you can use it.

Insulin is typically the drug of last resort or urgency for type 2. Other medications and diet are preferred in terms of overall long term outcomes, lower risks of errors and hypo etc. It definitely has a very useful place when other things don’t work but I wouldn’t want it be starting with it or staying on it if there were other options not yet tried or ruled out.

I know I said it before but food really could very likely be the way forward. It is supported by the nhs now too, but you may need to make less upto date staff aware. There’s an awful lot of us in here doing much better once we address the carbs for diabetes, weight, blood pressure, inflammation and a whole host of other issues. Making our metabolism work properly helps so much.

Unless of course changing your food is really not the way you want to go and prefer to have a more traditional medicalised approach. It is your choice for your body. In which case I wish you all the best sorting through the confusion you’ve been presented with and hope you find a solution that works for you.

 

[Jackie0022]

Depending on her experience and level of expertise and the further study she has undertaken she may or may not know. Sadly not all nurses working in specialist departments have anything like the level of knowledge you’d hope for and assume. Some do and some don’t. Insulin resistance certainly has some grounds for linking the two. As unpleasant as psoriasis is the diabetes is in my opinion the greater risk to your health. I’d be getting the diabetes sorted then returning to the psoriasis if they have to be done one at a time. (Do they?)


Jo has given excellent advice about getting the dr to go through it all.

For what it’s worth at my last review with a nurse she used the line ”not enough insulin”. I questioned that and asked but surely as a type 2 I have huge amounts of insulin but I just can’t use it as I’m insulin resistant. She said “well yes” so I said but that’s totally the opposition of what you just said. Her reply. ”oh well, its just wording! So sloppy explanations can lead to a great deal of misunderstanding.

“Not enough” could be an absolute not enough and obviously needs supplementing as there’s no other option. (Eg type 1 or typically in the later stages of type 2) or it could mean there’s not enough of it to do the job because it doesn’t get used properly (insulin resistant) so mega doses are needed to forced it to work by sheer weight of numbers. So a relative “not enough”. They are quite quite different. From what your specialist is saying the latter seems more likely. And if so becoming less insulin resistant is the key that way your own insulin will be enough - once you can use it.

Insulin is typically the drug of last resort or urgency for type 2. Other medications and diet are preferred in terms of overall long term outcomes, lower risks of errors and hypo etc. It definitely has a very useful place when other things don’t work but I wouldn’t want it be starting with it or staying on it if there were other options not yet tried or ruled out.

I know I said it before but food really could very likely be the way forward. It is supported by the nhs now too, but you may need to make less upto date staff aware. There’s an awful lot of us in here doing much better once we address the carbs for diabetes, weight, blood pressure, inflammation and a whole host of other issues. Making our metabolism work properly helps so much.

Unless of course changing your food is really not the way you want to go and prefer to have a more traditional medicalised approach. It is your choice for your body. In which case I wish you all the best sorting through the confusion you’ve been presented with and hope you find a solution that works for you.

I have changed the way and what I eat but starting on the insulin I was told to have 40-50g carbs per meal, I have tried to go in the middle or less per meal but have still needed to inject the same amount of insulin. I think I need to sit with the GP and like Jo has stated ask him to go through all the test results then explain to me the pro and cons of insulin, insulin & metformin together, and metformin on its own so I can understand the use of each treatment. What would happen if I stopped the insulin and concentrated on diet? Would blood sugars go up?? Surely that way I would find out if I need any medication??
I think I’m so confused because for me it’s not just the diabetes it’s the psoriasis as well so I have 2 things to change and manage.

 

[Jackie0022]

https://www.webmd.com/drugs/2/drug-...al/cyclosporine-oral/details/list-sideeffects <-- it does list high bloodsugars. Not all leaflets mention it, and I'm assuming you can't read the Dutch one I found, but it is something that rarely happens. And then there's this, linking psoriasis to insulin resistance: https://www.medicalnewstoday.com/articles/323744.php
Remember, you're talking to someone who is specialised in only ONE condition... They don't know anything about others, so the impact of one on the other might be a mystery to them.

This is interesting to read the psoriasis can cause over production of insulin too. May be that’s the answer!

 

[HSSS]

It’s confusing for sure. So you’re on fixed measures of insulin and being forced to eat what your medication requires, not what your meal required ie basal bolus or what you choose to eat (all other meds). Not a situation I’d be happy with. Medication should support you not control you if at all possible.

150g carbs a day is quite a lot for a type 2 and theres many of us who would struggle to control our condition on that alone, although metformin would help a little. I’d estimate most are below 100, all the way down to 20 a day but again many doing it without any meds or just with metformin It is a big change but we adapt and find alternatives and many prefer it once they adjust to a different way of approaching food. Some decide on a combination approach between lowish carb and some medications.

Now I agree it’s a great idea to sit down with your dr and discuss it all I just really really hope he’s up to date enough to know about low carb being such an effectively tool for control that he gives you good information. Whilst you’re waiting read around the forum some more idea of options.

Sadly many of us here (but importantly not all) have had some resistance to changing the tried and traditional approach of take medicine, try low fat diets and wait til it gets worse. This quite often changes when we do low carb anyway and return with great results that astound the drs and nurses. The nhs support the low carb program run by this site and also dr unwin has online gp training packages about low carb as well as a lot more recent research about.

Testing is another point misunderstood. It’s not just to check insulin doses and spot hypos coming. It’s also to check food before and after eating and see what effect it has on you so you can learn which foods are safe for you and which cause too high a rise. To know when to alter your planned meal if too high before eating and when to take a walk maybe to bring numbers down a bit.

 

[Jackie0022]

It’s confusing for sure. So you’re on fixed measures of insulin and being forced to eat what your medication requires, not what your meal required ie basal bolus or what you choose to eat (all other meds). Not a situation I’d be happy with. Medication should support you not control you if at all possible.

150g carbs a day is quite a lot for a type 2 and theres many of us who would struggle to control our condition on that alone, although metformin would help a little. I’d estimate most are below 100, all the way down to 20 a day but again many doing it without any meds or just with metformin It is a big change but we adapt and find alternatives and many prefer it once they adjust to a different way of approaching food. Some decide on a combination approach between lowish carb and some medications.

Now I agree it’s a great idea to sit down with your dr and discuss it all I just really really hope he’s up to date enough to know about low carb being such an effectively tool for control that he gives you good information. Whilst you’re waiting read around the forum some more idea of options.

Sadly many of us here (but importantly not all) have had some resistance to changing the tried and traditional approach of take medicine, try low fat diets and wait til it gets worse. This quite often changes when we do low carb anyway and return with great results that astound the drs and nurses. The nhs support the low carb program run by this site and also dr unwin has online gp training packages about low carb as well as a lot more recent research about.

Testing is another point misunderstood. It’s not just to check insulin doses and spot hypos coming. It’s also to check food before and after eating and see what effect it has on you so you can learn which foods are safe for you and which cause too high a rise. To know when to alter your planned meal if too high before eating and when to take a walk maybe to bring numbers down a bit.

I struggled with that amount of carbs which is why I staying in the middle. I inject 9 units in the morning and 10 units in the evening, I don’t know if this is a lot or little?? I haven’t had insulin today, I have eaten sensible keeping carbs low and my reading have been morning 8.4 then lunch time 10.1 (morning is usually 7.2 and lunch time (5 ish) not sure if these are good or bad readings, thought I’d try with no insulin for a few days to see what happens??

Also when I first went to hospital my ketone level was 4. I now get the impression that they were more worried and that than the diabetes?? Would this be the case.

Because the methotrexate is a chemotherapy drug so I’d have to stay away from germs, would this impact the diabetes if I did get a cold/flu or pick up germs??

 

[HSSS]

Test before the meal and again about 2 hrs later. An ideal reading is no more than a 2mmol rise. More than that and it’s likely you need to reduce the amount of carbs. Ultimately we want levels to say under about 8 but it doesn’t happen instantly.


What did you eat today?

 

[Jackie0022]

Test before the meal and again about 2 hrs later. An ideal reading is no more than a 2mmol rise. More than that and it’s likely you need to reduce the amount of carbs. Ultimately we want levels to say under about 8 but it doesn’t happen instantly.


What did you eat today?

I had a bowl about 30g of multi grain hoops and then a chicken wrap for lunch. (I work in a sandwich shop!!)

Also when I first went to hospital my ketone level was 4. I now get the impression that they were more worried and that than the diabetes?? Would this be the case.

Because the methotrexate is a chemotherapy drug so I’d have to stay away from germs, would this impact the diabetes if I did get a cold/flu or pick up germs??

 

[LittleGreyCat]

<snip>

Also when I first went to hospital my ketone level was 4. I now get the impression that they were more worried and that than the diabetes?? Would this be the case.

<snip>

For a T2 not on insulin and also on a ketogenic diet and also in a fasting phase then ketones of 4 are acceptable - getting into the "starvation ketones" area, which is good if that is what you are aiming for.

With a T2 who isn't eating keto (and you certainly aren't) ketones at this level are a serious warning sign.

It suggests that your body is not getting enough energy from glucose (because you don't have enough insulin to get it out of your blood stream and into your tissues) and your body is starting to mobilise fat and muscle as energy sources. This is a bad thing, because the next stage can be diabetic ketoacidosis where your ketones zoom up to dangerously high levels very quickly.

I note that you are stopping taking insulin for a bit to "see what happens".
If you have high ketones then that is probably not a good idea.
I assume your ketones came down again before you were discharged; did they talk to you at all about testing ketones?
I can see why they started you on insulin; high blood sugar and high ketones is not a good combination.

I would talk to your medical team as soon as possible and ask them about your ketone levels, insulin, and testing for ketones.

https://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html
Scary link about diabetic ketoacidosis.

So in answer to your question, yes I would expect them to be more concerned about a ketone level of 4 than about the fact you had diabetes.

 

[Jackie0022]

For a T2 not on insulin and also on a ketogenic diet and also in a fasting phase then ketones of 4 are acceptable - getting into the "starvation ketones" area, which is good if that is what you are aiming for.

With a T2 who isn't eating keto (and you certainly aren't) ketones at this level are a serious warning sign.

It suggests that your body is not getting enough energy from glucose (because you don't have enough insulin to get it out of your blood stream and into your tissues) and your body is starting to mobilise fat and muscle as energy sources. This is a bad thing, because the next stage can be diabetic ketoacidosis where your ketones zoom up to dangerously high levels very quickly.

I note that you are stopping taking insulin for a bit to "see what happens".
If you have high ketones then that is probably not a good idea.
I assume your ketones came down again before you were discharged; did they talk to you at all about testing ketones?
I can see why they started you on insulin; high blood sugar and high ketones is not a good combination.

I would talk to your medical team as soon as possible and ask them about your ketone levels, insulin, and testing for ketones.

https://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html
Scary link about diabetic ketoacidosis.

So in answer to your question, yes I would expect them to be more concerned about a ketone level of 4 than about the fact you had diabetes.

The ketones came down and in the first couple of weeks after the hospital they went high and low but haven’t had a problem with them. Yes they did explain to me about how to bring them down and how to test, I have testing strips for my glucose machine and urine test strips.

Although I have decided to stop the insulin for a few days I will still test my bloods 4 times a day so if they do go high I can go straight back to the insulin.

I’m seeing my GP on Wednesday and it’s the same GP that sent me to the hospital so he knows me and all about it. I know it’s probably a dangerous thing I’m trying but if it doesn’t make much difference to the blood levels then I’ll know that I don’t need the insulin and will feel more confident about trying the tablets.

 

[Jackie0022]

Ok 2 days of not taking my insulin, started off ok with levels of yesterday 8.2, 10.1, 8.4 then bedtime last night 12.4
Today 8.9, 8.4, 12.4. But 2 hours after lunch they shot up to 18.0. All I had was a couple of sausages and hot dog rolls!
Advice needed please. Do I carry on without the insulin until I see the GP on Wednesday or do I start it again in the morning thinking that yes what ever happens I will need insulin or tablets or both?? Which is better insulin and metformin or just a high dose of metformin then possibly gliclazide or insulin again. Do I try the tablets on there own?

 

[bulkbiker]

hot dog rolls!

And there is your culprit for high blood sugars.. nasty ultra processed rolls.. next time just have the sausages and try and get as high a meat content as possible 97% meat are the best.

 

[Jackie0022]

And there is your culprit for high blood sugars.. nasty ultra processed rolls.. next time just have the sausages and try and get as high a meat content as possible 97% meat are the best.

What about the other readings, they are still a bit high? should I continue with no insulin or start it again in the morning?

 

[bulkbiker]

What about the other readings, they are still a bit high? should I continue with no insulin or start it again in the morning?

You have just stopped a blood sugar lowering treatment regime so your sugars are bound to be higher.. I really can't advise as to treatment that's one for your medics.. keep monitoring your levels though to make sure you don't go too high.

 

[CondorX]

You don't say what type of diabetes you have, although it seems to be Type 2 as you are talking about oral medication as well as insulin. I don't think anyone is meant to give medical advice on this forum though, which is what you are looking for. If you use insulin and meds, then you are both insulin resistant and don't make enough insulin........

However, I must say that "hot dog rolls" and a couple of sausages would spike a lot of Type 2's ......the rolls are pure carbohydrate, probably around 20-30g of carbs apiece!! And depending on sausage used, they can be filled out with carbohydrate fillers. Pure meat sausages will not spike BS like those with a lot of fillers.

If you avoid carbs then your BS is likely to reduce, but the choice of using the insulin or not is not something anyone here really should be advising, as that would be online medical advice........

 

[HSSS]

thinking that yes what ever happens I will need insulin or tablets or both??

Not at all a forgone conclusion yet.

As bulkbiker says, the rolls would have sent mine skywards too! I don’t eat any breads at all. And possibly the sausages. Richmond’s send mine right up as I realised after I ate them they are only about 57% meat and goodness knows what carby fillers in them. Pick good meaty ones and you’ll be fine.

As far as the other readings go it depends what you were eating how much is down to the foods and how much you can bring it down given a bit of time

We can’t tell you what to do about your insulin but maybe if you decide to stay off the insulin - and. so long as you’re watching bloods very closely - consider using these few days before returning to the dr to see what you can achieve and test foods to learn what effects they have. You might surprise yourself. Obviously if the bloods get out of control or the ketones go up you’ll have to rethink and get some help or restart the insulin.

Have you done much reading about eating low carb or keto? We can give you some good resources to get you started