Type 2 At what point does Insulin become necessary?

[Deleted member 558820]

At what point does Insulin become necessary? I was diagnosed type 2 about 15 years ago, My weight has been approx 88kg all this time Started with usual Diet and exercise and after about 3 years I Then progressed to Metformin which I could not tolerate in any form. Moved onto Gliclazide and after a year was on Maximun dose. Was then started on Dapagliflozin which was brilliant, Was on this for about 3 years but kept getting thrush and constant water infections along with a rash so I was taken off this. Thrush ect all cleared and have never returned. I was then put on Ozempic injection, This just made me vomit and again covered in a rash, i continued like this for 6 months before I refused to continue. Because off all these reactions they now want to start me on insulin, which I feel my current HBA1c levels do not warrant, My current HBA1c is 68mmol/mol Is this too early to start on insulin?
Thanks for any advice

 

[EllieM]

Hi @G0WZB and welcome to the forums.
As a T1, I'm probably not the best person to comment on this, but three immediate thoughts spring to mind
1) Have yo had a cpeptide test to see how much insulin you are producing?
2) Have you tried reducing the carbs in your diet to see if that will lower your levels? "Diet and exercise" can mean different things to different people.
3) Is that 88kg a weight you are comfortable with? Depending on your height, you could be under or overweight....

 

[Jaylee]

At what point does Insulin become necessary? I was diagnosed type 2 about 15 years ago, My weight has been approx 88kg all this time Started with usual Diet and exercise and after about 3 years I Then progressed to Metformin which I could not tolerate in any form. Moved onto Gliclazide and after a year was on Maximun dose. Was then started on Dapagliflozin which was brilliant, Was on this for about 3 years but kept getting thrush and constant water infections along with a rash so I was taken off this. Thrush ect all cleared and have never returned. I was then put on Ozempic injection, This just made me vomit and again covered in a rash, i continued like this for 6 months before I refused to continue. Because off all these reactions they now want to start me on insulin, which I feel my current HBA1c levels do not warrant, My current HBA1c is 68mmol/mol Is this too early to start on insulin?
Thanks for any advice

Hello,

Welcome to the forum.

I’m sorry you had issue with some of the meds you were prescribed.

Firstly, could you give a breakdown on what the “usual diet” contained?
Forum rules state we can’t suggest stopping, changing or altering dose on any medication HCPs prescribe.

 

[Deleted member 558820]

Hi Ellie, Thanks for the reply to answer your questions

1, No

2. I've been low carb since I was first diagnosed, Not that that ate many to start with. I've read a lot of posts on here about the subject and I seem to be pretty much doing what others have been suggesting.

3. I don't seem to be able to loose or gain more than a couple of kg no matter what I do, I'm 57 years old and 5ft 11" tall and I consider myself as think fairly active, Walk dog in the mornings\evening then cycle 8 miles to work and 8 back, Longish rides or walks on weekends. Cover about 10 miles day just walking around work but weight stays pretty much the same.

I just think its too soon for insulin with my current HBA levels, there must be alternative medications that i wont react too.

Thanks again for the reply

 

[Deleted member 558820]

Hello,

Welcome to the forum.

I’m sorry you had issue with some of the meds you were prescribed.

Firstly, could you give a breakdown on what the “usual diet” contained?
Forum rules state we can’t suggest stopping, changing or altering dose on any medication HCPs prescribe.

Hi Jaylee thanks for the reply

Im not a breakfast person but if I do tends to be a couple of rashers of lean grilled bacon and maybe scrambled egg

Lunch is usually a salad, lettuce, tomatoes, cucumber spring onions ect with either Tuna, Chicken or lean beef

Evening meals along lines of chicken and Basmati rice or chicken and green veg, In fact I would live just on chicken if my wife allowed me, No potatoes or other starchy carbs

I drink loads of water, Tea and Coffee with skimmed milk, Don't eat sweets, biscuits or pastries, Last 12 months I've had 2 take away Chinese meals at family gatherings. which just left my with high glucose levels and feeling ****. All in all boring diet lol

 

[Jaylee]

Hi Jaylee thanks for the reply

Im not a breakfast person but if I do tends to be a couple of rashers of lean grilled bacon and maybe scrambled egg

Lunch is usually a salad, lettuce, tomatoes, cucumber spring onions ect with either Tuna, Chicken or lean beef

Evening meals along lines of chicken and Basmati rice or chicken and green veg, In fact I would live just on chicken if my wife allowed me, No potatoes or other starchy carbs

I drink loads of water, Tea and Coffee with skimmed milk, Don't eat sweets, biscuits or pastries, Last 12 months I've had 2 take away Chinese meals at family gatherings. which just left my with high glucose levels and feeling ****. All in all boring diet lol

Do you have access to a BG meter or sensor?

Sorry if my introductory post gave a hard time. (Not my intention.) prefer to ask & listen, before piling in?

 

[Deleted member 558820]

Hi Jaylee
Thanks for the reply and no your post didn't give me hard time, Sorry if I sounded like it did.

Yes I've got a meter, I've been very lucky and had one from the start which I have been encouraged to use, It seems otheres on the forum have had a hard time getting a meter from GPs.

My morning levels are between 8.5 and 12 and anywhere upto 18 after just simple meals with little to no carbs.

What I'm interested in is if people think that as my HBA1C is currently running at 68mmol and has been rising over the past 12 months is it too early for me to start insulin, I feel that it is and that there must be something else that wont have side effects I mentioned in my first post.

Anyway thanks for the help,
Brian

PS I used to be a member of this forum when I was first diagnosed but I lost my account so rearrested with my new details. I used to be BrianB

 

[lucylocket61]

Hi Jaylee
Thanks for the reply and no your post didn't give me hard time, Sorry if I sounded like it did.

Yes I've got a meter, I've been very lucky and had one from the start which I have been encouraged to use, It seems otheres on the forum have had a hard time getting a meter from GPs.

My morning levels are between 8.5 and 12 and anywhere upto 18 after just simple meals with little to no carbs.

What I'm interested in is if people think that as my HBA1C is currently running at 68mmol and has been rising over the past 12 months is it too early for me to start insulin, I feel that it is and that there must be something else that wont have side effects I mentioned in my first post.

Anyway thanks for the help,
Brian

PS I used to be a member of this forum when I was first diagnosed but I lost my account so rearrested with my new details. I used to be BrianB

I think this is a question only you and your medical people can answer. I would not be happy running a hba1c of 68 for any length of time. I suggest talking to your diabetes nurse or GP and explaining why you don't want any other meds except insulin. I don't recommend leaving it for any length of time. Just my opinion.

 

[Fenn]

Hi, I think it’s time for insulin when nothing else is working, although I agree 68 isn’t really high, I think it’s too high and might warrant “some help” just my opinion, I’m not medical… or even intelligent come to think of it lol

 

[Deleted member 558820]

Hi lucylocker61
Thanks for the reply, Just to be clear I DON'T want insulin but the oral meds I have been on either don't seem to be working anymore or I have had some sort of reaction to them, one of those reactions put me in hospital for 4 days, fist time id ever been in hospital lol

I feel that even at 68mmol its too early for Insulin but diabetes nurse says we have run out of alternatives. As you say its something I need to discuss with them, I suppose i was hoping someone would say 68mmol is fine and suggest an oral medication that I hadn't used previously that would by some miracle fix me. I can dream. Been getting myself a bit low about this and feeling like a failure.

Thanks for listening to me waffle on, I appreciate all the work you guys do in helping others.

 

[Deleted member 558820]

Hi, I think it’s time for insulin when nothing else is working, although I agree 68 isn’t really high, I think it’s too high and might warrant “some help” just my opinion, I’m not medical… or even intelligent come to think of it lol

Thanks for the advice, I've read some of your posts and you seem very intelligent lol. To me I always saw insulin as the last tool in the box and after that you dont have anything else that can do the job, Im only 57 years old to didnt want to use all my tools in one go if that makes sense

 

[Fenn]

Thanks for the advice, I've read some of your posts and you seem very intelligent lol. To me I always saw insulin as the last tool in the box and after that you dont have anything else that can do the job, Im only 57 years old to didnt want to use all my tools in one go if that makes sense

I totally understand, I felt like a failure for finally giving in to the dreaded insulin, but although it’s the final straw, it’s a very effective straw, your numbers are in my opinion, high enough to potentially cause complications later on so need to be brought down, one way or another, I’m sorry this isn’t the news you wanted but hey, I’m probly wrong, insulin isn’t as bad as it’s made out, it’s kind of nice being able to get numbers down after years of failing to do so.

 

[Fenn]

I know it’s incredibly frustrating when you are doing all the right things and it’s still not working, reading the forum where people are sharing their success stories doing what I was doing but my story was far from a success, was soul destroying, I refused insulin for ages, eventually agreed but kept on and on to get a C-peptide test, turned out I wasn’t making any of my own insulin so literally had no choice, I would push very hard for that, even if you use it as a condition maybe.

edit, it’s possible to have a private test done but it was aggravation and expensive so ask to see an endo consultant, they can request them, you would still end up on the insulin but at least you will know if it’s a good idea

 

[pumas]

Just the usual food suggestions - Do you keep a food diary? Do all foods give those readings or are some better than others? Have you tried 8 hour eating periods? Or longer fasting? Or smaller portions?

 

[lucylocket61]

Hi lucylocker61
Thanks for the reply, Just to be clear I DON'T want insulin but the oral meds I have been on either don't seem to be working anymore or I have had some sort of reaction to them, one of those reactions put me in hospital for 4 days, fist time id ever been in hospital lol

I feel that even at 68mmol its too early for Insulin but diabetes nurse says we have run out of alternatives. As you say its something I need to discuss with them, I suppose i was hoping someone would say 68mmol is fine and suggest an oral medication that I hadn't used previously that would by some miracle fix me. I can dream. Been getting myself a bit low about this and feeling like a failure.

Thanks for listening to me waffle on, I appreciate all the work you guys do in helping others.

In NO way, shape or form are you a failure. Our bodies just sometimes do their own thing, out of our control, despite our best efforts. You are doing your best, you have done your best, and that is enough.

 

[EllieM]

My understanding (possibly wrong, happy to be corrected) is that high blood sugars can cause damage to beta cells and hence very long term T2s can end up producing less insulin than they used to. And if you're not making enough insulin then it really is a great substance (As a T1 I'm a big fan),

I agree with @Fenn that a cpeptide test might put @G0WZB 's mind at rest.

 

[JohnEGreen]

If nothing else is working but Insulin will then go for it the longer you wait the worse the situation will become over time your medical team seem very switched on I wish my doctor would give me a meter on prescription I personaly would take their advice.

Though I would cut out the rice.

 

[jonathan183]

I'd suggest you ask for a c-peptide test to know where you are with your own insulin production - if your own insulin production is too low you will need to start on insulin.
The rice will get converted to glucose ... so will not help you control blood glucose levels

 

[brianb]

Hi All

Just thought id give you all an update.

I've started Insulin this evening

Lantus 10 units to start with and theve adjusted my other meds as below

Glimepiride 2mg
Linagliptin 5mg
Candesartan 16mg

I asked about a c-peptide test as was suggested by a few of you guys but they said wouldnt really change much as tyreatment would be the same.

Ill give it a month and see how it unfolds.

Just notified DVLA online, I'm assuming they will reply at some point and I'm guessing I'll be on 3 year driving licenses?? also phoned my car insurance company to let them know, Thieve just made a note of it and said that it doesn't really effect the policy, I did expect an immediate increase so was pleasantly surprised they didn't.

Oh and my username on here has changed from G0WZB (an Amateur Radio call sign ) to BrianB which is my original account name from when I first registered back in 2008. The admin team kindly helped me retrieve it.

Anyway thanks a lot to everyone who helped me out, Feeling a lot more positive now I've started.

Brian

 

[Mrs HJG]

Now you are on insulin, you should also be able to Libre on prescription, so you can keep a better eye on your levels - if they haven't mentioned it, chase!