Type 2 going on to Insulin?

[Sharlieboo]

Hi,

I haven't visited here in a while. Been too bogged down in everything

I was diagnosed as T2 in Dec '09 (aged 35). It was a lucky diagnosis because I thought I had a water infection and GP did tests 2 or 3 times because of my age and weight (healthy bmi). At that stage my results were just over 18. Since that time I've monitored every three months, with my meds going up and up each and every tme. I was referred to the hospital for consultant last year because of a query as to whether I was strictly T2 (I am ..... I am insulin resistant because I have PCOS apparently.....).

Anyway, my last blood tests showed a reading of 8.1 but daily monitoring showed individual results as being much higher - often up to 15 in the morning on waking, whereas 'only' 8 or 9 before going to bed. I've tried hard with my diet but am now at the depressing stage where it seems nothing I do seems to be working. I'm on 4 x metformin, 4 x glic and most recently, last week, I'm on sitagliptin 1 x a day also.

The consultant has warned me it is highly likely he will recommend I go on to insulin when I go back to see him in 3 months. He says I can be the model patient with my diet and see how I go with the new tablet but he said he wants me to seriously think about the insulin. He think I would find life easier and it is very possible that even with doing everything I possibly can and being very strict with diet and exercise - I may not be able to attain the magical level of 5.

So, my question is really how T2 take insulin? Is it in injection form and how often? Will I still have to take the pills? I've gained 7 lbs since being on all the meds and it's pushed me up to a BMI of 25 which, whilst just still ok, I'm unhappy about. Will insulin increase the weight gain further?

If I go on to insulin can I go back to eating relatively normally?

I'm feeling really depressed about it all. I also have kidney stones and have to limit protein, nuts and green leafy veg etc... so I kind of feel like 'well, what can I eat?'.

Any advice? Will insulin be 'easier' and will I feel better and will it finally get my blood sugars under control?

Sharlie

 

[Geoff]

Hi Sharlieboo, I believe that at this stage in your treatment, insulin would be of little value in helping you to reduce your bs levels downwards. Why I say this is that insulin is no magic bullet for most type 2 diabetics, it really infuriates me to continuously hear GP’s say that “as a last resort you will have to go on to insulin”, as if there is no hope left for you.

You have stated is that you are suffering from insulin resistance now, it does not matter how much you inject, you will not reduce that resistance, or achieve the stable result that you desire from your treatment. We type 1’s also suffer from time to time from insulin resistance and our very lives depend on taking the stuff on a daily basis.

It is going to be hard for you! But before you consider going on to insulin, you need to make major improvements in improving your body’s sensitivity to the insulin it is producing now. This can only be done by fine tuning the medication you are on at present, making adjustments to your diet, and best of all increase your level of exercise, if that is physically possible.

 

[smidge]

Hi Sharlieboo!

Well, you've asked a lot of questions there! I was misdiagnosed Type 2 and had the whole angst of not being a 'typical' type 2 - I actually still do not know what type of diabetes I have. Anyway, you seem to have some type of insulin resistance (I get a bit of that at time of month although am very insulin-sensitive the rest of the time). I tried so hard to control my BGs with diet and exercise, but II was losing weight rapidly - I know you're not in that situation, but if you can't eat protein, carbs or green leafy veg, there's not a lot left. You might be fighting a losing battle like \i was, eating less and less and getting really depressed that I wasn't able to control it. Sometimes you just have to re-group and accept a different strategy might be more appropriate. Insulin isn't a punishment - I was horrified at the thought of injecting insulin, but it's nowhere near as bad as you fear, and I am actually so relieved to be able to eat without my BGs going into double figures! I've had quite a roller-coaster since going on to insulin (learning to inject - and overcoming a fear of needles; learning aboout basal - starting to understand what my body is doing; changing to rapid-acting - learniing not to inject and then chat for half hour with a friend without eating ; learning to count carbs and adjust doses, getting mad about driving licence issues etc etc etc). I'm still struggling with a recent change from basal to rapid-acting insulin (bad hypo a couple of days ago), but you adapt, adjust and cope! You don't have to put weight on - that's up to your self-control! Really, I don't regret going onto insulin despite the problems - give it a try - you might just find it a relief like I do!

Good luck whatever you choose.

Smidge

 

[Sharlieboo]

Thanks for taking the time to reply.

I'm a bit worried in that one of you says that insulin is unlikely to help me - if that is a last resort then does that just mean I have complications and an early demise ahead of me?

 

[daisy1]

Hi Sharlieboo
Since you have been told you have insulin resistance you could try to reduce it. The most effective way to reduce insulin resistance is to reduce the need for insulin by reducing carbohydrate in the diet and adding physical exercise which wakes up the receptors. (It may be that your possible PCOS makes this impossible or inadvisable for you and I think you need to get some more information on that before modifying your diet.)

I'm not sure if you have already seen this information which was written by the Forum Monitors for newly diagnosed diabetics and I apologise if I am repeating what you already know. I know you are not newly diagnosed but perhaps the information on diet will be helpful to you and help you lose some weight if you need to. This will reduce your Insulin resistance and bring down your blood sugar levels.

Here is the advice we usually give to newly diagnosed diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.


As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l........(Type 1 & 2)
2 hrs after meals......no more than 8.5 mmol/l.....( Type 2)

2hrs after meals....... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Sue/Ken.

 

[phoenix]

I agree that doctors shouldn't use insulin as a threat, why make people scared of an effective option for some people?
google early insulin intiation and you'll find lots of info on the possible benefits. 'It's definitely not a 'last resort' and there is evidence to show it may help preserve remaining beta cells.

Insulin resistance is made worse by high levels of blood glucose, this is called glucose toxicity . Even people with T1 will find they need proportionally far more insulin to reduce higher levels than they need when their blood glucose starts from lower levels. In other words insulin resistance is not just a cause of diabetes, it is a consequence you are more insulin resistant If your blood glucose levels remain high . It is also the high levels that lead to more beta cell loss and complications.
No it's not a magic bullet and you can't just abandon all care over what you eat, but insulin can be work well by reducing your overall glucose levels to a much safer level.
Here's one article
http://www.johnshopkinshealthalerts.com ... 249-1.html