Hi Sarah,
I too want to say, Don't be scared of insulin. You could last for a long time without it, but it would make your eventual diabetes worse by burning out your insulin function. My decision was to conserve that by starting on insulin. As a result my BGs have got no worse and sometimes, when I'm good, even improves.
This is what I'd recommend based on my own experience:
I think it's better to start with insulin now rather than pussyfoot around with other drugs, because only insulin will arrest/reverse the decline and ensure that you can keep your daily insulin dose low into the long term, perhaps even permanently. That’s important, because insulin should be kept as low as possible, for two reasons: 1) you will preserve your residual basal insulin capacity and this means you will have enviably stable BG levels and will avoid the horrible lows that full T1s undergo; 2) low levels of insulin (i.e. insulin sensitivity) is associated with longer life expectancy. No other drugs can prevent diabetes progressing and keep insulin needs low, except possibly metformin, which can be taken alongside insulin for Type 1s and is an incredibly benign drug with other protective effects, if your stomach can tolerate it. I would agitate strongly to avoid any other kind of drug like sitagliptin etc: they may stimulate the pancreas, but will also burn it out quicker.
Your consultant may suggest one of these three alternatives.
1) Basal insulin only. I tried this; for me it was a waste of time, because the issue with me was post-meal spikes. I was incredibly good, ate less and less, exercised more and got more and more miserable, and my BG levels just continued to rise slowly. Once I took bolus, end of problem. My fasting levels went right down again.
2) Mixed insulin, on the grounds that you are new to all this and you need something simple. Here you are given a 70:30 mix of basal and bolus insulin, and you have to take it twice a day and match your meals to it. You may like this; I wouldn’t. It’s rigid, and you will have to eat to your insulin.
3) Full basal/bolus (or MDI, multiple daily injections). This is what I would recommend. Contrary to what you might think, it’s not difficult. Usually you have two basal injections (night and morning), or sometimes one only. Then you inject bolus 30 mins before each meal. You have to carb count for this. No problem – we are adults and this can be quickly learnt. I use the Carbs & Cals app, and you’ll need to weigh stuff for the first few weeks. Then you’ll know it.
Lucy.