Type 2 Possibly going onto insulin.

[Alan9009]

I’ve been a T2 for about 3 years 4 months. I have tried dealing with rising bg levels with exercise, diet (low carb intake) and starting with Merformin am now on maximum dose of that, Gliclazide and Pioglitazone. The next step is to be put on insulin and maybe other oral meds as well. My blood tests don’t point to me being a type 1.5. I’m just wondering if anybody else has been in a similar situation? I’m not overly worried about using insulin, but given I’m a T2 my progression into taking insulin has been relatively rapid. It’s been quite difficult to cope with the ever increasing need for different medication, diet etc. Does insulin make life any easier? What, if any, are the pitfalls I might expect?

 

[ert]

What tests did they do for your T2 diagnosis? What does your diet typically look like?

Insulin is not the easy option, but it will, if dosed correctly, bring your blood sugars down.

 

[bulkbiker]

I have tried dealing with rising bg levels with exercise, diet (low carb intake)

Any idea how many carbs?
Have you ever had a c-peptide test?

 

[Daibell]

Hi. Did the tests include a C-Peptide test? Many GPs just assume that T1 is only caused by antibodies so only do a GAD test. Viruses can cause LADA and the GAD will be negative but a C-Peptide test will show Low if your insulin production is low. I've been down the same route. Insulin is a nuisance rather than a problem but if you need it there is no alternative if your own insulin production is down. It's better to go onto insulin early so you don't have to stay on the Gliclazide and Glitazone for too long. The former can hasten beta cell decay according to some and the latter drug does have rare but serious side effects. The great thing about insulin is that it gives you freedom in what you eat but if you have too many carbs you may gain weight

 

[Alan9009]

What tests did they do for your T2 diagnosis? What does your diet typically look like?

Insulin is not the easy option, but it will, if dosed correctly, bring your blood sugars down.

Hi Ert,

I’ve had a few C-peptide tests done, they came back in the normal range. I’ve had a lot of other standard tests done. Nothing else came back unusual. I’ve been very careful with my diet and upped my exercise quite a lot since my T2 diagnosis. I have always been in the healthy BMI range and been reasonably fit. My HCP’s say I don’t fit the usual diabetic norm, but diabetes has recently appeared in other family members. I hadn’t heard of it before in our family. Thanks for your input.

Alan.

 

[Alan9009]

Any idea how many carbs?
Have you ever had a c-peptide test?

Hi Bulkbiker,

Thanks for your response. My carbs are carefully monitored and are about 150 to 200 grams per day. I relied on food labelling at first, but found that some foods were sending my BG sky high. Now I only eat foods that are low in carbs ie mushrooms, vegetables, pulses etc. I have found out by default which ones suit me best. Unfortunately my BG is rising beyond 16mmol/l with foods that were once not a problem, but my oral meds are now at the maximum dose.

I have had a few C-peptide tests, they’ve all come back in the normal range.

Kind regards, Alan.

 

[Alan9009]

Hi. Did the tests include a C-Peptide test? Many GPs just assume that T1 is only caused by antibodies so only do a GAD test. Viruses can cause LADA and the GAD will be negative but a C-Peptide test will show Low if your insulin production is low. I've been down the same route. Insulin is a nuisance rather than a problem but if you need it there is no alternative if your own insulin production is down. It's better to go onto insulin early so you don't have to stay on the Gliclazide and Glitazone for too long. The former can hasten beta cell decay according to some and the latter drug does have rare but serious side effects. The great thing about insulin is that it gives you freedom in what you eat but if you have too many carbs you may gain weight

Hi Daibell,

I’ve had a number of C-peptide tests, they all came back in the normal range. I’m interested to know whether or not the insulin you take works well? I thought that ‘Pioglitazone’ was to help with insulin resistance? In other words if I have insulin resistance, injecting insulin will only overload my body with insulin? Or does injected insulin bypass the insulin resistance problem because insulin resistance happens in the gut or elsewhere?

Thanks for your input it’s much appreciated, Alan.

 

[ert]

Hi Daibell,

I’ve had a number of C-peptide tests, they all came back in the normal range. I’m interested to know whether or not the insulin you take works well? I thought that ‘Pioglitazone’ was to help with insulin resistance? In other words if I have insulin resistance, injecting insulin will only overload my body with insulin? Or does injected insulin bypass the insulin resistance problem because insulin resistance happens in the gut or elsewhere?

Thanks for your input it’s much appreciated, Alan.

You need a lot more insulin if you are insulin resistant. I don't have insulin resistance and don't produce any insulin myself but only need 8 units of long-acting and 7 units of fast-acting a day, about 15 units in total. I eat low carb also. With high insulin resistance, some T2's need 300 to 400 units a day.

 

[Daibell]

Hi Daibell,

I’ve had a number of C-peptide tests, they all came back in the normal range. I’m interested to know whether or not the insulin you take works well? I thought that ‘Pioglitazone’ was to help with insulin resistance? In other words if I have insulin resistance, injecting insulin will only overload my body with insulin? Or does injected insulin bypass the insulin resistance problem because insulin resistance happens in the gut or elsewhere?

Thanks for your input it’s much appreciated, Alan.

First I know that Pioglitazone can work well but does have that background safety risk. I'm not sure how it works and it may help IR. Yes, injecting insulin if you already have enough may not be very effective and you may need a lot to see any effect. When i was struggling to control my BS with full dose Gliclazide (320mg), Metformin and Sitagliptin together with a low-carb diet I asked for insulin. It was initially refused (thank you NHS) but finally it was offered. It was a miracle 'cure'. I'm on Basal/Bolus (two insulins) and it gives total control but with the downside of regular checking. When on insulin there is a lot of guesswork deciding what to inject for each meal and so you can go too high or too low. Hypos are always round the corner but so far I've never gone too low and 'lost it'. You are in a difficult position as your C-Peptide is 'normal' but if you are LADA you will find future tests will show it dropping as mine has done. Make sure you or the GP follow the correct test procedure i.e. fasting or not etc.

 

[HSSS]

Points that stand out to me. Most type 2 will have high c peptide as we produce a lot of insulin to over come our resistance (certainly in the first decade or two til it might wain). LADA will gradually get lower and lower. There are other types like MODY that need specialist tests that often don’t fit the typical criteria.

But most importantly you say 150 to 200 grams of carbs a day! That’s still an awful lot for most of us. Many even need as few as 20g a day. If I ate that many I’d have levels like yours I suspect. Have you tried a real low carb approach rather than this moderate carb one? Adding yet more insulin on top of adequately production and insulin resistance will likely make the underlying problems worse even if it temporarily lowers bgl. It’s likely in that situation you’d need more and more and maybe not avoid complications due to hyperinsulemia. I know which would be my next approach in your shoes. But it’s your choice. Maybe lower carb is the great evil in your eyes.

 

[TriciaWs]

I agree with HSSS, 150g is not low carb. So you may want to review your diet.
I was lucky to be able to get into remission on 85g a day but most people have to go much lower. And even on 85g a day more than 30g in a single meal would spike my blood sugar.

 

[Fenn]

Hi, it took me about 6 years to exhaust other options, insulin was amazing for me at first, it gave me control which I hadn’t had in years, but now, a couple of years on, I pretty much hate it, I hate the hypos, I hate the guesswork, I hate that it makes little sense that the same meal can require 6 units today and 10 tomorrow, I give myself 10 next time and hypo.

I’m not trying to frighten you, I’m saying do everything else first, I did (including Vlchf) so had little choice (I don’t think) After years of very successful low carb, I grew to detest it to the point I figured I’d rather suffer the consequences than eat like it forever, I now eat moderate to low (40~80 g a day) I envy people that find low carb easy.

The only thing worse than insulin is numbers in the 20s and nothing to get them down.

In my opinion, if you have to start on insulin, ask for basal/bolus it’s so much easier to have direct control.

good luck

 

[Resurgam]

Hi Bulkbiker,

Thanks for your response. My carbs are carefully monitored and are about 150 to 200 grams per day. I relied on food labelling at first, but found that some foods were sending my BG sky high. Now I only eat foods that are low in carbs ie mushrooms, vegetables, pulses etc. I have found out by default which ones suit me best. Unfortunately my BG is rising beyond 16mmol/l with foods that were once not a problem, but my oral meds are now at the maximum dose.
I have had a few C-peptide tests, they’ve all come back in the normal range.
Kind regards, Alan.

I have normal levels as a type two without medication - but you probably eat as many carbs in a day as I do in a week.

 

[Alan9009]

You need a lot more insulin if you are insulin resistant. I don't have insulin resistance and don't produce any insulin myself but only need 8 units of long-acting and 7 units of fast-acting a day, about 15 units in total. I eat low carb also. With high insulin resistance, some T2's need 300 to 400 units a day.

Hi Ert,

I don’t know what my level of insulin resistace is, if at all. Thanks for pointing that out. I’ll be asking my DN about it when we meet next.

Kind regards, Alan.

 

[Alan9009]

First I know that Pioglitazone can work well but does have that background safety risk. I'm not sure how it works and it may help IR. Yes, injecting insulin if you already have enough may not be very effective and you may need a lot to see any effect. When i was struggling to control my BS with full dose Gliclazide (320mg), Metformin and Sitagliptin together with a low-carb diet I asked for insulin. It was initially refused (thank you NHS) but finally it was offered. It was a miracle 'cure'. I'm on Basal/Bolus (two insulins) and it gives total control but with the downside of regular checking. When on insulin there is a lot of guesswork deciding what to inject for each meal and so you can go too high or too low. Hypos are always round the corner but so far I've never gone too low and 'lost it'. You are in a difficult position as your C-Peptide is 'normal' but if you are LADA you will find future tests will show it dropping as mine has done. Make sure you or the GP follow the correct test procedure i.e. fasting or not etc.

Hi Daibell,

I don’t know much about my diabetes, I am learning as I go along and it’s constantly changing. I don’t know whether or not I have insulin resistance. Your reply has enabled me to formulate some questions for my DN nurse. I do want to have more control over my numbers, but can see from your experience that it won’t be an easy experience.

Kind regards, Alan

 

[Alan9009]

Points that stand out to me. Most type 2 will have high c peptide as we produce a lot of insulin to over come our resistance (certainly in the first decade or two til it might wain). LADA will gradually get lower and lower. There are other types like MODY that need specialist tests that often don’t fit the typical criteria.

But most importantly you say 150 to 200 grams of carbs a day! That’s still an awful lot for most of us. Many even need as few as 20g a day. If I ate that many I’d have levels like yours I suspect. Have you tried a real low carb approach rather than this moderate carb one? Adding yet more insulin on top of adequately production and insulin resistance will likely make the underlying problems worse even if it temporarily lowers bgl. It’s likely in that situation you’d need more and more and maybe not avoid complications due to hyperinsulemia. I know which would be my next approach in your shoes. But it’s your choice. Maybe lower carb is the great evil in your eyes.

Hi HSSS,

My carb intake could be improved, as in being less, I will take that point onboard. I don’t know about my insulin resistance situation and will discuss this with my DN. Thanks for raising the above points.

Kind regards, Alan.

 

[Alan9009]

I agree with HSSS, 150g is not low carb. So you may want to review your diet.
I was lucky to be able to get into remission on 85g a day but most people have to go much lower. And even on 85g a day more than 30g in a single meal would spike my blood sugar.

Hi TriciaWs,

I’ll certainly review my diet. Carbs seem to be my enemy! Thanks for your input it’s much appreciated.

Kind regards, Alan.

 

[Alan9009]

Hi, it took me about 6 years to exhaust other options, insulin was amazing for me at first, it gave me control which I hadn’t had in years, but now, a couple of years on, I pretty much hate it, I hate the hypos, I hate the guesswork, I hate that it makes little sense that the same meal can require 6 units today and 10 tomorrow, I give myself 10 next time and hypo.

I’m not trying to frighten you, I’m saying do everything else first, I did (including Vlchf) so had little choice (I don’t think) After years of very successful low carb, I grew to detest it to the point I figured I’d rather suffer the consequences than eat like it forever, I now eat moderate to low (40~80 g a day) I envy people that find low carb easy.

The only thing worse than insulin is numbers in the 20s and nothing to get them down.

In my opinion, if you have to start on insulin, ask for basal/bolus it’s so much easier to have direct control.

good luck

Hi Fenn,

I don’t find low carbing easy either, but it seems to be the only sensible option. I’ll have do better research for low carb meals. I’m grateful for the insulin type you recommend I’ll put that to the DN. Tanks for you input.

Kind regards, Alan.

 

[Alan9009]

I have normal levels as a type two without medication - but you probably eat as many carbs in a day as I do in a week.

Hi Resurgam,

Carbs review for me I think! Thanks for your input, it puts things into perspective.

Kind regards, Alan.

 

[sgm14]

I think I am in a similar situation, but I didn't get a c-peptide test done, so can't be 100% sure, but my official diagnosis is that I am Type 2. I was on metformin for three years and then moved to a Basal/Bolus insulin just over two years ago.

You don't mention what type of insulin you would be moving to, so if it is to a basal only regime then very little of what follows will apply.

One thing I have learnt about diabetes is that everyone is different in some way, so your experience with insulin might be completely different from mine.

Dis-advantages I found to using Basal/Bolus insulin.

• I have to be more careful and when I eat otherwise I risk going low.
  
• I have to inject before every meal.
  
• I need to monitor my levels more to make sure I don't go low or high.
• I need to know the carb content of everything I eat.

Advantages I found

• It gives me more freedom in what I can eat (Although in practice that does not seem to matter much to me)
  
• It works!

So in the end, it is the only last one that matters. Metformin stopped working for me, and insulin does work, so I'm happy to take it.

Re low-carbs - When I was first diagnosed I was underweight, and when I was switched to insulin even more so, so I wasn't on a low carb diet at that stage. My carb content is now around 100 per day, which I think is technically low-carb, but still considered a lot by the ultra-low carb followers. (I am aware that it is ironic that my carb content is lower now that I am on insulin than when I was on metformin). I did try lowing my carb content even further, but found that I still needed insulin even for a 4-carb meal and I started to loose weight again, so I went back to the 100-a-day level.

The other thing I that I found helped me enormously was the free-style libre which I have been using for about 15 months.