Type 2: Can They Switch to Insulin?

[three1ne]

Hi all.

After some advice and just a bit of general knowledge here.

I'm Type 1 and have very good control.

I know a few older people who have Type 2. They always mention their sugar levels are all over the place and they believe the tablets and their diet to be ineffective and restrictive.

Being a naive Type 1 diabetic I wonder why they can't simply switch to insulin which offers more freedom.

Is it that simple or is there an actual difference between the types which means it's not as simple as migrating to insulin injections with Type 2?

 

[eveshamgal]

As I believe it most tile 2's will eventually make theI've to insulin. I was threatened with it at my last check up buy managed to persuade them to let me try being mote compliant with taking my medication and sort my diet out.

I'm hoping it's not too late as I really don't want to be in insulin yet

Sent from the Diabetes Forum App

 

[anna29]

Hello three1ne.

You arnt naive at all .

I myself was initially baffled and wondered this when they were trying me on various pill/tablet formula's
initially as a new Type2 .

Asking my own consultant this very question - his reply was - we try the diet and metformin first .
Then progress onto other oral [pills/tablets] medication if no success .

When it was clear I couldnt tollerate or the ones that I could actually tollerate 'failed' to get my
high blood sugars under control .

The answer was staring us 'both' in the face - yep "insulin" only option left to me ...

I was very angry to have had 18months of being tried on many pills/tablets meds that had failed
one way or another :x
To me it felt like wasted precious time [my time too]

Within 3 months of being on insulin all was under control very quickly and I felt amazing a
trillion times better for it too !!!

So I do understand the reasoning behind your question three1ne .

Type1's its automatically insulin therapy , Type2's it seems a system of diet , diet plus pills/tablets first
are tried , if all else 'fails' to control or its got too progressive then yep its insulin therapy for us Type2's too .
The HCP's will only use or do this as a last resort though ...

Hope this can help .

Anna.

 

[Sid Bonkers]

Is it that simple or is there an actual difference between the types which means it's not as simple as migrating to insulin injections with Type 2?

Yes and no :lol:

A big factor in T2 is insulin resistance where we make enough insulin but it doesnt work due to our insulin receptors not being receptive enough so if we use insulin we need to use high doses which often means having excess insulin in our bodies this then just lays down more fat if we dont keep a very close eye on our diet and more fat creates more insulin resistance so it can become a viscous circle.

On the other hand I was put on insulin at diagnosis and managed to lose 56lb (25Kg) which reduced my insulin resistance to the point where I was able to come off insulin all together :thumbup:

Then there are those who go onto insulin who have both insulin resistance and beta cells that have died through being overworked by years of trying to produce more and more insulin to combat the insulin resistance.

So insulin can be useful but care needs to be taken not only to match the insulin to the food we eat as a T1 would but we also then need to address any weight issues to reduce any insulin resistance we may have or we slip into the same sort of problem as a T1 who develops insulin resistance, or double diabetes.

And even though 80% of diagnosed T2 diabetics are overweight even skinny people can develop insulin resistance which I guess explains the other 20% of diagnosed T2's. Insulin resistance It is commonly believed is caused by visceral fat which is why it is so important for T2's to try to deal with any weight problems. And diet can also help those T2's who are not overweight but may still have visceral fat around their organs. Visceral fat is unfortunately invisible and can not be judged by a persons appearance.

I believe that the aggressive insulin treatment in the form of multiple daily injections (MDI) and my very strict diet for the first year of my diagnosis was the reason I am now so well controlled and on just the minimum of medication. So insulin treatment can have great benefits for T2's even at diagnosis

 

[three1ne]

Anna, Sid Bonkers,

thanks very much for the detailed replies. It's really appreciated. I'll pass on the info to my mates.

 

[Daibell]

I would perhaps add a few points to Sid and others posts. The 'Type 2 'diagnosis contains a spectrum of diabetes types most of which, the 80% that Sid mentions, would be insulin resistant probably through being overweight but that's a generalisation. It is better to try to remove the insulin resistance first before insulin otherwise you have a vicious circle. This is why Metformin in particular is prescribed. The remaining 20% of those diagnosed as Type 2 can be anything from a mis-diagnosed late onset Type 1, to those with a failing pancreas due to pancreatitis, virus, or other less common pancreatic antibodies plus sometimes a bit of insulin resistance as well. I fit the 20% category with a failing pancreas for whatever reason but not due to insulin resistance. Late onset T1s and others like me need to go onto insulin when the three tablet regime fails (or even earlier some would say). The problem is GPs often think there are only two types of diabetes T1 and T2 and nothing in between and once you are labelled a T2 you are sent down a route regardless. Those who are insulin resistant or are T2 through steroids, pregnancy etc may well never need insulin; just diet, tablets and time. Those who have a naturally failing pancreas need to move to insulin when tablets fail to control blood sugar. I should have gone onto insulin 2 years ago but my GP refused saying 'it's a last resort' (well, I was labelled T2 wasn't I!). Fortunately at my last annual check-up common sense applied and insulin is the right solution for me. So, in summary the right diet is essential, then tablets and then insulin when the HBa1C goes above 7.5'ish. Note I also had a c-peptide test done privately which proved I had very little natural insulin so this is another indicator for insulin injections.

 

[Homer]

Not only do I think that the question is not naive I cannot see any sense in oral medication like sulphonylureas.

I was diagnosed type 2 in 1999 and was prescribed gliclazide and the NHS healthy diet (lots of carbs) and subsequently my bg's were all over the place, then I discovered forum's like this and came off my medication and controlled my bg's very successfully with diet and exercise.

About 2 years ago I made the decision (after a hb1ac of 7.5%) to take medication to help me better control my bg's and decided on Insulin and must say I have never looked back.

The advantage of insulin versus tablets is that you are in control, whereas with tablets you will still put on weight, burn out your pancreas and will have a difficult job in getting good control. I also think that taking tablets is like feeding steroids to your pancreas - your pancreas has already told you that it cannot produce enough insulin so making it do something (like running faster) cannot imo be good for you body and that is why imo we seem to get a lot of complications from these drugs.

I agree with sid that taking insulin can cause you to put on weight/increase insulin resistance but this is only if you eat too many carbs, so you still need to take care that you use insulin and diet and exercise.

 

[hanadr]

T2s can switch to insulin. I believe that with a little self discipline and a lot of knowledge it's not necessary. I've been diagnosed 10 years and I use less Medication [2 x 500mg Metformin pd] than quite a number of newly diagnosed people. I am very careful with eating, however.
I do think that using insulin as a way of making life easier is an illusion.
Many of the people I know who find their numbers too high with tablets, eat too much of the kinds of foods which put blood glucose UP.
My mother's neighbour was put on insulin recently. He still uses Metformin as well and has poor numbers, but he will not consider cutting back on bread and potatoes and doesn't eat veg4etables or salads at all.
Now he's at risk of hypos and all that entails, plus he's visibly gone into the weight gain spiral.
I have had a lifelong battle with my weight, which I don't want to lose. I'm holding at the moment!.
I also don't want to risk hypos or my driving license.
I'm married to a lifelong T1 and need to be able to be there for him if things go awry as they have a few times in the past.
my LC/HF diet works well provided I stick to it, which I do overr 90% of the time. I have had HbA1cs in the 5s for years. I don't feel any serious deprivation, not eating cakes and biscuits etc. I'm pretty fit for my age and rarely ill. although I had a virus earlier this year, which was hard to shake off.
So I shall avoid insulin, because it's just not worth the drawbacks to me.
Hana