Should I now consider insulin?

Newbat

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I have been managing to control my Type 2 for the best part of 15 years now but my diabetic nurse is now telling me I should now consider starting on insulin. Presently, I am taking the (apparently) max dosage combination of Metformin, Pioglitazone and Glicazide. My father takes insulin for Type 2 but seems to regularly suffer from hypos and, I must say, injecting insulin fills me with trepidation.
Can anybody please give me a balanced view on whether I should hold out against the starting of insulin and maybe some sound unbiased experiences of how they "crossed over" and the benefits/problems I might experience. Thank you.
 
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Hi, I too controlled my diabetes with diet and medication for a number of years, and was very worried about starting insulin, even though I could see my blood sugars gradually creeping up. However, I have to say it was the best thing I did! I was really worried about the injection (even though I'm a nurse/midwife!!), but it really isn't a problem, easy to do and painless. Hypo's can be a problem initially and I had to adjust my dose a few times, but now it only occurs a couple of times a month, if that. The best bit is that you are really able to control your diabetes, holidays and christmas etc, when I tend to stray a little from my usual diet/lifestyle, is not a problem as you can just give yourself a bit more insulin. I use Lantus which is once a day, and then Apidra with my main meal of the day, but when on holiday and eating more I use a bit of Apidra with every meal.

All my bloods are normal and my last HbA1c was 6.2% which I am pretty happy with. My advice is to give it a try, I fully understand your worries but I'm sure you'll be absolutely fine.

Good luck :D
 

Dennis

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Hi Newbat,

If you are on the maximum doses of metformin, pioglitazone and gliclazide, then I can understand why your nurse would suggest insulin treatment. However, there are other things that you can do that will not only ensure that you don't need to progress to insulin, but will also allow you to reduce all the current meds.

If you can give us some more information on what your typical daily BS readings are and what your HBA1C tests show, then we may be able to help you reach better control without resorting to insulin.
 

Newbat

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Thank you nativenewyorker and dennis.
Dennis - my BS first morning readings (before breakfast) are generally below 7.0 - this morning was 6.4 and 2hrs after meals range from 10.0 to 13.0. My last HBA1C was (I believe) 7.8. I'm off to my clinic tonight so I can be more precise after that. But, is this enough to be going on with?
 

hanadr

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Hi Newbat
Have you tried the other approach to BG control, ie diet?
In other words, the carbs you haven't eaten won't make your BG go up. that's the principle on which the low carbers work.
I too was diagnosed over 5 years ago, but my latest HbA1c was 5.6% and I use less medication than before. I ditched the Gliclazide and manage with up to 4 x 500mg Metformin per day. Most days I use only 2. My doctoe said I can make my own decision on it from meal to meal.
 

Dennis

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Hi Newbat,

Your daily readings are pretty high, particularly the 2 hour post meal ones. Your HBA1C is very high but as you have an appointment today I guess it may be an old reading?

What the post-meal readings seem to indicate is that your blood sugar is being elevated to a level where even the high dosage meds you are on are really struggling to cope with it. There is a reason for this. Your blood sugar is raised not by the act of eating, but by what sort of food you eat. What creates blood sugar is carbohydrate – this converts into glucose and is stored in the blood as blood sugar. The simple answer to having lower blood sugars is to eat less carbohydrate and more of the food types that do not convert into sugar.

Most of us eat far too much of the unhealthy carbohydrates that temporarily make you feel full, but add very little in the way of vitamins and minerals. The worst culprits are the starchy foods, potatoes, rice and anything made from wheat and other cereals. The best source of healthy carbs is from vegetables and fruit, so I would recommend that you have a good look at the sort of things you typically eat over a day and see if you can cut down the amount of starchy foods and replace these with either a lower carb version or with an alternative.

For example instead of cereals for breakfast, have scrambled egg on a slice of low-carb bread. If you have sandwiches for lunch, make them from one of the low carb breads (Nimble, WeightWatchers, Burgen). With your evening meal have half the potatoes but double of an alternative vegetable. I am sure that if you were to try this then after a week you will see a noticeable reduction in your BS readings. You can always tweak this by a slightly bigger or smaller reduction in the carbs, depending on what results you get.
 

Jay3109

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I accept that what I am about to write may be an unpopular view but having spoken to many diabetics and medical practioners over a few years now, time and time again those struggling with controlling their BS with pills and diet have said how much better they feel once they switch to insulin and wish they had done it earlier.

Insulin is not of course a panacea and comes with its own issues. It's just that for many, control becomes easier and diet sometimes less restrictive than with pills or food control alone.
 

Dennis

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Hi Jay,

I certainly wouldn't disagree with you. There are many people who, for whatever reason, are not prepared to take the opportunity that their diabetes diagnosis has given them to improve their diets so that they don't need insulin. As a type 2 I believe that you have 2 choices - you can either say I can and will do something about this, or you can say I can't be bothered to do something about it so I'll just take the insulin thanks! And I think that those in the second group often do see insulin as a panacea - it allows them to continue an unhealthy lifestyle that they can't be bothered to change.

And I suspect my comments may ruffle a few more feathers than yours will!!
 

chocoholic

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But sometimes the docs. get it wrong Dennis too or folks really try to help themselves and STILL have to go onto insulin. I fought tooth and nail not to go onto insulin after only 1 year as a Type 2. I was not overweight but I did increase my level of exercise and was already eating what I considered a healthy diet (admittedly a few more carbs. than I now have). I felt a dreadful failure,even though I had really, really tried to help myself.
As you know, my dignosis was wrong and I'm actually a LADA case but I'd like to bet there are lots more out there who are diagnosed as Type 2 but are actually Type 1 and it drives me crazy when folk think I didn't try to do anything to stop me progressing to insulin so quickly. I did and I bet lots of others have too.
 

Dennis

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Hi Chocoholic,

Yes, I remember well the battles you had to get yourself correctly diagnosed, and I also remember that you tried really hard with diet and exercise before realising that they weren't helping. So it was that experience as much as anything that made you realise that you had been misdiagnosed. There are other cases like yours, but there are too many others where insulin is seen simply as a means to carry on with an unhealthy lifestyle. I have a brother-in-law who falls into that camp. He eats too much, drinks too much and from the day he was diagnosed he made up his mind that the only thing he was going to change was to get himself onto insulin as quickly as possible so that he could carry on eating and drinking as much as he wanted.
 
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Dennis, I do find it slightly offensive that you insinuate that some people use insulin because they can't be bothered to try a healthier lifestyle/diet first. I am sure there are some people like that, but for the majority the thought of going onto insulin is not something they relish. I controlled my diabetes for a number of years but as it is a progressive disease the time came for me to commence insulin, and I was very against it. However I have to say I have never felt better, I control my blood sugars well and with just a little bit of thought around meals I am able to live an entirely normal life.
 

chocoholic

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Point taken, Dennis. I guess there will always be 'some' who won't try. I suppose I just tend to think the majority of folk would do anything rather than succumb to injecting.
 

Dennis

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nativenewyorker said:
Dennis, I do find it slightly offensive that you insinuate that some people use insulin because they can't be bothered to try a healthier lifestyle/diet first.
Hi Nativenewyorker,

I'm not trying to be offensive, just stating a fact. You can deny that some people have that attitude if you want, but as a moderator on this forum for quite some time, I have come across many cases, plus as I mentioned, there is one in my own family! I am not for a moment suggesting that this is your own reason for preferring to be on insulin.