Advice on reducing Insulin as I diet

[Geminigirl]

Hi all.

I have achieved a much better HBA1C (6.7) from 13! after several months on adjusting diet, injecting Humulin M3 and Dapagliflozin. I make very little of my own Insulin but am def T2.

I haven't gained weight while on the Insulin but am 3 stones overweight and finding it hard to shift.

The DN at the hospital is not keen on my doing low carb because of the Dapagliflozin not liking it and doesn't want me to stop it as she says my HBA1C will rise. She advises 30-50g of carb each meal (×3). I have found I can't really tolerate much carb at all (bread, rice, pasta etc are out as my levels shoot up and stay there for hours, even with the Insulin. I can manage half a weetabix, half a very tiny frozen mccains jkt spud, or 2 crackers though. Currently I take 38 units of the mixed Insulin at breakfast and evening meal.

I want to calorie count and do lower carb. The snacks suggested to me might be very low carb or no carb but i'm filling up on nuts and cheese! Calorific stuff.

I am bored with my diet too as I have to more or less replicate each days menus to stay within target. As soon as I digress my levels shoot right up. I rise overnight without reason too.

I am inclined to stop the Dapagliflozin. My biggest worry is how to manage the reduction in Insulin. Obviously it is a mixed Insulin, 70% low acting and 30% fast acting. I want to avoid the risk of severe hypos and wonder if I would be better off with separate long acting and rapid so I could match my meals to my units. The DN isn't keen on "complicating" matters!

I daren't carry on with the 38 units x2 if I count my cals and reduce carbs a lot so thought about maybe doing 20 units x2 and seeing what happens.

Exercise wise I walk each day but can't manage too much as I have Polymyalgia and Chronic Pain Syndrome.

Anyway, any suggestions would be welcome.

Thanks.

 

[AndBreathe]

Hi all.

I have achieved a much better HBA1C (6.7) from 13! after several months on adjusting diet, injecting Humulin M3 and Dapagliflozin. I make very little of my own Insulin but am def T2.

I haven't gained weight while on the Insulin but am 3 stones overweight and finding it hard to shift.

The DN at the hospital is not keen on my doing low carb because of the Dapagliflozin not liking it and doesn't want me to stop it as she says my HBA1C will rise. She advises 30-50g of carb each meal (×3). I have found I can't really tolerate much carb at all (bread, rice, pasta etc are out as my levels shoot up and stay there for hours, even with the Insulin. I can manage half a weetabix, half a very tiny frozen mccains jkt spud, or 2 crackers though. Currently I take 38 units of the mixed Insulin at breakfast and evening meal.

I want to calorie count and do lower carb. The snacks suggested to me might be very low carb or no carb but i'm filling up on nuts and cheese! Calorific stuff.

I am bored with my diet too as I have to more or less replicate each days menus to stay within target. As soon as I digress my levels shoot right up. I rise overnight without reason too.

I am inclined to stop the Dapagliflozin. My biggest worry is how to manage the reduction in Insulin. Obviously it is a mixed Insulin, 70% low acting and 30% fast acting. I want to avoid the risk of severe hypos and wonder if I would be better off with separate long acting and rapid so I could match my meals to my units. The DN isn't keen on "complicating" matters!

I daren't carry on with the 38 units x2 if I count my cals and reduce carbs a lot so thought about maybe doing 20 units x2 and seeing what happens.

Exercise wise I walk each day but can't manage too much as I have Polymyalgia and Chronic Pain Syndrome.

Anyway, any suggestions would be welcome.

Thanks.

Firstly, well done on bringing that HbA1c down. That's quite a shift.

To be honest, nobody here can tell you how to change doses as that would break our rules.

My suggestion would be that you speak to your diabetes team and explain you want more flexibility in your diet, and that your eating patterns have become more repetitive than you really want. One option could be to swap your mixed insulin for a basal and bolus susyem, whereby you take the long and short acting insulins independently, but ate able in adjust the short acting, relating to what you eat, without impacting the longer acting at all.

Personally, I might throw in that I was considering winging it a bit to try to adjust meds, although I realise this has some not insignificant risks, and that it would be much better done with (their) support. I'm not suggesting you say that as a lever, but merely reflecting what you are already suggesting here.

If they will not do it, I would ask for an explanation of their rationale in writing. Trust me, it's much easier to mumble some reason or the other about taking no action than it is to rationally justify their actions.

For all we know, based on your overall condition(s), there could be a valid reason, but personally I'd want to see it, if they won't support you in change.