are type II's who need insulin like type I??

Hi. Another factor is that around 20% of those diagnosed as T2 don't have insulin resistance i.e. are not overweight etc and some of those T2s will in fact be undiagnosed late onset T1s (LADA), so the T1/T2 categorisation is just an over-simplification of a spectrum of 'types' and hence some so-called T2s will one day need insulin. Although Diabetes UK and others will claim that a T2 can never become a T1 that isn't a sensible position as some T2s will eventually lose most of their islet cell capability just as a T1 has and the end result is the same even though the cause of islet failure may or may not be different.

hanadr said:

I'm not very knowledgeable about insulin for T2. It's something i wouldn't consider for myself. I also believe that it can be avoided by using LC diet. The problem in T2 using insulin is often in the resistance. If you need to use massive doses, you are still stuck with the fat storing aspect of insulin. So I've met several T2 insulin users, whose weight is going up like an express lift. I even met one once who was using U500[ insulin solution of 500units per Cm3. common insulins are U100] in a pump and he was huge.
I'm struggling to get my weight down and no way would Itouch insulin for myself.
Anyway I don't need it. Last HbA1c was 5.6% and I hope the next will be lower. The meter averages are.
Hana

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It is quite wrong to assume that weight gain is all part and parcel of insulin treatment, insulin treatment does not have to mean weight gain Hana, I was on insulin, basal/bolus routine for 12 months after diagnosis and managed to lose 4 stones in weight by cutting back on the carbs and portion control which I still use today, I started out on 10 units of humulin I at night to keep my night time levels down and 10 units of humulin s before each meal, these amounts went up during the first couple of weeks as I was getting my levels down and then started to drop month by month till I was using around 6 to 10 units a day in total, at which point I was told I no longer needed to use insulin.

Many T2's may have no choice but to accept insulin treatment as part of their treatment and your statement is ill informed at best if not scaremongering.

If at some point in my life I had to go on insulin again it would hold no fear for me what so ever, and providing that you match your insulin needs to your food/insulin resistance then there should be no reason to put on weight. Of course had I carried on taking the 10 units at night and with each meal without tweaking it every day/week /month then I may have had a different outcome but the SDN who advised me on insulin treatment taught me to own the treatment and adjust as necessary, just as you own your diabetes Hana.

Sid Bonkers said:

If at some point in my life I had to go on insulin again it would hold no fear for me what so ever

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Sid a question if you please. Do you think on a "standard" T2 insulin regime like Phoenix described you could hold your 5.4% HbA1c? Like you I don't have any particular fear in ending up on insulin so long as its at a time of my choosing. I wouldn't like it if I thought I was sacrificing good control though.

TallPaul, you didn't write anything offensive in the slightest, all are entitled to their opinion. What I objected to is that although Brett says he doesn't know the cause (who does?) he then goes on to the bad diet/no exercise or genetics route. Either or, no other options. This is the part that really gets to me, for personal reasons but valid ones I think. Too many assumptions made by too many people who should stop and think before posting possibilities as fact.

Re the possibility of diet and exercise contributing to t2, I agree absolutely as you can see from my last paragraph in my post. I am obese and feel that my diabetes and health in general can only be improved if I try and take better care of myself, lose some weight and take as much exercise as I can manage.

Maybe we shouldn't let personal sentiment come into our posts but we are only human. When I know just how much my daughter went through, her other health problems as well as the diabetes I do get bothered when I see remarks about how people cause this themselves. Nothing is set in stone, we don't know for sure so until we do, perhaps a bit of thought before posting.

Just a quick response to Hana. I admire your ability to keep your numbers in check by VLC. Again, you are entitled to your belief about insulin and that you would never consider using it for yourself, that is fair enough. My girl is on insulin and Lantus as well as Metformin. She has had other oral meds as well. Her blood sugars were regularly in the 20's, I mean nearly every single day. Her case is unusual and quite complex, I admit that. BUT-in some cases, insulin is very necessary to prevent long term problems, especially as dietary needs are an issue. We do what we have to do and if there had been another way for her, we would have tried it.

Different strokes and all that.

The under-lying cause of the condition is different however a type II can get into a situation that is similar to type I. If as a type II you have very poor control over a period of time then you are going to do significant damage to your beta cells.. effectively massively reducing the function of your pancreas.. in effect your situation is now similar to someone with type I that has no or extremely limited pancreas function.

It is also worth pointing out that you can be type I and get type II diabetes as well! This is known as double diabetes..

Double diabetes sounds frankly terrifying. Is this how some people end up taking hundreds of units of insulin? For me on like 7 that seems like a pretty hefty amount to inject as a regular thing. :shock:

Daibell said:

Hi. Another factor is that around 20% of those diagnosed as T2 don't have insulin resistance i.e. are not overweight etc and some of those T2s will in fact be undiagnosed late onset T1s (LADA), so the T1/T2 categorisation is just an over-simplification of a spectrum of 'types' and hence some so-called T2s will one day need insulin. Although Diabetes UK and others will claim that a T2 can never become a T1 that isn't a sensible position as some T2s will eventually lose most of their islet cell capability just as a T1 has and the end result is the same even though the cause of islet failure may or may not be different.

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Hi I agree with you.

I am in the eye of the NHS a Type 2 Diabetic. However, I was diagnosed at 26 years old when I nearly went into a coma. My blood glucose was so high my doctor phoned me at work and ask me to go and see him there and then (that was in France).

My Diabetic Nurse here in the UK, a couple of consultants she talked to about my circumstances, and myself are convinced I am actually a misdiagnosed Type 1. We asked to have the blood test done to confirm but unfortunately, my NHS trust thinks it is too expensive.

The issue I have with the fact that I am misdiagnosed as a type 2 is that I am restricted in the number of blood testing strips I get monthly. And this is getting on my nerves. Surely if I test more often I am able to manage my diabetes better, but NO, this is too much to ask. If I was labelled as a type 1, I could have a carton a month if I wanted. That also goes with access to course like DAPHNE etc... type 1 yes you can go, type 2 no sorry you can't.

I just don't understand the thinking which goes, "You are insulin resistant, therefore the best thing for you is to inject you with loads of insulin", although to be fair, I don't think that my doctor appreciates I am insulin resistant as opposed to having a pancreas which doesn't work properly. He might catch on now that my sugars have plummeted. I've reduced my sugars due to low carbing, but have to live with the stress that this might not work forever. I've had my glipilizide (?spelling?) reduced, but now I have zero energy, throughout the day and night, and my sugars are creeping up again. It may be that my pancreas function has been impaired somewhat, and I do still need the extra push. But I still want to put off insulin intake because all the evidence would suggest that I will balloon on that.....

Ah, I'm interested to hear that Type 1's can become insulin resistant. I know someone whom I suspect is going that way. The last time I saw him, he was eating biscuits and carbs quite happily. Are T1's told that sugar is fine? In the sense that they should be able to live a normal life excpet for needing insulin. I mean, a normal diet surely includes some sugar? You see, I would advise him like I would advise a T2, to cut down on his sugar intake wherever it's from, but he could turn around and blast me with a "You don't know about type 1 and my doctor said it was OK and I need to include it in my diet anyway". Which could be a fair statement.

Well, I thought that at first, and then other people said that I would gain. And as I am insulin resistant, I do suspect I would out some on. Oh well, cross that bridge when I come to it. I just don't like the thought that doctors seem to be fixed on the idea that injecting people with insulin is the only answer, and being huge is just something to be ignored.

I was diagnosed as type2 but had trouble control my BG. I then asked to go onto insulin and am now on Insuman Comb 25 and metformin (4 x 500mg per day). However, as far as I know, I am still classed as type2 with a great deal of emphasis on diet control.
I realise this isn't the answer to the question asked, but again, a problem shared is a problem halved.

Mike

Pneu » May 2nd, 2012, 5:30 am
The under-lying cause of the condition is different however a type II can get into a situation that is similar to type I. If as a type II you have very poor control over a period of time then you are going to do significant damage to your beta cells.. effectively massively reducing the function of your pancreas..

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This is bothering me as I was told today by my DSN that, even if I get very good control then my pancreas will have reduced function over time due to the progressive nature of diabetes.

So those who progress to insulin may have done everything they could to try to keep their disease under control. Not just those who havent bothered.

lucylocket61 said:

Pneu » May 2nd, 2012, 5:30 am
The under-lying cause of the condition is different however a type II can get into a situation that is similar to type I. If as a type II you have very poor control over a period of time then you are going to do significant damage to your beta cells.. effectively massively reducing the function of your pancreas..

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This is bothering me as I was told today by my DSN that, even if I get very good control then my pancreas will have reduced function over time due to the progressive nature of diabetes.

So those who progress to insulin may have done everything they could to try to keep their disease under control. Not just those who havent bothered.

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Well that to my mind that is THE question Lucy. My GP said much the same thing. He looked at my BG's which are pretty much constantly between 4.5 and 5.8 so in the non diabetic range and paraphrasing said "Expect to see those rise, maybe it will take a year, maybe it will take ten years but at some point expect them to rise. At that point come back and I'll put you on Januvia for a bit then onto insulin"

Now the counter argument that will be put forward quite rightly by lots of forum members is "xyzzy don't be stupid, don't believe the doc. You're running at non diabetic levels therefore at those levels you wont be damaging any more beta cells so you have stopped the progression. Yes you have lost an amount of function while your levels were high which is why you can't eat rice any more but running at non diabetic levels will stop any more damage occurring."

There is a variant which says even if you are running at non diabetic levels but need insulin stimulating drugs like glic to do it you might still progress as those drugs themselves may shorten the life of your pancreas. That one is a lot less clearer to me but is why I will never go on glic but would consider going on Januvia which isn't insulin stimulating.

Now 99% of me says my fellow forum members are correct and that by keeping to non diabetic levels I will not progress (or the progression will be so slow that something else will get me first). 1% says the doctor may have a point so I will mentally try to prepare for either outcome. Like a load of things in life to cope with them you just need to get your head around them and work through the consequences then they're not so surprising or alarming when the unexpected happens.

I was diagnosed by my GP as T2 about 15 years ago and put on two different pills, advised me about my eating habits, gave me literature about what to eat, what not to eat, and foods to deffinitley avoid, and that was the limit of my 'treatment' for some years. I have had some hypos over the years, not too many, but they can be a blasted nuisance. Up till about 7 years ago, the diabetic clinic at the hospital was always happy with my numbers, then they started going mad, the numbers, not the hospital. I was having readings of anything up to 25, and then having hypos which came on suddenly - the lowest I had, and stayed concious, was 1.1, which frightened me a lot.
I asked my GP if I could go onto insulin, as I had been reading an article about T2 diabetics, and it said that a lot ofT2s who went onto insulin felt so much better in themselves. He said that he would look into it and told me to come back in a week. One week later I saw him again, and he said that he would put me on insulin, drop one of the pills, and keep me on metformin as well.
I asked him if this meant I was now T1, but he said that diabetes didn't work like that, and I was still T2.
Since being on the insulin, I have been a lot better in myself, my glucose readings have been a lot more stable, and I don't feel as washed out by bed time like I used to.
It is always worth asking your GP about whether you would be a good candidate for insulin, and see what he/she says. If I hadn't read that article, I would probably still be having the pills only treatment, and feeling grotty by the time I went to bed.
Hope this helps, good luck and keep well.
Wilma

For those of you who have GPs that refuse to give you the CPep and GAD tests to establish type 1 from 2, you can ask for a private referral to an endo at any time and pay for those tests. You would be looking at around £500 - £600 in total for a couple of consultations either side of the blood tests. You will usually be seen within a fortnight and from my experience, you get a very interesting and detailed consultation in a relaxed atmosphere, unlike the rushed NHS experience.

I have only ever seen my knee surgeon when I paid him and when he did the op (back on his NHS lists). All follow ups were with his senior physio as was my consultation for the second knee last week! These days if you want to see the right people unfortunately you sometimes have to pay.

Luckily, we have Benenden Membership, a friendly society based in Kent.

Ali

Ali H said:

For those of you who have GPs that refuse to give you the CPep and GAD tests to establish type 1 from 2, you can ask for a private referral to an endo at any time and pay for those tests. You would be looking at around £500 - £600 in total for a couple of consultations either side of the blood tests.

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WOW - that is SUCH a bloody comfort to those of us who are on benefit, scraping a living working part time cos there is not more hours available.

Let me see - yep, if I go without food for myself and my children for at least 7 weeks, I can just about afford it!!

(can you tell I am cross and upset)

Edited to add: I have just realised that sounds like I am getting at you Ali H, sorry, didnt mean it that way. I am furious at the situation.

Yep the situation sucks doesn't it, it shouldn't have to be like that. Whilst I am currently a carer also on a limited income and not paying NI because I am exempt, I have paid a ton of tax and NI in the last 25 years. As I said, I am very lucky to have Benenden membership at £1.50 a week. It is being opened up to anybody next year so please look at their website. They have been a godsend for me. I pay up front but claim back my costs, no excess.

However, the point I was making was that for those who have a GP that flatly refuses to help and is in a position to go private, it is always an option. Some people do not realise you can ask for a referral at any time. Then once you are armed with the facts, and for those that are found to be type 1, they can then go back to their GP and start to get the right advice re DAFNE and testing strips. I was only trying to point out another avenue available to some.

Ali