Confused!!

Cut a long story short!!
11 weeks ago I was admitted to hospital with blood levels of 18.8-25.4, had a shot of insulin (humulin m3) had to go back the following day for more tests and another shot of insulin. The tests came back type 2 although the tests were for type 1!! I have been on 19 units of insulin daily (injection) for all of the 11 weeks. Went to see the doctor at hospital today and he want to put me on metformin as well as the insulin, I did ask him why but thinking about it now I don’t understand why and what the metfofmin will actually do along side the insulin? Does anybody know? I left a message for the nurse to phone back tomorrow but if anybody knows why in the mean time it would help me relax a bit!!
He also wanted me to stop the insulin but due to other issues and medication change for psoriasis because of the diabetes I said I didn’t want another change of meds. He has also signed me back over to the GP, is this normal? Many thanks

Moderator note: This thread contains merged content.

The nurse also said that if I did decide to stay with the insulin the doctor would probably change it to something that gives me more meal flexibility, (basal-bolus) is this something the GP can do?

MeiChanski said:

Hello, Could you please tell us what type of diabetes do you have? so we can give you tailored answers to your diabetes.
Oh sorry I didn't read it properly - you're type2?

There are type 2 diabetics on insulin along with metformin, I'm assuming you're still quite insulin resistance. Some are on the basal-bolus regime to give them more flexibility with meals.

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Yep, sorry. Type 2

Is the change to basal-bolus regime something the GP can do, I didn’t like to ask the doctor as he wanted me to come of the insulin altogether but I wasn’t comfortable with having another medication change. I will ask the nurse tomorrow but I’m so confused right now, I always seem to come out of doctors appointments with more question than I go in with.
What job does the metformin have working along side the insulin?

MeiChanski said:

I'm only speaking as a T1, but I know consultants can recommend insulins etc and get the GP to prescribe it. So my answer would be no, the GP can't change you to basal-bolus regime without the consultant or your team giving him or her the go ahead. Diabetes especially those on insulin is out of the GP's expertise. I'm assuming you need more education on the basal-bolus regime, so I'd think thats what your diabetes nurse or your team is trying to help you with?

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The doctor signed me back to the GP so I’m presuming the hospital diabetes team will do the same?
Also what job does the metformin do along side the insulin?

Freema said:

usually, a person that has just become diabetic type 2 can actually live without adding insulin if he/she does follow a very low carb eating style, most can get back to normal levels of blood glucose, in this forum you can also learn how...
metformin helps a bit, in my case, it lowered my blood glucose in general with around 1 mmol, which was actually enough when I was strict with my food choices..

you could have had type 1 that´s why they gave you insulin initially..
some type 2 diabetics do end up needing to have insulin on a daily basis along with the progression of their diabetes, where their pancreas in many cases end up producing too little insulin due to the high levels of blood glucose maybe damaging the pancreas

but I guess in your case you just need to learn to cope and chose the right kind of foods.

most type 2 actually have very raised levels of insulin initially, but the body doesn´t react enough to it and it doesn´t seem to let the too high levels of blood glucose into one's cells, the system of storing blood glucose is a bit out of whack it seems.. a lot of people do gain a lot of weight from the very raised level of insulin too.


till now there has not been a lasting solution to cure insulin resistance which is the main problem in type 2 diabetes... the problem is not a lack of insulin initially. when having too high insulin and blood glucose all the time some damage will take place in the body, which is why many end up with a lot of adding diseases , but you can learn to control your blood glucose levels by avoiding carbs...

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Thanks, I understand it all a bit better now which is obviously why the consultant wanted to take me off the insulin and start the metformin. The reason I said no was that I suffer from severe psoriasis and because of the diabetes the dermatology consultant want to change me from cyclosporin to methotrexate so I’m not keen on yet another change until I know the methotrexate has been started and my psoriasis is under control.
I do eat well and am very careful with food stuff that I do eat, I initially lost 1.5stone when admitted to hospital so I have been very careful

Daibell said:

Hi. First GPs can diagnose diabetes and prescribe insulin. DNs in the surgery if trained can change the insulin and advise on it's use. I'm on Basal/Bolus. I have never gone beyond my surgery. I'm still listed as T2 but obviously LADA but that's another story. My DN knows what she is doing so I have no problems with my surgery except my initial diagnosis was mis-managed by the GPs. I do have Metformin which I've had for years (as I'm a 'T2'!). It does make a small difference to your blood sugar when on insulin and apparently does have other protective properties and for most of us very few side effects (for me none). I'm surprised the consultants are worried about insulin interactions with other conditions but there will be exceptions. So don't worry about having the Metformin. You need to see whether the diabetes clinic will continue to manage you or the local surgery. Some posters have hit confusion with this. If you have a good surgery like mine overall then just being managed by a good DN can be fine. Make sure you do finally get a good diagnosis as I never did. Insist on the tests for T1 if there is doubt about a T2 diagnosis. If you really do need to lose weight then T2 is the most likely.

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Thanks for this it has put my mind at ease. The hospital doctor referred me back to the GP so I made an app with him (the GP who dealt with and sent me to the hospital) so I’m confident with him. I’ll phone the surgery today to make an app with the DN, and have booked on a carb counting course and make a decision if I would like to change. I’m not convinced by the t2 diagnosis as when in hospital I had all the systems of t1 so that what they tested for and started treatment as t1 (straight on insulin). When the test results came back and t2 they wanted to change to gliclazide and said they may not work as there max dose was equivalent to the amount of units of insulin (19 units a day) I was taking therefore metformin would work. The dr at hospital wanted to take me of the insulin and start on metformin so you can imagine my confusion when only 4 weeks ago they said metformin wouldn’t work. I have chosen to stay on the insulin because I know it works and feel uneasy about as the meds for my skin has to change. (Too many changes in such a short space of time and I’m really struggling with it all).

Bluetit1802 said:

Metformin is a mild drug that is prescribed as a first line medication for T2 diabetics. It helps very little with blood sugars. It does help to reduce the amount of glucose your liver produces naturally and can help with weight loss. What it won't do is prevent your blood sugars from going high after eating.

If you are overweight, and as the tests you had confirmed you are not type 1, it is highly likely you are insulin resistant. If that is the case, your pancreas is producing plenty of insulin on its own, but this isn't working as it should because the cells reject it due to the resistance, and the glucose remains in your blood stream until such time as the pancreas has secreted enough insulin to clear it. I imagine your doctor wants you off insulin because this could be making your diabetes worse - too much insulin circulating will make the resistance worse. Perhaps it would be a good idea to ask the doctor why he wants you off the insulin. Was he suggesting another drug in addition to the Metformin?

It is quite normal for the hospital diabetes clinic to discharge you back to the GP. Hospital clinics normally only care for type 1's except in very unusual circumstances.

I assume you have your own blood testing monitor. What sort of levels do you see?

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I lost 1.5 stone before diagnosis and weigh just under 10stine so not over weight. He just said stop the insulin and I’ll get your GP to prescribe metformin. That’s it. I didn’t want to stop the insulin as I know it works and with the change in meds for psoriasis I didn’t want too many changes. I am struggling with everything anyway so feeling easier sticking to/with what works. Maybe once the other meds have changed and if they work then I’ll think again about the insulin. I have a dr app and will phone the surgery to make app with the DN nurse. It’s just a case to too many changes but too little information. Please also read my reply to diabel which explains my confusion. Thanks

JoKalsbeek said:

I had a quick read about the meds you're on, and the medication for psoriasis which you were on, lists diabetic symptoms or worsened diabetes as a side effect. Could be why things got so bad so fast, and could also mean you'll improve over time, as you've gone off it. So switching to methotrexate is a good thing for you right now. As for metformin: It tells your liver not to dump as much glucose as it normally would (by about 75%). Insulin tackles the bloodsugars from both what you ingest as well as your liver's dumped glucose, but if your liver calms down some (which is where the metormin comes in) could make a difference in how much you need. The less you need, the better, especially since you're a T2 with insulin resistance. The more you use, the more insensitive you become, and you want to avoid making that worse. They tested you for T1 because they needd to rule it out, it's a good thing that test got done.

I don't know whether your pancreas is still producing insulin by itself, but when things calm down a little and your body stabilises a bit, you could look into a dietary change to assist your body. Since carbs are a problem for T2's, and they are an inflammatory macronutrient which probably doesn't do your psoriasis a whole lot of good either, it may be something to look into. Or not. I do think right now you need to keep things as stress-free as possible, get some rest, get into a regular flow, and go from there. You might want to read The Diabetes Code by Dr. Jason Fung, as there's a whole lot of answers in there to questions you don't even know you have yet. I know the feeling of coming away with more questions than answers after an appointment. It helps if you read up in advance, so you know what to ask, and understand the answers given. It's a lot to deal with, but give yourself a little time eh.

Good luck!
Jo

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Thanks for all this information, it is useful reading actual people going through experiences rather than just reading from the websites.
A lot of the confusion comes from the fact that when the results first came back as type 2 the nurse said that I wasn’t producing enough insulin so another test had to be done, result still came back the same. Then 6 weeks later I see the diabetic doctor and he tells me that I’m insulin resistant and producing too much insulin? (Which is it??). Because of this the wanted to take me off the insulin and onto gliclazide but that may not work as was equivalent to the amount of insulin I was injecting and the metformin wouldn’t be strong enough so WHY 6 weeks after telling me that do they want to put me into metformin and off the insulin??? The diabetes needs to be under control before they will change my other meds to methotrexate but I’m worried that the metformin on its own will imbalance the diabetes and put me back to square one. Do I try this and just not think about the other meds for now?? If the metformin doesn’t work then try something else then possibly back on insulin anyway? Or stick with the insulin because I know it works and starts the other meds then if they stabilise the psoriasis then think about coming off insulin? I have so many doctors, consultants and nurse all telling me something slightly different and not communicating amounts themselves?? The good thing is that I phoned my surgery to make an app with the diabetic nurse and when I explained to them that the hospital has just referred me back to the surgery they pulled my GP app forward so am seeing him next week. It’s all happening too quickly and I have so many questions. It only because of the diabetes that they have noticed that I have out run the time span on the cyclosporin and that’s why they need to change to methotrexate.

I’m almost tempted to stop the insulin just to see what happens!!