Considering asking to go on insulin

[Liam8668]

Hey! I was diagnosed with T2 in 2017. Started on the usual metformin, that was ok for 12 months. Then my HBA1c started creeping up so they started adding more tablets into the mix, over the years I’ve been on empaglaflozin, glicazide, linagliptin, semeglutide, tried Mounjaro but had bad side effects from that. The most recent tablet she’s put me on is pioglitazone.
I spoke to a DSN who works on the ward I work on at the hospital and asked her advice what to do, she said Pioglitazone is an old fashioned treatment which is rarely used now only as a last resort. I asked what I should do next and she said to consider insulin. I’ve tried the low carb eating, hasn’t worked wonders. My HBA1c in September was 77. I’m due for a repeat in January
Any advice or opinions on insulin is greatly appreciated

 

[JoKalsbeek]

Hi @Liam8668 ,

Something that stood out for me: You said the low carb diet didn't work wonders. The why is worth diving in to. It's a diet some people accidentally get wrong, they eat more carbs than their body can handle still without knowing it, or they can't keep up the diet due to a whole host of issues (like eating disorders, sensory things, depression, what have you), just, you know.... It doesn't work right if it gets done wrong for whatever reason, or it doesn't have the impact it potentially could have had because someone's on steroids for another condition, or statins, or... It really is worth it to find out why lowering carbs, which should lower your blood glucose, isn't working. Because if you got the diet right, you kept it up just fine, there were no other medications or medical issues throwing a wrench in, if there is no actual identifiable reason why it didn't work... Then I think the question shouldn't be "should I consider asking for insulin", it should be "should I request a C-peptide and GAD test to see whether I truly am a T2?". Because if your insulin output is compromised, then yes, insulin would be the way to go, and there'd be no more throwing everything but the kitchen sink at it, anymore. If you're a T1, LADA, Mody... You need to know.

Just something to consider. I can't tell you on whether or not to consider insulin, but I think I'd personally want to get to the bottom of why all these various measures aren't working for you. Is it something other than T2, or is something else keeping you from improving blood sugars? But yeah... If you're high all the time and nothing else works, I'd give it a go. Simply to avoid complications later, as being high all the time is just damaging throughout. But really... Look into why you're high, why nothing seems to do the trick. Where do things go wrong, try to find the cause and if you can, do something about it.

I hope you'll feel better soon.
Jo

 

[Lakeslover]

I was like you. I’d been diagnosed for 12 years, now 63. Had been following a low carb diet which worked for a while then stopped. My diet hadn’t changed, I logged everything and was under 40g carbs a day. Couldn’t go lower because I’m on Empaglifloxin. Ran out of other options. Couldn’t try Mounjaro/Ozmelic because I have background retinopathy. My HbA1c just kept rising. It hit 80.

in October I reluctantly agreed to try insulin. A single daily dose of Lantus, starting on a low dose which I have steadily increased. I have no side effects, don’t find taking it difficult, and it has immediately improved my blood sugars. I wear a CGM which is useful to warn me of any impending hypos, but is also predicting my next HBa1c should be just under 50. I’m happy that by doing this I reduce the risk of complications later.

 

[Royjk]

Hello @Liam8668

I am not sure that insulin is the answer to all diabetes problems, perhaps there is some good reasons a low carb diet and tablets might be also good. My doctor started me on insulin 3 weeks ago, and since then I have been watching every meal, and snack, and altered all my drinks to sugar free.
Even with insulin my blood tests are not automaticly down to the recommended levels, it appears that I need to control carb intake, and adjust insulin input every mealtime to suit the food my wife prepares.
My HCA1c was 103 when the doctor changed my medication, and I will not know what it will be until he tests again, and until then I must continue with insulin and empaglifozin. Before it was so much easier to just take the tablets and test one day a week, now I must test often.
So my recommendation to you would be to wait for you doctor to give you your blood test in January, and hope that she does not recommend insulin. That Carb free diet could be good.
Royjk

 

[Childske1]

I have been T2 since 2015, 55yo & 14st. and initially was diet controlled and managed to drop my weight by 2.5st to under 12st. with a BMI of 23. My HBa1c was les than 40. In 2020 had health issues and work problems and I put on a stone in weight and HBA1c went up to 50 so was put on Metformin which I reacted to and was a massive issue at work ( need I say more), I was put on slow release Metformin which was better but after a year started getting terrible sweats to the extent I had to take a Couple of extra shirts to work everyday. So was put on Lilagliptin which stopped the sweats but did not help, blood sugars constantly >14,neither did my diet HBA1c up at 55 so nurse put me on dapaglifozin for about a year it was great, really well controlled bloods. Then I was diagnosed with an Enlarged prostate. 6months later had urinary issues which I initially put down to the prostate, but it was the data putting the sugar into my kidneys and bladder causing infection. I was off any medication until it cleared up, which was 10 weeks up to early December, and I felt great, bloods have been below 10, nurse then put me back on lilagliptin and bloods are higher by 3 or 4 points.
had n appointment with her yesterday and she told me to stop the lilagliptin and said I think we need to discuss Insulin.
come back in 2 weeks with your blood meter readings and food intake.
I have tried to do low carb, but never managed to get into it as well as I should have.

 

[vslon]

I am referred to see a consultant, hopefully this materialises soon, because after a recent change in medication my blood sugars, especially fasting figures, have generally shot up and I think I would ask to be put on insulin.

My question here are more around:
(a) how would I go about managing the changes in day-to-day life, and in special situations like international travel
(b) social etiquette in terms of injecting myself with insulin while at work or around colleagues in a social setting say at meals
(c) am I jumping the gun in asking for insulin instead of having gliclazide added back

For background, I am a type 2 diabetic, diagnosed over 16 years ago in late 2008, and treatment comprising of diet and oral medication. Soon after my diagnosis, I was put on metformin and sitagliptin. Over the next couple of years, Metformin dosage was increased to 2000 mg per day, and around 2012 gliclazide 240 mg was added. In later years, gliclazide dosage was reduced (early 2016), Empaglifozin added (4th medication) in 2021, gliclazide removed in 2022 and then added back in early 2023 and again removed in January 2025. After this last change, I noticed significant increasing in fasting blood sugars to 11-15 levels instead of 7-8 levels (I generally show high fasting BG numbers as part of the Dawn phenomenon; and this spike is something I have checked a few times with the Abbott CGM sensor), in addition to showing multiple symptoms including confusion (is that was brain fog is?). Recent HbA1C in early March is at 69, up from 59 in late October 2024 and 50 in September 2023.

 

[searley]

From what I read

Weight went down so did hba1c
Then the opposite happened

I’m my mind you need to try and see if you can get back on track

Insulin will probably make you gain weight as it does for many, this in turn will increase insulin resistance and again see raising hba1c

Even if you do get good hba1c unless you have the good diet and exercise then you’ll need ever increasing insulin amounts

In reality insulin needs to be last resort because nothing else works

Also insulin adds all sort of other complications to life, like restricted driving licenses, hypo risks etc

Obviously see the consultant, ask questions and take advice, and if they offer non insulin treatments consider them, as there are many more options rather than metformin

Me looking back, if I had the choice I would have delayed insulin as long as possible

 

[grantg]

My question here are more around:
(b) social etiquette in terms of injecting myself with insulin while at work or around colleagues in a social setting say at meals

can only answer etiquette question part. When i've eaten out prior to going in to sit down for a meal, i've mentioned to staff that need insulin injection and ask if its ok to do. have yet had any say no. If u feel uncomfortable injecting in front of others you could pop into babychange room (if place has one) could also use loo (personally dont like idea of that needs must thou) you could also say for instance ask the waiter for rough time then nip outside 15-20 mins before arrives and do there. I've also injected insulin sitting down beside a chippy (ye i know not the best food...) but hey ho. in busy world buffet place i've moved my jacket to hide it with couple friends/family members either side usually picking a table against the wall which would shield view.

 

[vslon]

can only answer etiquette question part. When i've eaten out prior to going in to sit down for a meal, i've mentioned to staff that need insulin injection and ask if its ok to do. have yet had any say no. If u feel uncomfortable injecting in front of others you could pop into babychange room (if place has one) could also use loo (personally dont like idea of that needs must thou) you could also say for instance ask the waiter for rough time then nip outside 15-20 mins before arrives and do there. I've also injected insulin sitting down beside a chippy (ye i know not the best food...) but hey ho. in busy world buffet place i've moved my jacket to hide it with couple friends/family members either side usually picking a table against the wall which would shield view.

Thank you, this helps. Appreciate your help.