DIABETES 2 INSULIN QUESTION

[NicoleC1971]

I have looked into those newer drugs and I found some of the risks from them to be too serious to trial for myself, especially given the reading I have done about insulin therapy, and that two doctors in my medical team recommended insulin. I haven't asked the others but they probably would have too. I think Fung's work is interesting from a theoretical point of view but I don't see it as being applicable to my own situation.

If you look at Dr Richard Bernstein's advice then he thinks insulin in combination with a low carb diet is a good option for type 2s and recommends which are the best types to take. Not sure why he is against the drugs but if you are doing low carb then at least you are minimising your insulin requirements whereas as I now of type 2s taking 100s of units daily to be able to eat the standard high carb diet and keep their glucose under control (just barely). This is a lot more than a non diabetic produces although that amount is hard to quantify as there are few trials.
Agree that those drugs do have side effects as do all drugs although at least since the Avandia scandal there are more rigorous safety trials.

 

[lindisfel]

Would he give insulin to type 2Ds having low insulin and also those having hyperinsulinemia?

Would seem to go against the science to give insulin to hyperglycaemic T2Ds?

Derek

If you look at Dr Richard Bernstein's advice then he thinks insulin in combination with a low carb diet is a good option for type 2s and recommends which are the best types to take. Not sure why he is against the drugs but if you are doing low carb then at least you are minimising your insulin requirements whereas as I now of type 2s taking 100s of units daily to be able to eat the standard high carb diet and keep their glucose under control (just barely). This is a lot more than a non diabetic produces although that amount is hard to quantify as there are few trials.
Agree that those drugs do have side effects as do all drugs although at least since the Avandia scandal there are more rigorous safety trials.

 

[Alexandra100]

Would he give insulin to type 2Ds having low insulin and also those having hyperinsulinemia?

Would seem to go against the science to give insulin to hyperglycaemic T2Ds?

Derek

Dr B certainly does give insulin to those of his T2 patients he considers need it to attain "normal" bgs. However in his Law of Small Numbers he advocates eating very low carb (for T1s and T2s) in order to keep insulin doses as low as possible.

 

[NicoleC1971]

Would he give insulin to type 2Ds having low insulin and also those having hyperinsulinemia?

Would seem to go against the science to give insulin to hyperglycaemic T2Ds?

Derek

I don't know his rationale but if giving insulin in combination with a low carb diet is key ot his treatment (under 30g carbo a day though he doesn't like to mention the k word!). He is a little quirky e.g. he does not rate insulin pumps but has a tonne of experience and was a pioneer in the low carb approach.

 

[Alexandra100]

You can read about Dr B's Laws of Small Numbers here: http://www.diabetes-book.com/laws-small-numbers/

 

[Alison Campbell]

Insulin for T2 is often misunderstood and we get a lot of unwanted questions and comments from people who do not understand the reasons why we are on insulin.

This a great post @pollensa and adding to my knowledge. If we don't ask questions, how can we improve our understanding.

On the forum we see a lot of people with type 2 prescribed mixed insulins rather than basal/bolus. They read about reducing carbs and want to try to reduce their carbs but find it difficult to adjust without intense medical input and permission from HCP's in a system that does not recognise low carb diets.

Hi @NicoleC1971 , thanks for responding. I've read about ACCORD and thought it was more to do with a now banned drug rather than insulin?

It's not about comparison as I read that type 1's are subject to a postcode lotteries with CGM, pump funding, monitors and test strips etc.

I may only be reading the horror stories on here rather than a true reflection of NHS treatment for insulin dependent type 2 but mostly I see no CGM, no pump, no Dafne, no specialist referral or ongoing support from a Consultant Endo team, no basal bolus, years of high sugars before insulin, and no c-peptide or other insulin level tests.

Not sure of which of the above options might even be useful to a type 2 but do you think is it the treatment of insulin leading to poor outcomes in those diagnosed with type 2 or the care and support surrounding that treatment?

 

[Jenny15]

If you look at Dr Richard Bernstein's advice then he thinks insulin in combination with a low carb diet is a good option for type 2s and recommends which are the best types to take. Not sure why he is against the drugs but if you are doing low carb then at least you are minimising your insulin requirements whereas as I now of type 2s taking 100s of units daily to be able to eat the standard high carb diet and keep their glucose under control (just barely). This is a lot more than a non diabetic produces although that amount is hard to quantify as there are few trials.
Agree that those drugs do have side effects as do all drugs although at least since the Avandia scandal there are more rigorous safety trials.

Thank you for your kind and constructive response. I have studied what Dr Bernstein, and Jenny Ruhl and others have written about the issue and I find their advice logical and a good balance between safety and practicality for me in my life. I am low carbing along with insulin and have no intention of treating insulin like a licence to eat lots of carbs. My carb intake is well under 120g a day - In the last 9 years since diagnosis I have never tried to eat 15-20g a day as I don't consider it necessary or sustainable for me. Thanks again for being thoughtful.

 

[Jenny15]

This a great post @pollensa and adding to my knowledge. If we don't ask questions, how can we improve our understanding.

On the forum we see a lot of people with type 2 prescribed mixed insulins rather than basal/bolus. They read about reducing carbs and want to try to reduce their carbs but find it difficult to adjust without intense medical input and permission from HCP's in a system that does not recognise low carb diets.

Hi @NicoleC1971 , thanks for responding. I've read about ACCORD and thought it was more to do with a now banned drug rather than insulin?

It's not about comparison as I read that type 1's are subject to a postcode lotteries with CGM, pump funding, monitors and test strips etc.

I may only be reading the horror stories on here rather than a true reflection of NHS treatment for insulin dependent type 2 but mostly I see no CGM, no pump, no Dafne, no specialist referral or ongoing support from a Consultant Endo team, no basal bolus, years of high sugars before insulin, and no c-peptide or other insulin level tests.

Not sure of which of the above options might even be useful to a type 2 but do you think is it the treatment of insulin leading to poor outcomes in those diagnosed with type 2 or the care and support surrounding that treatment?

Excellent points, IMO. I would not have felt confident about my decision to use insulin if it wasn't for reading Jenny Ruhl and Dr B. I knew from reading them to avoid mixed insulins. I'm on basal only for now and if that's enough for control then I won't need to add in bolus.

When I was first diagnosed 9 years ago I did not think I would ever need insulin, because LCHF was enough for me. Then I experienced a nightmare 2 year period through no fault of my own... long term hyperglycaemia is so horrible... it can make people desperate for relief before they give up on living altogether.

I think some of those criticizing my decision have not experienced something like that. It's also very unfair to repeatedly criticize someone for their treatment choices... I don't think it would be tolerated here if it was a different treatment for something else.

 

[satindoll]

For any t2 having to take Insulin is not a sign of failure to follow a particular diet or lack of will power......... anyone who thinks it is and criticises us for same isn't worth a second thought.
I was Low Carb (IBS and Diverticular Disease) Low Fat (No Gall Bladder) for many years before diagnosis and went straight on Insulin as oral meds were counter indicated due to the above.
I weighed 9st 6lb at diagnosis and still weigh between 9st 2lb and 9st 6lb....... my Insulin units are 5 units Insulatard in the morning and 6 units Insulatard at night.......... I also take 5 or 6 units Novo Rapid with my evening meal dependant on menu.
I consider myself very lucky as my insulin needs are very small, mainly because I still low carb and the only changes I've made to my diet is to change to full fat cheese, yoghurt and mayo and double cream instead of single cream in my coffee and a little more protein

 

[Jenny15]

For any t2 having to take Insulin is not a sign of failure to follow a particular diet or lack of will power......... anyone who thinks it is and criticises us for same isn't worth a second thought.
I was Low Carb (IBS and Diverticular Disease) Low Fat (No Gall Bladder) for many years before diagnosis and went straight on Insulin as oral meds were counter indicated due to the above.
I weighed 9st 6lb at diagnosis and still weigh between 9st 2lb and 9st 6lb....... my Insulin units are 5 units Insulatard in the morning and 6 units Insulatard at night.......... I also take 5 or 6 units Novo Rapid with my evening meal dependant on menu.
I consider myself very lucky as my insulin needs are very small, mainly because I still low carb and the only changes I've made to my diet is to change to full fat cheese, yoghurt and mayo and double cream instead of single cream in my coffee and a little more protein

Thanks, I don't let the criticism upset me, it's water off a duck's back what some person on a forum thinks of me personally. It's just that it's not allowed by the forum rules, for good reason. Not everyone has thick skin like me.

I am waiting to have my gallbladder removed so I'm interested in what you say about eating low fat after removal. My surgeon and GP have assured me I will still have the same amount of bile to digest fats, but it won't be a mealtime "bolus," it is more "basal" as it drips out from the liver to the digestive tract all the time. They also said that if I develop ongoing diarrhoea from this, there is a medication that can control that and get things back to normal. Keen to learn anything about it you can share, thanks.

 

[satindoll]

Thanks, I don't let the criticism upset me, it's water off a duck's back what some person on a forum thinks of me personally. It's just that it's not allowed by the forum rules, for good reason. Not everyone has thick skin like me.

I am waiting to have my gallbladder removed so I'm interested in what you say about eating low fat after removal. My surgeon and GP have assured me I will still have the same amount of bile to digest fats, but it won't be a mealtime "bolus," it is more "basal" as it drips out from the liver to the digestive tract all the time. They also said that if I develop ongoing diarrhoea from this, there is a medication that can control that and get things back to normal. Keen to learn anything about it you can share, thanks.

Don't want to hi-jack the thread, so lets just say.........No Bile Bolus + IBS + too much fat in one meal = diarrhoea.

 

[Jenny15]

Don't want to hi-jack the thread, so lets just say.........No Bile Bolus + IBS + too much fat in one meal = diarrhoea.

Thanks. Would it be possible to private message you about this, as I want to ask a bit more and as you say, I shouldn't do that further here.

 

[ickihun]

Except of course that his "work" is far from theoretical and is widely used in his clinic to help people.
I'm also slightly worried by your statement that the risks of some of the newer drugs are too serious but that insulin therapy is recommended to you by your doctors especially as you have begun low carbing again. That is a fairly risky practise too.

All insulin taking is risky. When ill or if alcohol is introduced or extended.
Insulin isn't without risk but manageable risk. Without insulin I don't think I'd be here. My kids would be motherless.
My gains are more than just fat cells. I can go swimming or build up my walking or exercise. I can join in with society.
Low carbing isn't enough for me but others must try it as it works for many. Regimented people especially who can afford the time on themselves. My 2 children don't want their mum picking every label up in supermarket when one needs a wee and the other needs more stimulation than the back of a food product.
My full life can only afford a small portion of time and money on my diabetes. Not all.
In my ideal world I'd have nannies and money to buy the best protein goods and the time to cook everything from scratch.
I cannot always do that.
I do what I can.
I'm sure many other mums or lower income workers feel the same. Diabetes isn't their whole life, just a part of it.
Life just isn't the same for everyone. Some are more privileged than others but when food becomes more and more expensive..... "Mums go to Iceland" . Especially in the 6weeks holidays otherwise they are stuck at home when cheap sandwiches can work.

 

[ickihun]

Don't want to hi-jack the thread, so lets just say.........No Bile Bolus + IBS + too much fat in one meal = diarrhoea.

Maybe for none diabetic too.

 

[ickihun]

People can be insulin resistant for decades before diagnosis. Catherine Croft (PHD research into the Insulin Assay and its findings by Dr. Kraft) has discovered that there are people who are non Diabetic but who live with a measure of IR. It must be remembered that raised bg levels is one of the last symptoms of T2 but the HbA1c is the preferred diagnostic tool when a serum insulin test would catch/screen for IR far, far earlier.

I'm wondering if none diabetic or prediabetic. How did they measure it, I wonder?
I wasn't tested as a child but I had the type2 symptoms with weight gain. My 11yr old isn't diabetic (from one blood test) but definitely has the growth hormone as he is nearly 5ft 5in tall and size 11uk mens feet. A baby not treated with metformin in the womb. Compared to other son who was.
11yr old gets very very hungry (leptin levels may be very high like in leptin resistant people).

 

[Jenny15]

I'm wondering if none diabetic or prediabetic. How did they measure it, I wonder?
I wasn't tested as a child but I had the type2 symptoms with weight gain. My 11yr old isn't diabetic (from one blood test) but definitely has the growth hormone as he is nearly 5ft 5in tall and size 11uk mens feet. A baby not treated with metformin in the womb. Compared to other son who was.
11yr old gets very very hungry (leptin levels may be very high like in leptin resistant people).

Interesting questions. In childhood I was just like your son. Very tall for my age, but ended up not much above average, so I must have been growing fast.

Looking back, I think I had poor sleep quality. I showed all the signs of it and was later diagnosed with sleep apnoea at a relatively young age in adulthood. I believe I had mild apnoea in childhood which, if treated, could have helped with my leptin levels and my weight.

Sleep apnoea and other similar disorders are rare in kids but they have a big impact on the child's health and learning. Sleep disorders can contribute to hyperactivity, which is basically fixed when they get treatment.

An easier way to define a child's height and weight for those unfamiliar with children's sizes is to use the paediatric h/w charts to find out where they sit as a percentile. At one point in my childhood I was measured as being in the 96th percentile for girls my age. I read this in my notes as an adult. The GP wrote !!!! after the number but failed to do anything effective to help my parents or me.

If only he had known to ask about my sleep quality and any possible hyperactivity...

 

[ickihun]

People can be insulin resistant for decades before diagnosis. Catherine Croft (PHD research into the Insulin Assay and its findings by Dr. Kraft) has discovered that there are people who are non Diabetic but who live with a measure of IR. It must be remembered that raised bg levels is one of the last symptoms of T2 but the HbA1c is the preferred diagnostic tool when a serum insulin test would catch/screen for IR far, far earlier.

I'm wondering if none diabetic or prediabetic. How did they measure it, I wonder?
I wasn't tested as a child but I had the type2 symptoms with weight gain. My 11yr old isn't diabetic (from one blood test) but definitely has the growth hormone as he is nearly 5ft 5in tall and size 11uk mens feet. A baby not treated with metformin in the womb. Compared to other son who was.
11yr old gets very very hungry (leptin levels may be very high like in leptin resistant people).

 

[ickihun]

Interesting questions. In childhood I was just like your son. Very tall for my age, but ended up not much above average, so I must have been growing fast.

Looking back, I think I had poor sleep quality. I showed all the signs of it and was later diagnosed with sleep apnoea at a relatively young age in adulthood. I believe I had mild apnoea in childhood which, if treated, could have helped with my leptin levels and my weight.

Sleep apnoea and other similar disorders are rare in kids but they have a big impact on the child's health and learning. Sleep disorders can contribute to hyperactivity, which is basically fixed when they get treatment.

An easier way to define a child's height and weight for those unfamiliar with children's sizes is to use the paediatric h/w charts to find out where they sit as a percentile. At one point in my childhood I was measured as being in the 96th percentile for girls my age. I read this in my notes as an adult. The GP wrote !!!! after the number but failed to do anything effective to help my parents or me.

If only he had known to ask about my sleep quality and any possible hyperactivity...

He has no sleep apnea. His sleep is reliable and very deep, thankfully. I'll see what gp says today as a other concern about his growth is concerning us. Being told puberty will change things isn't enough for me. They need to support him, mentally too. I'm out of my depth, medically.

 

[Jenny15]

He has no sleep apnea. His sleep is reliable and very deep, thankfully. I'll see what gp says today as a other concern about his growth is concerning us. Being told puberty will change things isn't enough for me. They need to support him, mentally too. I'm out of my depth, medically.

That's great that he has deep sleep and no apnoea. Good on you for pushing to get him the care he needs.

 

[ickihun]

That's great that he has deep sleep and no apnoea. Good on you for pushing to get him the care he needs.

I don't know what's available but I'm going to ask for metformin as his appetite is out of control.