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Is control easier with insulin?

Discussion in 'Type 2 with Insulin' started by ClareBearJ, Mar 23, 2019.

  1. ClareBearJ

    ClareBearJ Type 2 · Member

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    Is insulin really only used as a last resort in type 2?

    Ive had trouble with control since diagnosis, only with being on the high side really. I had my testing strips taken off my prescription months ago as I dont qualify for them being a type 2. So nowadays I test very rarely with the remaining strips I have left. I knew something was wrong just now so tested for a result of 29.9 mmol.

    I currently take Janumet twice a day along with 2 gliclazide twice a day. Just wondering if the tablet options are running out, or if they have more up their sleeves? Sometimes I think itd be easier being on insulin as in this situation I could quickly bring it down.
     
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  2. Fruitella

    Fruitella Type 2 · Well-Known Member

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    Hi, as far as I know if the gp has prescribed gliclazide they must also prescribe testing strips.
     
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  3. Guzzler

    Guzzler Type 2 · Master

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    With that reading of 29.9 I urge you to call the NHS Advice line on 111.

    You say you are rationing your last few glucose strips so I'm guessing that you do not have a ketone monitor or pee strips?
     
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  4. Jaylee

    Jaylee Type 1 · Moderator
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    Especially if the prescribed drives...
     
  5. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    You really need to find some way to reduce that blood glucose level - are you eating a lot of high carb foods?
    Your doctor must surely have to prescribe some way for you to test if you are taking gliclazide as it can cause hypos, the least of your worries just now but it shows an astonishing level of either ignorance or disinterest in your safety.
     
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  6. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    @ClareBearJ - I understand there are over 400 combinations of drugs available to treat T2, excluding insulin, so it seems there could be room for some adjustments for you.

    At almost 30, I'd say something needs to change. I don't know how you get along with your diet, but for T2s that tends to be a key critical element for control.

    In terms of it being easier with insulin? This is the eternal, circular argument we often see on here. On the surface it seems that way, but many T2s have a problem using insulin effectively. By that I don't mean they're hopeless at injections, but mean their bodies doesn't deal with it too well, and therefore they need a lot of it to achieve results.

    Unfortunately an impact of large insulin doses, not exactly matched to intake/exercise/sleep/stress/illness and all the other factors, can lead to weight gain, which many T2s really don't want or need.

    I'd urge you to try to work something out before considering insulin, but for now, something has to happen to bring those numbers down. In the high 20s they are in danger of causing damage.

    As others have said, if you take Gliclazide, and you drive, you should be prescribed testing strips, due to your driving requirements
     
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    #6 DCUKMod, Mar 24, 2019 at 1:29 AM
    Last edited: Jun 11, 2019
  7. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    Some information on your diet would be a good idea. Examples of what you eat for meals. Diet is imo the most important aspect of your health.
     
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  8. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    Is that a legal requirement? I would of thought so.
     
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  9. Roseanne01

    Roseanne01 Type 2 · Well-Known Member

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    Certainly any hypo inducing meds you need to be testing by. See someone quickly.
     
  10. poemagraphic

    poemagraphic Type 2 · Well-Known Member

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    The DVLA are only interested in ... If you take 'Insulin' Then you MUST inform them and you MUST MUST MUST have a meter... You CAN NOT drive if you go below 5! There is no mention of an upper limit on their website that I can recall seeing.

    I drive 1500 miles a week, every week! I have just requested a license from them as a newly diagnosed insulin taker.
    Whist waiting for this I can still drive as I HAVE informed them.

    On Insulin the danger of going HYPO (Below 5 in their book) is very real. PLUS if like me you are starting a LCHF diet the dangers are even higher of going lower.

    Meters cost less than a tenner! Why would you NOT buy one? The strips cost a few quid granted, However this is your LIFE we are talking about here.

    Is Insulin 'the magic bullet'? Not if you don't change your eating habits it's not!

    Po
     
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  11. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    I don’t know about easier. In terms of glucostability I imagine it will take a fair bit of practice to get right, especially safely. It will, however, almost certainly be more effective.

    But - there’s always a but - it won’t make the glucose disappear. It will forcibly remove it from the blood, sure, but it will cram it into tissues that are already overburdened with too much. Research suggests that insulin resistant people taking exogenous insulin to do not experience better long term health outcomes, despite having apparently better control.

    One must remember that T2DM is not a disease of too much glucose in the blood. That is merely the symptom. The cause is too much glucose in the tissues/nerves/organs and too much circulating insulin trying to keep it there. Using yet more circulating insulin to push yet more glucose into the body is not an ideal treatment, in my opinion.

    It should be added however that there are very few black & whites in this business. Many insulin resistant diabetics also become simultaneously deficient over time, in which case they may have no choice other than to inject. Quantity and effectiveness of your own insulin is paramount. If you have plenty but it’s not really working, then injecting some more isn’t going to do you much good in the long term.
     
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  12. MEValentijn

    MEValentijn Type 2 · Active Member

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    I just started on insulin myself a few weeks ago, so have been reading up a lot.

    Basically it's helpful to start on insulin as soon as it's clear that other meds and lifestyle changes aren't sufficient. Research shows that most Type 2's will need insulin eventually, though it might take over a decade for some. Drawing out the process more than a couple months when blood sugar is poorly controlled just prolongs the misery and the hyperglycemia. But going on insulin is expensive due to the testing materials, so that's probably why health services delay switching to it as long as possible.

    Initially I started on rapid insulin with a prescription from my GP for a few weeks while waiting to see the specialist. The specialist switched me to basal primarily, with the rapid just for corrections (I get sick a lot). The basal insulin is really wonderful. Very low risk of hypos and weight gain compared to rapid insulin. I assumed that meals would still raise my glucose levels enough to require the rapid insulin, but this hasn't been the case - it seems like having my basal output handled by injections means that my pancreas can relax most of the time, and kick into action in response to meals adequately now.

    The mechanisms of insulin resistance don't seem very well understood, but it is known that increasing the amount of insulin with injections is helpful and not harmful for Type 2. So basically, elevated insulin levels are not causing or exacerbating insulin resistance, and injections simply help your cells get enough insulin to persuade them to take up the glucose in your blood.

    The major thing to watch out for is injecting too much and over-eating to counteract the resulting falling blood sugar. Though I haven't had a problem with that, even at 70 units basal every night. Also no problem with hypos ... when I get down to under 5 or so, I think my liver just dumps a bit of glucose to bump me up to a comfortable level. So with one injection every night, 30-60 carbs at lunch and dinner, and some small snacks during the day, I'm nearly always at 6-8 blood sugar, with a brief peak for an hour or two after meals before it goes down again.

    Insulin shouldn't be feared or avoided or delayed if the regular meds aren't working. It can be extremely helpful and end the misery of constant hyperglycemia.
     
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  13. HSSS

    HSSS Type 2 · Well-Known Member

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    At the risk of derailing but I feel it is important dvla guidelines for insulin users are here https://assets.publishing.service.g...e-to-insulin-treated-diabetes-and-driving.pdf. It actually says if under 5 eat a snack to raise levels and if it’s under 4 (hypo) don’t drive but eat and wait 45mins after it reaches 5 again.

    And with regards to glicazide - nice guidelines para 1.6.18 say self testing should be provided if a driver or having hypos or suspected hypos. https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#self-monitoring-of-blood-glucose
     
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  14. poemagraphic

    poemagraphic Type 2 · Well-Known Member

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    The leaflet given out at hospital says you must be 5 to drive.

    That is fine except that 10 mins after testing you could well have dropped below 5 and if you don't test for another 2 hours you could well be below 4 and have no symptoms whatsoever.

    Thank god for jelly babies and rich tea biscuits.
     
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  15. LooperCat

    LooperCat Type 1 · Expert

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    This is from the actual DVLA guidelines on driving. Clinics and hospitals say “five to drive” because it rhymes, is easy to remember and allows some leeway. You can legally drive above four, just have some carb if you’re between 4 and 5. It’s only after a hypo (<4mmol) that you have to wait until you’ve returned to 5mmol, and remained there for 45 minutes.

    9586C777-449F-415D-A742-713F8F1BC852.jpeg
     
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  16. HSSS

    HSSS Type 2 · Well-Known Member

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    Well it is a much catchier slogan and it allows for more leeway as you point out.
     
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  17. HSSS

    HSSS Type 2 · Well-Known Member

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    Snap, cross posting again
     
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  18. poemagraphic

    poemagraphic Type 2 · Well-Known Member

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    True. I wonder how many non diabetics drive around all day under 4. Can a non diabetic go hypo?
    I know very little about this deadly issue we tussle with daily.
    I do know that I feel more alive, more healthy, more energetic, more mentally alert in last few weeks than I have done in over twenty years! All thanks to this website, its contributors, and my new found LCHF lifestyle. Long may it continue.

    Being put on Insulin three months ago was in hindsight the best thing that could have happened to me.
    What a huge wake up call that was. I was 100% determined to come off it after my first night of sticking that tiny needle in my tummy. It felt like 'Seppuku' Not a good feeling for a black belt like myself.

    Po
     
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  19. poemagraphic

    poemagraphic Type 2 · Well-Known Member

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    I am well aware of what is required I was testing up to 10 times a day, every two hours whilst driving without fail. I drive 1500 miles a week! That is a lot of strips ;)

    This was another huge incentive to change my life around and come off insulin.
     
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  20. HSSS

    HSSS Type 2 · Well-Known Member

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    Well a non diabetic is very unlikely to go further hypo and unconscious or dazed and confused and infact being in the 3’s isn’t unusual for metabolically healthy people as their liver glucose and insulin work effectively in tandem unlike ours.

    That said I’m sure lots of people do in fact drive in a state they shouldn’t (eg just plain old tired or whilst sick) but being under 4 for a diabetic on strong glucose lowering meds is a known, quantifiable and recognised risk whereas other risks are less measurable. I guess the nearest comparison would be alcohol as that is also be measurable and that risk is legislated against.
     
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