issues with insulin

[Trinkwasser]

This is beginning to sound suspiciously like some slow onset form of LADA where your pancreas is gradually crapping out whatever you do. It seems to have more capacity in the morning which is the exact opposite of what *most* (but not all) Type 2s find with IR reducing throughout the day, Maybe the overnight rest enables you to store a small amount of insulin for the morning: the storage/release system for Phase 1 insulin is often the first thing to go in Type 2 while the Phase 2 production is initially less affected.

Whatever, you need more tests and more opinions IMNSHO, and a bunch of lessons in balancing insulin against food.

 

[LittleSue]

the damage due to high blood sugar is because it is high, it doesn't really matter if its stable or not so long as overall it pretty much stays low, if it doesn't then the complications develop anyway... (?) People who can't produce their own insulin (I'm assuming) don't have many options , but if the issue is insulin resistance then taking BGs down by 1 mmol/l or making them more stable arguably is not worth the risks 'artificial' insulin or drugs carry..

You're right that tradiationally type 1s don't have a choice about taking insulin, and I accept that may alter our attitude to taking it. But if bs is more stable with insulin you're less likely to get the unpredictable spikes you describe, hence you spend less time with high levels.

I've had insulin that hasn't suited me and caused major problems (not just with bs) so I'm not dismissing the risks, but at the end of the day the only way to assess the risks of insulin is try it. A risk, by its nature, is not a guarantee it will cause problems. Believe me, as someone who used to have random bs like you describe and now much more predictable, stability rules!

 

[Trinkwasser]

If I remember correctly chronic high BG is responsible for macrovascular complications but even brief spikes may cause microvascular damage.

Then prinicipally in Type 2s the insulin resistance causes hyperinsulinemia and the high insulin levels themselves are also responsible for some of the cardiovascular and lipid problems.

Add to that genetics, and also luck. My Type 1 uncle (only one on that side of the family) lived into his seventies with no major complications despite the ****** insulins and lack of testing. Mother's Type 2 uncle lost several parts of limbs etc.

 

[increasingly cynical]

Hi Little Sue & Trinkwasser,

Thanks again for your helpful and supportive comments. I did mention the possibility of LADA to the first consultant I was posted to, their comment was that it didn't matter because they treat all diabetics the same anyway (clearly counter to the literature).

I agree with Sue's comment re stability and spikes, esp. given Trink's comments on micro vs macro complications . At the risk of being obsessed with insulin (and/or with my BGs!!) there is though still something I really don't understand.... please bear with me here, as I value your comments which are far more insightful than any medics so far...the available research evidence including large trials and also evidence direct from the insulin manufacturers (who would want to give the best possible picture) says that insulin only takes blood sugar down by an average of just over 1mml/l (1% HBA1c), in combination with other 'diabetes' drugs it can (mainly in poor quality uncontrolled trials) take it down by up to 3. If, as I and no doubt many others seem to experience, one's blood glucose averages around 13 or higher and frequently spikes into the 20s, a reduction on average of just 1 or even 3 mml/l simply cannot prevent eventual adverse outcomes. Since the effect of insulin injection/drugs is not cumulative, what exactly is the mechanism for the assumed prevention of complications by taking insulin/drugs ? I can see that taking an average reading of say 8 mmol/l down to 7 might, but not 13 down to 12, or 23 down to 20..... What is it that I am missing here, since everyone seems to take drugs (although there is not, as far as I am aware, a single study which tests the assumed benefits of taking drugs in terms of either micro or macro vascular complications). Please help if you can - I want to get my head round whatever it is that I have not understood here....

many thanks again :?

 

[totsy]

without my insulin my bloods wouldnt go up from 4 or 5mmol to say 6 or 7 mmol,they would be way up in double figures so insulin does lower it as much as u need it to

 

[increasingly cynical]

Hi Totsy,

Well, that's very comforting information, thank you. Maybe I just need to try it out for a while. I wish the medics were more helpful - they just keep sending me from one consultant to another without anyone explaining what, if anything, they intend to do and why... the Forum in sharp contrast has been really helpful, informative and supportive definately the most helpful advice to date!

Thanks again,

 

[totsy]

your welcome,
all u can do is try it and see, if u need to know anything else just ask

 

[LittleSue]

Hi Little Sue & Trinkwasser,
evidence direct from the insulin manufacturers (who would want to give the best possible picture) says that insulin only takes blood sugar down by an average of just over 1mml/l (1% HBA1c), in combination with other 'diabetes' drugs it can (mainly in poor quality uncontrolled trials) take it down by up to 3.

The key word is average. 1mmol is not the max possible reduction. These studies usually don't take account of how well informed/motiviated the participants were and their HbA1c level at the start.

If you give a T2 (with average diabetes education as supplied by their GP lol) a fixed dose of insulin, without teaching them to adjust dose for themselves (dose only gets adjusted when they see GP every few weeks) then no surprise if it has limited impact on their HbA1c. Compare this with T1s who once settled on insulin are expected to adjust their dose independently for changes in activity, viruses etc. Traditionally changes are made after observing for 3 days but on DAFNE regime any rogue highs are corrected at the next mealtime, not their next medical review!

If I comment on a bs reading, folks at work often ask if that means I need to go to the doctor to get my dose changed. Yeah right, if I did that my GP'd never get time to see anyone else!

If you want insulin to have greater impact on your HbA1c, you need to embrace it and learn about it as if you were a T1. Its time consuming to get the doses right and you'll need to do most of the work. Of course, if your HbA1c is very high at the start you're likely to see a bigger improvement almost immeidatley than if it's lower to start with.

 

[increasingly cynical]

Hi Sue,

That's aos intersting - both you and Totsy seem to feel that the research under-estimates the impact of insulin... very promising from my perspective as I was beginning to give up assuming that any medical intervention was likely to be of benefit... out of interest, did you/do you find that the same amount of the same food (all else held constant) tends to take your BG up by the same amount, or does the change in BG for the same food / same conditions vary a great deal - if so, do you just add in more insulin wehn you find an unexpectedly high reading?

many thansk again for you rvery well informed advice!

 

[jopar]

Hi

To sucessfully get the most out of your insulin, you need to learn to carb count, understand the different carbs react to you and take in other factors such as exercise etc...

It sounds a lot to take on board at one go, but you find that your medical team will give you a good starting point with your insulin doses, then it is a case of monitoring your BG's seeing how they react to the insulin and the carb content of your food, a bit of trial and error, but as time goes on it gets easier, and you will get a good idea of how much insulin you need to inject to cover the food you are eating...

I noticed that you thought that insulin would mean weight gain, I can on my part sort of say I wish... I haven't gained any weight after 20 years of using insulin... I think the trick is the quicker you are up and runing with the carb counting, and true undestanding of carbs you can adtapt your diet to prevent the weight gain... Because in the days you inject a set amount of insulin 2x daily, you sort of had to feed the insulin with carbs.. Just as much as the carbs feeding the insulin..

But the flexibilty of the newer regimes means that weight gain or even weight reduction can be achieved

 

[increasingly cynical]

Hi Jopar,

Many thanks for joining in with your helpful comments. I am new to this and confused, as, clearly, are my medics since they have passed me on from one consultant to another now with no advice or treatment for over a year ... I am a 46 year old 8 stone, lifetime vegetarian with v. small daily intakes of carbs or sugar... my daily calorie intake is about 1/3 of that advised for the 'normal' person.. my average BG now is on about 15 and on a daily basis I spike up to a max of about 27... holding everything the same (exercise, stress, whatever) exactly the same amount of food intake of the same type, under the same circumstances, can take my BGs up by 0 or by 7 or more.. or by none... or take it down......... over the last year both my BGs and my diastolic (but not systolic) bloodpressure has risen astronomically from an average of around 70 to an average of 90, with highs commonly above 100 on a daily basis and up to 148 on occasion... any suggestions anyone? I fear the medics have given up and just want to pass the buck until I fall out of the system...

many thanks

 

[phoenix]

Cynical, I really do think that you need to to something to lower your BS and insulin seems the obvious route. Like the others I think that you are being overly cynical about the BS lowering properties of insulin. Considering how high the BS are in most type 1s are when diagnosed, its very fortunate that it works very well indeed.
What is necessary is that you end up on the right insulin regime for you.
If you are indeed type 2 then it maybe that you need insulin + one or more oral medicines to deal with the insulin resisitance and gain as much as possible from your own insulin production. I did a quick literature search on the ADA journal website and found several studies showing better results than a 1% reduction. In this study they introduced either Insulin glargine (lantus) or rosiglitazone added to people already taking sulfonylurea plus metformin. The A1c reduction was an average of 1.7% for the glargine subjects, glargine also worked better than rosiglitazone in subjects with the highest A1cs at baseline.
http://care.diabetesjournals.org/cg...RSTINDEX=20&fdate=9/1/2004&resourcetype=HWCIT

It maybe that you would be better on a basal bolus regime as described by the others. I've certainly read of very many type 2s (more on American forums than here) using this technique (often with the addition of an oral drug) some of whom have very low Hba1cs.

The other thought is as Trinkwasser suggested that you are not type 2 anyway but have LADA. If so you will need insulin as some oral drugs will either not work at all, or not for long. These sites tell you more about LADA

http://www.locallada.swan.ac.uk/faq.html
http://www.diabetesmonitor.com/lada.htm

 

[totsy]

hya cynical,
i would try insulin,otherwise with numbers like this you are going to end up in trouble,since on insulin ive never had a reading over 11mmol and that was when i was ill :?

 

[increasingly cynical]

Hi Totsy & Pheonix,

Thanks again for comments. I am certainly in agreement with you that something needs to be done with my symptoms! I also agree that a 'trial' with insulin might be informative, but the medics are not that interested - they say that anyone of my age 'must be type 2' and that 'they treat all diabetics the same anyway' so I should 'start on gliclazide' (which incidentally would kill any beta cells I have left if they happen to be wrong....)

I also checked the ADA website. The studies are the same ones I have looked at, so I am still confused (although I don't wish to take up anyone's time anymore, so don't bother to reply unless you are also interested in this). Totsy, you mention a reduction amounting to about a minimum of 9 BG average since starting to take insulin (I notice from your profile that you take about 8 medications, do these all contribute maybe? Have you done anything else like losing weight, exercising more, eating fewer carbs, whatever, or is it really just the insulin?), the manufacturers of Lantus claim no more than the 1.7% average HBA1C reduction noted by you Phoenix (OK, as an average some people may reduce more, but some also reduce by less), but a glass of red wine can take BG down by 2.5 mmol/l .... exercise can take it down by even more... so, in contrast to the research evidence on up to 22,000 people, do you feel that insulin / other drugs have a cumulative effect? Have the researchers got it wrong, or is it a more holistic lifestyle gain that people experience with insulin/drugs? :?:

Thanks again - as above, don't feel obliged to reply unless you are interested , you have all been very helpful and I don't want to take up more of your time

 

[lilibet]

Hi increasingly cynical

I am type 1, on a mixed insulin. This is my only medication of note.
I still feel quite under par (not diabetes related, ongoing investigations for other stuff) so am not exercising yet. I manage carbs but probably eat more carbs than you do at present. I am likely still in honeymoon period but in response to your last post it is only the combination of insulin/managed carbs that make the difference to my bg. I am not overweight but then I never was so there has only been the weight loss associated with diet/dx and that was in Sept and minimal.

Discussions re the limitations of mixed regime aside, like totsy and in fact prob most other type 1's, if i didnt have insulin then my bg would also be in double figures.
More importantly without exogenous insulin all type 1's would eventually die. Timescales for this may vary but without meds and even with starvation it would cause DKA and death. If thats not proof that insulin works then I dont know what is :lol:

I agree with Trink that there seems to be something else going on. If you are a low body weight (btw are you not knackered eating only that amount of calories per day?), manage your carbs well but are still hitting bg in the teens and above regularly then your body clearly needs more help.
The BP may be related to the stress of your body of running bg high most of the time and Im sorry to say that if you want to secure long term health then its not really a matter of if you take insulin but when.

I appreciate your cynicism, and If i was type 2 and had the option of diet/exercise and perhaps oral meds then I would of course have preferred this than to go straight to insulin. However, whatever your medics are suggesting to you isnt working. I cant believe that when you tell them about your diet and that you bg can rise without eating that they arent coming to the conclusion that something is not going on (LADA being most likely).

L

 

[totsy]

im interested,
yes i do take other meds and the majority of these are known to higher blood glucose so i think the insulin works well, i was around 30mmol on diagnosis and hba1c of 12.6, with plus 4 ketones, if i hadnt taken insulin i would have been dead within days, i was just on lantus and metformin for a yr and my hba went from 10.1 to 7.2 so lantus can lower a fair bit, and no i didnt exercise due to other problems :?

 

[Trinkwasser]

IMNSHO your doctors are truly clueless if they are seeing the numbers you quote here and are still trying Type 2 oral meds.

I'm trying to recall the story, he was actually a Type 2 but had a massive infection which was also driving his BG into the 300 - 400 range (15 - 20+) and he was correctly put on insulin in the hospital. It took him only a few weeks (allied to low carbing) to reduce his numbers to normal range, after which he was able to reduce and eventually eliminate the insulin. His A1c was something like 18 and reduced to the fives eventually.

Some Type 1s hit even higher numbers before being rediagnosed and while the fives are not necessarily doable for Type 1s the sixes are comparatively easy.

Personally I would RUN not walk to a different doctor (ask your friends, your pharmacist, any other diabetics for recommendations) and try for a referral to an Endo.

 

[increasingly cynical]

Hi lilbet, Totsy & Trink,

Apologies for delayed reply - I have been away on work. Thank you very much again for your insightful replies. I wonder if there is a case for medics having a workshop run by diabetics rather than the other way around?! i did go back to my GP (who is OK and willing, but said that she 'didn't know anything' about diabetes... she gave me an urgent referall to an endocrinologist, unfortunately he seemed clueless also, he gave me a thyroid test (no results as yet) but when I asked him to do a test that would distinguish between 'type 1/LADA' and 'type 2' he just said 'why - I would treat both the same.. you should start with gliclazide'...aaargh.

I am seeing another consultant soon... in the meantime I think I will just do my own resrecah - let you all know if there is anything which might interest any of you...

Re calorie intake.... I've always been pretty low on calories, I feel rotten now, but not through eating less I don't think... I used to rock climb, horse=ride, fence etc, on this sort of intake, no problem and loads of energy.. not sure if its the BGs or the high diastolci BP that is making me feel knackered now..


Anyway, many thanks again for support - you are all great!