Type 2 Moving into insulin!

I'm T2 and moved onto insulin about 3 months ago. I take Lantus as a long acting basal dose and NovoRapid as a bolus dose with meals.

miahara said:

I'm T2 and moved onto insulin about 3 months ago. I take Lantus as a long acting basal dose and NovoRapid as a bolus dose with meals.

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have you been checked for possible signs of late onset type 1?

I don't think it matters what type of insulin, although eventually people develop preferences. But it's usually at first what the doctor decides to prescribe you. Sometimes they will start with just one of either a long lasting or a fast acting and sometimes both.

I am wondering how long you have been a type 2?

I would reccomend trying to get control with diet first if you havent already. Taking it does not mean you can eat whatever you want because you take it, I beleive type one’s can but not T2’s, its a pain in the butski tbh.

I believe they are all variations on the same theme, so matters little which you start on, it can be very effective if youve been struggling to get your numbers down though, nothing to be afraid of if its right for you.

The stigma of being type 2 does not go away either, its still our own fault as far as the world is concerned lol

Sorry if ive made assumptions, best of luck

EllieM said:

The reason for both these questions is likely to be that many many adult diagnosed T1s are initially misdiagnosed as T2. (A recent study said 38%.) If you move to insulin within a short space of becoming T2 then the misdiagnosis becomes more likely, and it's better to know whether you're T1 or T2, even if you're on insulin either way. Apart from anything else, you may get a slightly better slice of the NHS cake if you're T1 (eg eligibility for continuous glucose monitors).

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The thin type 2 clinical picture can be caused by one of two things: the person has overexpanded a particularly meagre fat store and so is "fat" without being overweight (liposuction/lipodystrophy), or the person is also type 1 at the same time but they're still in the honeymoon phase somehow so they're not running pathologically high ketones (so they may have the autoimmune pancreatic damage that they would have only seen until it got far more severe had they not been driving the DM2 cascade).

And yes it can be both to a degree.

Fenn said:

I would reccomend trying to get control with diet first if you havent already. Taking it does not mean you can eat whatever you want because you take it, I beleive type one’s can but not T2’s, its a pain in the butski tbh.

I believe they are all variations on the same theme, so matters little which you start on, it can be very effective if youve been struggling to get your numbers down though, nothing to be afraid of if its right for you.

The stigma of being type 2 does not go away either, its still our own fault as far as the world is concerned lol

Sorry if ive made assumptions, best of luck

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Even type 1s can-but-shouldn't eat anything they want because the physics of intramuscular or peripheral vein insulin do not work the same as insulin injected into the hepatic portal vein (which the pancreas does, or doesn't in the case of DM1). Persons with insulin agenesis often develop insulin resistance and the resulting metabolic syndrome as a result of a high-carbohydrate diet and trying to match the blood sugar rises with bucketloads of peripherally injected insulin. This can work reasonably well (in the sense of not ever getting too high to function and rarely getting too low) for a long time if they have no family history of type 2 diabetes or its prodromes (idiopathic hypertension, obesity, unexplainable low HDL and high triglycerides (explainable high trig would be due to coffee)), but if they have that family history of insulin resistance, the doses of insulin rapidly escalate (as they do in their non-type 1 family, it's just that their family don't have to inject it and they retain glycemic control for much longer) and it becomes an unmanageable nightmare.

One thing is clear though: DIABETES IS NOT YOUR FAULT, AND NEITHER ARE ITS COMPLICATIONS. Whether it's insulin agenetic or insulin resistant, it's not ultimately your fault. You have a hand in solving the high blood sugars it causes (in type 1, this is done with insulin treatment and a diet leg that does not require of the patient unreasonable amounts of insulin to cover, and in type 2 without any element of type 1 this is done with just the diet that doesn't require of the pancreas unreasonable amounts of insulin to cover) but it's not ultimately your fault. In a very misleading, mechanistic sense, type 2, and complications of both type 2 and type 1, are the sufferer's fault, but the sufferer is not to blame for it - they're just a victim of a broken food system (for both types), and of dentists that can't seem to find tooth infections (for some very bizarre type 1 cases where brittle blood sugars appears to be caused by an asymptomatic tooth infection), among other incompetent parts of The System.

Okay, Ellie M hit it , I wanted to know if I should warn you about being a type 1. But I don't know any type 1 that would have survived 12 years without any insulin and not getting deathly sick before then.

Have you tried a dietary approach as an adjunct?

Ellenor2000 said:

have you been checked for possible signs of late onset type 1?

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I had a pretty comprehensive review with a consultant diabetologist/endocrinoligist back in March and as far as I know I'm still classified T2. I don't really know if T1/T2 really make much difference to me, as now I'm on insulin my BG have been under pretty good control for the first time for very many months. I'd 3 years being treated by my GP who doesn't really know a lot about diabetes before she referred me to secondary care and the local diabetes team have been brilliant. First thing the DSN told me is that I'm not insulin resistant - I'm insulin deficient.
I'll be getting a Libre CGM on the NHS next week. Yippee!!

Hi. Taking Victoza implies you may have some excess weight? If so then T2 is more likely than LADA and insulin may not help that much. Any insulin resistance due to fat deposits would prevent insulin being used by the muscles and adding more insulin to that may achieve little. A c-peptide test would indicate your level of insulin. If your BMI is on the high side then the low-carb diet is the best way forward.

miahara said:

I had a pretty comprehensive review with a consultant diabetologist/endocrinoligist back in March and as far as I know I'm still classified T2. I don't really know if T1/T2 really make much difference to me, as now I'm on insulin my BG have been under pretty good control for the first time for very many months. I'd 3 years being treated by my GP who doesn't really know a lot about diabetes before she referred me to secondary care and the local diabetes team have been brilliant. First thing the DSN told me is that I'm not insulin resistant - I'm insulin deficient.
I'll be getting a Libre CGM on the NHS next week. Yippee!!

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DISCLAIMER: I am not a doctor and this is not medical advice. Please consult a medical professional before applying any principles I advocate for.

If your DSN is right about the insulin deficiency, you're not (at least predominantly) type 2. LADA (adult-onset DM1) can occur around the same time people get DM2, and some people have both at the same time.

FreeStyle Libre is one of those things that's useful to have, because you can prick less often than if you're getting all of your glucose markers from pricks. Many people think you only need to prick once per sensor, or even less - this is wrong. I'd recommend pricking once every other day, because some sensors are woefully inaccurate (but the inaccuracy is consistent) and you need to calibrate how you read the sensor's output against what's real. You may show a long erroneous night hypo if you sleep on your side - pressure appears to make the Libre sensor less accurate (reads low).

Did they actually pull a C-peptide to decide that you were insulin-deficient? Having ultra high bHB in the blood is a perfectly good surrogate, as is combined ketonuria/glycosuria. If your ins. dose looks like that typical of a type 1 your age and size, you likely actually are insulin deficient. This also holds true if you were showing ketones on top of hyperglycemia while having eaten carbohydrates.

I wrote a big block of text about what I understand to be the mechanism behind ketoacidosis (a clear and present danger for someone presenting a type 1 diabetic phenotype). In the block of text I also cursorily discuss physiologic ketosis, and the distinction between that and ketoacidosis. However, I do not want to place the wall of text here because I am worried it will be factually inaccurate or inappropriate. Ask, though, and you will receive.