New to forum, looking for general advice for Insulin

[super_mum1001]

Hi All,

I'm currently 70 years old, been type 2 diabetes for more than 20 years and my recent HBA1C was 72mmol. My blood sugar does fluctuate quite a lot throughout the day, normally is around 8-10 fasting and can shoot up to 10-17 2 hours after meals.

Current medication:
Gliclazide 80mg x 4
Canagliflozin (Inovkana) 300mg x 1
Metformin/Sitagliptin x 1

I probably need to find a new GP as he doesn't spent the time asking about my diet/lifestyle and has said I should really think about taking insulin but I'm worried about the side effects and do not want to go down this route. I'm trying to make lifestyle changes by lowering my carbs, increasing my fat and going on 30min-1hour walks everyday.

Should I look to get insulin to bring my levels down initially and then reduce back to tablets potentially? Or find another GP who will re-review my medication and try and get my levels down without insulin?

 

[EllieM]

Welcome to the forums @super_mum1001

For T2 diabetics, the biggest difference they can make to their lifestyle is to reduce their carbs. You are carb intolerant, and produce more and more insulin to process those carbs. If you eat too many for your body to cope with, your blood sugar goes up because your body is producing the maximum amount of insulin it can and it still isn't enough. Unfortunately a side effect of lots of insulin and high blood sugars is weight gain, which tends to lead to more insulin resistant, and you can begin to see why for many T2 is a progressive illness.

More exercise is good for everyone, diabetic or not, so it's excellent that you are doing that.

As regards insulin versus diet, the first thing to look at is how many carbs you are eating now. If you post up a typical day's diet here, the T2 experts will be able to make suggestions as to how many carbs are in it and how much you can cut from your diet. And also, they'll be able to point out carb heavy items in your diet that you may not have realised are carb heavy. (eg apples). The perceived wisdom here is that if your blood sugar goes up by more than 2mmol/L 2 hours after a meal, then you had too many carbs in that meal.

As regards insulin and your GP, I'm not a doctor, and can't advise on medication. Be aware that most of the folk on here seem to report that their GPs are quick to prescribe and don't spend much time talking about lifestyle. (There are quite a few intro threads where poor T2s are sent home with some pills and advice to improve their lifestyle after what appears to be a 2 minute consultation.) So I'm not sure whether you'll necessarily do any better with a different GP, though I suppose that you'd have until the new appointment to see if diet can improve your levels.

My recommendation would be to try reducing your carbs anyway, whether or not you decide to then take up insulin. (Be slightly careful as gliclazide can cause hypos if you reduce carbs too drastically. It encourages your body to make extra insulin, so has the same side effect of insulin - hypoglycemia.)

Personally, as a T1, I am a big fan of insulin , as I'd have died 50 years ago without it. As a T2, there are arguments for and against, and I can understand you not wanting to go on it. But plenty of T2s take it and do well on it, so I wouldn't rule it out.

Good luck, whatever you decide to do.

ps and here is @JoKalsbeek 's awesome introduction to T2 and diet.
JoKalsbeek's blog | Diabetes Forum • The Global Diabetes Community