possible change ahead with medication..some ideas needed

i would take your fully up to date and completed daily diary with all your BG readings , a listing of all your food intake , your reduction in insulin doses

and maybee..... she will listen and put the brakes on following through with the new med.

I suppose I can only recount my own experience ( and I am not sure if that will help or hinder..)

I was diagnosed with Type 1 in 1972 and placed on 1 injection per day that was made up by mixing 2 insulins into 1 syringe and injected at the ( pretty much ) exact same time every morning ( 7am) . this regime carried on for about 9 years until at one appt with my endocrinologist he just announced I was going to be put on 2 injections per day of a pre-mixed insulin.

now i am sure i was not the first person to be changed to this new regime but at the time it made me actually sick because it was like my whole life was being disrupted yet again.

another similar episode when changed from animal to synthetic insulins in the very early 1990's.

ok -- so repeat that when I was switched on to multiple daily injections in 1997 ( that was scary because so much more freedom was given but no education really to speak of ( education courses didn't come for a few years after)

move forward to 5 months ago and i went on a pump and I truly had to teach myself all over again because a pump behaves quite differently to injections. and there is nothing like the lonliness of being told by the DSN that if I had a problem on a saturday night that first weekend on the pump I was pretty much on my own because nobody in A&E would have any knowledge on what to do If I went DKA ( really high bloods and ketoacidosis) -- so they give you a page of written instructions.
I cried a fair few tears that first few days on the pump because it took me back to how i felt all those 43 years ago all over again.

i am sure by now you have figured out there is a pattern and I can't answer what you should do - your attitude to change , and to risk , your routine , and lifestyle will all play their part in coming to a decision.

I am sorry if this has not helped but I hope it has

all the best !!

@Finsky I'm going to reply to this properly later as I have some ideas but I need time to find a couple of links I want to post and I don't have time just at the moment. But for what it's worth I can fully relate to all that @himtoo says as well - each time you change it's like starting afresh and I find it quite challenging too.

I will ask one thing first though - why the proposed change - does what you're currently doing not suit you any more? Is it just because you've improved so much on a lower carb routine?

@Finsky I would look up both the possible injections and see what the "indications" for use are; then I would compare them with your current HbA1c and meter readings. It's quite possible that with lower readings and a downward BG trend (i.e. an upward trend in control) you don't need the jabs - though you may well need to keep decreasing the insulin you take. If you don't fit the criteria any more it would be helpful to print them out to take to the nurse and show why.

Kate

You've obviously removed your post about the previous post colour, but it seems to be that all the text is a clickable link - it seems the text is wrapped in 'user' tags which make it link to your profile.

I'm at a proper keyboard now, so it's easier to type. Thank you for explaining, it does preclude some of what I was thinking.

I am however of the school of thought that if something ain't broke, don't fix it. If insulin is working for you and isn't causing any specific problems, why change it? Sounds like it might be for the sake of it or to just fit the doc's personal preferences - doesn't sound as though there is a pressing clinical reason for it.

You're on two insulins, a background and rapid acting, so you have lots of potential to tweak your doses as your numbers improve, as you already have, as you're still on quite a decent Lantus dose, so there's capacity to reduce it further. I spent the last year on two different mixed insulins (not at the same time, progressed from one to a different one), which worked very well at getting me back under control, but their lack of flexibility and 'best guess' nature meant they weren't as good for long term management when your numbers are decent. But it all went awry a few weeks ago, so it was time for me to make a change and I've not fully completed that yet.

I came off the insulin for a week to get stabilised as I was rebounding low to high quite dramatically, so I needed to reset my numbers and start over. At that time we (with DN and with my husband) had much discussion about how to move forwards and I was of the view that as I'd done well on insulin and felt significantly better on it (i.e. no side effects and it actually works), compared to meds that weren't working anyway, so I'd rather stick with it. The DN suggested various options I could consider, but the thought of going onto either newer meds (Forxiga she suggested) or the type of injectables I assume you're talking about (Victoza?) - all of which had the potential for new side effects - to which I am very prone.

My own view was to stick with what I knew worked for me, I felt well on and also gave me some personal flexibility to manage in accordance with my own monitoring and diet. Luckily my DN agreed and was the path she'd already thought for herself was probably best for me. I'd personally rather inject 10 times a day and feel well and be able to manage my BG with flexibility, than inject once a week and feel poorly and only have one chance a week to manage my dose - if at all. But that's my personal preference and my thinking to remain on insulin. I'd totally lost control on meds, they just didn't work, even at maximum doses, yet I can manage well on a modest insulin dose (currently 8u Lantus and 6u NovoRapid, but that will increase, we're not fully titrated yet).

I'm currently on a regimen called 'Basal Plus' which seems to work well for T2s in my circumstances. In quick and dirty terms, you have a basal and set it at a level to ensure your FBG is at your target number and then add a bolus to the meal where you have what they call the 'widest post prandial excursion' - i.e. your highest spike - mine's my evening meal. You set that bolus to ensure that you stay under your target for that meal. I'm pretty settled with this regimen to a range between about 6 and 10 all day at the moment - I'd like to get that to between 5.5 and under 9 - I'll do my next weekly dose tweak tonight, so should be a bit better next week.

So you need to find a routine and treatment that works for you. I would be equally uncomfortable in feeling potentially bullied into a new med and all that potentially entails. I think you need to perhaps listen to what they suggest initially and their reasons, but then stand your ground if you don't think it will suit you. It sounds like you've already got a good handle on what works for you diet-wise - and as you say, you've not been doing it that long yet, so stand to improve yet more.

Keep us posted.