T2 uncontrolled with metformin etc now told to go on insulin

[tigelly]

Hi
I have come to this forum, as my friend cannot get much sense out of the 'professionals' that are available to him, so I am hoping that somebody here may be able to help with some questions.
I have a friend with long term T2 Diabetes. He is now 48 and weighs approx 24 stone. He has been on metformin for many years, but his diabetes has always remained uncontrolled. When he goes for a blood test (after fasting) the result is usually 16. (On his last fasting blood test they gave him a reading of 144 - so i can only assume they've changed the measurement level, but im sure this would translate to blood sugar level of 16 in the old measurement level.) He has been told that he needs to go onto insulin injections.
He was due to have a gastric procedure, but he has now been told that he can't have it due to his uncontrolled diabetes, yet at the time of going for all the assessments at the hospital, they were always aware of his uncontrolled diabetes and this was never raised as an objection. On the assessment I went to with him, the only issue raised was that he would have to learn to eat his food slowly - small meal portions to be eaten over half an hour period.
I would appreciate any advise on the following points:
1) If he were to try insulin injections would he always have to take insulin, ie will the body shut down if he stopped taking it, as he is reluctant to go on insulin long term if insulin injections fail to bring his diabetes under control?
2) What are the chances of insulin injections controlling uncontrolled type 2 diabetes given that various tablets have never controlled his diabetes?
3) If he were to go on insulin, would that make him a type 1 diabetic?
4) Concerning the hospital's sudden refusal to perform the gastric procedure, is there anywhere or anything he can do to get the procedure, as promised to him?
He is now beginning to get some of the diabetic complications, such as eye problems and numbness in feet.
I am of no use to him as I know nothing about what he is going through as I dont have the condition, so please give feedback etc.
Many thanks
Tigelly

 

[Osidge]

Re: T2 uncontrolled with metformin etc now told to go on ins

Tigelly

As you friend is overweight, he might want to ask his doctor/specialist if he can try Victoza, Byetta or Bydureon(which are all injected) before trying insulin. These medications usually cause weight loss as well as lowering blood sugars so are often prescribed for those with a high BMI. They would usually be taken in conjunction with Metformin - to increase insulin sensitivity. I am assuming that your friend is also eating a sensible diet as medications including insulin will only work if diet is controlled.

Should insulin eventually be necessary, your friend would not become a Type 1 diabetic

I hope this helps. I am sure others may have more help to pass on to you.

Regards

Doug

 

[IanD]

Re: T2 uncontrolled with metformin etc now told to go on ins

Has he tried to control his diabetes? & his weight?

Before further medication, surgery or insulin, I would suggest a determined attempt to gain control by a drastic calorie reduction - see posts on the Newcastle diet; and a reduction of all carbohydrate foods. It's worth it. I don't know how old your friend is, but if he can gain control NOW, he will find his health can be transformed.

Hope we can help further - there is lots of advice available from people who have come for advice, improved their health, & stayed around to help others.

 

[tigelly]

Re: T2 uncontrolled with metformin etc now told to go on ins

Thanks for the replies.

He has a calorie controlled diet.
He has tried Byetta.

 

[phoenix]

Re: T2 uncontrolled with metformin etc now told to go on ins

Concerning the hospitals refusal to carry out the procedures. I would think this is because of the high glucose levels.
If, as I suspect his HbA1c is 144 (15.3%) in 'old' terminology, then his day to day glucose levels are very high indeed.
This will make surgery more dangerous and the high glucose levels may result in slower healing, especially if there is any infection. If they think this is a risk then they shouldn't perform elective surgery.
Please don't let your friend fear insulin, I know of T2s who use insulin who have great control and a good quality of life.
This is written by a person with T2

Many times the start of insulin use for someone with type 2 is said to be a “last resort.” This way of thinking is wrong! More and more studies have shown that good glucose control will help to prevent complications. Introducing insulin use to your Diabetes care plan can help you have better glucose control. If your pancreas has pooped out and your beta cells are no longer producing enough insulin, how is that your fault? You have not failed, but instead should be commended for doing what you need to do to control your Diabetes

.
http://www.diabetesdaily.com/voices/201 ... -diabetes/

 

[Snodger]

Re: T2 uncontrolled with metformin etc now told to go on ins

1) If he were to try insulin injections would he always have to take insulin, ie will the body shut down if he stopped taking it, as he is reluctant to go on insulin long term if insulin injections fail to bring his diabetes under control?
2) What are the chances of insulin injections controlling uncontrolled type 2 diabetes given that various tablets have never controlled his diabetes?
3) If he were to go on insulin, would that make him a type 1 diabetic?
4) Concerning the hospital's sudden refusal to perform the gastric procedure, is there anywhere or anything he can do to get the procedure, as promised to him?

hi there
I'm a Type 1 on insulin.
answers:
1) tricky one. If he is able to get under control using insulin enough that they give him gastric band surgery, he might be able to come off it again once he's lost weight. The weight is stopping his body using insulin effectively. If he does have to stay on insulin afterwards, it will be because his pancreas has deteriorated from having to keep up with the amount of natural insulin it's been having to produce, rather than because of the injected insulin. If anything, the injected insulin will help give him a boost (eg it might give his pancreas a break and help it keep going longer).
2) It will make a huge difference. They work in different ways. Without knowing exactly what he's on I can't say for sure, but I'd guess that his tablets have been trying to help his body use his natural insulin more effectively. The injected insulin is like saying, 'ok, there's just not enough natural insulin, let's give it a top up'. But do you know what insulin regime they are planning for him? Sometimes they put people on one injection of background insulin to start with. If his pancreas is packing up, he may not see real benefits until they put him on a full, Type 1-style regime of 4 or 5 injections a day (1 or 2 of background, plus quick acting insulin every time he eats carbs).
3) as others have said, no it won't - although if his pancreas has totally stopped producing insulin it could be argued that he is now a Type 1. I would bet it's still producing a little bit though and he just needs to lose the weight.
4) I'm afraid I don't know. Maybe others can help.

I hope that's of use. Let me know if it's not clear. Don't think you aren't any use to him - if you are willing to learn all of this you are a great friend.

 

[Indy51]

Re: T2 uncontrolled with metformin etc now told to go on ins

Thanks for the replies.

He has a calorie controlled diet.
He has tried Byetta.

A calorie controlled diet is not necessarily the same as a carbohydrate modified diet. The role of carbohydrate in diabetes is explained here:

viewtopic.php?f=39&t=26870

I think the suggestion about the Newcastle Diet is a good one because it more or less mimics the diet he would have to adjust to after the bariatric surgery and is known to reduce blood glucose levels very quickly.