T2D and insulin. Diet?

EllieM said:

Having said that, I guess the insulin still gives you more flexibility for an occasional carb splurge, just take lots of insulin for it, whereas when you're on oral meds you have no choice but to restrict your carbs.

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Hi, we are advised to only take increased insulin for such things as sick days and then only small increases. Generally the dose stays fairly constant.

Also it’s worth considering that the latest thinking of pancreatic ‘burnout’ in type 2, is that it may actually be more about the pancreas being very badly cloggged with fat rather than the beta cells actually dying. If there’s any truth to this then overuse of exogenous insulin will likely cause further metabolic damage as well as exacerbating glucotoxicity in the body - only the blood will appear ok.

As always there’s very few black & white answers, but generally speaking a non-resistant type 1 (T1 can become resistant too) will have greater flexibility in bolusing for meals without risking over-ingestion of glucose. So the answer to the question, in my view, is still no.

Jim Lahey said:

No. Type 1 is an autoimmune condition of insufficient insulin. Type 2 is a dietary disease of excessive insulin. For a while, perhaps years, you’ll be able to force more glucose into your cells with increasing doses. Your blood may appear clean but you’ll be making your diabetes worse if you attempt to adopt a similar approach to your T1 friend.

As an aside, not that I’m prying into your diet, but it’s a surprise that LCHF has led you to insulin. Normally it’s the other way around. Are you sure there’s no further dietary intervention that you can make in order to avoid insulin? It’s really not the best treatment for insulin resistance and should be avoided if at all possible.

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OP mentioned he is also taking a sulfonylurea (Gliclazide) as well as doing the LCHF WOE.
I belong to the school of thought who hold the opinion, that Sulfonylurea therapy in the management of T2DM is one of the reasons why T2DM is seen as a chronic progressive disease.
It forces the pancreas to produce yet more insulin, into a system that has an insulin glut already. Thus worsening IR.

miahara said:

It seems likely that after 3 years on Gliclazide and a LCHF diet that seems to have ceased having the desired effect, I'm quite possibly likely going to have insulin added to my meds.
I've a pal who is T1 and can more or less eat what he wants so long as he adjusts his insulin accordingly. My question is does this dietary flexibility also apply to T2D?

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You might find this interesting especially in light of many of the other replies up thread.. I'm not a great fan of Cyrus Khambatta and his low fat plant based bias but I think in this video he sheds some good light on LADA and the importance of C-Peptide testing. I hope you find it intersting (I will admit I stopped halfway through because he's quite annoying...)

https://www.masteringdiabetes.org/c-peptide-diabetes-test/

I've not had any tests other than the hba1c. I'm to go on victoza soon. Should I be asking for tests of any description?

miahara said:

Thanks @bulkbiker . I've had a C-Pep and anti-Gad tests as I suspected I might be LADA but both tests returned 'normal' results. I'm now awaiting an appointment with an endocrinologist and a CT scan to check out a pancreatic cyst that an MRI prostate scan revealed.
Also awaiting an appointment with DSN, who may well suggest adding insulin to my present Gliclazide.
Had a full body nuclear bone scan last week and thankfully results were good.

I'm certainly getting my moneys worth from the NHS !!

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Glad someone is..although I hope you get a decent diagnosis out of it... I wonder what the "normal" results were and if they have changed over time?