To be (on insulin), or not to be? That is the question!!

[snurger]

I'm struggling!
Recent results have not been too good.
I'm type 2, and have been diagnosed for approx 3-years.
BS readings up to 22.3, rarely below 10.
HbA1c: 8.6 and increasing!
Male - Age 62.5 Weight 18st 9lb. Height 5'7" Waist 57" BMI 41
Daily Medication: 4x 500mg Metformin. 1x 100mg Januvia.

My Diabetic Nurse has recommended that I go on to Insulin.
I'm very nervous about this, and think the move is a bit drastic.
Can anyone out there give me any information, especially if you've now gone on to insulin?

I have to confess, that although I've been compliant with my medications - as you'll see from my person data, I'm a "bit" on the "cuddly" side!! Regretably, when my BS have dipped, I have literally binged on Mars Bars, Waggon Wheels and the like!
I love puddings, cheese and chips.

Perhaps I'm in denial, and waiting for a medical catastophe to occur.
However, my retinopathy tests have proved ok, understandably my BP is sometimes a bit high, but other than that, I feel in fine fettle!!

I know what I need to do, but my appetite for life changes is low.
Apart from being uncomfortably fat, I feel reasonably well.
Nevertheless, I've joined a gym, and start a regime this week.
I do need to lose weight, and am really going to try to sort out regular and healthy meals.

Why on earth can't I get it right?
Has anybody tried hypnosis or similar?
I don't really want to be on Insulin - can anyone help me?
Your comments, even critical, would be very much appreciated.


Thanks
Geoff

 

[borofergie]

BS readings up to 22.3, rarely below 10.
HbA1c: 8.6 and increasing!
Male - Age 62.5 Weight 18st 9lb. Height 5'7" Waist 57" BMI 41
Daily Medication: 4x 500mg Metformin. 1x 100mg Januvia.

Hiya Geoff - sorry to hear that you are struggling.

I agree with you that something has to change. The good news is that you haven't had any complications yet.

I think the answer to the question is kinda up to you. Either you make an effort to sort your diet out and start cutting out the rubbish carbs or you go onto insulin and deal with it that way. Having a HbA1c of 8.6% a bit like playing Russian Roulette, you might continue to be complication free for a few more years or something might go wrong tomorrow.

You know that "Mars Bars, Waggon Wheels, puddings and chips" are incompatible with being a diabetic (although the cheese is absolutely fine). If you decide you cannot live without those things then insulin would seem to be the only way forward, although you should make yourself aware just how difficult that can be (constant injections, measuring doses and potential hypos). I certainly wouldn't take that option lightly.

I don't really want to be on Insulin - can anyone help me?

If you really don't want to be on insulin, then we can help you try to get that HbA1c down. The great thing is that you'd probably lose weight and feel better about yourself in the process.

Good luck mate, I know it doesn't seem easy, but there is a way through all this.

Stephen

 

[AMBrennan]

you should make yourself aware just how difficult that can be (constant injections, measuring doses and potential hypos)

True enough, although personally (T1 with no choice) I don't think it's that bad. However, snurger didn't mention the proposed insulin regime - most type 2 diabetics will start on basal insulin only (once or twice daily injections that you can do at home). If hypos are a problem then more modern analogues are available that cause fewer hypos (in case you are worried)

 

[borofergie]

...and there are at least a couple of T2 Diabetics here that advocate the use of insulin over diet and oral medication (NewDestinyX springs to mind), suggesting that it might be the best way to delay the decline in pancreatic function that some people suggest is an inevitable part of T2 diabetes.

 

[SueR]

T2 new to insulin - well I started late last year and it's still early days.

I didn't want to go on it either, but with sugar levels getting higher by the day I felt that I had no choice. It was either insulin or suffer the consequences. I still take Metformin etc and watch my diet.

As yet no hypos - I use Humalog mix 25 twice a day - but them my levels are still high.

At the end of the day it is up to the individual. I'm happy with the choice I made and know it's for the best...

 

[Anonymous]

I now strongly regret going on to insulin, which I pushed for as a magic bullet solution to bad levels just before I got married.
I think that I should have properly looked at my diet first. Insulin means driving license restrictions, higher insurance costs etc.. too.

 

[AMBrennan]

Oh, and another thing is the psychological component - diabetes is a medical condition, and failing to control it through diet and exercise alone is no more your fault than being unable to walk with a broken leg; it's different for everyone, and some manage with diet and exercise whilst others don't (I think my analogy breaks down at this point).

I fear that, if you declined insulin now for bad* reasons, that you would just end up beating yourself up again if there was no improvement by the next review.
* I am not saying that there aren't good reasons to try it without insulin; swimmer2's point is valid (extremely so if you depend on your ability to drive for work; less so if you work in an office and have good public transport)

Realistically, you said your HbA1c is high, and rising, so putting you on insulin does not seem a particularly drastic measure. Unless you have a good reason to expect a change, I would not wait for another review to see if things improve - if you were to try a radically different diet (e.g. Low carb * assuming you have been eating NHS recommended diet), go on a structured education program (assuming you have not done so already) then I would see how short term BG develops and reconsider my options after a few weeks.
* note that that doesn't mean that I would suggest such a diet**
** which doesn't mean that I suggest that you don't eat such a diet either

 

[Pneu]

To be honest your diet sounds pretty high carbohydrate.. and to top that off the wrong sort of carbohydrate.. Insulin will help control your blood glucose but with the sort of diet you describe I would be amazed if you didn't start to put on weight as insulin also regulates our fat metabolism. This will only increase your insulin resistance and increase the amount of insulin you need and very soon your stuck in a sticky cycle.

I think you would be amazed at the results of a low carbohydrate diet to your levels and your weight and I would certainly give that a go first before I made the decision to go onto insulin.

 

[borderter]

Going on to insulin was a massive relief to me after nothing else touched the bgs. It gives you control especially if its basal/bolus ,so dont be afraid we all have to start at some point, and if it helps PM me and will do my best to be an insulin buddy

 

[Anonymous]

Going on to insulin was a massive relief to me after nothing else touched the bgs. It gives you control especially if its basal/bolus ,so dont be afraid we all have to start at some point, and if it helps PM me and will do my best to be an insulin buddy

Sorry , but I disagree as I am on Basal/Bolus and my control has been all over the place - constant near-hypos, like chasing bubbles in wallpaper. It's much better now that I'm low carbing at the same time and my insulin doses are much smaller.

 

[Helenababe]

Hi snurger.

Couldn't you just 'try' a low carb diet, to see if your sugar levels go down, so perhaps preventing you from having to go on insulin? You'll get alot of help on here about what to eat, and there's also the recipie threads that are very good and useful.

Good Luck,
Helena

 

[Grazer]

As has already been said, it's your choice. If you want to go onto insulin then fine. If not, it's extremely likely (but not certain) that you could control things by adjusting your diet.
Let's not beat about the bush. You're not "cuddly". You're obese. While you are, your insulin resistance will be high. So not only do the terrible (for you) carbs you're eating raise your BG too high, your resistance means your weakened insulin response can't bring it down again. That's why you're always high. If you don't have complications now, you will. Even if you go onto insulin, I suspect that the insulin resistance caused by your weight and waist measurement will mean that the basic low dose regime mentioned here won't be adequate.
Your solution is to go STRICTLY on a reduced carb diet. How low is up to you. Count th carbs carefully, and maybe start on, say, 125 a day. 125 of GOOD carbs that is. That way, not only will your BGs not go up so much, you'll lose weight and your insulin rersistance will improve. So a double whammy of improvement. Look at Daisy's post to newcomers to the site regarding diet and use that as a start point.
Your choice. A big one. I'd try the diet first. You probably know you should as well, but are looking at ways of controlling your BGs (insulin) while still eating wagon wheels. Won't work.

 

[iHs]

Going on to insulin was a massive relief to me after nothing else touched the bgs. It gives you control especially if its basal/bolus ,so dont be afraid we all have to start at some point, and if it helps PM me and will do my best to be an insulin buddy

Sorry , but I disagree as I am on Basal/Bolus and my control has been all over the place - constant near-hypos, like chasing bubbles in wallpaper. It's much better now that I'm low carbing at the same time and my insulin doses are much smaller.

Hi

So that you dont have too many high and low bg levels instead of using just guesswork, start adding up the carb content of the food you are about to eat and then use an insulin to carb ratio. Adjust the ratio to what your bg levels are before breakfast, mid morning, before lunch, mid afternoon, before evening meal and before bed. Get yourself 2 insulin pens that can deliver insulin in half unit increments. People tend to start with a ratio of 1u to 10g carb and then adjust it. It might need to go to 1.5u to 10g carb or even 2.0u to 10g carb. If it turns out that you need something inbetween then a ratio such as 1.0u to 8,9,11,12,13,14 grams of carb can be used as well. Carb ratios are not that difficult to work out as long you can write down in a bg diary your bg results, the amount of carb that you eat and the insulin youve injected to achieve the bg results. You just keep adjusting the ratio until your bg levels start to even out more without going up down all the time.

 

[smidge]

Hey there Geoff!

Your choice. A big one. I'd try the diet first. You probably know you should as well, but are looking at ways of controlling your BGs (insulin) while still eating wagon wheels. Won't work.

:clap:

Grazer is spot on and has given you the best advice on this thread, along with Pneu. For some of us with certain types of diabetes, insulin is the only option and it is marvellous. Nowhere near as bad to deal with as you might imagine. However, in my opinion, it is not the appropriate treatment for you at this time - losing weight, taking exercise and changing your diet is. Sorry to be so blunt, but nothing will really help you until you help yourself. Insulin is not a magic bullet for avoiding the lifestyle changes that in your heart of hearts you know you need to make.

Good luck with whatever you choose to do.

Smidge

 

[xyzzy]

I'm struggling!

Yes

Recent results have not been too good

Agree

BS readings up to 22.3, rarely below 10.
HbA1c: 8.6 and increasing!

You look screwed.

I'm a "bit" on the "cuddly" side!!

I know someone with a BMI of 41 wouldn't call them cuddly

Perhaps I'm in denial

Yes **** right you are matey.

As I see it you have a choice. Get control of your BG's using

DIET only
DIET + Met
DIET + Drugs
DIET + Insulin

Oh and add + Bit of exercise to those.

or pretty soon it will be the word like DIET but with only the first three letters.

Take care Geoff

 

[catherinecherub]

Hi snurger,
You have either got to get to grips with changing your lifestyle or you will face that medical catastrophe that you seem to be waiting for in your post.
No change in your eyes, that's good but how about a heart attack around the corner waiting for you?
People underestimate their chances of a heart attack when thinking bout complications that may occur. Feet and eyes worry most people but your heart is something that is also high on the list of possible complications. Fancy a stroke with your next wagon wheel?
http://diabetes.niddk.nih.gov/dm/pubs/stroke/
Stop burying your head in the sand and man up to your responsibilities for yourself and your family.

We may sound harsh but you need to take all this on board and decide what you are going to do about it.

 

[xyzzy]

Stop burying your head in the sand and man up to your responsibilities for yourself and your family.

Yes Geoff why do you think its fine to let your wife and / or your family pick up the pieces when the disaster happens, which it will, real soon...

 

[Cjmen]

My opinion, It wouldnt have been suggested that you need to be on insulin if it wasnt the best way forward for you medically. Whether you or anyone else 'wants' to be on insulin is not relevant here. Just do it and adapt and as xyzzy said, think about your family. Its not the end of the world but speaking as someone who has been on insulin for 23 years I am satisfied I am taking the best course of action for me. My life has adapted to the requirements but it has never stopped me doing anything and for the sake of my family I am doing all I can to make sure I can be here and support them for a while to come.

 

[Anonymous]

It wouldnt have been suggested that you need to be on insulin if it wasnt the best way forward for you medically.

Oh if that were true, but this forum is full of examples of bad advice from medical professionals. Decide to go on insulin by all means, but decide to do it once you've changed your diet for 3 months. What's the rush? I bet you'd learn far more about your condition in those 3 months.

Using insulin to eat what you like (unless you're type 1 of course) is a cop out. My, very experienced, DB nurse suggested that I just jab extra if I want a pudding. Wouldn't it be better to say "don't have a pudding and you won't have to jab as much". She might as well have said "you're a weak willed overweight man with an incurable urge for eating biscuits, I don't have the time or inclination to make you eat properly so here's a ton of insulin - just jab whenever you feel the need to eat processed sugar"

You should always heed medical advice - but you need improve our eating anyway so why not do that first because moving on to insulin is pretty much a one way street.

 

[borofergie]

My opinion, It wouldnt have been suggested that you need to be on insulin if it wasnt the best way forward for you medically. Whether you or anyone else 'wants' to be on insulin is not relevant here. Just do it and adapt and as xyzzy said, think about your family. Its not the end of the world but speaking as someone who has been on insulin for 23 years I am satisfied I am taking the best course of action for me. My life has adapted to the requirements but it has never stopped me doing anything and for the sake of my family I am doing all I can to make sure I can be here and support them for a while to come.

In the words of the great philosopher Sir Bruce Springsteen: "Blind faith in your leaders, or in anything, will get you killed".

Yes you should listen to your HCP's advice, but you need to be a critical informed patient and take an active part in your own treatment. It's the only body you're going to get and, at the end of the day, you are ulitmately responsible for it.

(My elderly Grandfather fell and hit is head and, despite numerous visits to his GP, he was told that the fact that he could suddenly no-longer read or speak coherently was down to his age. It was only because we did our own research, and paid for a private referral, that we discovered that he'd had a brain haemorrhage. Because we were critical we managed to extend his life by 10 years).

This isn't a dig at Doctors of HCPs, the same is true of any professional you interact with. If you rely entirely on their judgement then you will be exposing yourself to the occaisional rogue piece of bad advice.

(I'm also

saying that the advice given to the OP in this thread was bad, because it sounds entirely reasonable in his case, but same thing applies, do your own research before submitting to anyone else's decision).