Type 2 with complications, not on insulin

[HLW]

A post I just saw made me think of this - at the diabetic clinic, I have met people with type 2 diabetes and complications from diabetes but weren't on insulin. I also knew someone who had had an amputation due to diabetes, he was not on insulin at the time.

What causes the complications in diabetes? If it is high blood sugar, why are people not offered insulin in time, before it gets so bad? Or is it that people refuse to take insulin? Or is it not just high blood sugar that causes the nerve damage? Or is it that the high blood sugar is not picked up on, because people do not get the blood tests done?

In my case, my hba1c was up to something like 12, but insulin was not mentioned at all, until I had the blood test for type 1 come back positive. If it had not been positive, would I have just been left to rot on tablets?

 

[viviennem]

I don't quite understand about Type 2s and insulin, being fairly newly diagnosed myself, but as far as I do understand it . . .

Type 1s make very little insulin or none at all, so always require insulin;

Type 2s make insulin, sometimes far too much, in an effort to get the blood glucose out of the blood and into the cells; so if caught in time they can be controlled by diet only, or diet + meds, for a long time, perhaps always.

If Type 2s don't take control of their blood glucose levels to take the strain off the pancreas, or if they are not diagnosed in time, the pancreas will eventually fail out of sheer exhaustion, and produce much reduced amounts of insulin or none. Then they too need extra insulin to top up their own levels. This can eventually happen no matter how well-managed your condition is.

Complications can happen to anyone, I think. But they are much more likely to happen if you don't take control of your diabetes and manage it well. I have known Type 2 diabetics who just ignored their condition and carried on eating a high-carb diet full of sugar, which in my opinion is bound to lead to trouble.

I think that's right, even if over-simplified. Could someone else join in, please, and explain better, 'cos I'm interested too!

You most likely wouldn't have been left to "rot" on tablets, unless you were very incompetently treated. I have metformin to lessen my insulin resistance and help get the bg into my cells - and to give my poor abused pancreas a rest from pumping out all that insulin! With diet, it seems to be working for me, and I hope never to be a Type 2 on insulin.

Viv

 

[HLW]

I have known Type 2 diabetics who just ignored their condition and carried on eating a high-carb diet full of sugar, which in my opinion is bound to lead to trouble.

The guy I knew had a very poor diet, the people at the clinic didn't look in the best health either (overweight), so their diets presumable didn't help them, but still I'm wondering why the high blood sugar was not noticed, and why they were not changed to insulin if they had high blood sugar.

With me, I had high blood sugar, so they increased the tablets and said come back in three months for hba1c. This went on for a year at least.

Every single hba1c I've had has been too high - all were above 8 I think. So why, as the hba1c was not 6 or below, was I not told I needed insulin? This was years it was high for.

Since being diagnosed type 1 the NHS attitude towards me has completely changed - as many test strips as I want, told to aim for low hba1c, if my blood sugars are high then that is discussed and dealt with there and then rather than as before 'come back in 3 months'. It makes me very uncomfortable, this difference in attitudes.

 

[viviennem]

It just goes to show what a lottery diabetic heatlh care can be! I don't know enough to know when they should put a type 2 on insulin, but as you say, if your BGs weren't responding, they should have looked at you more closely.

I think this needs a 'Panorama-style' investigation - into the whole thing.

Do some of 'them' think that Type 2s have only themselves to blame, so aren't worth the effort?

Viv

 

[HLW]

I do get the impression that some of them think that. But they are happy to treat me, and they know I do not at the moment either care much about my health or put much effort into controlling my diabetes (they can see I've put on weight, they know I don't test very often). This is not at all their fault - they have given me the knowledge and means to control my diabetes.

Is this just because I'm type 1, if I was type 2 and behaving the same way would they just give up?

I also wonder maybe do they think if someone does not at all care eg eats sweets all the time, then maybe they would not bother with the injections, but I think the NHS should at least offer people the choice (and, in some cases, do more than offer - they should say 'your blood sugar is too high with diet and tablet control. You have 3 months to improve your blood sugar, here is free gym membership and an appointment with a dietician, if it's not improved in 3 months you need to go on insulin to avoid complications' or something like that).

 

[viviennem]

You sound as if you're in a bit of a 'February' mood at the moment - it's the time of year when I go and burst into tears all over the surgery :shock: It's almost worth it to watch how the doctor tries to cope! :lol: I bought myself a SAD lamp last year, and take extra vitamin D, and I think they both help. Also I'm not stressed since I retired, which really does help!

Maybe when the better weather comes you can take charge again? I know I shall exercise much more when the weather's better - like tomorrow, they've promised. Oh yeah?

Hang on in there

Viv

 

[bowell]

I don't know enough to know when they should put a type 2 on insulin,

for info see T2 Map of Medicine
http://healthguides.mapofmedicine.com/choices/map/diabetes1.html

I am reasonably happy the way NHS have been teated my T2

Started with A&E for suspected stroke BG taken 30+ put on insulin just over a week in hospital to bring me down then taken off the insulin and prescribed Metformin and Glipizide
3 year ago i have managed to keep low BG level ,until lately

see GP every 6 months for diabetes only review
I have my Hb1c every 3 months and see nurse
Eyes done every year
podiatrist every year

I alway wanted to stay off the insulin as long as poss due to work and driving
and if popping a few pills keeping an eye on crabs would do that,, Bing Bam 8)

As a T2 I would still need to take Metformin because of insulin resistants

I'm slowly having to up the dose of Metformin and Glipizide .
maybe the day is getting closer for insulin :shock:
Gp says he would want me to try Byetta first before the move onto insulin


Think you will find that most t2s respond well to Metformin
then moved onto sulphonylurea to help pump out more insulin

The cost of Metformin and Glipizide is more cost effective .
Than insulin & Metformin treatment with as many test strips as you can eat :roll:

 

[HLW]

You say your hba1c is 9.2, and all they are doing is 'slowly' increasing your tablets??!

That's an example of the difference in care I was talking about - my last hba1c was 8.something, and the reaction from the doctor was 'that's too high, we must sort it out now', they said I must change insulin dose if needed, change diet, and test more, blood sugar must be better immediately.

But with you, they don't seem to care, with a hba1c so massively high, it would take more than a slight increase in tablets to make it normal (5 or so) surely.

So why the difference in attitude from the NHS towards us?

 

[viviennem]

Bowell, did they actually measure how much insulin you are producing? I want that test - how can you treat someonoe if you don't know exactly what's going on? - but have been refused it because of cost.

I want to know if my bg was high because of insulin resistance, or because I'm not producing enough insulin.

Incidentally - do you mind me asking what symptoms you had that made them treat you for a stroke? Can high bg cause paralysis, eg arm not working?

Viv

 

[bowell]

do you mind me asking what symptoms you had that made them treat you for a stroke? Can high bg cause paralysis, eg arm not working?

well yes ,,my Left side went numb /dead . my left arm i could move but very numb my left leg was numb and i could not move it , I woke up like this middle of the night wife called ambulance taken to A&E
I made a complete recovery from this in a matter of weeks.

Now 3 years later

did they actually measure how much insulin you are producing? I want that test

NO
GP Care only at this stage
First the amount of Metformin was increased with no or little Affect on BG
then the Glipizide has been increased only now its bringing down my BG pwwwww
all this has been done over 6 weeks, No new Hb1c has been done(Due in March)
only my own daily records to show if the medication is dropping BG
My next visit to my GP is next week to talk over the last two weeks records
last two days i am back to around 5.4 ish pre meal

so if im lucky i am now back in range (for how long i don't know)

Some of this i believe is down to being less active and muscle loss
from accident and being wheelchair bound ,also could be the effect of dozens of other medication i take daily?

steroid the nerve block injections into my spine?

because i had operation in Nov had to stop taking Meds for 2 days BG was controlled with insulin by the ward nurses then back to my Pills could have been shock to system?


my pancreas is slowly getting warn out ?


Bob

 

[viviennem]

Thanks for the info, Bob. Good luck with all your problems - I don't realise how lucky I am!

I'm worried about wearing out my pancreas, too. Wouldn't you think they should run tests on how well it's coping? Or is that too much like common sense?

Viv

 

[bowell]

viviennem
I would think if Metformin was doing the job ? on its own your insulin resistant ?
otherwise doc would add some other drug to help with the lack of Insulin

Type 2 diabetes mellitus is characterized by insulin resistance which May be combined with relatively reduced insulin secretion

HLW » 08 Feb 2011 23:12

You say your hba1c is 9.2, and all they are doing is 'slowly' increasing your tablets??!

That's an example of the difference in care I was talking about - my last hba1c was 8.something, and the reaction from the doctor was 'that's too high, we must sort it out now', they said I must change insulin dose if needed, change diet, and test more, blood sugar must be better immediately.

For your medical history that may well have been the right Ans

For me ummmmmmmm ! not so simple
GP is very involved with my heath ,very proactive with ongoing treatments and things coming up
my diabetes can Not be the most important thing going on at the moment.
it has to fit in with other treatments . so the chance of dealing with this first BG hic-cup in three years slowly, was welcome and i still have other options left
I am always given a choice so at the moment I am Happy :lol: and Grumpy :twisted:

Bob

 

[searley]

My last test before insulin and diet only was 7.4 and they allowed me to go onto insulin

But even at only 7.4 I was starting to get diabetic related complications

Another thing is some people think that they can still eat what they like, when they like, and in part bring the complications on themselves by not taking the advice they are given