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Type 2 What happens if I get offered insulin therapy?

T

Tezzz

Active Member
Messages
31
Location
Sussex
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I've been type 2 for a few years.

I have a low tolerance of Metformin, I tried all the generic brands over the years and 500mg a day is all my body can tolerate without getting incontinent.

I eat low carbs, and walk each day. I am losing the battle to keep BG levels low. I self fund my strips.

According to my meter, my average BG over the last month is about 17 mmol/L. I have asked for an HBA1c test and I can guarantee it will be over 100 mmol/mol or 10% DCCT.

I want to settle down to safe BG levels within 6 months. I know insulin is not the cure all, I just dont want to get the diabetic complications. In the long run it will be the cheapest option for the NHS.

I know many diabetics and the general consensus appears to ask to start on MDI (multiple daily injections), not the pre-mixed type as I am told it is the most flexible way for people who work shifts like me.

Can somebody suggest a good reason to ask for insulin therapy?

What happens if I get approval to get insulin therapy?

Can I choose MDI?

What will the first doses be - what would the calculations be?

I hope somebody can answer for me.
 
You can request to go on insulin and you can request that you go on to an MDI routine that is your right and do not let anyone tell you it isn't.
 
They initially start you on small doses of basal & bolus till you get used to the regime, so you don't hypo. The amount you inject takes a lot of trial and error I've found and you will have to do lots more testing on insulin. At least before and after each meal plus on waking and bedtime. So that would be 8 x minimum
 
Forget what the cheapest option for the NHS is, your health is priority.

You really need to get that A1c lowered as the short and long term implications of a BG level that high are really not promising I'm afraid. If that means insulin then so be it.

Have you tried to engage in more intensive activity other than walking? If you are heavily insulin resistant then exercise can help massively in allowing your body to make use of your insulin. I'm afraid walking by itself as your sole form of exercise just isn't enough.

Don't worry or feel nervous about insulin therapy. Your DSN and Dr will talk you through everything you need to know and if you're ever in doubt then you will certainly be able to find the answers here:)

Grant
 
Hi and welcome. Can you let us know what your BMI/weight is as it's always possible you are Late onset T1. Yes, do ask for the insulin and MDI. The reason to ask for insulin assuming you don't have excess weight is that it works, has no side effects and in fact isn't that expensive for the NHS; particularly if you use the same needle more than once during the day (not everyone will agree with that approach). If you have excess weight you may have insulin resistance and taking insulin can conflict with that so is not as effective.
 
I'm glad to see all your replies. I'll do them all in one post if that's OK.

CarbsRok said:
You can request to go on insulin and you can request that you go on to an MDI routine that is your right and do not let anyone tell you it isn't.
Click to expand...

Thanks for that Carbsrock. I'm pretty meek when it comes to fighting the system, I'm a good doormat.

Seeker2016 said:
They initially start you on small doses of basal & bolus till you get used to the regime, so you don't hypo. The amount you inject takes a lot of trial and error I've found and you will have to do lots more testing on insulin. At least before and after each meal plus on waking and bedtime. So that would be 8 x minimum
Click to expand...

Thanks Seeker. I'm not afraid to test. I Just started a few months ago. Strips are not cheap. I know the warm fingers before testing on the sides helps so I don't notice the short sting.

GrantGam1337 said:
Forget what the cheapest option for the NHS is, your health is priority.

You really need to get that A1c lowered as the short and long term implications of a BG level that high are really not promising I'm afraid. If that means insulin then so be it.

Have you tried to engage in more intensive activity other than walking? If you are heavily insulin resistant then exercise can help massively in allowing your body to make use of your insulin. I'm afraid walking by itself as your sole form of exercise just isn't enough.

Don't worry or feel nervous about insulin therapy. Your DSN and Dr will talk you through everything you need to know and if you're ever in doubt then you will certainly be able to find the answers here:)

Grant
Click to expand...

Thanks for the reply Grant. I'm not frightened to go on insulin to get the HBA1c down. I'm not lazy, I do get into a good sweat. I have a weak back and a damaged knee joint, so a long brisk walk 3 miles at least is the best I can do most days rain or shine. I do a couple of miles at the swimming pool when I can. I'll be back for help, though I will search here before asking the obvious questions.

Daibell said:
Hi and welcome. Can you let us know what your BMI/weight is as it's always possible you are Late onset T1. Yes, do ask for the insulin and MDI. The reason to ask for insulin assuming you don't have excess weight is that it works, has no side effects and in fact isn't that expensive for the NHS; particularly if you use the same needle more than once during the day (not everyone will agree with that approach). If you have excess weight you may have insulin resistance and taking insulin can conflict with that so is not as effective.
Click to expand...

I'm 75kg and 5 foot 11 tall. I'm not worried about resusing needles, I reuse lancets.

I think with some crossed fingers I'll get the insulin therapy.
 
Go for it, it should give you more control. If you can ask for accuchek fastclix lancets, you can set the gauge so it doesn't hurt so much and they are self contained, so need to use a sharps bin. Wish you well.
 
That's no problem :)

At 5' 11" and 75kg there seems to be absolutely nothing wrong with your weight.

Swimming, probably the best exercise you can get. An excellent choice. Cycling is another good option as it's non impact so shouldn't aggravate your knee.

I hope everything gets better for you soon!

Good luck,
Grant
 
Hi Tezzz

Rather than think of insulin, have you considered the possibility of tablets that cause an increase in insulin production in your body?

Obviously, you will be discussing all this with your GP and s/he will be able to tell you what your options are. These meds, for example, Gliclazide or Glipizide, taken once or twice a day, can have dramatic effect on blood glucose levels, still leaving the option of moving on to insulin at a future time, if necessary.

Good luck in getting medication that's right for you.
 
OK I am going to ask the important question that everyone else seems to have missed. Have you had a c-peptide test done? If you are already hyperinsulinemic the last thing you want to do is jam more insulin in. That just causes weight gain and more damage to your pancreas. If you are not producing very much of your own insulin then you need more. In this case going on insulin would be a good choice. You need to get this test done and then decide with your doctor what is the best choice for you. I hope you are feeling better soon.
 
Hi. @chalup offers good advice if you can get the GP to do the test. I gave up with my GP and had mine done privately and it showed my insulin level to be quite low. Your weight sounds fairly good for your height so you may not have much insulin resistance and the MDI may help. I did have Gliclazide for many years at full dose but it finally had no effect as my islet cells had given up. It can be worth a try for a while but T1 can progress although at widely varying rates. If a high dose has no effect then you can be confident your natural insulin output is low and insulin is needed.
 
Thanks for the replies. A quick update. Saw the doctor yesterday and got me urgent bloods ordered.

I have given the armfull of blood this morning, they actually have some very nice vampires (blood nurses) at the hospital clinic.

I will ask about the c-peptide test when I get the results on Friday. (Tomorrow).

Fingers crossed :)
 
My HBA1c is 101.

I was offered an appointment to see the nurse at the doctors surgery in three weeks.

I asked if 101 was a high number and I got offered a doctors appointment for Sunday (really).

As the receptionist was very kind to me I just said thanks and walked out.

Next update on Sunday afternoon.
 
Yes 101 is really high. I do not know if you have seen @daisy1 post for newcomers but she is now tagged in this thread. You should read it thoroughly and follow the links, especially the one at the bottom for the low carb program. Getting a c-peptide done would be a very good idea if you can convince your doctor to order it and you need to get a meter and learn to use it. A meter is very important
 
@Tezzz

Hello Tezzz and welcome to the forum :) Here is the information we give to new members and I hope you will find it useful. Ask more questions when you need to and someone will be able to help.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 210,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates
Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
 
Hold on! You are jumping the gun! Once a day basal insulin is the norm to start with!
 
Thanks for the replies.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Click to expand...
I'm low carb (not zero) so i guess I'm too resistant to my tablets.

I'd go for basal to start with too - however what about bolus correcting from silly 30's highs to safer 10's (not normal) levels once I get the basal right?
 
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Insulin needs to be respected, but not necessarily feared. It seems you already have a solid understanding of that.

The problem people have is that they take insulin and begin to neglect other aspects of their treatment. That's an approach destined for failure. That can be especially true for people with insulin resistance as you're essentially treating the problem which more of the substance that's causing it in the first place.

Having started insulin therapy a little over a year ago, I'm very glad that I learned the basal/bolus carb counting approach all at once. I will say that there was a week after my diagnosis that I was on only basal insulin and it was incredibly frustrating because I still felt out of control.

The best thing about my approach is that I feel my doctor has provided me with every tool I need to manage my diabetes. As long as someone can be disciplined enough to manage those tools responsibly, I'd advocate that approach to anyone.

If it were me (which is not the same as me saying "You should do this...") I would be open to continuing Meformin. It's a safe drug with very minor side effects.
I'd be very much against sulfonylurea classed drugs like Gliclazide because there is evidence to reflect that they can kill off your body's ability to produce natural insulin.
I'd be open to a basal/bolus insulin approach if everything before that didn't work.

Note: I'm still on the fence about glp1 inhibitors ((I think that's what they're called) like, Invocana. They seem to be safe, but I haven't read enough about them to have an opinion.
 
An update:

I saw the doctor today. (Yes Sunday)

After following all the advice from everybody I managed to hold my ground and... I kept calm and said that I wished to try basal therapy. I kept fending off offers of more tablets to try.

So I am being refered to the diabetes clinic in the hospital.

Thanks everybody!!

Torq, Thanks for your message. I agree entirely with your viewpoint. I am on my maximum dose of Metformin without being incontinent and I am keen to still take it. I can't tolerate more than 2 grammes of slow release a day. If I can lower my basal insulin needs then I can do more excercise like swimming (which I love but dont have the energy for) I see a happy vicious circle.

Asparagus, I'll ask about Lantus or Levemir.

I'll let everyone know what happens at the hospital.
 
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