Blood Sugars still high

[Ooosha]

I have been T2 for over 15 years. My BS has never been below 9 on my meter. Now dietician wants to put me on insulin. My last Hb1c was 84, down from 94 time before that. I am reluctant to go down insulin route. I don't want to put on any more weight. (currently 9 1/2 stone at 5 feet) Do I have to go down insulin route? Can I not try diet and exercise route first? I do little exercise but eat very healthily with low carbs, high protein & fat

 

[Bruce Stephens]

I am reluctant to go down insulin route. I don't want to put on any more weight. (currently 9 1/2 stone at 5 feet)

As a general point, insulin does not necessarily lead to weight gain. There are obvious costs to insulin (it's dangerous and needs careful management), but weight gain isn't inevitable.

 

[Leadinglights]

I am surprised that id you have been Type 2 for 15 years and your blood glucose has been at that high level for all that time that some additional / alternative oral medications have not been suggested before the insulin route as that is not always an easy option if Type 2. Has it been considered that you may be Type 1 or LADA.?
I could be that even though you are saying you are having low carb it is not low enough and you are not tolerating the amount of carbs.
What sort of meals do you have and what would be the amount of TOTAL carbs you have per day.
Testing your blood glucose at home might help you identify particular foods which you are not able to cope with because they increase your blood glucose.
Everybody is different and so their tolerance of particular carbs can be very different. Some are fine with 20g of carb if it is rice but not if bread or potatoes so it could be you are particularly sensitive to what you are thinking is an OK amount of some of the carbs you have.
However there are some people whose Blood glucose levels remain stubbornly high despite a cocktail of oral meds and a very low carb diet and they may then need insulin.

 

[Ooosha]

I am surprised that id you have been Type 2 for 15 years and your blood glucose has been at that high level for all that time that some additional / alternative oral medications have not been suggested before the insulin route as that is not always an easy option if Type 2. Has it been considered that you may be Type 1 or LADA.?
I could be that even though you are saying you are having low carb it is not low enough and you are not tolerating the amount of carbs.
What sort of meals do you have and what would be the amount of TOTAL carbs you have per day.
Testing your blood glucose at home might help you identify particular foods which you are not able to cope with because they increase your blood glucose.
Everybody is different and so their tolerance of particular carbs can be very different. Some are fine with 20g of carb if it is rice but not if bread or potatoes so it could be you are particularly sensitive to what you are thinking is an OK amount of some of the carbs you have.
However there are some people whose Blood glucose levels remain stubbornly high despite a cocktail of oral meds and a very low carb diet and they may then need insulin.

I am on Metformin slow release x4, Gliclazide x4, and Januvia x1. I often miss morning Gliclazide as I have my first meal around 11:30am. Not a breakfast person. They wanted to swap my Januvia for a new drug but I did not like the sound of all the possible side effects. Think it was called Forxiga (dapagliflozina). My BS has reduced and I have asked for longer to continue trying to further lower carbs, take more Gliclazide and increase my exercise levels. I am just so tired all the time and have been feeling more depressed every day. I don't measure my carbs just reduce consumption. Slice of toast for breakfast, Little or no carbs with main meal. Maybe I need to concentrate more on the amounts etc but I am feeling very overwhelmed. 10 minute telephone appointments do little to get to the root causes and if meds seem not to be working then just changing to insulin without any prior education or discussion just seems wrong.

 

[DaveB]

First, insulin doesn't cause weight gain; it can't as it's just a hormone. It enables the body to metabolise the carbs and if you have too many carbs you may gain weight. You do need to set yourself a daily max carb target. I suggest 150gm/day and less if you can. Better to have eggs and bacon for breakfast rather than toast but one slice isn't too bad. You appear to be on the usual tablets for T2 and they should be working. I wonder if you are a LADA and hence have low insulin output from your beta cells? Ask for the two tests for T1 i.e. C-Peptide and GAD. Insulin may well help you. I've been down a similar route and been on insulin for several years which was the right decision for me. You do need to take your Gliclazide regularly

 

[harbottle]

Insulin can cause weight gain - it promotes conversion of glucose into body fat.

 

[Bruce Stephens]

Insulin can cause weight gain - it promotes conversion of glucose into body fat.

It can permit weight gain, of course. But it doesn't necessarily cause weight gain.

 

[Lucyr]

If you’re already eating well and it’s been 15 years, then the problem with “can I not try diet” is… what changes are there left to make to your diet and are they sustainable? Your a1c is pretty high so they would need to be quite significant dietary changes to get your a1c down to a good level. Is that amount of dietary change realistic for you?

 

[Leadinglights]

Perhaps if you post examples of some of the meals you have then people might spot some things which you don't realise may be causing a problem.
Ideas have changes in the 15 years since your diagnosis as to what constitutes a dietary regime which is sufficiently low in carbs to be effective. In general the standard NHS advice is too high in carbs for many people to tolerate.

 

[DaveB]

Insulin can cause weight gain - it promotes conversion of glucose into body fat.

The point I made is that insulin itself can't cause weight gain - fact as it's not a food. It does however enable the body to metabolise any carbs producing glucose which can be stored as fat. When some medics say insulin causes weight gain they mis-lead patients about the importance carbs have in affecting weight.