Advice Please T2 Going on Insulin

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thepominlaw

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Relationship to Diabetes
Type 2
I have been a T2 diabetic since 2006 (54 year old male), always controlled with tablets up to now. Last year I started on Ozempic which has been fantastic at weight loss, but it makes me feel so ill I basically do not eat hence the weight loss. I can easily go 48 plus hours without eating a thing, illness usually lasts for the first 2 days after the injection then things calm down and I can eat a little. (Currently on slow release Metformin and Ozempic, was on Gliclazide this was stopped when i started Ozempic)

Last week I had my diabetic review, expecting to see better figures I was shocked everything had gone up, my weight has gone from 145kg to 100kg (15kg since starting Ozempic 5 months ago) so I was genuinely expecting a lower result, my long-term level was 105 up from 82 last time. The nurse has suggested I go on Insulin and asked that I take daily readings so they can understand my levels. Currently I am averaging 18mmol when I wake up, 25mmol after eating and 20mmol when I go to bed (this is all I have been asked test at present).

I know my diabetes is worse than it was, my eyes aren’t good I have grey transparent patches in my vision these come and go, my eye screening they have noticed signs of retinopathy. Plus, I get awful nerve pain (burning sensation) in my feet every night (blood flow is good though I am told).

I think insulin is the way to go but it makes me nervous, and I feel that I have failed as my sugars are not in control despite weight loss and careful eating.

What I am really after is advice please, anything I should know about going on insulin? Do I need to keep it cold (I love travel and camping quite often I have no way to keep things cool). I’m a UK driver too and require driving for work what will happen here will I get a restricted licence? So many questions sorry.......

Thanks all
 
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Hi and welcome to the forum.

Sorry to hear your HbA1c has gone up so significantly, despite the weight loss. I am guessing your own insulin production is now sufficiently "burn out" to need supplementation.
Can I ask if you made any dietary changes whilst you were on oral diabetes medication and what you were eating on the days where Ozempic allowed you to eat? The reason I ask is that if you had not reduced your carb intake and continue to eat carb rich foods whilst on insulin, you are likely to regain the weight you have lost which would be a shame.

As regards storing insulin, your "in use" insulin should be fine at "comfortable" room (or tent) temperature here in the UK but other prescribed pens which are not in use need to be kept cool in the fridge, usually the fridge door so that it isn't at risk of getting frozen from a malfunction. It can degrade in high temperatures like being left in a car or conservatory or on a windowsill in summer. You could buy a Frio pouch which uses evaporation to cool it's contents in hot climates or if it is particularly hot in the UK when you go camping.

As regards driving, are you a HGV or PSV driver or just standard commercial vehicles? The former require more stringent testing before your licence is renewed and I believe you have to show 3 months of testing before you can resume driving commercially but regular vehicles I think it is just a question of applying for your restricted medical licence and abiding by the guidance, which is to test before driving and every 2hours afterwards on longer journeys and you have to be above 5mmols to drive, but if you are between 4 and 5, you can eat some carbs and drive straight away. If you are below 4 you are effectively grounded for 45 mins AFTER your levels come up above 4 and again need to be 5 to drive.
 
hi , it must be a thought to change but it hopefully will be able to get your sugars to a safer acceptable level.
Diabetics do drive but might be good to have time off until insulin settles and you cope. This sounds like it might be better than not eating etc but hypos might be a risk especially if you do not eat.
There is a hot line here and professional help is at hand so you can get back up.
i hope to your GP gives you advice as well as just giving you a prescription.
DVLA allows my friends to drive but they might want to make sure your safe as should your employer .
others should give you advice too but id phone n chat to the hotline if you need as they know more .
 
Is there any reason that you could not go back onto the gliclazide or other oral medications instead of insulin as that would make your driving situation more straightforward. Also looking at your diet again.
 
As a long-time (over 20 years) insulin user with Type 1, I can confirm that insulin should not limit your life. In fact, lowering your BG will help you enjoy it more.
I am very active, love travel, have camped (but only where there is nothing else on offer so in more remote places than in the UK), drive, etc.
I am surprised by the suggestion to "have time off" driving as the risks is hypo (low blood sugars) because we are always started on low insulin levels to greatly minimise the risks of hypos early on. The idea of taking insulin is to allow you to get on with your life, not to put it on hold.
You do need to inform the DVLA which will mean you will get a license which will need to be renewed every 3 years. You will also need to tell your insurance company but they should not put up your premiums as that could be seen as disability discrimination.
There are additional rules for drivers of HGVs (and pilots of airplanes) which you will need to look into if that is what you drive for work but, if you just drive a car and/or motorbike, there is no problem. The point is, there is very little insulin will stop you doing. I am not sure if you are able to do deep sea diving or become an astronaut but you can be an Olympian like Steve Redgrave or play rugby for England, like Henry Slade. Today we have a Speaker of the Commons (Lindsay Hoyle) taking insulin and have had a prime minister (Theresa May).
 
thepominlaw said:
Currently I am averaging 18mmol when I wake up, 25mmol after eating and 20mmol when I go to bed (this is all I have been asked test at present).

I know my diabetes is worse than it was, my eyes aren’t good I have grey transparent patches in my vision these come and go,
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Hello @thepominlaw,

The grey transparent patches in your vision sound potentially REALLY SERIOUS These could be the symptoms of a mini-stroke or TIA. I say this because that is exactly what I had last week some 30 minutes after I'd finished having a rigorous eye test and ocular examination which confirmed there was absolutely nothing wrong with my eyes. I had, most luckily, a Cardio appointment the next day (Thursday) which led to an Urgent referral to the local Stroke unit on Friday and a phone summons to the Stroke Unit for an MRI 1st thing on Sat morning.

The net outcome was a confirmed diagnosis of a TIA by mid Saturday and immediate changes in my medications. Spoilt my weekend plans, but I am so lucky!!

If I'm correct - and I have no medical qualification - you need to be seen by a Dr straightaway. Either phone for an ambulance or get someone to take you to A&E. Do not risk driving yourself. If I'm correct I can not over empathise how important this is. Mini-strokes invariably lead to another mini-stroke and /or a major stroke. Major strokes are totally life changing; mini-strokes are a nuisance but manageable once diagnosed and treated. Diagnosis very promptly after a mini-stroke is essential, the outward visual signs or from a scan disappear rapidly; my scans showed nothing but the MRI showed this very clearly along with much older evidence of some other brain scarring.

Diabetes can increase the risk of TIAs if you are vulnerable to these, but (as in my case) my TIA is probably not influenced by my Diabetes. But who knows.

DO SEEK MEDICAL HELP NOW. I hope I am not correct, but better safe than sorry.
 
If you are having too many carbs causing your weight and insulin resistance to rise then insulin may be of little help. The key to this is probably your diet and amount of carbs. So, before you move to insulin consider your diet and carb intake.
 
I sorry to hear your having such a hard time.I have type 2 diabetic and have moved to insulin and metforminand quite stable now.I did have very high levels sugar and got DKA and then TIA.But things have settled down now.i on halve the insulin that I was on 60 units on long acting and 6 units short acting and thing that has improved is exercise walking every day around 4600 steps per day.
 
helli said:
I am surprised by the suggestion to "have time off" driving
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Well I’m not surprised, having grey spots in vision doesn’t sound like safe driving! I’d stop driving until that is resolved too.

Plus as they drive for work, and we don’t know what type of vehicles they drive, they may lose their licence for a while anyway. Since just starting insulin means you lose your large vehicle licence for at least 3 months, then there’s the vision issues to resolve too.
 
Thanks all, sorry should have said i drive a car to get to and from site meetings that's all, no HGV etc. I have had an eye exam and the patches i am told they are floaters and will pass with time.
 
Finally after a week of testing I have had my consultation with my diabetic nurse. Lowest reading all week was 12 just after waking highest 27 after eating some pasta. Readings averaged 17 for the week so it seems my pancreas isn't producing the insulin in needs (so I am told). I have been told for now they will reintroduce Gliclazide (which I was taken off when I went on Ozempic) and add in Dapagliflozin, wait another 3 months and if no improvement look at insulin. Personally i just want my sugar levels down but im due on a cruise in 8 weeks so i can at least get that out of the way before i have to think about insulin
 
thepominlaw said:
Finally after a week of testing I have had my consultation with my diabetic nurse. Lowest reading all week was 12 just after waking highest 27 after eating some pasta. Readings averaged 17 for the week so it seems my pancreas isn't producing the insulin in needs (so I am told). I have been told for now they will reintroduce Gliclazide (which I was taken off when I went on Ozempic) and add in Dapagliflozin, wait another 3 months and if no improvement look at insulin. Personally i just want my sugar levels down but im due on a cruise in 8 weeks so i can at least get that out of the way before i have to think about insulin
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Pasta is high in carbs, did they not tell you reduce carbs from your diet?
 
Hi @thepominlaw. If my experience is anything to go by, the floaters will come and go with a mind of their own and not affect any activities. Mine come with flashes! Yup, in low light I get flashes of multicoloured lights at the edge of my vision. Most disconcerting when they start but once the optician is happy there is nothing serious behind them (floaters and flashes) then you get to sit back and enjoy the show because as I understand it, there is not a lot that can be done about them.

Also, it seems to me that your DN is amongst the better ones and in my view, if you have one of those, it is best to work with them as they have your interests at heart. Maybe you could help things along a bit by looking at cutting back on carb content of your diet. Might delay, might even eliminate, the need to move to insulin depending on what is the root cause of your poor glucose control. Look around the forum and you will find this is a topic often referred to and most have found it helpful in controlling blood glucose, me amongst them. There are different ways of going about it and you will pick up the main themes in your reading and work out what might work for you.

Good luck and I am sure that with a bit of good planning you will be able to work around things to make sure your cruise is all that you want from it.
 
Hi @Docb yes my DN is fantastic she seems to really care, certainly more than the Doctors I have seen in the past.

The floaters have finally gone which is a relief at least i know what they are if they ever return. My Gliclazide arrives today i am also going to try a low carb diet so hoping it will improve, DN want to leave it a few weeks with Gliclazide added in then start retesting to see if my levels are any lower with a view on adding Dapagliflozin when it is safe to do so (she says not safe at moment due to high sugar levels). Hopefully this will work at least no insulin for now so i can get my cruise out of the way ...... just need to figure out what low carb foods to eat on the ship.
 
I know that others have from time to time questioned my tendency to share with the chefs at "away" venues my wish for help in portion sizes and potential high carb items - so with some trepidation .....

If ever there was an opportunity to get outside assistance in finding low carb options it is on a Cruise. Every member of staff on a cruise ship has a vested interest in making sure that passengers get a great and memorable (for the right reasons) experience. The kitchens tend to be providing meals from very early to very late 7 days a week and much of that food is freshly prepared - because that is generally very cost effective when the chefs are already in place and thus the labour cost is not particularly variable. A Head chef will have huge knowledge of food and be right up to date with food allergies as well as a good awareness of carb contents; it is their professional remit.

I would have no qualms about starting an initial dialogue with the ship's purser (the initial interface between a passenger and any requirement they may have) and outlining my catering requirements. If I were T2 and struggling with my BG control, I would be happy to talk with the Head Chef or one of the senior Dining room chefs and ask them to help me with finding low or lowish carb foods. In no time at all the chefs and associated waiting staff would know what my somewhat special needs are and would make it seem like a pleasure for them to assist me. That is an art in itself. I would also see this as a learning opportunity for me to glean from those chefs ideas that I could use, once back home. The experience that top flight Chefs have would probably far outreach the knowledge of many Dieticians (which I have too often found to be constrained to NHS generic formulas that don't cater for individuals and end up not being useful). Passenger's on Cruise ships frequently have medical ailments and support and service to such passenger's is very normal.

If the Chef's services to me during a Cruise was helpful I would make a point of not just thanking the chefs at the end, but of commenting to that effect on any followup survey, maybe also an email for the attention of the Ship's Captain. Good service by staff in such a close knit workforce family environment can (and usually will) result in due rewards in the annual pay rise negotiations and bonus awards. Good staff are hard to attract and then keep, particularly in the Cruise world; lengthy periods away from home might sound glamorous but its mainly work not play.

I hope you have a great trip @thepominlaw.
 
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