Insulin for Type 2 Yes or No?

[Catz63]

I have been put forward by my specialist nurse for Diabetes to start Insulin shortly. I am still not sure this is the route I want to go. My Hb1ac is in low 70's that;s down from the last but still up from what it has been in the past. My blood glucose is tested 2 to 3 times daily some days its behaving and is 6.8 - 7.4 in the morning before breakfast other mornings it's 9 - 9.9 for no reason (but I suspect liver dump). My specialist nurse says my bloods are not super high but my meds don't seem to be coping. I've tried everything and reacted badly to a few. So I'm currently on :
Metformin SR 1g twice a day
Glicazide 160mg twice a day
Canagliflozin 300g once daily
She has now decided I need insulin to help bring my numbers down. I have looked into it - I am not convinced its the right path.
I would rather try to reverse the insulin resistance causing the type 2 diabetes. I am prepared to try the Liquid Diet and start an exercise reigeme.
Does any one have any thoughts?

BTW I've been labelled Type 2 since 2012, I've lost over 5 stone and am now 13st.

 

[rebrascora]

Can we ask the sort of food you are eating as you make no mention of lowering your carbohydrate intake, which is by far the most powerful tool in lowering BG levels. Many people, particularly those diagnosed a long time and given standard NHS advice assume they just need to cut down on sugar and eat wholemeal bread etc but continue to eat quite a high proportion of carbs including plenty of fruit and this unfortunately will not help many Type 2 diabetics. Cutting a significant proportion of all carbs from the diet is much more effective and can result in some people pushing their diabetes into remission and coming off all medication. Weight loss alone will work for some people but not all, so for me cutting your carb intake would be the thing to do if you haven't tried that before starting insulin.
If you can give us an idea of a typical day's food and drink we might be able to see where carbs could easily be cut and alternatives suggested.

 

[rebrascora]

I should say that the only medication as powerful at reducing BG levels as low carb diet, is insulin, so don't be afraid of it if you need it, but if there is room for dietary improvement as regards reducing carbs, then I would ask your nurse to give you 3 months to try that first. The draw back with insulin is that you have to get the dose just right and it can be a tricky business and obviously who wants to inject themselves several times a day if they don't need to.

If you are already following a low carb diet and your numbers are still stubbornly high then it may be that you are LADA (Type 1.5) which is a slow onset Type 1 rather than Type 2, so knowing what you currently eat will give us an idea if that is likely. If you are LADA then you will likely need insulin at some point, but you might want to ask for a C-peptide test to assess how much of your own insulin you are able to produce which should help indicate your Type and possibly a GAD antibody test. Most standard Type 2 diabetics produce a lot of insulin but their body is resistant to it and ignores it, so extra insulin injected can help along with Metformin which improves the body's responsiveness to insulin. If you have LADA or Type 1 then your pancreas is no longer able to produce enough insulin itself and taking gliclazide (which stimulates the pancreas to produce more insulin) is like flogging a dead horse. That is a very simplified version and it is of course much more complex but gives you an over view of the rough differences between types. With Type 1 and LADA the insulin producing Beta cells in the pancreas are attacked by the body's immune system and killed. In standard Type 1 that happens quite abruptly and people get very ill (Diabetic Ketoacidosis or DKA) pretty quickly, but with older adults the die off of beta cells can be slower and therefore appear to be more like Type 2 diabetes initially and even respond to Type 2 medication in the early stages.... which can last months or many years.

 

[Catz63]

Thanks for replying.
I have all my life tried to follow a low fat diet as I have always struggled with weight. I have reduced carbs but obviously not enough . I eat some fruit but am limited as I have allergies to a lot of fruit acids. I eat nuts as a replacement for snacks. My appetite in recent years has reduced considerably. My breakfast is my main meal, by tea time my interest in food is minimal. I still have wholemeal bread if I have bread but I am not drawn to bread as I'm having problems swallowing it. I have soups mainly vegetable with one grated potato to help thicken it. I still enjoys crisps at lunch time as I want to taste some flavour. My down fall is my sweet tooth I always want something sweet after lunch or tea. Usually a 66 - 99cal snack bar.
My drinks in a day:- start with a coffee with a dash of semi skimmed milk, sometimes a 2nd at eleven but more often I have a flavoured fizzy water low /no sugar or a no added sugar fruit squash. I regularly drink more than 2litres in cold drinks a day including water.
I also take a pro-biotic with breakfast.
My activity is limited, my knees are not good. I enjoy walking and will walk to PO or to the grocers when I can. I have lost a lot of muscle mass and as I have very loose joints this is very painful as I get nerve pain as the bones move about in their joints. I have found some exercises on line to help build the mussels so am going to give that a go.
I have been self employed for over 12 years and since I closed the business I now have more time to look after me.

 

[rebrascora]

Low fat diets are half the problem. Fat keeps you feeling full for longer so you don't need to eat so much and don't feel hungry in between meals and need snacks. It also helps to stabilise BG levels by slowing the rate at which any carbs you eat hit the blood stream, so having cream or creamy Greek natural yoghurt with your fruit will help to make it more filling... (edited to add.... and mean the fruit has less of an impact on BG.... it is a good idea to severely restrict the likes of bananas and other exotic fruits though as these are the highest carb fruits)

Can you elaborate on what you have for breakfast specifically, as this is a time of day when we as diabetics, are often more insulin resistant so having a low carb breakfast is often more beneficial than any other meal and saving the majority of your carbs for later in the day can make a big difference as your body may well be able to cope with them better then.

With no added sugar fruit cordials, you need to look at the carb content on the nutritional info label (usually in small print on the back label.... same with all food labelling when looking at carbohydrate content, as some contain real fruit juice which of course contains sugar. 1 glass a day may not make much difference but if you are having several glasses a day then it all adds up. You may be surprised to know that semi skimmed milk contains more carbs than whole (blue top) milk and cream contains less than both of them so many of us diabetics have our morning coffee with double cream instead of milk... less carbs and the fat keeps us feeling fuller, so we don't feel the need to snack.

I know this will be contrary to everything you have been told about diet but for us diabetics we have to learn to think differently and eat things which our body can cope with, not the things it can't process any more. If we cut back on carbohydrates significantly, then we have to get our calories from somewhere else and fat has less impact on our BG levels than protein, which is the only other food group. It is even believed by some quite high level scientists that our low fat diet is in part responsible for the obesity and diabetes epidemic we are now seeing in the world, because that fat has been replaced by cheap carbs and those carbs create a glucose spike in our blood, which when it drops, triggers us to want to eat again to get another sugar high and gradually we eat more and more of them and our body gets immune to the insulin we produce to deal with it. Again, a simplification, but once you cut the sweet stuff and a lot of carbs from your diet and eat more fat, you don't crave the sweet, carb rich foods you did before and feel sated eating less food in general.

 

[adrian1der]

And let's face it, who can complain at an eating plan that includes pork scratchings and cheese 🙂

 

[rebrascora]

Adrian, we are so on the same page!!

 

[Catz63]

Low fat diets are half the problem. Fat keeps you feeling full for longer so you don't need to eat so much and don't feel hungry in between meals and need snacks. It also helps to stabilise BG levels by slowing the rate at which any carbs you eat hit the blood stream, so having cream or creamy Greek natural yoghurt with your fruit will help to make it more filling.

Can you elaborate on what you have for breakfast specifically, as this is a time of day when we as diabetics, are often more insulin resistant so having a low carb breakfast is often more beneficial than any other meal and saving the majority of your carbs for later in the day can make a big difference as your body may well be able to cope with them better then.

With no added sugar fruit cordials, you need to look at the carb content on the nutritional info label (usually in small print on the back label.... same with all food labelling when looking at carbohydrate content, as some contain real fruit juice which of course contains sugar. 1 glass a day may not make much difference but if you are having several glasses a day then it all adds up. You may be surprised to know that semi skimmed milk contains more carbs than whole (blue top) milk and cream contains less than both of them so many of us diabetics have our morning coffee with double cream instead of milk... less carbs and the fat keeps us feeling fuller, so we don't feel the need to snack.

I know this will be contrary to everything you have been told about diet but for us diabetics we have to learn to think differently and eat things which our body can cope with, not the things it can't process any more. If we cut back on carbohydrates significantly, then we have to get our calories from somewhere else and fat has less impact on our BG levels than protein, which is the only other food group. It is even believed by some quite high level scientists that our low fat diet is in part responsible for the obesity and diabetes epidemic we are now seeing in the world, because that fat has been replaced by cheap carbs and those carbs create a glucose spike in our blood, which when it drops, triggers us to want to eat again to get another sugar high and gradually we eat more and more of them and our body gets immune to the insulin we produce to deal with it. Again, a simplification, but once you cut the sweet stuff and a lot of carbs from your diet and eat more fat, you don't crave the sweet, carb rich foods you did before and feel sated eating less food in general.

Hi, well Breakfast as I said I eat as my main meal and so I have some carbohydrate usually wholemeal toast from freezer with clover spread. I usually add a piece of fruit - small banana, small apple or a handful of white grapes. Occaisionally cereals Oat flakes with semi skimmed milk and sliced grapes along with my pro biotic and coffee with semi skimmed milk.
I read over the weekend about increasing the fat intake and I can see the logic but having lived two thirds of my life on a limited fat diet it will be a difficult change to make.

My no added sugar drinks - I have checked the lables the squash just says negligible amounts of carbohydrate -6 cals a glass. the fizzy water 0.8g carbs of which 0.5g sugar/100mls ,neither very accurate. In the summer I tend to drink more water. I have at least 1 litre of water a day at the moment.
I have put a call into my diabetic nurse and I want to ask her to refer me to join the Low Carb Program as my chances of getting on the React trial is very unlikely at the current time.
Just thinking about what foods are in my house at the moment is mind blowing, they are protein high and carb not so high but I do still have to feed my husband who just balked at going to full cream milk when I mentioned it. When I met him he was using full cream milk, I was on skimmed so we compromised to semi-skimmed but now he cant face returning. He says he doesn't like it in his coffee. It is going to be a long hard journey unless he climes on board too.
Personally I only use coffee to wake me up in the morning and as something warm to drink on cold mornings I only started drinking coffee 8 years ago prior to this cold drinks or hot chocolate.

 

[adrian1der]

Well, your breakfast is very carb heavy. Most people are more insulin resistant first thing in the morning so not a great time to load up on carbs. Wholemeal bread is no better for you than white bread. Carbs are carbs. Bananas and grapes are also very high in sugar and cereals are again high in carbs

 

[Catz63]

And let's face it, who can complain at an eating plan that includes pork scratchings and cheese 🙂

Cant say I will ever enjoy pork scratchlings but I do like cheese but usually with poatoes but I could eat them more on veg instead.

 

[adrian1der]

Cant say I will ever enjoy pork scratchlings but I do like cheese but usually with poatoes but I could eat them more on veg instead.

Rather than potatoes how about a nice cauliflower cheese?

 

[Catz63]

Well, your breakfast is very carb heavy. Most people are more insulin resistant first thing in the morning so not a great time to load up on carbs. Wholemeal bread is no better for you than white bread. Carbs are carbs. Bananas and grapes are also very high in sugar and cereals are again high in carbs

I see that now but haven't been following a low carb diet more low calorie to loose the weight. My bloods were coming down with the weight but now the weight has plateaued and blood sugars are climbing again.

Rather than potatoes how about a nice cauliflower cheese?

I will eat that too but husband wont eat cheese cooked.

 

[adrian1der]

You can also use cauliflower to make a substitute for mash and rice. Celeriac also makes a nice mash

 

[rebrascora]

We can only advise you on what would help improve your HbA1c. It is up to you to figure out how to implement it into your lifestyle and circumstances. Maybe let your husband cater for himself for a few weeks whilst you sort your own diet, and have a small carton of whole milk or cream for your morning coffee but have a small bottle of green top for him.

Your breakfast looks to be the biggest problem and my feeling is that if you were able to address that.... maybe a 2 or 3egg mushroom and/or ham omelette with salad and a big dollop of cheese coleslaw, since you like something substantial, then that would most likely deliver a marked improvement in your levels.

 

[rebrascora]

You also need to restrict bananas and grapes to an occasional treat, maybe once a fortnight and one or the other, never both in the same day. Even apples are not ideal. Berries are the best option for us diabetics because they are the lowest carb fruits and packed full of flavour and nutrients so a small handful is enough and if you find the acidity a problem have them with cream or Creamy Greek yoghurt which will reduce the effect both of the few carbs they contain and also the acidity.
The low fat advice is something that we have all probably struggled to overcome. We have been indoctrinated with it for years and the NHS are still pushing it at us, so it is difficult to overcome that propaganda. Those of us who have embraced Low Carb Higher Fat eating find it sustainable long term because it is enjoyable and filling but also find we feel fitter and healthier and can adjust that fat intake to lose or gain weight without any great effort along with increasing exercise. I am 56 and I now have the figure I had in my 20s (down to a 26" waist"), my joints no longer give me grief and I feel 30 years younger.... and I eat more fat than I have in my whole life and I enjoy my food. I was a carb monster and sugar addict pre diagnosis, so I understand about having a sweet tooth. I love the fact that I now taste food differently and I enjoy sour and bitter flavours which I didn't like before because all I wanted was sweet and the more sweet I got, the more I wanted. I also like that I have more control over my diet nw because I don't suffer the cravings..... apart from pork scratchings 😉 .... but sounds like you are safe from that guilty pleasure.

 

[adrian1der]

I love the fact that I now taste food differently and I enjoy sour and bitter flavours which I didn't like before because all I wanted was sweet and the more sweet I got, the more I wanted.

I really love the earthy, meaty umami flavours as well

 

[Catz63]

You also need to restrict bananas and grapes to an occasional treat, maybe once a fortnight and one or the other, never both in the same day. Even apples are not ideal. Berries are the best option for us diabetics because they are the lowest carb fruits and packed full of flavour and nutrients so a small handful is enough and if you find the acidity a problem have them with cream or Creamy Greek yoghurt which will reduce the effect both of the few carbs they contain and also the acidity.
The low fat advice is something that we have all probably struggled to overcome. We have been indoctrinated with it for years and the NHS are still pushing it at us, so it is difficult to overcome that propaganda. Those of us who have embraced Low Carb Higher Fat eating find it sustainable long term because it is enjoyable and filling but also find we feel fitter and healthier and can adjust that fat intake to lose or gain weight without any great effort along with increasing exercise. I am 56 and I now have the figure I had in my 20s (down to a 26" waist"), my joints no longer give me grief and I feel 30 years younger.... and I eat more fat than I have in my whole life and I enjoy my food. I was a carb monster and sugar addict pre diagnosis, so I understand about having a sweet tooth. I love the fact that I now taste food differently and I enjoy sour and bitter flavours which I didn't like before because all I wanted was sweet and the more sweet I got, the more I wanted. I also like that I have more control over my diet nw because I don't suffer the cravings..... apart from pork scratchings 😉 .... but sounds like you are safe from that guilty pleasure.

I see where your coming from, I have told my husband he must eat the bananas off the side when they ripen. I have also told him he could have anything from the cupboards until they empty then it will all change. I will try my own meal plan and he can eat his own.
I will try some berries in Greek yogurt, I've always got my allergy meds to fall back on if it all goes to hives. I cant think what to have for lunch and cant actually face any food at the moment but I foresee a lot of eggs cheese mushrooms and maybe a slice or two of ham in my future. Parts of this diet reminds me of the Atkins diet I tried many moons ago. But then wasn't allowed any veg either.
I struggled to eat a hot breakfast in the past on Atkins so I will try the Greek yogurt with berries and then an omelette at lunch and some cheesy veg for tea. I still await a call from my diabetic nurse.

 

[Hammy]

Hi I'm just recently become type 2 diabetic and have found this thread to be really useful for me as I'm struggling to get my numbers down have got some good things to change and try

 

[Lucyr]

Personally, insulin is the best thing I’ve ever tried. I had side effects from all other medications and haven’t had that with insulin. I’m able to eat a normal diet of 150-200g carbs per day, (though with calorie counting to lose weight), which suits me as fat upsets my stomach so I eat low fat which makes low carb pretty difficult for me. I take long acting insulin in the evening and rapid acting insulin before meals. If it’s just long acting you took you would still need to watch your diet but may help to bring the blood sugars down.

The only downsides to insulin that I’ve found are all the carbohydrate counting and the driving restrictions. You have to test before driving, if under 4 then you have to eat something, wait 15 minutes until over 4, then wait a further 45 minutes. Sitting in the car for an hour in the freezing cold, without being able to start the engine to put the heating on, late on a dark night, and all because of a bg of 3.9 when you just want to be at home is a total pain.

 

[goodybags]

Insulin helped me when I needed it !
although I’m now taking quite a bit less
I’m getting my blood sugars under a better control (lower carb diet)

BUT plenty of testing needed if taking insulin and eating a low carb diet
(one night I woke up and my B/S was 2.9 !
omg nearly ate the contents of the kitchen @ 3:30 am (now I keep a test kit & glucose tablets by the bed)