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Insulin for Type 2

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birdd09

New Member
Relationship to Diabetes
Type 2
Hi, new to the site today,
diagnosed type 2 6yrs ago, struggled to control levels for some time and am being advised by nurse to move to insulin. This scares me as not sure about side affects, weight gain etc, can anyone share their experiences of insulin when type 2? Thank you
 
You’ll probably find lots of different opinions on insulin. I’d give a very positive opinion as I love the flexibility and control insulin gives me and I would hate to go back to tablets. Others use insulin but work to move back to tablets or non insulin injections. If you prefer not to use insulin then there are lots of medications to try first, but you may have tried those already. What medications do you take at the moment and what sort of diet and exercise plan do you follow?
 
It depends a lot on what insulin regimen you are taking, and what the alternative is. I had the opposite experience of Lucyr, but that is due to our diabetes being different. And my type is now under reinvestigation anyway.

Presumably if you are going on to insulin you will have tried various medications, including Gliclazide, or on with a similar -azide name? If so you will already have experience of hypos, which is the main side effect of insulin. Though depending on your situation you may find with insulin you have more control to avoid them than you did with medication.

When I could no longer respond to Gliclazide I was put on a once-a-day long-acting insulin regimen, and I hated the inflexibility of it. But that could be just because of my particular needs, as it seems as though my problem is my pancreas not being able to produce enough insulin rather than resistance. So just adding a big lump of insulin to sit working away all day meant having to work around it.

But it works fine for other people, so no reason to think it could not work for you if that is what is recommended. You doctors and nurses will know you and your individual needs better than any of us can.

Shortly I will be moving to a multiple daily injection (M.D.I. or basal-bolus) regimen, which is what Lucyr is on. There you take some long-acting insulin to cover your resting needs, then some short-acting insulin with meals, so you only take as much as you need. So you have complete flexibility, but you have to put in the effort of working out and managing those needs. At least for me that makes it still less flexible than tablets, as I could just take them and never have to worry abut what I ate. But I have been told my diabetes is not typical (why it is being reinvestigated) and that is no longer an option anyway.

The insulin I am currently taking — insulin glargine, which is mainly prescribed under the names Lantus, Abasaglar, and Semglee — supposedly causes weight gain. And I am sure in four months of taking it I have been gaining weight, however when weighed at the diabetic review I was told I had only gained 2 lbs. And that could be normal variance, so maybe not?

As well as daily and M.D.I. regimens, there is a third insulin option which is a mixed insulin. This is normally taken twice a day with breakfast and tea, and contains enough long-acting insulin to keep you covered during the day and night, but also some short-acting insulin to cover those meals. It means you need to eat your meals about the same time every day, and them being roughly balanced in terms of carbs for your insulin need. But it also means you do not need to have to work out insulin doses or test and inject so much. For me it would be completely inflexible, but the lower requirements on time and effort can make it more flexible to other people where it suits their lifestyle.

But the most important thing to consider is, for all the issues of hypos and weight gain, what are the alternatives? The side-effects of untreated diabetes include blindness, amputations, cardiovascular disease, and premature death. Doing nothing is far more scary than insulin! But if medication is not helping those are your two options to choose between.

And injecting is pretty trivial, it hurts less than doing a glucose test and is nothing like a blood test where the needle is thicker and has to go deeper. I find you just need to rest it on the skin and the needle is fine enough that it will simply "drop" through, then it is just a little pressure to go underneath it without you feeling anything.

The only real downside of insulin to me is having to test levels every two-hours when driving, but that is because I like going on all-day motorcycle rides which means a lot of testing. I would probably find it a bit less onerous in a car, and for normal commuter type journeys it only means a test before setting off.

You will need to talk to the nurse about what sort of insulin regimen they recommend, but given the alternatives of not being able to control your levels, I would recommend any of them as being better.

And specifically of my experience of a once-daily regimen, it is not really any different to taking tablets. It only differed from taking Gliclazide in that you took an injection at around 10pm every day (or whatever time better suits you) rather than a tablet in the morning and evening, and in the extra testing required when on my bike. Which arguably should be required with Gliclazide too as the risks are the same. I was not required to test any more than I did before and I should not have had to think any differently about what and when I ate.
 
When I started insulin, I started straight onto an MDI regime (both long background insulin and a mealtime insulin), not the typical T2 path of starting onto a background only insulin first, which is perhaps why our experience has been different @Becka as well as just the general different things suit different people.
 
Possibly, but it was that you made it sound like tablets were not good for you which I was mostly contrasting with my experience.

Since being prescribed I was never ben told to do anything different to my diet, just the normal health advice of it being balanced, and tablets worked. So they were great for me, and had the daily regimen worked for me it would have been too. I could have continued in blissful ignorance of carbs etc.

Sadly daily insulin was never going to work out, as it did not address my situation. I think they were just following the T2 pathway rather than looking at my individual needs. So effectively I have lost ten months as they first put me on another oral medication, and then on the wrong insulin therapy, all of which should have been as apparent to the diabetes clinic as it was to me and my G.P.

It is about three weeks until my appointment where I will be educated and switched over to M.D.I., so I have started paying more attention to labels. Just knowing how much things weigh, let alone the carbs in them, is quite a thing to get used to. Given how my diabetes is now, having that control I currently lack will be a big improvement, I am certainly looking forward to that, but the initial effort required is quite daunting.

But, as with my advice to birdd09, doing all that is much more preferable than the consequences of doing nothing at all.
 
If you find other options are not working for you, I wonder if it has every been confirmed that you definitely have type 2. It is amazing how many adults are misdiagnosed with type 2 because of their age and size with no blood test to confirm it.
LADA is a very slow onset Type 1 which is often confused with type 2.

Something you may want to discuss with your doctor/nurse.
The consequence will probably be the same - you will definitely have to take insulin - but the reasons will be different.
 
Possibly, but it was that you made it sound like tablets were not good for you which I was mostly contrasting with my experience.

Since being prescribed I was never ben told to do anything different to my diet, just the normal health advice of it being balanced, and tablets worked. So they were great for me, and had the daily regimen worked for me it would have been too. I could have continued in blissful ignorance of carbs etc.

Sadly daily insulin was never going to work out, as it did not address my situation. I think they were just following the T2 pathway rather than looking at my individual needs. So effectively I have lost ten months as they first put me on another oral medication, and then on the wrong insulin therapy, all of which should have been as apparent to the diabetes clinic as it was to me and my G.P.

It is about three weeks until my appointment where I will be educated and switched over to M.D.I., so I have started paying more attention to labels. Just knowing how much things weigh, let alone the carbs in them, is quite a thing to get used to. Given how my diabetes is now, having that control I currently lack will be a big improvement, I am certainly looking forward to that, but the initial effort required is quite daunting.

But, as with my advice to birdd09, doing all that is much more preferable than the consequences of doing nothing at all.
Ah yes I tried every tablet going over the course of a year or so and never really got my blood sugars below 10% (sorry don’t know the new numbers) until insulin. I agree on everyone being different and the most important thing being that you get your blood sugars to a good level through whatever diet, exercise and/or medication is necessary to do that.
 
Ah yes I tried every tablet going over the course of a year or so and never really got my blood sugars below 10% (sorry don’t know the new numbers) until insulin. I agree on everyone being different and the most important thing being that you get your blood sugars to a good level through whatever diet, exercise and/or medication is necessary to do that.
Thanks for responding, Ive been on the same medication for 6yrs, Metformin and Glicklazide, nurse now recommends insulin as sugars are high. Do you mind me asking what if any side affects you have experienced of insulin
 
Thanks for responding, Ive been on the same medication for 6yrs, Metformin and Glicklazide, nurse now recommends insulin as sugars are high. Do you mind me asking what if any side affects you have experienced of insulin
Insulin doesn’t really have side effects, other than the symptoms of high or low blood sugars if you take too much or too little. Very occasionally someone can be allergic to it and get symptoms of that but that isn’t common.

Have you tried any of the new non insulin injectables like ozempic etc? If you’ve just been on metformin and gliclazide for 6 years then there are lots of other new treatments in that time which may be suitable.
 
It is amazing how many adults are misdiagnosed with type 2 because of their age and size with no blood test to confirm it.
LADA is a very slow onset Type 1 which is often confused with type 2.

It is because it is not that easy. For one thing, test accuracy is greater the further they are done after diagnosis, so it is better for confirming later, if necessary, rather than diagnosing.

NICE guidelines say not to do such blood tests unless someone is suspected to be type 1 but with atypical features, so it is used for confirmation rather than to determine type; someone is treated as type 1 but suspected to have a monogenic form; or where the type is uncertain but knowing it would enable specific therapies. The latter is because the type does not normally affect treatment, so there is no benefit to reinvestigating a type 2 diagnosis if care and treatment would be the same. But if it is felt a pump of Libre would be beneficial then a change of diagnosis would be required, so reinvestigation would be helpful.

And the problem with LADA is that in the early stages it does not present in way that can be separately diagnosed.

Despite my C-peptide level I get the feeling my diagnosis is not going to change. I think the reason the consultant wants to investigate more is to test for monogenic forms.
 
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Have you tried any of the new non insulin injectables like ozempic etc? If you’ve just been on metformin and gliclazide for 6 years then there are lots of other new treatments in that time which may be suitable.

Those treatments were not an option for me as here you need to have a B.M.I. over 35 and an HbA1c over 7.5% to qualify for them. There are some exceptions to the former but only for certain ethnicities; where insulin is incompatible with an occupation; or it gives additional weight loss benefits.

I do not know how the doses compare, but a GLP-1 pen costs about £70 compared to around £35 for five glargine pens. Which makes it sound like insulin is a lot cheaper, especially as glargine is now generic, and most mixed insulins use older ones.
 
I don’t have experience from a T2 perspective @birdd09, but as far as weight goes, I’ve been using insulin since 1991, and haven’t seen any weight gain that wasn’t caused by eating more than would keep my weight stable. I’m still pretty similar to the weight I was in my 20s 🙂
 
Hi. Do you have excess weight or are you slim. Taking insulin with notable excess weight may not have much effect as a T2 with excess weight would normally have too much insulin already due to insulin resistance. If you are slim then it could be a good move. Insulin itself normally has no side effects apart from hypos if you have too much. Note that insulin, like Gliclazide, doesn't cause weight gain but both enable the body to more easily metabolise carbs which can then cause weight gain if you have too many.
 
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