Insulin to Tablets Pros and Cons

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NikyAndro

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Relationship to Diabetes
Type 2
Hello.
I am T2 and on Insulin. I have the possibility of coming off insulin and going on to Tablets. I find the prospect very scary but am willing to try if its better for me. On insulin i have very tight control and very good hba1c i know where i am at. Downs of insulin are the night hypos and general hypos plus all the normal stuff around injecting. Im worried that it will go wrong on tablets. I have many diabetic complications and i do not want my blood sugars to rise for any reason. Am i worrying unnecessarly? Has anyone else been in this predicament?
Thank you in advance for your help.
Nicky
 
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If you are having lots of hypos then you are taking too much insulin and need to at least reduce the dose, or switch to tablets if you’re already on a low dose. If you switch to tablets just keep an eye on your bgs and you can always go back to insulin if it doesn’t work out for you.
 
NikyAndro said:
On insulin i have very tight control and very good hba1c i know where i am at. Downs of insulin are the night hypos and general hypos plus all the normal stuff around injecting.
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I would also suggest you are on to much insulin, which is quite dangerous as you will end up with no hypo awareness. Try relaxing a little bit and allow your numbers to go up slightly so you stay safe.
 
Hi.

Can you explain what you mean by "very tight control" and how you assess this?. Is it just via HbA1c results or are you using Libre or similar CGM or regular finger pricks?
To me if you are having more than occasional nocturnal hypos, your control is not that tight, but I accept that despite our best efforts they do happen sometimes and similarly during the day, so it very much depends on how frequently you are having them and is this why the nurse is offerening oral meds instead?.

Which insulin(s) do you use and what sort of doses do you use? If you are on quite high doses, then I would imagine some sort of steady scaling back would be needed.

What sort of dietary restriction if any do you currently follow? Just wondering if you already follow a low carb way of eating whilst using insulin then you will likely struggle without insulin, but if you eat a normal or carb rich diet at the moment, then reducing your carbs would mitigate the loss of insulin.

Do you have much/any weight to lose? Again, following a weight loss program like the Newcastle Diet might help if you came off insulin, but if you are already slim, then that may not be helpful.

I know you have suffered amputation so it is totally understandable for you to be wary of high BG levels and control being all the more important to you.

As @Lucyr says, it doesn't have to be a one way only shift. Maybe try it whilst you still have some reserves of insulin and see how you get on or make an agreement with your nurse that you will try oral meds for a limited period on the understanding you can go back to insulin if it doesn't work out for you.
 
Lucyr said:
If you are having lots of hypos then you are taking too much insulin and need to at least reduce the dose, or switch to tablets if you’re already on a low dose. If you switch to tablets just keep an eye on your bgs and you can always go back to insulin if it doesn’t work
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rebrascora said:
Hi.

Can you explain what you mean by "very tight control" and how you assess this?. Is it just via HbA1c results or are you using Libre or similar CGM or regular finger pricks?
To me if you are having more than occasional nocturnal hypos, your control is not that tight, but I accept that despite our best efforts they do happen sometimes and similarly during the day, so it very much depends on how frequently you are having them and is this why the nurse is offerening oral meds instead?.

Which insulin(s) do you use and what sort of doses do you use? If you are on quite high doses, then I would imagine some sort of steady scaling back would be needed.

What sort of dietary restriction if any do you currently follow? Just wondering if you already follow a low carb way of eating whilst using insulin then you will likely struggle without insulin, but if you eat a normal or carb rich diet at the moment, then reducing your carbs would mitigate the loss of insulin.

Do you have much/any weight to lose? Again, following a weight loss program like the Newcastle Diet might help if you came off insulin, but if you are already slim, then that may not be helpful.

I know you have suffered amputation so it is totally understandable for you to be wary of high BG levels and control being all the more important to you.

As @Lucyr says, it doesn't have to be a one way only shift. Maybe try it whilst you still have some reserves of insulin and see how you get on or make an agreement with your nurse that you will try oral meds for a limited period on the understanding you can go back to i nsulin if it doesn't work out for you.
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Thanks for your long(av5, 9)reply.. I use Libre and usually stay in the 4.5 to 8 range (av 5.9) 95% of the time. I count carbs and eat majority plant based although i do eat some egg and fish. I take Nova Mix very low dose 3 units in the am and 3 at night this has gradually come down over time from 10 and 10. I am exercising more as i have recovered from my amputation and Ulcer enabling more mobility. The diabetic nurse has offered me the choice of stopping insulin and going on tablets i dont know which way to go.
 
Pumper_Sue said:
I would also suggest you are on to much insulin, which is quite dangerous as you will end up with no hypo awareness. Try relaxing a little bit and allow your numbers to go up slightly so you stay safe.
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I have been cutting it back gradually with the Diabetic teams advice. I usually feel my lows around the high fours or low fives.
 
NikyAndro said:
I have been cutting it back gradually with the Diabetic teams advice. I usually feel my lows around the high fours or low fives.
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Sounds like you would benefit from some general diabetes education, if you read around the site you’ll find a lot more information to learn about target bgs and what a hypo / hyper is etc. a blood sugar in the 4s and 5s is not a hypo. A hypo is a blood sugar in the 3s or below.

At only 3u twice a day then stopping it and trying tablets seems a good option. You have the libre so you’ll soon know how it’s going and can just start taking the insulin again if you need to
 
NikyAndro said:
take Nova Mix very low dose 3 units in the am and 3 at night
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I hope you are taking the mix before your breakfast and also your evening meal.
If you are taking the mix before bed, then that's the reason for your night-time hypos.
The mix is a combination of basal (background insulin) and bolus which is used before a meal.
 
Pumper_Sue said:
I hope you are taking the mix before your breakfast and also your evening meal.
If you are taking the mix before bed, then that's the reason for your night-time hypos.
The mix is a combination of basal (background insulin) and bolus which is used before a meal.
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Except they aren’t night time hypos as they are bgs in the 5s
 
Thanks. Maybe i confused you. I feel the symptoms at late fours and act upon it before its full blown. As as i know a hypo is considered be below 4. But i will look and educate myself further as you suggest. I was really hoping to hear from people that made the swap from Insulin to tablets and have a discussion around that. I do appreciate your help though.
 
Lucyr said:
Sounds like you would benefit from some general diabetes education, if you read around the site you’ll find a lot more information to learn about target bgs and what a hypo / hyper is etc. a blood sugar in the 4s and 5s is not a hypo. A hypo is a blood sugar in the 3s or below.
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I think @NikyAndro is demonstrating that he/she has good hypo awareness rather than that they are considering these levels as actual hypos. I think this may be in response to @PumperSue's suggestion that their awareness would be eroded by too many hypos.
 
rebrascora said:
I think @NikyAndro is demonstrating that he/she has good hypo awareness rather than that they are considering these levels as actual hypos. I think this may be in response to @PumperSue's suggestion that their awareness would be eroded by too many hypos.
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Fair enough but I’ve never heard anyone refer to a bg in the 5s as a hypo before.
 
Pumper_Sue said:
I hope you are taking the mix before your breakfast and also your evening meal.
If you are taking the mix before bed, then that's the reason for your night-time hypos.
The mix is a combination of basal (background insulin) and bolus which is used before a meal.
Click to expand...
Thanks.
Yes of course, before breakfast and before dinner. Have you swapped grom insulin to Tablets?
 
Lucyr said:
Fair enough but I’ve never heard anyone refer to a bg in the 5s as a hypo before.
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When i was first put on insulin i used to get actual hypos at 6 / 7. That seens crazy but ii was from years and years of having very high blood sugar and not doing anything about it. When i finally did something my body was all over thr place.and has taken a year to settle but recently its changing again. .
 
@NikyAndro Congratulations on your amazing reduction in insulin.
It is inspirational to read stories like yours.
Like @Pumper_Sue , having Type 1, I have been on insulin all the time and will never have the choice of tablets so i am sorry but I cannot advise you on that.
I think you have confused some of us with your mention of hypos higher than 4.0. Typically, these are called “False hypos”. Whilst they feel rubbish, this is only because your body was used to being higher and, to my understanding, they should not be dangerous in the long term. I wouldn’t like to be driving and feel hypo symptoms at any levels so I hesitate to say they are not dangerous in the short term.
It is good to avoid hypos but, bear in mind treating when in the 5s could continue your body thinking it is wrong and not give it a chance to familiarise itself with “safe” 4s when people without diabetes can experience levels in the high 3s. My understanding is we treat hypos when below 4 because our bodies do not regulate the insulin when we inject so we risk going lower.
 
With your doses having come down so much, and with you still seeing low (or borderline) BG levels, it does sound like trialling a week or two without mixed insulin would be worthwhile.

Your ‘time in range’ sounds great, and i can understand why you are protective of that, but you might find your levels stay impressively in range without the mix.

At 3u every 12 hours taking a 70:30 mixed insulin you have 30% fast acting and 70% slow acting, so only 0.9u of your dose is available for meals for the first 4-5hours after injecting. And roughly 0.175u/hr of the slow acting component. So enough to give a little bit of a helping hand, but I would imagine its effect is fairly modest?
 
Wow thank you for that info that is really helpful. I spoke with the diabetic dietician ealier and she gave me a suggestion about seeing what happens if i just let my body self correct (its more long winded than that) and if do to review the insulin after that. It seems fairly unusual to be in this situstion. Im worried about tablets because i dont want to put any more prssure on my kidneys.
 
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