Interesting article on considerations and factors for starting type 2's on insulin

[Amity Island]

In patients with extreme hyperglycemia, insulin should be started immediately to lower glucose levels. The patient may present with any of the following:

• Fasting plasma glucose (FPG) levels >250 mg/dL;
  
  
• Random plasma glucose consistently >300 mg/dL;
  
  
• Glycated hemoglobin (A1C) >10%;
  
  
• Ketonuria; or
  
  
• Symptomatic diabetes with polyuria, polydipsia, and weight loss.[2,3]

Patients on maximal doses of available combinations of oral antidiabetic agents who are not meeting glycemic targets should also be started on insulin. In most patients with type 2 diabetes, it is reasonable to initiate therapy with oral agents. Then, A1C levels should be checked every 2-3 months, and therapy should be changed if glycemic goals are not met. A combination of 2 oral agents may be used, and A1C levels should be re-assessed in 2-3 months. If blood glucose and/or A1C targets are not met, initiating insulin is preferable to adding a third oral agent.[2,3]

The goals of insulin therapy are the same as the goals of any therapy for the treatment of diabetes: to achieve optimal glycemic control without causing undue hypoglycemia or excessive weight gain and to minimize the impact on lifestyle. With that in mind, it is critical to know the individual. Who is the patient? What is a typical day for this person? Does the patient have a relatively consistent pattern from day-to-day or does it vary significantly? Is this person consistent with meals and types of food eaten? How old is the patient, and what are his/her cognitive abilities? Are there any other limitations, such as dexterity problems due to advanced arthritis or neuropathy? All of these considerations will have a bearing on the type of therapy that will be most beneficial.

Initiating Insulin in the Type 2 Diabetes Patient

How can clinicians and patients overcome their resistance to insulin?

www.medscape.org

 

[Skinny T2]

Well that has answered my question. I was wondering if insulin would help me. I am a skinny type two female aged 62 that exercises well and eats low carb. I have lowered my hba1c to 5.6 but take 2000mg metformin and sitagliptin ( Januvia) . But not terribly pleased with my restricted diet. And hungry during the night. My blood sugars at night vary from 5.9 to 6.4.
But it looks like I am just stuck dealing with these challenges. I just want to eat a whole apple without spiking to 9.8 within the hour. If I have a really suitable meal high protein low carb I am 6.7 but then I end up hungry and eat cheese and a bit of grain cracker, then I am hungry again and eat 20g protein yoghurt . I am waking up in the middle of the night hungry. My weight is stable so I am meeting my calorie needs.
I was hoping that a bit of insulin would make all this hunger and overly restrictive eating go away.

 

[Leadinglights]

Well that has answered my question. I was wondering if insulin would help me. I am a skinny type two female aged 62 that exercises well and eats low carb. I have lowered my hba1c to 5.6 but take 2000mg metformin and sitagliptin ( Januvia) . But not terribly pleased with my restricted diet. And hungry during the night. My blood sugars at night vary from 5.9 to 6.4.
But it looks like I am just stuck dealing with these challenges. I just want to eat a whole apple without spiking to 9.8 within the hour. If I have a really suitable meal high protein low carb I am 6.7 but then I end up hungry and eat cheese and a bit of grain cracker, then I am hungry again and eat 20g protein yoghurt . I am waking up in the middle of the night hungry. My weight is stable so I am meeting my calorie needs.
I was hoping that a bit of insulin would make all this hunger and overly restrictive eating go away.

The normal time for testing whether meals/foods are suitable is after 2 hours not 1 and looking for no more than 8-8.5mmol/l so you many be fine with your apple especially if you have some cheese or nuts with it.
There are lots of low carb foods which you could add to your menu, increasing healthy fats and protein should help with not feeling hungry. Your overnight levels look good.
Have a look at this link for some more ideas for low carb https://lowcarbfreshwell.com

 

[Skinny T2]

I will modify my diet further. Yes I eat nuts or nut butter with the apple now or a low carb protein bar. I still try to eat less than a whole apple. I understand what you are saying about levels at 2 hours being it, but I feel awful when my level spikes, whatever time after the food that is. I had an alarming glucose tolerance test. At one hour I had to lie down and be given a blanket. I thought they turned the heating off ( it’s winter here)
I will check out your link . Thank you.