Should I ask f or Insulin?

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Hi Tom,

My last HBA1C was 101 and I am on Metrormin and Sitagliptin too. I eat a low carb diet.

After a lot of "running around" and asking many questions I eventualy got a phone call from the diabetes clinic and an appointment the next day.

I was asked about trying Glicazide and I just kept asking questions about how can people fine tune safer blood glucose with the Glicazide tablets as I dont want the complications.

In the end the nurse said I put up a good case for trying basal therapy and I was prescribed Humulin I.

It was agreed to reduce my blood sugars slowly to prevent eye damage, something nobody else had told me about.

I have been on Basal therapy for 24 hours now so I am beginning a new journey.

Best wishes on getting your sugars down safely.
 
I'm pretty certain I acknowledged the potential frailty of the BMI measure and suggested having a look at waist measurement too.

Whilst I have seen people come off insulin, it is also fair to say that even as a temporary measure the learning curve for the changes required, including driving license considerations, is steep.

I'm not suggesting that insulin might help the OP, but it strikes me in a discussion, both sides of the debate need to be viewed, and considered by the OP. It's his life after all.

For all any of us know, he could have a couple of "quick" (because the c-peptide test isn't a quick result, from observation) tests and hey presto the OP is T1.
 
@tomcamish

Well, unless you know how much insulin your own body is producing, you can't know whether you have LADA or T2. And neither can your health care team. They are just guessing. The test is the c-peptide test I believe. If your doc won't run it, I would be tempted to do it privately, if it is available.

If you are T2 and producing plenty of insulin, but are so insulin resistant that it isn't having the effect it should, and your blood glucose is high as a result, then adding more injected insulin will further drive up insulin resistance, with all the attendant health risks of hyperinsulinaemia. You will probably gain weight too. Kind of like adding gasoline to a fire. Reducing the need for insulin (diet changes, exercise, even fasting) will reduce insulin resistance astonishingly well. I speak from experience.

On the other hand, if you are LADA and your blood glucose is high because you are unable to produce enough insulin to cope with your current diet, then there are various options. Reduce the foods that produce the blood glucose (cut the carbs like porridge), OR take more T2 drugs to flog your pancreas to produce more insulin, OR use injected insulin to supplement your own. If you are LADA, you will end up on insulin in the end, but you may be able to delay it quite a long time.

In your situation, I would place the c-peptide test as a priority before adding any more meds which may, or may not, be appropriate to your situation.
 
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Mini-Vicki said:
Just as an aside, I think we should be careful when looking at BMIs I have a friend who would be considered overweight by his BMI, however he is into weight lifting, and therefore his weight is muscle, not fat!
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I agree that BMI is a load of crock - in some circumstances. But I think we all kind of know whether we belong in the muscly superfit class. 🙂

Mr B is 6'1" with broad shoulders and a good set of muscles, and varies between 15 and 18 stone, but he knows perfectly well that he should drop to 14 stone or below. His nurse tells him he is 'slim' and 'fine' too, but he knows that is rubbish. He has been slim, and knows what it is like - and it ain't 15-18 stone!
 
Hi all,

Thanks for your replies - given me lots to think about.

I've just got off the phone from the doctors having called to get my latest Hba1C - in June it was 97, it's now 98, so the Sitagliptin has done nothing.

In answer the the points about my weight etc - yes i carry a bit of weight around the mid section as "love handles", but based on the waist size thing, i was 42 inch but i'm now in 36inch clothes.

Granted I don't exercise as much as I could, but I do cycle to and from work when the weather allows, and i walk alot with my son in his buggy so i'm definitely more active than I used to be. It just seems that my Hba1C came down really quickly to start with and is now creeping back up.

Also, I kept a food diary for a few weeks along with blood tests (which I intend to do again) and cut out the foods that were sending me high - perhaps my tolerance has changed and other foods effect me.

I will call the local Diabetes clinic and ask for a phone consultation to start with to see what they say.

Thanks again.
 
@tomcamish that's exactly what happened with me. I was 101 on diagnosis. Put on 2G metformin and cut out carbs drastically and my next hba1c was 91. Then I was put on gliclazide and canagliflozin and it went down to 67. I had to come off canagliflozin due to it exacerbating another medical condition. I was then put on 100g sitagliptin alongside the other two meds. My hba1c was 102. So exactly back where I started which is when I had enough and went to a&E with blood sugars of 27. I got admitted and the next day I saw a consultant. That was in August and I've been on insulin since.
 
Rosiecarmel said:
@tomcamish that's exactly what happened with me. I was 101 on diagnosis. Put on 2G metformin and cut out carbs drastically and my next hba1c was 91. Then I was put on gliclazide and canagliflozin and it went down to 67. I had to come off canagliflozin due to it exacerbating another medical condition. I was then put on 100g sitagliptin alongside the other two meds. My hba1c was 102. So exactly back where I started which is when I had enough and went to a&E with blood sugars of 27. I got admitted and the next day I saw a consultant. That was in August and I've been on insulin since.
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@Rosiecarmel

So many people's experiences are exactly the same. I just called the Diabetes Clinic at the Hospital and after being bounced around 6 different multiple choice machines and ended up leaving a voicemail for a nurse to call me back. I don't want to step on my current nurse's toes as she's apparently a diabetes expert but my sugars are high for a reason.

My wife was put on a slow release insulin before she went to sleep when she had gestational diabetes and that worked a treat so perhaps i could start on that. My father in law just thinks i should have a jab before meals, to the point that he even offered to waste a new needle to give me some of his when we were there for a meal yesterday - obviously I said no as I dont know the effect it would have.

How are you getting on with the Insulin?
 
tomcamish said:
@Rosiecarmel

So many people's experiences are exactly the same. I just called the Diabetes Clinic at the Hospital and after being bounced around 6 different multiple choice machines and ended up leaving a voicemail for a nurse to call me back. I don't want to step on my current nurse's toes as she's apparently a diabetes expert but my sugars are high for a reason.

My wife was put on a slow release insulin before she went to sleep when she had gestational diabetes and that worked a treat so perhaps i could start on that. My father in law just thinks i should have a jab before meals, to the point that he even offered to waste a new needle to give me some of his when we were there for a meal yesterday - obviously I said no as I dont know the effect it would have.

How are you getting on with the Insulin?
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I am sure Rosie will answer as well, but before insulin, I could not get below 18 unless I completely cut carbs. Now I have a very small amount of insulin and have some of my life back. Certainly the part effected by diabetes. The change was instant. Gliclizide causes more weight gain than insulin. I have BMI that classified me as obese, with a 32 inch waist. Go figure.
 
tomcamish said:
@Rosiecarmel

So many people's experiences are exactly the same. I just called the Diabetes Clinic at the Hospital and after being bounced around 6 different multiple choice machines and ended up leaving a voicemail for a nurse to call me back. I don't want to step on my current nurse's toes as she's apparently a diabetes expert but my sugars are high for a reason.

My wife was put on a slow release insulin before she went to sleep when she had gestational diabetes and that worked a treat so perhaps i could start on that. My father in law just thinks i should have a jab before meals, to the point that he even offered to waste a new needle to give me some of his when we were there for a meal yesterday - obviously I said no as I dont know the effect it would have.

How are you getting on with the Insulin?
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I think you might initially be put on what's called a basal insulin. This is a once or twice a day background insulin which will be what your wife had. Some people can manage just on this. I couldn't so was also put on bolus insulin. This is quick acting insulin which you take before meals and can carb count, like your FIL does.

I'm doing so much better on insulin. I have more energy, I'm not tired all the time, I feel so much better AND I'm regularly seeing numbers in the 5s and 6s. On oral medications, even eating low carb, I was seeing readings in the 20s.

I have put weight on since starting insulin however that's my own fault as my diet and exercise regime has basically gone to pot...

Don't get me wrong, it comes with its own challenges and can be frustrating especially as your insulin sensitivity can change throughout the day. Don't worry about that just now though, as if you do get put on insulin, you will be given advice and support from a DSN. Plus the lovely people on this forum also give great advice.
 
My FIL has had issues where he's left it a little too long (or jabbed before the takeaway arrived) and we've ended up using glucogels and getting paramedics to come and bring him back round. However, his most recent review they dropped his insulin dose to a third of what it was and told him to try another jab site and he's found he hasnt had a hypo since, he's just annoyed nobody has noticed he's on too much.

Hopefully the clinic will call me back and i'll be able to have a proper conversation about it all, hopefully with someone who doesnt just shrug off the type 1 idea and say "take another tablet".

Thank you all for your advice. Much appreciated.
 
tomcamish said:
It just seems that my Hba1C came down really quickly to start with and is now creeping back up.
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Yes this is exactly what happened to me too. My HbA1c was 56 at diagnosis, dropped down to a normal for 9 months (I was essentially starving myself at this point, and my dramatic weight loss, although I wasn't overweight to begin with, was congratulated by the GP) then for the next few years it crept gradually, until by the time I was put on insulin, it was 125 o_O despite exercising as much as I could, although I couldn't do much as my muscles hurt so much, eating well, and I have a very active job, and taking the three tablets you are on. The two years before I was started on insulin were horrendous for me.

I have put on weight since starting insulin too, but I absolutely don't think that's the insulins fault. It is my own, as after 5 years of eating almost nothing, the freedom insulin gave me, led to my diet going to pot, so I'm slowly getting back on top of things... 😳

don't worry about stepping on the GP nurses toes, you have to get the healthcare that's best for you!

Let us know how you get on 🙂
 
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