Starting insulin

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Helplass

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Relationship to Diabetes
Type 2
hi
I am allergic to Metformin. ( Itchy Rash, Hoarseness , tight chest. I am on Empaflaglozin 25mg once daily and have Fluclonazole to control severe thrush once week that i get from using Empaflaglozin. I was told yesterday that my folate blood tests are also low from Metformin use so the doctor is now thinking to put me on Glipizide or insulin. I cant take Semaglutide, Liraglutide etc as I have had Pancreatits. Just want to know how people manage with the insulin and has it affected their ability to drive and general daily life. panicking just a wee bit.
any advice appreciated.
Thank you
 
As someone with Type 1 diabetes, I have no choice but to take insulin.
It has not stopped me driving .. or doing anything. I just have to test my blood sugars regularly and carry fast acting carbs (e.g. jelly babies) around with me all the time.

We have to inform DVLA and I only have a 3 year driving license but as I have not experienced a serious hypo and have no other conditions which affect my driving, I have no problems getting this renewed.
I always test before driving and follow the guidelines.

The "good news" is if you are treated with insulin you are entitled to a Libre on prescription which should make it easier to keep an eye on your levels.
 
I also, after 30 months of my changed status, have not found that being insulin dependent is a major issue - on its own. The hypo aspect is very important but not really a big issue for me. Libre alarms mean that it is now extremely infrequent for me to actually go hypo; took me a while to get to grips with that, but I was post major surgery and having chemotherapy - so my world had been abruptly turned upside down. I get warned as I drop below 5.6 and monitor thereafter taking corrective carbs if appropriate. How many carbs and at what point was a bit of trial and error, but is now routine. I get into the low 4s sometimes, but am fully aware and have my JBs handy! I haven't had a deep, horrible, hypo for 12 months or more and only 2, possibly 3, shallow hypos (where I've definitely felt wobbly) in 2022. Plenty of incorrect Libre "low glucose events" - but apart from altering my FreeStyle statistics, no other adverse aspect to those.

Yes, there are still challenges; probably the main one is lost spontaneity, eg planning food choices and taking a pre-bolus. Timing is deceptively important; understanding the principles and thus response for raised natural insulin resistance as a result of raised BG (for whatever reason) is, for me, helpful - arguably for me essential. But this is about staying in range and managing drift towards hypers, not preventing hypos. The loss of spontaneity is a big challenge, for both meals and activity and carries across to affecting my wife, who is the chief cook and has to be carb counting aware on my behalf! If I decide to take on unplanned activity or exercise I need to become more aware of BG falling - but again Libre does the work for that.

So don't be afraid of moving onto insulin. It can provide an element of predictability that helps, not hinders; seems a strange thing to read! The challenges are manageable.
 
I wonder if your Type 2 diagnosis is actually correct since you mention pancreatitis. Have you had a scan to assess the condition of your pancreas or some other investigation of it's functionality. If there is damage to your pancreas and the choice is between Glipizide (Gliclazide equivalent) or insulin, you may be better with the insulin. Glipizide works by stimulating the pancreas to produce more insulin. If your pancreas is damaged by disease or inflammation, putting it under increased stress by using this medication may cause further damage whereas injected insulin would support it's limited capacity rather than flog it to produce more.
Are you under a GP or Endocrinologist for your care? If GP you might be well advised to push for a referral to a specialist clinic where you would be under a consultant's care. Your diabetes Type is quite important because whilst you might be able to access technology like Libre through the NHS you will likely struggle to get it as a Type 2 but as a Type 3c which your pancreatitis would suggest, you would be treated as a Type 1 and find that technology was more easily accessible.

As regards insulin use, it is a steep learning curve to start with but most people find that it doesn't prevent them doing anything but does need more thought and planning and can occasionally catch us out and leave us stranded in the supermarket car park for an hour when a sneaky hypo catches us unawares. I find it more of an inconvenience now, but my first few hypos were pretty scary although I was able to manage them myself, I wanted someone to be there with me to monitor me. I used to ring my sister if I was on my own and talk to her after I had taken hypo treatment if I was on my own, until my levels came back up. Now I mostly just chew a couple of jelly babies and crack on with what I was doing ..... other than driving obviously which I have to allow 45 mins for after returning to normal levels. I don't have the alarms on my Libre like some people do, so I don't always get enough advance warning to prevent them. I average about 1 hypo a day according to Libre but it usually exaggerates how low my levels are so a 3.5 on the Libre might actually be 4.5 when I check with a finger prick. I think one of the things that I found helpful was to understand that hypos are part of insulin usage and they can be as frequent as several times a day or as rare as once or twice a year. Some of it will depend on your lifestyle and your own body and metabolism. Diabetes likes routine so the more structured your day the less difficult it ishould be to balance it. I am not good at routine 🙄 but I still manage my diabetes very well. I just have to be switched on to it. It takes up quite a bit of your brain's band width keeping track of it all.

I hope the above doesn't sound too negative because it isn't meant to be but there are a lot of factors to think about. I used to fear going to sleep each night for months in case I hypoed and didn't wake up. Then I had a week of nocturnal hypos almost every night (due to increased exercise) and I woke up fine and treated them and went back to sleep and that cured me of the fear and I sleep like the dead now and if I wake up hypo, I struggle to stay awake long enough to chew my jelly babies. You just get used to it and build up your confidence and learn how your particular body responds and that takes time and trial and error. You can learn lots from people here on the forum to help you find your way with it though.

I would say that insulin may well be your best option but I would discuss possibly being Type 3c with your doctor and a referral to a specialist clinic as this will help you to access better support.
 
helli said:
The "good news" is if you are treated with insulin you are entitled to a Libre on prescription which should make it easier to keep an eye on your levels.
Click to expand...
That’s not true. You need to be injecting insulin multiple times a day not just once, and also need to meet other criteria such as being advised to fingerprick more than 8 times a day otherwise to qualify for libre as a type 2. Then even when you do meet those criteria it’s a postcode lottery whether your area follows the guidance, my area doesn’t follow the nice guidance for T2s yet so I can’t get libre on prescription despite meeting the criteria
 
Switching to insulin is the best thing that happened to me. It took a year or so of bad control after diagnosis, trying everything but nothing working, before I got my hands on insulin but it’s been the best thing for my control since then. I went straight onto MDI which is a seperate long and short acting insulin, and started with carb ratios straight away, so there was a lot to learn. Many T2s just start with a background insulin first though which may be easier to get to grips with. If I could go back I’d go for the insulin over the tablets any day, no side effects and actually worked whereas tablets weren’t doing anything for me.
 
Best thing that happened to me as far as diabetes care was to move to insulin. Even better now the doses are almost right 🙂

I started on background insulin and then moved to the two when it wasn't enough on its own.

A few months in and its the norm for me now.
 
As a newbie, I hate to disagree with people but.... I was put on insulin 17 years ago and no one told me it would increase my weight by 15kgs in 6 months. I eventually went from 65kg to 82kg. That was a big thing for me as I am only 4'11" so every kg shows. The last 17 years the doctor has been telling me to lose weight - I have now lost around 12kgs but need to lose more but the daily shots of insulin make it so difficult, like fighting a losing battle but I am managing.

I started on 12 units of Lantus every evening, supplemented with glycazide 90 mg (spelling might be different as I live in France) and soon moved to 14, 16, 20 and so on until I was on 46 units daily and fasting bloods were still over 220 mg/DL and creeping higher. The only thing the doctor could suggest was take more exercise, eat less but never say what - cakes, ice cream (btw I dont eat those anyway). I am now trying to get off insulin as, for me, it was the worst thing my doctor could have prescribed for me.

Just thought you might need a different perspective as everyone else is saying it is the best choice. Obviously with your pancreatitis you might be in a totally different situation - I couldnt tolerate Metformin as it gave me stomach problems - so I guess you will have to go along with whatever your doctor says.
 
Update:
My Pancreatitis was caused by gallstones blocking the tube to pancreas. I am now under the care of a Professor in Endocrinology due to my medical history. I have been put back onto semaglutide as the Pancreatitis was caused by gallstones and not a problem with pancreas itself. Gallbladder has now been removed. So far ( 3 doses of 0.25 weekly) I am fine, just tired but that could be because of other stuff going on right now. I move onto 0.50 next Wednesday and we see how I go then. I am glad not to be on insulin as I am the only driver in my house and I am around 27 stone. We are hoping the semaglutide will also help me lose weight. I have not weighed yet as I am waiting till I start on higher dose semaglutide. I don't feel as hungry as I used to and am therefore not eating as much, so hopefully I have lost some weight. I have EDNOS & Binge Eating Disorder, Anxiety, PTSD, Depression, Hypnic Headaches, Vitamin D Deficiency, Folate Deficiency , Chronic Pain Syndrome, Sleep Apnoea, Osteoarthritis in hips, knees, ankles, shoulders, wrists and hands, to name a few!
Onwards and Downwards - with the weight!
 
Dennzie said:
As a newbie, I hate to disagree with people but.... I was put on insulin 17 years ago and no one told me it would increase my weight by 15kgs in 6 months. I eventually went from 65kg to 82kg. That was a big thing for me as I am only 4'11" so every kg shows. The last 17 years the doctor has been telling me to lose weight - I have now lost around 12kgs but need to lose more but the daily shots of insulin make it so difficult, like fighting a losing battle but I am managing.

I started on 12 units of Lantus every evening, supplemented with glycazide 90 mg (spelling might be different as I live in France) and soon moved to 14, 16, 20 and so on until I was on 46 units daily and fasting bloods were still over 220 mg/DL and creeping higher. The only thing the doctor could suggest was take more exercise, eat less but never say what - cakes, ice cream (btw I dont eat those anyway). I am now trying to get off insulin as, for me, it was the worst thing my doctor could have prescribed for me.

Just thought you might need a different perspective as everyone else is saying it is the best choice. Obviously with your pancreatitis you might be in a totally different situation - I couldnt tolerate Metformin as it gave me stomach problems - so I guess you will have to go along with whatever your doctor says.
Click to expand...

Insulin itself doesn't cause weight gain. What it does do is allow your body to more effectively use the food you are eating than it did when you were first diagnosed diabetic and allows you to store any surplus as fat.... just like people who are not diabetic can get fat. The problem is the food you eat ....or... it can be that your doses of insulin are too high and you eat to use up the insulin to keep your BG levels in range, but it is the food and not the insulin which causes the weight gain. That is why many of us who are Type 1 and using insulin, do not put weight on.
It is good that you are now losing weight and hoping to come off insulin, but to me, if you can manage without it, then you should probably not have been put on it in the first place. Dietary changes can have a massive impact on Type 2. Usually more than any other medication but unfortunately NHS dietary advice is not always the best for Type 2 diabetes and of course any change in eating habits is difficult, especially in modern day society where temptation is all around us and readily available. I follow a low carb way of eating myself, so I know how difficult it can be, particularly in the early stages/first few months. I wish you lots of luck in losing weight and coming off the insulin.
 
Helplass said:
Update:
My Pancreatitis was caused by gallstones blocking the tube to pancreas. I am now under the care of a Professor in Endocrinology due to my medical history. I have been put back onto semaglutide as the Pancreatitis was caused by gallstones and not a problem with pancreas itself. Gallbladder has now been removed. So far ( 3 doses of 0.25 weekly) I am fine, just tired but that could be because of other stuff going on right now. I move onto 0.50 next Wednesday and we see how I go then. I am glad not to be on insulin as I am the only driver in my house and I am around 27 stone. We are hoping the semaglutide will also help me lose weight. I have not weighed yet as I am waiting till I start on higher dose semaglutide. I don't feel as hungry as I used to and am therefore not eating as much, so hopefully I have lost some weight. I have EDNOS & Binge Eating Disorder, Anxiety, PTSD, Depression, Hypnic Headaches, Vitamin D Deficiency, Folate Deficiency , Chronic Pain Syndrome, Sleep Apnoea, Osteoarthritis in hips, knees, ankles, shoulders, wrists and hands, to name a few!
Onwards and Downwards - with the weight!
Click to expand...
So pleased you are getting some better support with your diabetes and have found a medication which is helping. It sounds like you have a lot of health issues on your plate which makes everything so much more complicated. I found following a low carb way of eating has helped my disordered eating significantly (I have much less cravings and therefore more control) and improved joint pain and a whole host of other benefits as well as enabling me to manage by diabetes better.
 
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