T2 and Insulin

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Skellei

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Type 2
I am interested in people’s experience in moving onto Insulin (I am expecting that to happen to me shortly)

Personally, it’s not something that I particularly want to happen given a choice but equally I not overly concerned and if makes things easier to control that would be great

specific things I am interested in, what tends to the approach of GPs - i assume that they put you on long term insulin with daily injections - do the injections really not hurt, well not anymore than testing, can I have a less restrictive diet and do the NHS now prescribe pens and how did you find the transition ?
 
Hi. If T2 with some excess weight always give preference to losing any excess weight before moving to insulin. That will normally mean reducing the carbs in the diet. Insulin may not work well if you have insulin resistance from stored fat. The tendency these days is to go onto what's called the Basal/Bolus regime with two different insulins. It means 4 to 5 injections daily. A lower level option is to have twice daily mixed-insulin. I've always found the injections are less painful than the finger-prick. You can have pens with replaceable cartridges or disposable pens; the former are more Eco. My diet advice before or after starting insulin would be to keep the carbs down to a level that avoids weight gain.
 
Moving to insulin was the best thing I ever did, gives me much more control over my blood sugars and much more flexibility in my diet. I started on a basal bolus regime, I chose that over a mixed insulin because it was more flexible. Do you know what kind you will be starting?
 
Skellei said:
I am interested in people’s experience in moving onto Insulin (I am expecting that to happen to me shortly)

Personally, it’s not something that I particularly want to happen given a choice but equally I not overly concerned and if makes things easier to control that would be great

specific things I am interested in, what tends to the approach of GPs - i assume that they put you on long term insulin with daily injections - do the injections really not hurt, well not anymore than testing, can I have a less restrictive diet and do the NHS now prescribe pens and how did you find the transition ?
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Can you explain why your GP is thinking you need to go onto insulin. Has oral medication and dietary changes not been effective at managing your blood glucose levels.?
 
Same as Lucy, best thing that happened and mostly don't even feel the injections (fingerpricks are more nippy in my opinion).

I'm still tweaking and adjusting. Its been a slow process to get to better control so don't expect an instant fix until you are on the right doses for you. This will be done slowly.
Listen to your healthcare provider about how to adjust doses yourself, take notes, ask questions at appointments.

My experience was being put on a once a day insulin (was humulog i) and that was increased to twice a day and then I was switched onto a new long acting and mealtime insulin added as it wasn't enough to keep me on track all day.

https://www.diabetes.org.uk/resourc...20of%20Leicester%20-%20Insulin%20Profiles.pdf
That is a link with all the different insulins and profile so if/when you are prescribed it, you will know what one they are talking about.

Essential info for me was:
know what insulin I was on and how it was likely to act
know when I should take it and should it be at the same time each day
Should I adjust my insulin dose myself and by how much
know what to do in the case of hypos and have stuff on hand to deal with them at all times and let other family members / friends know about hypos too
know when to test
make sure I have medical id on you when out (i have an ID in my bag, and ICE on my lock screen and have a wrist band)
 
If you are only on Metformin there are other drugs that can be added usally before Insulin.
 
grovesy said:
If you are only on Metformin there are other drugs that can be added usally before Insulin.
Click to expand...
This is what I was thinking too. There are a number or oral meds and injectables, aside from the usual ‘first line’ of Metformin, that commonly precede insulin.

Having said that, I do think it’s a shame that there is often a degree of stigma or even implied ‘threat’ around insulin use in T2, “If you aren’t careful you’ll end up on insulin”.

You don’t get that sort of nonsense with T1!

I’d much rather it was phrased along the lines of, ”Looking at your results, and the way your body is responding to the medications we’ve tried so far, it looks like insulin might be helpful at this stage” or something like that.
 
everydayupsanddowns said:
This is what I was thinking too. There are a number or oral meds and injectables, aside from the usual ‘first line’ of Metformin, that commonly precede insulin.

Having said that, I do think it’s a shame that there is often a degree of stigma or even implied ‘threat’ around insulin use in T2, “If you aren’t careful you’ll end up on insulin”.

You don’t get that sort of nonsense with T1!

I’d much rather it was phrased along the lines of, ”Looking at your results, and the way your body is responding to the medications we’ve tried so far, it looks like insulin might be helpful at this stage” or something like that.
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I totally agree. It has also been used as a sort of a threat to me in the past as well.

Personally, i assume it must be a bit more inconvenient compared to just taking a tablet and injecting myself will take some getting used to but if the best option I don’t see a big issue with it and after all most if not all the medication has potential side effects.

Medication wise, I am also on Trajenta.

As I said in the previous thread, there’s just something strange going on, in that my BG levels seem to baseline at 11.x (normally around 11.3). It does go up after meals to 15ish and then comes back down again so something is doing that. It also does the opposite with exercise - I have got it down to 8 and then a hour or so it goes back to 11. Before anyone asks, I have tested on 2 different meters so it’s not a testing issue.

I am not particularly overweight and I am a regular runner so I do a lot of exercise. it still might that I just need to give it time because I know I have been out of control for the last 3 years or so for a number of reasons.
 
Skellei said:
I totally agree. It has also been used as a sort of a threat to me in the past as well.

Personally, i assume it must be a bit more inconvenient compared to just taking a tablet and injecting myself will take some getting used to but if the best option I don’t see a big issue with it and after all most if not all the medication has potential side effects.

Medication wise, I am also on Trajenta.

As I said in the previous thread, there’s just something strange going on, in that my BG levels seem to baseline at 11.x (normally around 11.3). It does go up after meals to 15ish and then comes back down again so something is doing that. It also does the opposite with exercise - I have got it down to 8 and then a hour or so it goes back to 11. Before anyone asks, I have tested on 2 different meters so it’s not a testing issue.

I am not particularly overweight and I am a regular runner so I do a lot of exercise. it still might that I just need to give it time because I know I have been out of control for the last 3 years or so for a number of reasons.
Click to expand...
What sort of meals are you having, if you give some examples then people may spot some food which may be a problem.
Do you test before eating and after 2 hours to check the effect of that particular meal.?
 
Lucyr said:
Moving to insulin was the best thing I ever did, gives me much more control over my blood sugars and much more flexibility in my diet. I started on a basal bolus regime, I chose that over a mixed insulin because it was more flexible. Do you know what kind you will be starting?
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I completely agree with this, best 2 back to back HbA1c results i have ever had especially when i have had a birthday and all inclusive 10 night holiday thrown into the mix
 
Leadinglights said:
What sort of meals are you having, if you give some examples then people may spot some food which may be a problem.
Do you test before eating and after 2 hours to check the effect of that particular meal.?
Click to expand...
fasting Levels are 11 to 12.

breakfast is grapefruit with cinnamon (cinnamon was seen as something as something helpful for controlling glucose and I actually really like it now) and/ or rolled oats with milk. I know the oats have a lot of carbs but they really help me to control my hunger all day). I probably have around 30g carbs in total but thats about all I currently have carb wise all day. This will raise by levels to around 14/15

lunch/ tea is one of cheese omelette (no impact to BG), meat/ fish salad, a tin of tuna. That’s just about all I’ve had over the last few weeks whilst I try and get it under control. If and when this happens, I will reintroduce a small amount of carbs (maybe another 20g) because I always believe diabetes has to be a balance.

i do also eats nuts if I’m hungry and I have the occasional beer(which I know is bad but again its a balance) and wine.

thats all really
 
Skellei said:
fasting Levels are 11 to 12.

breakfast is grapefruit with cinnamon (cinnamon was seen as something as something helpful for controlling glucose and I actually really like it now) and/ or rolled oats with milk. I know the oats have a lot of carbs but they really help me to control my hunger all day). I probably have around 30g carbs in total but thats about all I currently have carb wise all day. This will raise by levels to around 14/15

lunch/ tea is one of cheese omelette (no impact to BG), meat/ fish salad, a tin of tuna. That’s just about all I’ve had over the last few weeks whilst I try and get it under control. If and when this happens, I will reintroduce a small amount of carbs (maybe another 20g) because I always believe diabetes has to be a balance.

i do also eats nuts if I’m hungry and I have the occasional beer(which I know is bad but again its a balance) and wine.

thats all really
Click to expand...
Yes, I would find it quite puzzling, and you do seem to be having very few carbs. I think you need to be discussing with your GP of diabetic nurse.
I wonder if you had a free trail of the Libre 2 it would provide some data to show what is happening.
 
everydayupsanddowns said:
This is what I was thinking too. There are a number or oral meds and injectables, aside from the usual ‘first line’ of Metformin, that commonly precede insulin.

Having said that, I do think it’s a shame that there is often a degree of stigma or even implied ‘threat’ around insulin use in T2, “If you aren’t careful you’ll end up on insulin”.

You don’t get that sort of nonsense with T1!

I’d much rather it was phrased along the lines of, ”Looking at your results, and the way your body is responding to the medications we’ve tried so far, it looks like insulin might be helpful at this stage” or something like that.
Click to expand...

There is a school of thought that insulin may well give the pancreas of a type 2 a break, and allow it to recover.
Unfortunately a lot of the meds prescribed after the first line Metformin can do the opposite, and drive the pancreas harder.

It's an interesting theory, but not one I've seen any real testing of yet though.
 
travellor said:
There is a school of thought that insulin may well give the pancreas of a type 2 a break, and allow it to recover.
Unfortunately a lot of the meds prescribed after the first line Metformin can do the opposite, and drive the pancreas harder.

It's an interesting theory, but not one I've seen any real testing of yet though.
Click to expand...

Interesting! I’ve certainly heard that in the context of LADA - but again more in terms of ‘forum chat’ than any research papers I’m aware of or presentations I’ve seen at diabetes conferences I’ve wormed my way into.
 
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everydayupsanddowns said:
Interesting! I’ve certainly heard that in the context of LADA - but again more in terms of ‘forum chat’ than any research papers I’m aware of or presentations I’ve seen at diabetes conferences I’ve wormed my way into.
Click to expand...


"use of insulin early for type 2 diabetes"

brings up some studies from Google.
 
I would wonder if you are actually LADA (slow onset Type1) and not Type 2. I think it may well be that your flagging insulin production is no longer able to cope with your liver output since you are eating so few carbs and that is why you are leveling out in low double figures. Have you had GAD antibody and C-peptide tests to check for Type 1.

I think you should be pushing for a referral to a specialist diabetes clinic and testing for Type 1 rather than remaining under the GP treatment. GP's have a very limited understanding of diabetes and insulin treatment and if you are actually Type 1 then you will need more support than they can offer.
 
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