Type 2 insulin or low carb/keto?

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Kkayy

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Type 2
Hi maybe a bit of a long post, sorry!
I got diagnosed in 2012 by a GTT as my hba1c was still within range so an early diagnosis. I ignored my diagnosis and have just carried on eating as normal (high carb and lots of sugar due to binge eating) I know this was not very responsible :(
My hba1c was 85 earlier this year and I then got it down to 70 through half hearted efforts due to not really trying very hard and not understanding enough about diet control. I was constantly exhausted, falling asleep, and feeling nauseous and so hungry all the time.
My GP nurse said if it doesn't come down I will have to go on insulin. I am currently on metformin MR max dose and liraglutide injection 3mg daily. I agreed to a referral to diabetic clinic. I went there on Wednesday. I had been reading a lot about a low carb diet and have been self funding a libre sensor for a few weeks. I had cut down my carbs and apart from the morning spike of glucose from my liver was managing to stay in the range of 4to7 BG. I was only doing this for a fortnight before my clinic appointment though.
At my appointment I saw a dietician who said I need to eat some carbs at 2 of my meals, not loads of them but some. If I had a day of high blood sugars due to a family occaision then that was ok as it was only one day. The nurse said I will be going onto insulin because of T2 being progressive (I know I can refuse) and went through the 3 different regimes that are used for insulin treatment. I wasn't asked if they could look at my sensor reading at all but if I could email in a couple of weeks and they would look at my sensor readings then when I've been eating some carbs. I feel maybe the insulin has been decided because of my hba1c?
I feel very confused and quite unsure what to do for the best. I dont know that I can maintain a low carb diet long term and now I have read so much information I am scared for the future if I don't control my BG. I was wondering whether to try what they are expecting with the carbs and see how that works out, although the outcome I fear would be insulin for definite as my BG spikes with any dinner related carbs. Maybe I should tell them I want to see how a low carb diet pans out when I've been doing it a few months and what my hba1c reacts like? My triglycerides are very high and I was referred to Barts because of them which is why I take the liraglutide but I don't have an up to date reading for them.
Any thoughts would be very welcome!
 
Hi Kkayy,

I was put onto insulin from diagnosis. At one point I managed to get down to 4-5 units of rapid acting a day whilst keeping glucose below 7 but haven’t been able to sustain that as the diet and exercise discipline needed we’re not something that I managed to sustain.

We’re all different but I prefer to be on insulin and stay on it as it gives me better opportunity to maintain better glucose control. For me insulin is a very minor inconvenience that is a price worth paying to have the peace of mind that I can be consistently in better control than I could relying on diet and exercise discipline alone.

Again we’re all different and for me the discipline of learning to use insulin safely and effectively has been worth the effort but that might not feel like the right thing for everyone.

You mentioned not being asked about your finger prick self testing. I choose to show my results to nurses, gps and specialists whether requested or not and ask then for feedback.

I’m sure others might also comment that T2 isn’t inherently progressive if good glucose control can be maintained and that is a major part of why insulin is a welcome tool for me.

It‘s 8 years since my diagnosis and I’ve been able to keep my hba1c in the non-diabetic range. I‘m not boasting in any way, just letting you know that good control is very possible.

Hope this helps
 
Hi. Your dietician is clueless like so many of them. You don't need to eat any carbs at any meal as long as you are having enough proteins and fats that can provide glucose. Insulin may not be good idea if you have high insulin resistance as you may already have too much insulin in the body - sadly many GPs/DNs don't understand that. A low carb diet is a vital first step. If that does reduce weight and/or BS then the Liraglutide may be able to be reduced but discuss with the GP/DN.
 
Kkayy said:
Hi maybe a bit of a long post, sorry!
I got diagnosed in 2012 by a GTT as my hba1c was still within range so an early diagnosis. I ignored my diagnosis and have just carried on eating as normal (high carb and lots of sugar due to binge eating) I know this was not very responsible :(
My hba1c was 85 earlier this year and I then got it down to 70 through half hearted efforts due to not really trying very hard and not understanding enough about diet control. I was constantly exhausted, falling asleep, and feeling nauseous and so hungry all the time.
My GP nurse said if it doesn't come down I will have to go on insulin. I am currently on metformin MR max dose and liraglutide injection 3mg daily. I agreed to a referral to diabetic clinic. I went there on Wednesday. I had been reading a lot about a low carb diet and have been self funding a libre sensor for a few weeks. I had cut down my carbs and apart from the morning spike of glucose from my liver was managing to stay in the range of 4to7 BG. I was only doing this for a fortnight before my clinic appointment though.
At my appointment I saw a dietician who said I need to eat some carbs at 2 of my meals, not loads of them but some. If I had a day of high blood sugars due to a family occaision then that was ok as it was only one day. The nurse said I will be going onto insulin because of T2 being progressive (I know I can refuse) and went through the 3 different regimes that are used for insulin treatment. I wasn't asked if they could look at my sensor reading at all but if I could email in a couple of weeks and they would look at my sensor readings then when I've been eating some carbs. I feel maybe the insulin has been decided because of my hba1c?
I feel very confused and quite unsure what to do for the best. I dont know that I can maintain a low carb diet long term and now I have read so much information I am scared for the future if I don't control my BG. I was wondering whether to try what they are expecting with the carbs and see how that works out, although the outcome I fear would be insulin for definite as my BG spikes with any dinner related carbs. Maybe I should tell them I want to see how a low carb diet pans out when I've been doing it a few months and what my hba1c reacts like? My triglycerides are very high and I was referred to Barts because of them which is why I take the liraglutide but I don't have an up to date reading for them.
Any thoughts would be very welcome!
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Yes insulin looks like a good option. Most of us of course fight it and delay going onto it for too long. Yet once on it most of us think 'What were we fighting against, this is so straightforward!' And of course insulin always works in T2 whether it's overcoming insulin insufficiency or malformed insulin ( upto 30% of T2s have insulin with stubby or non-existent tethers which means it can't tether itself to the insulin receptor on the cell, signalling a glucose delivery). It's a shame the bean counters deny T2s insulin until a lot of damage has been done. Even then they try to deny T2s modern analogue insulins and try to push them onto old fashioned 'human insulins' from the 1980s. Mixed insulins are often used in T2s starting insulin. They have short and long acting insulin in one dose so it is difficult to adjust the individual components. What options did they discuss with you?
 
Like you, I used to comfort eat and I freely admit I was a sugar addict and carb monster pre diagnosis. Portion sizes had got out of control with both sweet and savoury and I had lost the off switch! I went low carb as soon as I was diagnosed. I started with cutting the sugar and sweet stuff and then I followed the guidance on this forum, progressively cutting more and more carbs from my diet until there was nothing left to cut because I was determined to reverse my diabetes. Unfortunately that wasn't to be as it turned out I was Type 1 and not Type 2 but despite starting on insulin and being told to eat normally, I have opted to continue low carb and use minimal mealtime insulin. The reason I have continued to eat this way is that it has at long last given me control over those cravings and comfort eating that I have struggled with for years. I eat so much less now and I don't feel hungry. Two meals a day is often enough and I enjoy my food now, although it was the introduction of fat into my diet which made low carb sustainable.... initially I followed the low fat NHS advice (and no alcohol) as well as going very low carb and it was a pretty demoralizing way of eating and I couldn't have stuck it long term, but the weight certainly dropped off me!! It took about 6 months to really start to get my head around low carb and develop a repertoire of recipes and meals that I enjoyed and were filling and tasty. It is now a way of life and I don't feel deprived and whilst I very occasionally treat myself to a few of my partners chips or at the moment a rare sweet mince pie, I actually find that the desire for them is tempered with a bit of disappointment that I don't really enjoy them that much when I do have them and I certainly don't crave them even if he is eating them in front of me. In other words, I don't find it difficult to stick to my current low carb, higher fat eating regime and I enjoy it, but most of all, I enjoy the control I now have over my eating and not having to battle the cravings which were a torment. I also feel fitter and healthier and younger and slimmer than I have for many years.
I do still use insulin, because as a Type 1 I need it to survive and it should not be feared or used as a threat but life is easier if you can control your diabetes without it. In your position, I would negotiate a 3 month period to give you an opportunity tp reduce your HbA1c through diet and then make a decision. If you see extremely effective results which is likely considering the BG readings you are getting, then you need to work out at that point whether it is sustainable longer term. The dietician is wrong about carbs. I don't eat bread, pasta, rice, couscous, maybe once a fortnight I will have some potatoes or sweet potatoes, but I do eat lower carb veg like peppers and courgettes and aubergines and onions and garlic and broccoli and cabbage and swede and squash and cauliflower of course and mushrooms. Occasionally a few chick peas or kidney beans or lentils... again just about once a fortnight/month. The NHS dietician told me I would be very ill and end up in hospital if I ate this way but I feel far healthier for it.

I also take great exception to a medical professional telling people that Type 2 is progressive. That is only the case because they don't give people appropriate dietary advice in a lot of instances.
 
Burylancs said:
Yes insulin looks like a good option. Most of us of course fight it and delay going onto it for too long. Yet once on it most of us think 'What were we fighting against, this is so straightforward!' And of course insulin always works in T2 whether it's overcoming insulin insufficiency or malformed insulin ( upto 30% of T2s have insulin with stubby or non-existent tethers which means it can't tether itself to the insulin receptor on the cell, signalling a glucose delivery). It's a shame the bean counters deny T2s insulin until a lot of damage has been done. Even then they try to deny T2s modern analogue insulins and try to push them onto old fashioned 'human insulins' from the 1980s. Mixed insulins are often used in T2s starting insulin. They have short and long acting insulin in one dose so it is difficult to adjust the individual components. What options did they discuss with you?
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Hi
They said a once a say long acting was the first option but probably not advised as more for much older person with very little physical movement throughout the day. Second option was 2 injections a day of mixed long acting and short acting, one with breakfast and one at teatime and thirdly a long acting once a day with the short acting with meals.
Out of those 3 options the last one would be better suited to me I think
 
Kkayy said:
Out of those 3 options the last one would be better suited to me I think
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That would be the wise option if you go for an insulin treatment regime. Much more flexible.
 
Kkayy said:
Hi
They said a once a say long acting was the first option but probably not advised as more for much older person with very little physical movement throughout the day. Second option was 2 injections a day of mixed long acting and short acting, one with breakfast and one at teatime and thirdly a long acting once a day with the short acting with meals.
Out of those 3 options the last one would be better suited to me I think
Click to expand...
Yup they are the usual choices for T2s going on insulin. The first one is often a single shot if a 24 hour insulin like Lantus, efficient for T2s if they have a strong Dawn Phenomenon. The second is the mix like Humalog 25 which is not all that flexible with varying meals. The third option is MDI, four or five injections a day. But then it all depends whether the insulins are upto date analogues or cheap stuff that came ashore with Noah's Ark. The phrase you used 'long acting once a day' suggests they might allow you at least one modern analogue insulin. You're
right that it's probably the best choice, you can adjust meal time injections to suit.
 
Burylancs said:
Yup they are the usual choices for T2s going on insulin. The first one is often a single shot if a 24 hour insulin like Lantus, efficient for T2s if they have a strong Dawn Phenomenon. The second is the mix like Humalog 25 which is not all that flexible with varying meals. The third option is MDI, four or five injections a day. But then it all depends whether the insulins are upto date analogues or cheap stuff that came ashore with Noah's Ark. The phrase you used 'long acting once a day' suggests they might allow you at least one modern analogue insulin. You're
right that it's probably the best choice, you can adjust meal time injections to suit.
Click to expand...
Thank you
 
'More flexible' is the very appropriate term whatever 'Type' label your diabetes happens to have. Because the 'fast acting' insulin is only there to take care of what you actually eat as opposed to your body's background needs for insulin (stuff like your heart beating, your lungs breathing, your kidneys and digestive system functioning etc - and it's quite surprising how much insulin that is!) getting the balance right between them isn't done overnight, so it does mean you'll need to test your BG more often too.

Good luck with it anyway!
 
Welcome to the forum @Kkayy

Sounds like you have made dramatic changes to your menu, and have seen significant improvement in your BG levels. But it sounds like you don’t feel that way of eating is going to be sustainable long-term?

Lower carb eating plans have certainly gained wider acceptance among healthcare professionals in recent years, and there is emerging evidence about the effectiveness of moderate or low carb meal plans. Very low carb approaches (keto) have less available evidence as to safety and long-term outcomes, so most HCPs are understandably a little cautious about meal plans which restrict carbohydrate low enough to put the body into ketosis (alongside higher fat intake).

Diabetes UK have some helpful low carb resources if you want to explore a more moderate/mixed approach with a few more carbs (up to 130g per day), to see if there’s a ‘happy medium’ that works for you.

Low-carb diet and meal plan

Eating a low-carb diet means cutting down on the amount of carbohydrates (carbs) you eat to less than 130g a day. But low-carb eating shouldn’t be no-carb eating. Some carbohydrate foods contain essential vitamins, minerals and fibre, which form an important part of a healthy diet.
www.diabetes.org.uk www.diabetes.org.uk

As to insulin - there is no need to feel that this is a ‘threat’. If your body needs it, then you should be able to use it in a way that works for you.

Recent evidence demonstrates that T2 is not inevitably progressive for everyone. There are some who can manage for decades with a tailored eating plan, and for others losing 15kg or more can clear visceral fat around organs which can lead to a remission in diabetes symptoms as the organs can work more efficiently.

As with most things related to diabetes, it’s all very individual - and the important thing is to treat and manage your specific diabetes in the most appropriate way, with the right blend of meds and menu that is sustainable for you and gives the right results long-term.

‘Your diabetes may vary’ as we often say here 🙂
 
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DaveB said:
Insulin may not be good idea if you have high insulin resistance as you may already have too much insulin in the body - sadly many GPs/DNs don't understand that.
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I don’t think there’s any evidence that injected insulin is anything other than helpful for those with insulin resistance - particularly if there is also a degree impairment to insulin production. We have had a number of members over the years with insulin resistance who have very much benefitted from adding extra insulin to help manage their diabetes (even in large doses). It all depends on what your body needs.

As long as insulin is balanced with a healthy meal plan that keeps weight and BGs stable, there’s no reason to try to avoid it. 🙂
 
everydayupsanddowns said:
Recent evidence demonstrates that T2 is not inevitably progressive for everyone.
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That's an oxymoron. And a claim that it won't be possible to substantiate until about 2057, forty years after Prof. Taylors experiment when all his carefully selected guinea pigs are dead and gone.
 
Burylancs said:
That's an oxymoron. And a claim that it won't be possible to substantiate until about 2057, forty years after Prof. Taylors experiment when all his carefully selected guinea pigs are dead and gone.
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It is true that the work is ongoing, but multiple published and peer-reviewed papers are showing that remission is possible (and can be maintained) for a number of people with T2.


“In 2017, the 12-month primary outcome results of the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) were published, providing randomized controlled trial evidence to challenge the conventional view of Type 2 diabetes as a permanent and progressive condition. They showed, for the first time, that a three- phase integrated weight management programme, delivered within routine primary care, achieved remission of Type 2 diabetes in almost half of participants. “

Personally I think there is something quite motivating about the possibility of remission for some people with T2. Though there certainly should not be any stigma or blame attached to anyone for whom remission is not possible.

T2 Diabetes is a very serious, complex and individual condition with potentially devastating long-term consequences. And it seems there are rarely if ever any absolutes (and that T2 itself may be sub-divided into multiple subtypes each with different characteristics).

Whatever type we have, all any of us can do is to try to manage our own individual diabetes as best we can, for as long as we are able, and to make use of any strategies and/or meds that our bodies need. 🙂
 
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everydayupsanddowns said:
It is true that the work is ongoing, but multiple published and peer-reviewed papers are showing that remission is possible (and can be maintained) for a number of people with T2.


“In 2017, the 12-month primary outcome results of the Diabetes UK-funded Diabetes Remission Clinical Trial (DiRECT) were published, providing randomized controlled trial evidence to challenge the conventional view of Type 2 diabetes as a permanent and progressive condition. They showed, for the first time, that a three- phase integrated weight management programme, delivered within routine primary care, achieved remission of Type 2 diabetes in almost half of participants. “

Personally I think there is something quite motivating about the possibility of remission for some people with T2. Though there certainly should not be any stigma or blame attached to anyone for whom remission is not possible.

T2 Diabetes is a very serious, complex and individual condition with potentially devastating long-term consequences. And it seems there are rarely if ever any absolutes (and that T2 itself may be sub-divided into multiple subtypes each with different characteristics).

Whatever type we have, all any of us can do is to try to manage our own individual diabetes as best we can, for as long as we are able, and to make use of any strategies and/or meds that our bodies need. 🙂
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Oops! Prof Taylor himself is contradicting you ! He says his work 'challenges ...the view' that T2 is progressive. You go all in, saying his work 'demonstrates' that T2 is not progressive. Who is right?
 
@Burylancs. Is it your view that T2 is a progressive disease and that it will inevitably get more severe with time in all those who have a diabetes diagnosis?

PS, not looking for an argument, I prefer consensus. Just checking to make sure that my understanding of your posts is correct.
 
Docb said:
@Burylancs. Is it your view that T2 is a progressive disease and that it will inevitably get more severe with time in all those who have a diabetes diagnosis?

PS, not looking for an argument, I prefer consensus. Just checking to make sure that my understanding of your posts is correct.
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Not my view. That's the view of the whole weight of medical and scientific knowledge and experience garnered over the last four thousand years since diabetes was first diagnosed in Ancient Egypt. Of course the definition of 'progressive' then comes into the discussion. Does it mean a progressive whittling away of the beta cells ability to produce insulin, does it mean progressive invisible deterioration of the organs and processes in the body, does mean the increasing tendency to get complications ? We are told that we suffer from Type 2 Diabetes / Insulin Resistance for 5 to 10 years before we are dxed and have lost 50% of pur Beta Cells i.e. diagnosis comes in the middle of a relentless progression. Thereafter T2s are said to lose 2% of whatever Beta Cells are left per annum no matter what control they have. The causes of Type 2 are not known and so therefore there are no treatments for it, only management strategies. I'm happy to see you use the eord 'control' in your sig and not one of the recently fashionable buzzwords like 'remission' . How are the tips of your big toes, sure bellweathers.
 
Slow down a bit @Burylancs. There are important issues here and it would be nice to get to the bottom of them.

You say that we [those with a T2 diagnosis] are told that we suffer from Type 2 Diabetes / Insulin Resistance for 5 to 10 years before we are dxed and have lost 50% of our Beta Cells i.e. diagnosis comes in the middle of a relentless progression. No body told me that when i was first diagnosed and if they did I would probably say that it was an interesting assertion and ask how they knew since no attempt had been made to measure the number of beta cells I had originally and how many were then working.

It happens that, as far as I am concerned, I think your analysis has some relevance. Diagnosed 12 years or so ago, soon to be 76, not overweight and reasonably fit for my age, it is a reasonable assumption that my diabetes is due to an ageing pancreas and if it is going to change, it will only get worse. If I manage things well, essentially keeping the weight off and controlling carb intake, there is a reasonable chance that I will be able to keep off insulin treatment for however many years I have got left. I am sure there are a lot more like me around.

Were I 40 years younger, overweight, unfit and diagnosed with diabetes my first thought, based on the evidence as I see it, is that there was a fair chance that if I could get rid of the excess weight and get fit then I could get control of my blood glucose without recourse to medication. Call it remission or good control or whatever, the problem has gone away and provided I don't relapse into my previous ways, it will stay away. I am sure there are a lot of T2's around in this position.

I am also quite sure that there are a lot of T2's who are somewhere between these extremes where the problem of an underperforming pancreas is exacerbated by excess weight and lack of fitness. The future for those is a variable feast but there are options open to them which offer a good chance of gaining, and maintaining good glucose control. For some, insulin treatment is inevitable but to my way of thinking it should not be a forgone conclusion for all.

My big toes, by the way, are fine and send you their greetings. 🙂
 
Burylancs said:
Oops! Prof Taylor himself is contradicting you ! He says his work 'challenges ...the view' that T2 is progressive. You go all in, saying his work 'demonstrates' that T2 is not progressive. Who is right?
Click to expand...

Well I think it was natural to phrase things fairly cautiously in the early results, but more work has been undertaken since, and the language has become bolder as changes have been observed in some subjects as to their insulin production and response (with talk of ‘rebooting’ beta cells).

News & Views | Diabetes UK

www.diabetes.org.uk www.diabetes.org.uk

This is from the paper:
“This study demonstrates that β cell ability to recover long-term function persists after diagnosis, changing the previous paradigm of irreversible loss of β cell function in type 2 diabetes.”
pubmed.ncbi.nlm.nih.gov

Remission of Human Type 2 Diabetes Requires Decrease in Liver and Pancreas Fat Content but Is Dependent upon Capacity for β Cell Recovery - PubMed

The Diabetes Remission Clinical Trial reported return and persistence of non-diabetic blood glucose control in 46% of people with type 2 diabetes of up to 6 years duration. Detailed metabolic studies were performed on a subgroup (intervention, n = 64; control, n = 26). In the intervention group...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Further work is taking place with RETUNE, which I think studies the effect of weight loss in those who would not normally be identified as being particularly overweight

ReTUNEing type 2 diabetes remission

www.diabetes.org.uk www.diabetes.org.uk

It’s still research which is ongoing, but the results certainly seem to have caused a bit of a stir.
 
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