Type 2 on Insulin and now confused

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berryr99

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Type 2
I am a type 2 on insulin, went to speak to the diabetes specialist nurse and got a confusing message which I have not heard before in 20 years. Apparently for type 2 , hba1c isn't that important and they look more at the day to day readings. Anywhere between 8-15 mmol is considered OK. Yet when I go to the GP nurse, she often comments on hba1c levels. Also adjusting my dosage according to BS levels seemed to be considered odd. It took me 17 years to get on a carb counting course (which I now do). Is this new thinking or have I had it wrong all these years ? There was no time to query this because an emergency came in. Just wondering how other type 2's on insulin manage their dosage/BS levels.

Thanks if you can help

Robert
 
Type 2 is (wrongly) considered a lesser problem than type 1 and many professionals don’t seem that bothered about it. I’ve been told by many different doctors at the the GP surgery and the hospital diabetes department that they are very surprised I count carbs and adjust insulin doses. I’m amazed you’ve managed to go on a carb counting course, I’ve never been allowed on one. Was also told at my latest hospital diabetes appointment that an a1c of 68 is good, and not to take any extra insulin to bring bgs down even if in 20s. You definitely have to pick and choose what bits you listen to when you’re T2.
 
I think you need to find some different medics. HBA1C is important for all of us and adjusting insulin dose is valid, again, for all of us. I assume you also try to keep the carbs down as well as counting them?
 
It’s shocking how T2 is treated in some areas. I was initially diagnosed as T2 and in fact remained on that diagnosis for 20 years, the diagnosis only being changed to T1 this year after 15 years on insulin in a basal-bolus MDI regime. Maybe I was fortunate to have a good GP who listened to me and referred me to the hospital diabetes clinic to get tuition on basal-bolus and carb counting?

The NICE guidelines for T2 do refer to HbA1c levels : https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management

Specifically :

1.6.7 For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

so it would seem that your GP nurse is right to be concerned to keep HbA1c in a suitable range, very odd that the DSN doesn’t feel levels for T2s aren’t that important.

Not sure I can really comment on how other T2s manage insulin as I must have been T1 all along. However there was certainly no issue when I was diagnosed as T2, in getting me on basal-bolus and adjusting my insulin based on carb counting, making corrections to tackle high BG, etc.

There are T2s on the forum who are on insulin so I’m sure they can give you more advice.
 
Lucyr said:
Type 2 is (wrongly) considered a lesser problem than type 1 and many professionals don’t seem that bothered about it. I’ve been told by many different doctors at the the GP surgery and the hospital diabetes department that they are very surprised I count carbs and adjust insulin doses. I’m amazed you’ve managed to go on a carb counting course, I’ve never been allowed on one. Was also told at my latest hospital diabetes appointment that an a1c of 68 is good, and not to take any extra insulin to bring bgs down even if in 20s. You definitely have to pick and choose what bits you listen to when you’re T2.
Click to expand...
I ended up on a carb counting course because the GP's dietitian hadn't a clue and I ended up with a Tier 3 dietitian who got me on the course after much pushing from me.
 
Eternal422 said:
It’s shocking how T2 is treated in some areas. I was initially diagnosed as T2 and in fact remained on that diagnosis for 20 years, the diagnosis only being changed to T1 this year after 15 years on insulin in a basal-bolus MDI regime. Maybe I was fortunate to have a good GP who listened to me and referred me to the hospital diabetes clinic to get tuition on basal-bolus and carb counting?

The NICE guidelines for T2 do refer to HbA1c levels : https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management

Specifically :

1.6.7 For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

so it would seem that your GP nurse is right to be concerned to keep HbA1c in a suitable range, very odd that the DSN doesn’t feel levels for T2s aren’t that important.

Not sure I can really comment on how other T2s manage insulin as I must have been T1 all along. However there was certainly no issue when I was diagnosed as T2, in getting me on basal-bolus and adjusting my insulin based on carb counting, making corrections to tackle high BG, etc.

There are T2s on the forum who are on insulin so I’m sure they can give you more advice.
Click to expand...
I specifically asked if I had been mis-diagnosed as a T2 because of a chance comment from another DSN that my body was no longer producing insulin. This was instantly dismissed by the DSN I saw a few days ago. Feeling very second class at the moment !
 
Eternal422 said:
It’s shocking how T2 is treated in some areas. I was initially diagnosed as T2 and in fact remained on that diagnosis for 20 years, the diagnosis only being changed to T1 this year after 15 years on insulin in a basal-bolus MDI regime. Maybe I was fortunate to have a good GP who listened to me and referred me to the hospital diabetes clinic to get tuition on basal-bolus and carb counting?

The NICE guidelines for T2 do refer to HbA1c levels : https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management

Specifically :

1.6.7 For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

so it would seem that your GP nurse is right to be concerned to keep HbA1c in a suitable range, very odd that the DSN doesn’t feel levels for T2s aren’t that important.

Not sure I can really comment on how other T2s manage insulin as I must have been T1 all along. However there was certainly no issue when I was diagnosed as T2, in getting me on basal-bolus and adjusting my insulin based on carb counting, making corrections to tackle high BG, etc.

There are T2s on the forum who are on insulin so I’m sure they can give you more advice.
Click to expand...
I think so much depends on local circumstances. I had to agitate like mad to get on a carb counting course and regular support at tier2 is almost non-existent.
 
berryr99 said:
I specifically asked if I had been mis-diagnosed as a T2 because of a chance comment from another DSN that my body was no longer producing insulin. This was instantly dismissed by the DSN I saw a few days ago. Feeling very second class at the moment !
Click to expand...
I was told by my current DSN that the amount of insulin I need and it’s effect on my BG behaves just like a T1 and after reviewing my medical history the consultant decided to change the diagnosis. I did have GAD and c-peptide tests done a long while back but it was too long after the initial presentation with symptoms that it was considered to be inconclusive. I’m presuming now that I don’t produce any insulin but also don’t have insulin resistance which both point to more like T1.

It’s pretty much down to who you can see and their experience and knowledge I guess, so I feel your pain. Getting a proper, correct diagnosis is important and will help in determining the correct course of treatment. However, once on insulin I kept going with that and after initial instructions on how to adjust it I continued on my own for years. I assume much like you have done?

If I were you I would continue carb counting and adjusting to get the best HbA1c results you are able to achieve without having hypos all the time.
 
I pushed hard to move onto carb counting when basal only wasn't working and moved onto fixed dose MDI.
I jumped through some hoops, had a libre on (not on prescriptions) and showed DSN I needed to be able to adjust doses per meal (and understood what was involved) and she caved in.
I have targets of 7 on waking a pre meals and I can adjust what needs adjusting myself. (DSN and not GP who set this)
Not had an a1c since seeing the DSN team and GPs don't get involved at all which suits me as I have 0 faith in them managing it 😉
 
Eternal422 said:
I was told by my current DSN that the amount of insulin I need and it’s effect on my BG behaves just like a T1 and after reviewing my medical history the consultant decided to change the diagnosis. I did have GAD and c-peptide tests done a long while back but it was too long after the initial presentation with symptoms that it was considered to be inconclusive. I’m presuming now that I don’t produce any insulin but also don’t have insulin resistance which both point to more like T1.

It’s pretty much down to who you can see and their experience and knowledge I guess, so I feel your pain. Getting a proper, correct diagnosis is important and will help in determining the correct course of treatment. However, once on insulin I kept going with that and after initial instructions on how to adjust it I continued on my own for years. I assume much like you have done?

If I were you I would continue carb counting and adjusting to get the best HbA1c results you are able to achieve without having hypos all the time.
Click to expand...
I intend to carry on carb counting and adjusting my dose and will raise the T1 issue again at the next review. Thank you for your advice
 
gll said:
I pushed hard to move onto carb counting when basal only wasn't working and moved onto fixed dose MDI.
I jumped through some hoops, had a libre on (not on prescriptions) and showed DSN I needed to be able to adjust doses per meal (and understood what was involved) and she caved in.
I have targets of 7 on waking a pre meals and I can adjust what needs adjusting myself. (DSN and not GP who set this)
Not had an a1c since seeing the DSN team and GPs don't get involved at all which suits me as I have 0 faith in them managing it 😉
Click to expand...
My local management (in my GP's) of diabetes is not good and the last couple of reviews have also involved a Tier 3 nurse (the DSN) so it may have been realised that things need to improve. I am going to keep pushing for a T1 diagnosis.
 
I was sitting with numbers in the 20s/30s consistently and told to just check for ketones by GPs and wait for my (hospital linked) DSN appointment.
My DSN made the decision to put me on insulin within 2 mins of hearing my weeks worth of fingerpricks (background) and on MDI about 8 weeks later and carb counting after another 2 weeks. Different ballgame entirely seeing a DSN outside of the surgery. Came off all oral meds too.
 
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