Type 2 - Starting on Insulin

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ClaireDiane

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Type 2
Hi. I’ve just picked up my first prescription for insulin - Abasaglar & Humalog. Am type 2 and was on Metformin 1g twice a day, Sitagliptin & Gliclazide. A year after starting the gliclazide my HbA1c was higher than before starting it so got changed to another medication I can’t spell but couldn’t tolerate it so back to gliclazide but my readings still too high and was suffering effects of hyperglycaemia so referred to diabetic nurse team and put on insulin as BMI not high enough for other injectables.

Just looking for any tips or words of advice from other people with type 2 about starting on insulin. I’m to start on 4 units then phone nurse after 4 days.
 
Hi @ClaireDiane
prior to being prescribed Insulin we’re you previously self testing ? also do you drive ?
 
Hi Claire

The most important thing with insulin is to make sure you always have your testing kit with you and always have hypo treatments to hand. That means by your bed, in the bathroom in your handbag and pockets. I divide them up into hypo treatment portions, so that I have little bags of 3 jelly babies. That way, if I do have a hypo, I have my portion and don't have to count them or be tempted to eat the whole pack..... which is a real problem with hypos because they sometimes make you ravenous..... and then test again after 15 mins to make sure my levels have come back up.
I know you have been on Gliclazide which can cause hypos but it sounds like it wasn't able to stimulate your pancreas to produce more insulin, so I am guessing you never had a hypo with it. If your levels are currently very high, you may find that you feel hypo symptoms when your levels are actually above 4 so not actually a hypo, but can still feel horrid. This is a false hypo and is common when people are first started on insulin. In that situation don't take a full 3 JBs but maybe just one and then something low carb like a boiled egg or a chunk of cheese. You need your body to get used to normal levels (4-7) but if it has been used to being up at 15, it may go into panic when you drop down to 5 or 6 and your heart may start to race and feel hot and clammy.
Hopefully they will have started you off on a low dose and your levels will come down slowly but it is difficult to gauge exactly what a low dose should be as it is different for everyone which is why they want you to check in regularly with your readings over the first few days and weeks to adjust things as they see how your body is responding.

I have to say, I rather wonder if you are actually Type 2 when the Gliclazide and Metformin had no effect and your HbA1c has gone up. Did you also adjust your diet after diagnosis to reduce your carbs? There is no specific test for Type 2. An HbA1c of 48 or more gets you a diagnosis of diabetes. After that it is often an assumption based on age and BMI and lifestyle/diet information. Many of us were initially assumed to be Type 2 but were eventually found to be Type 1 or LADA for which there are tests.... GAD antibody and C-peptide.... the first shows if your immune system has attacked your insulin producing cells in your pancreas and the second shows how much insulin you are still able to produce yourself.

It is good that they have started you on what is called a Basal/Bolus insulin system as this is the insulin regime a Type 1 diabetic would be started on and gives you much more freedom over what and if and when you want to eat, whereas a mixed insulin would mean you would have to have fixed meals containing a set number of carbs at regular intervals.
Basal/Bolus or Multiple Daily Injections (MDI) allows you to be much more flexible with your food.

Anyway, I think I have typed enough for one post. Don't be frightened of using insulin. It will make you feel better but it is a balancing act and it will take time to learn how best to use it. The pens make dosing easy and the needles are tiny, so don't worry about the actual injecting part. Just give yourself some time to get used to the whole process, so if you are not signed off work then I would ask to be for a couple of weeks at least to get your doses sorted and find a routine which suits your lifestyle.

Good luck and any questions, just ask.
 
goodybags said:
Hi @ClaireDiane
prior to being prescribed Insulin we’re you previously self testing ? also do you drive ?
Click to expand...
Yes was self testing when on gliclazide. I do drive. My current job requires me to drive to visit people though at present not so much as still mainly phone or video calls.
 
rebrascora said:
Hi Claire

The most important thing with insulin is to make sure you always have your testing kit with you and always have hypo treatments to hand. That means by your bed, in the bathroom in your handbag and pockets. I divide them up into hypo treatment portions, so that I have little bags of 3 jelly babies. That way, if I do have a hypo, I have my portion and don't have to count them or be tempted to eat the whole pack..... which is a real problem with hypos because they sometimes make you ravenous..... and then test again after 15 mins to make sure my levels have come back up.
I know you have been on Gliclazide which can cause hypos but it sounds like it wasn't able to stimulate your pancreas to produce more insulin, so I am guessing you never had a hypo with it. If your levels are currently very high, you may find that you feel hypo symptoms when your levels are actually above 4 so not actually a hypo, but can still feel horrid. This is a false hypo and is common when people are first started on insulin. In that situation don't take a full 3 JBs but maybe just one and then something low carb like a boiled egg or a chunk of cheese. You need your body to get used to normal levels (4-7) but if it has been used to being up at 15, it may go into panic when you drop down to 5 or 6 and your heart may start to race and feel hot and clammy.
Hopefully they will have started you off on a low dose and your levels will come down slowly but it is difficult to gauge exactly what a low dose should be as it is different for everyone which is why they want you to check in regularly with your readings over the first few days and weeks to adjust things as they see how your body is responding.

I have to say, I rather wonder if you are actually Type 2 when the Gliclazide and Metformin had no effect and your HbA1c has gone up. Did you also adjust your diet after diagnosis to reduce your carbs? There is no specific test for Type 2. An HbA1c of 48 or more gets you a diagnosis of diabetes. After that it is often an assumption based on age and BMI and lifestyle/diet information. Many of us were initially assumed to be Type 2 but were eventually found to be Type 1 or LADA for which there are tests.... GAD antibody and C-peptide.... the first shows if your immune system has attacked your insulin producing cells in your pancreas and the second shows how much insulin you are still able to produce yourself.

It is good that they have started you on what is called a Basal/Bolus insulin system as this is the insulin regime a Type 1 diabetic would be started on and gives you much more freedom over what and if and when you want to eat, whereas a mixed insulin would mean you would have to have fixed meals containing a set number of carbs at regular intervals.
Basal/Bolus or Multiple Daily Injections (MDI) allows you to be much more flexible with your food.

Anyway, I think I have typed enough for one post. Don't be frightened of using insulin. It will make you feel better but it is a balancing act and it will take time to learn how best to use it. The pens make dosing easy and the needles are tiny, so don't worry about the actual injecting part. Just give yourself some time to get used to the whole process, so if you are not signed off work then I would ask to be for a couple of weeks at least to get your doses sorted and find a routine which suits your lifestyle.

Good luck and any questions, just ask.
Click to expand...
Thanks. I need to sort out something for hypos for carrying around with me. Only started insulin yesterday. Not a fan of jelly babies but read you can also use wine gums which I do like.
I have had false hypos a few times. My bloods usually run between 12 and 18. They started me on 4 units for each dose then to phone nurse after got 4 days readings.
I was diagnosed in 2017 at which point I think my HbA1c was 48. In 2019 it was 63 then 69, up to 82 last year then 93 this year. I started gliclazide last April after my bloods were done then changed to a different type of medication in May but didn’t tolerate well. Metformin from start and think the sitaglyptin was 2019 low dose then increased. I have several autoimmune conditions - inflammatory arthritis, raynauds & Sjögren’s - for which I see rheumatology. I don’t know if my immune system is attacking other parts of my body too. Came off immunosuppressants about 12 weeks ago due to side effects (had been on them since 2012). Type 2 runs in the family though even in those of a healthy weight. My uncle died of a diabetic coma after having a hypo whilst sleeping. My mum naturally wasn’t happy about me being put on insulin but my weight was coming down & blood sugars going up despite changing my diet.
I’m used to needles as did my methotrexate injections for several years & was bigger needle. Just the rest of it new to me.
I’ve already had just over 4 weeks off sick due to hyperglycaemia so can’t really take more time off. Went back to work as was going to be put down to half pay and can’t afford for that to happen. Working from home most of the time & only work 2 half days and 2 full days a week. Work haven’t been that understanding of my diabetes and think it’s my mental health causing me to struggle with my cognitive functioning.
Thanks for all your advice.
 
You don’t have to have jelly babies @ClaireDiane I use Dextro tablets and always have done. They’re cheap, small and come in lots of flavours so you can find one you prefer. I keep a pack in each bag and coat pocket, and by my bed too.

You can also use things like those little 150ml cans of full sugar Coke. Avoid sweets that are too chewy because sometimes hypos can make you lack coordination.
 
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I prefered glucose tabs as less likely to over treat with them than sweets.
 
I use LIft (used to be called GluocTabs).
When I started, I too was a Dextrose muncher but I would often lose some once the paper wrapper was opened. Some would get dropped, some would get damp, some would dry out. I guess I didn't expect my dextrose as much as I should.

Lift come in a plastic tube of 10 or a tub of 50.
I bought a couple of tubes years ago and now fill them up from the larger tubs which I buy in bulk from eBay.
And the tubs get reused to hold the disposable, non-sharp components from my pump.
 
And unlike sickly sweet Dextro Energy tablets, Lift ones also tastes okay when you are hypo.

Buy a multipack of tubes and you can leave them everywhere. You can keep one in every bag, in winter coat pockets, in your car or motorcycle.

And because they are in tubes with silica gel in the lids they will last as long as they claim, while Dextro Energy will go off once opened, and just carrying them around the paper will wear and rip. Though if you are crazy enough to like the taste of them, you can refill a Lift tube with them instead.
 
A matter of taste though, isn’t it? I tried the Glucotabs and didn’t like the taste of them. When I had then they didn’t have many flavours either. Dextro has Original, Orange, Lemon, Blackcurrant and Tropical just off the top of my head. The latter two are my favourites. The Glucotabs also broke more easily. The very sweet taste of Dextro is good psychologically and also signals them as ‘medicine’ rather than something you could snack on, I think.

The OP would be best trying both maybe and seeing what taste she prefers but also what works lifestyle-wise.
 
Lift comes in four flavours: Lemon & Lime, Raspberry, Blueberry, and Orange. Though I have not tried the latter. They also taste too sweet for me normally that I would not want to eat one otherwise, but somehow in a hypo they are just fruity. (A coupe of times I have taken one when a D.V.L.A. test was too low in the fours that I wanted to get it up quickly.)

For all the flavours of Dextro Energy, they are completely overpowered by the over-sweetness that yo me they all taste pretty much the same. A taste which signals to me "does a hypo really taset that bad," which is why I always used to use Cola straws.

The switch to Lift was to replace the Dextro Energy I would carry around for emergencies and hoped to never need, but which would fall apart and end up covered in spots. I was only expecting the reusable plastic tubs to be a benefit of Lift, I was quite surprised they were nice to take too.

Though I still use cola straws at home too, but they are more difficult to have on hand when still shopping online.

If only someone would do sour glucose tablets. Or savoury ones. Imagine Hendo Relish tablets, wow.
 
@ClaireDiane Please remember to inform DVLA that you are on insulin. I personally worry that wine gums would take too long to release sugar if you had a hypo. Can you keep a bottle of Coke or proper Orange juice in the car? I always have a small banana with me plus my dextrose jel. Good luck with it all
 
I still like Rowntrees fruit pastilles, start to work instantly you bung em in your mouth as the sugar on the outside dissolves, 3 pastilles = 10g carbohydrate.
 
Thanks for that. I like fruit pastilles so will get some next time at shop. Not a jelly baby fan so it said on my plan wine gums.
 
Matilda-Rose said:
@ClaireDiane Please remember to inform DVLA that you are on insulin. I personally worry that wine gums would take too long to release sugar if you had a hypo. Can you keep a bottle of Coke or proper Orange juice in the car? I always have a small banana with me plus my dextrose jel. Good luck with it all
Click to expand...
Yes I have filled in the form for DVLA. Already on a medical license which is in process of being renewed.
 
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