Whose Idea Was It?

To start insulin therapy, that is.

The great majority of insulin users—or so I presume—began using insulin because a doctor told them to. Not all of us followed that path, though.

I was a long time T2 whose control, good for many years, was going to hell in a handbasket. So I started reading everything I could get my hands on about diabetes; it became my single-minded focus. It was obvious to me that I was going to have to figure this out myself.

It wasn’t long before I realized that only insulin would give me the degree of control I wanted and required. So I went to the pharmacy, bought a vial of Humulin R (which does not require a prescription where I live), and started testing to determine carb sensitivities, ISFs, I:C ratios, etc. By the time I saw the doctor to ask for scrips for basal and fast acting insulins, I could cite chapter and verse. Essentially I marched in and said, “I want insulin and I want it now, and here are the reasons why.” It didn’t take him long to realize that I had done my homework, and we were off to the races, so to speak.

I’ve never looked back. In hindsight I wish I’d done it ten years sooner. Ah well, c’est la vie.

What about you? How did you arrive at this point?

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I became pregnant and realized that the control I had achieved was slipping through my fingers (hormones!). So I walked into my endo’s office and suggested that I start insulin. She agreed. I have no idea what will happen after I give birth, since that will definitely shake things up again!

It wasn’t my idea. My idea was to kick and scream as much as I could to avoid it. But finally the day came that I could no longer fight it.

I now wish like, @David_dns, that I had started ten years earlier.

I decided to go on insulin very early, about a year or two after diagnosis. My fasting numbers weren’t too bad (especially considering that Darn Phenomenon) but even with Actos or Avandia my post-meal spikes were horrible, and quite frankly super low carb just wasn’t something I could keep up with along with my social life, which involved eating out - often at ethnic restaurants, which are notoriously hard, esp if it’s buffet style.

Like David, I pretty much marched in with a stack of research, including action charts and how-tos, and my PCP’s physician’s assistant gave me what I wanted and let me get on with getting on.

Some days, I admit, I’m not exactly sure WHY I wanted to preserve my beta cells. Every now and then, after 15 years, it’s as if my pancreas randomly decides to work overtime. I wonder now and then if my BG control wouldn’t be a little more predictable without unpredictable spurts of help.

It definitely was not my idea. I was mistakenly diagnosed as a type 2, and I was determined to handle it in a natural way. I exercised until I hurt (especially if #'s were high), I became very disciplined with my eating, I tried cinnamon supplements, spent hours looking up info, etc. They had me on metforman for a while, and I think the lowest I got down to on that was a 180 or 200. So one day when I was at my diabetes education class, they tested me for ketones and that’s when they told me I was type 1 and would have to be on insulin.
Looking back, I don’t know why they thought I was type 2, because my random bg at that time was more than 432, and the fasting bg was 234…

Maria, that is a common mistake that doctors make with unnerving frequency. You should find this post by Melitta interesting, if you haven’t seen it before.

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Sorry to veer slightly off-topic, but your decision to grab ahold of this issue, get educated, and press the doctor for cooperation is a critical emotional inflection point. At that point, you accepted responsibility, surveyed your options, and made a sound decision. I think some people spend years making that jump.

To answer your question, I presented with very high BGs, normal weight, and as a physically active 30-year old. I was lucky not to get misdiagnosed and my physician, not an endo, prescribed insulin immediately and there was no question that this was my only choice. I accepted the diagnosis with little knowledge about what this meant in terms of my quality of life.

Looking back, I had high blood sugar symptoms up to two years before my diagnosis. If I could wind the clock back, knowing what I know now, I would have started insulin at the first signs of substantial blood glucose anomalies.

It’s unfortunate that insulin creates fear and uncertainty, even in doctors. It’s a potent and powerful tool to treat diabetes. Given the right education, curiosity, persistence, and a good attitude, it’s often the best tool in the diabetes tool-box.

And the tragedy is that some never do at all. Like I said, I wish I’d done it years earlier.

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If I should ever happen to be diagnosed with Type 2 (or any Type for that matter), I plan to insist on insulin as my first-line and immediate treatment. Once my BGs have stabilized, I’m willing to consider Metformin alone, but if my BGs cannot be maintained within what I consider to be a “tight” range with a lower carb diet and Metformin alone, I will ask (demand if necessary) to resume treatment with insulin. I have learned so much from you all!

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Well, after all, it is the most powerful weapon we possess.

As I’ve said elsewhere, Joslin, which is pretty much the gold standard, routinely starts T2s on insulin right away if they fit certain criteria. Presumably they know something. (These are the people who, when the first DCCT results were published, went around wearing buttons that said “We Told You So”. :laughing:)

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Wow, that’s a helluva story David, color me seriously impressed. Your story really highlights the more enlightened attitude about insulin and T2 that you see around here, versus the “insulin as a last resort!” attitude in the wider culture. What’s curious about that attitude to me is that it sort of echoes back and forth between patients and physicians. You have the (not unreasonable) fear of it on the patient side because it’s scary and unpleasant (hypos! needles!), and then that gets reinforced on the medical side, where the assumption is patients don’t want it and you don’t want to give it to 'em because it’s scary and unpleasant, and complicated and so on. But at some point it seems like a kind of mutually reinforcing resistance that isn’t wholly rational. Instead of allaying fears about it you get physicians playing on them, using it as a bogeyman to get T2 people to improve their self-care: “If you don’t lose that weight yer gonna end up on insulin!!!” Again, it’s not that there’s nothing to worry about but there seems to be this other layer around it that may be keeping people from getting the treatment they really need. Your story is such a clear counter-example to that. Most impressive.

I take it the question here is more directed toward people dx’d (rightly or not) with T2, but FWIW, I was dx’d with T1 at age 28 and had my first shot right then and there. I had all the textbook symptoms, felt like death warmed over, and the Doc came in with the nurse with vial and syringe in hand right behind him. Doc said “you’re the proud owner of juvenile diabetes” (as they still called it), They showed me how to do it and I administered my first shot myself. Doc went on to explain that “juvenile” was a misnomer and plenty of people my age or older got it (he used the terms “insulin dependent” and “auto-immune diabetes”). My symptoms were all textbook, and the doc said I was in imminent danger of DKA (“If she hadn’t brought you in this afternoon your wife probably wouldn’t have been able to wake you in the morning”).

This was 1983, mind, so it adds to my confusion about people getting misdiagnosed today. It never occurred to me until hanging out here at TuD that you could be in that perilous a state and have the Dr send you off with nothing but a prescription for Metformin just because you’re out of your teens. I could have been in seriously bad shape or even dead within a few days if that had happened to me. I shudder to think.

Continuing the discussion from Whose Idea Was It?:

Metformin wasn’t working and I increased the dose a lot! So insulin it was, prescribed, no patient teaching. Just the attitude of “go away and figure it out yourself, maybe the pharmacist can show you how.” Had to start insulin all alone, but wait 4 days before I could get in to see education centre nurse.

Looking back, I think insulin is the worst thing to give to someone with insulin resistance. Now I’m kinda stuck… insulin is a hate/love relationship for me.

It was my doctor’s idea - four months after my initial diagnosis. In my case, I was (am) afraid of needles, so would not have thought to ask for insulin at all; however, after several months of various oral medications (metformin, glimepiride, Januvia) and suffering from intolerable side effects from each one of them, it came down to: Do we try one of the other Type-2 medications, most of which were injectables, or do we go with the “injectable” that won’t have any of the side effects (insulin)? Put that way, went along with his idea to “try” insulin.
The one “side effect” (or, really direct effect) of insulin that I hadn’t considered was weight gain – and I struggle with that to this day; however, I do not believe I could have achieved the level of control that I have, if not for insulin.

That said, I understand @Sheepdogs’ viewpoint – IF insulin resistance is a result of the presence of too much insulin, as some believe, then taking more insulin would seem counterproductive. Based on my TDD, I seem to have at least some insulin resistance, though not “a lot,” so it might be a concern. On testing, though, at this point, I do not appear to be producing much of my own insulin most of the time, so taking insulin may have become my only choice by now, anyway. As I think @David_dns has pointed out in other threads, “Type 2 Diabetes” is not a homogeneous condition or even a specific diagnosis. Instead, it a catch-all, or “default” diagnosis: any patient with “diabetes” that can’t be identified definitively as Type 1, LADA, or MODY is diagnosed as “Type 2 or unspecified type diabetes mellitus.” As such, there will definitely be some people for whom “adding” injected insulin is the best first choice, as well as those for whom it may be better considered as a “last resort” – and probably many people in between those extremes.

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In my case i got pregnant. The endo I’d been seeing for hypothyroid insisted in a glucose tolerance test, which i failed at about 4 weeks pregnant. I tried diet up to about 10 weeks pregnant at which time i had appendicitis. After not eating for 2 weeks related to that and the amoebiasis that emerged immediately after surgery i was started on mixed insulin. Rapidly escalating doses of insulin for the rest of the pregnancy until delivery,.including a scarey episode while on holiday in China when i took the insulin but didn’t eat soon enough and woke up in a Chinese hospital. After delivery that same endo told me no need for insulin or to test blood sugar anymore.

Me being the anal control freak type, disbelieved him, and continued testing very soon to realise that insulin Was absolutely still on the cards if i wanted both to be able to eat and have decent blood sugar control.

Aft that time i discovered bernstein and switched myself from mixed humalun-n and r insulin to basal-bolus. By the time i presented myself back to the endo he didn’t realise the new combo wasn’t his idea. A second pregnancy on industrial doses of insulin, and now i choose to maintain myself on insulin due to its ease and my ability using it to have good blood sugar control. I am yet to have an official diagnosis nearly 8 years in, though my current pcp seems to think i am type 2. Haven’t seen the old endo in 4 years.

I live in Philippines where most drugs are available over the counter so self management is easy. Don’t knew what I’ll do if and when i ever go home to Australia.

If i could change career and get qualified i would like to be a diabetes educator.

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I went on insulin after being diagnosed as T1, it was the endo’s recommendation.
Initially I was diagnosed as T2 and tried virtually all the oral meds (none of which worked for very long or at all) over a period of a few years.
I finally went on Victoza, it worked for a while but the side effects were horrible and it’s effectiveness didn’t last long either.
Anyway, long story short, my endo finally decided to test me for T1 indicators and I was positive for insulin anti-bodies.

I guess you could say I really didn’t have a choice, it was either go on insulin or suffer some really nasty consequences.

Wheelman

I was in dka and I was put on iv insulin first in the er and then went to the icu. It was not my choice, I pretty much hate it and I would do nearly anything not to be on it but that is my life now that or die. When I came out of dka I was sure they must have made some huge mistake and when I went home things would go back to normal and I could get off insulin. I came back to the er and was readmitted within 24hrs with a dvt which I had been released with symptoms of.

Before that I went to numerous doctors for several years at the end with obvious symptoms of diabetes but I was never even tested specifically for that. About 2 days before I ended up in the hospital I was diagnosed as type 1.5 and a “little” type 2 even though my blood work and urine sample and symptoms clearly showed I was in dka. My then doc gave me metformin rx, sent me home and said come back on Monday to see if you need insulin. I had to argue with the office staff to give me a blood glucose meter which he said they would do and I was told to test my bg but not when, so I was under the impression I could test once per day. I went online and asked people at a diabetes site. They told me I was most likely type one and going into dka, and they were right- except I was already in dka then. By a few miracles I survived that and everything that happened after.