64 year old T2 for 20 years needs advice

Hi–New to this forum and this is my first post! I was diagnosed T2 diabetes 20 years ago after years of being told I was “glucose intolerant”. Initial BS was >500 (error HI on the glucometer) and all the symptoms associated with that. I was placed on Metformin and glipizide and eventually got it somewhat under control with weight loss/exercise and metformin alone, which was eventually at 500 mg 4 x a day. Unfortunately, over the last 10 years or so I got lazy with my diet and was eating too much processed junk foods like sausage, bacon etc. My weight creeped up to 192 (I am 5’5" height) after being 175 10-15 years prior to that. I was placed on Trulicity 1.5 mg and despite becoming a prisoner of my house on Saturday when I did the injection due to severe cramping and diarrhea, I kept taking it and for 3 years I always had bad reactions to the Trulicity. Ozempic was tried and it was even worse GI symptoms. I was placed on glimeperide as well. None of these meds seemed to help that much. After my last A1c was 7.9 in February and glucometer readings were often in the 200’s and never lower than 140, I decided I had to do something. I went (along with my wife who is not diabetic but wanted to lose weight and eat better) vegan with emphasis on low glycemic load foods and started exercising again (I can only do walking, bike, weights due to back issues). I decided no more Trulicity or glimeperide for me and stopped them 4 weeks ago. I got the Freestyle Libre 14 day and it has helped me see how my sugars really are after meals and exercise and at night. So far it is correlating well with my glucometer readings. Almost immediately, my BS’s started dropping and I was so happy with average BS around 123 mg/dl! Unfortunately, my BS’s are creeping up despite keeping up the vegan diet and exercise. I believe it is due to the gradual clearing out of the Trulicity from my body. I am only on Metformin 500 mg twice a day right now, but average BS is now 155!!! I am losing weight with current weight at 180 and I am very weight sensitive to the diabetes, with lower weights helping me control it better.
I consulted with an endocrinologist when I was first starting the vegan diet and things were great, but now that things are getting worse by the day, I am not sure what to do. I was hoping for your input. I will consult with the endo soon again as well. He had said I might need to go on basal insulin or a DPP4 inhibitor. I really hate the T2 meds with all the side effects!!! I tolerate metformin fairly well though. I am assuming my pancreas is crapping out after so many years of T2 that wasn’t well controlled. The other issue is creatinine has increased to 1.36 in February when it was 1.10 in 2017 for example. I don’t want to end up in renal failure. Anyway, thanks for all your input!!!

Ken N.


Ken, welcome to our forum. We are always here to help in any way we can and appreciate your joining us. We all learn from each other.

It sounds like you might need ongoing advice and follow-up to a well-developed short-term and long-term plan as there is no magic bullet to T2. You can, of course, do this on your own and many on this forum will be happy to give you their thoughts that you can test or reject. An easier, faster route based on your post may be to sign up with Virta Health.

I am not recommending them, just recommending that you review what they have to offer as one possible option to reaching your goals both faster and easier.

In the meantime, I am sure you will soon have many others on this board chime in with other great possibilities and/or options to try. We all wish you a fast path to great diabetic health and look forward to your additional posts.


I’ve been reading about these diets. I tried low carb and keto.
It didn’t work for me. I eat a moderate carb diet about 100-120 a day. It works for me and my sugars are stable for the most part.
The opposite idea is high carb low fat, and this helps with type 2 more than you might think.although it seems opposite from logic.
High fat diets cause increased insulin resistance according to the article attached here.
That effects typ2 people more than type 1.

I know a few people who go back and forth between high carb low fat, and high fat low carb and it seems to work because all diets become tiresome.

It might be worth trying since you have exhausted your current regime.

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Thanks Timothy for your feedback. I am enjoying eating vegan and I am trying to watch so I don’t have a lot of bad carbs—no rice, potatoes, bread, pasta, etc. I eat fruit, but limit it to small amounts of blueberries, watermelon and other low GL foods. I don’t do the low fat idea at this time, as I love avocados (especially guacamole), olives, and other “healthy” fats. I like to get protein thru the natural plant sources, but find I “need” to eat a “burger” like Gardein or beyond meat without the bun to satisfy me at dinner at times. It seems better than eating meat at least. I know it’s still processed food. I also like Catalina Crunch cereal which is keto and vegan at the same time, developed by a diabetic and is low carb. It satisfies my sweet tooth with stevia as the only sweetener. I will check out your article as well.

Hi Ken,

You mentioned that your endo suggested that you might need to go onto basal insulin. If you pancreas is crapping out after 20 years then insulin may be the drug of choice. It has few side effects other than hypoglycemia and you can learn to manage that risk especially as you are already using a Libre. People often think of insulin as the last step - almost a punishment. Insulin is an excellent drug and having to use it is not a sign of failure.

Take care,



Thank you Maurie for your help. I have a feeling that is where things are going.

Welcome to the group. I am type 2 30 years. I take Tresiba in the morning. It last 24 hours so cover a day nicely. I have had a few meds I couldn’t take,too. But this may help give you better numbers. Good luck,again welcome. Nancy50


Thanks Nancy. Glad to hear it’s working out well for you. I’ll update when I know more.

I was diagnosed as a T2 30+ years ago (I’m 71 now). I progressed through many of the oral meds and then had to add basal insulin at night. I have since progressed to full insulin usage. I started using an insulin pump about 4 years ago.

Like others have said, insulin works so don’t be afraid of it. Get your diabetes under control by whatever means necessary and ask questions if you need help.


Thanks for sharing your story. It helps to hear what others in similar positions have gone through.

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bsmorgan—Very helpful, hopeful and encouraging post. Thank you. We all need to see these and tonight was my night to really need it. Thanks!

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Hi Ken,
My name is also Ken. I am an HNF1-alpha (one of the monogenic types) diabetic. I am going to try to be concise with advice:

  1. Get off the vegan diet, and consider animal-sourced only diet. The former we have not evolved guts (i.e. intestinal systems) to eat at all. The latter is what we are highly and almost exclusively evolved for as modern hominids. We are the highest level carnivore on earth, and the stable-isotope archeological evidence and analysis proves this without any possibility of valid challenge now.
  2. Stop all of the expensive and ineffective drugs that are “sold to” T2Ds. And especially any sulfonylureas. These overstress beta cells (in anyone, including nondiabetics) and accelerate apoptosis and hence INDUCE and ACCELERATE diabetes. One of the little-recognized fields of research that demonstrates this beyond much of any doubt (in my opinion/interpretation) is that of the larger 4+ decades long clinical trials (with study cohorts or many hundred) of monogenic diabetics of my type (one of the three HNF forms – HNF stands for “hepatic nuclear factor” and these are homeobox genes expressed in endocrine pancreas and intestine and kidney as well as liver) of diabetes. HNF-type diabetics have dramatically smaller (in size) beta cells than normal. But in every other respects those beta cells are normal in architecture and number, and are stable in function for life unless the HNF diabetic uses sulfonylureas. Even though the effective dose of sulfonylurea is ~20% of what is prescribed and required (for efficacy) for T2DM in HNF diabetes, and this slows down the iatrogenically induced loss of beta cells via apoptosis, HNF diabetics become insulin-dependent if they use sulfonylureas. And most do. It takes several times longer than for T2Ds, but iatrogenic insulin dependence eventually ensues.
  3. Learn to use bolus insulin. This is by far the most important one for any form of diabetes in which there is loss of BS/BG acute insulin response and consequent acute loss of BG regulation in response to meals. This is the result of loss of 80% or more of normal/initial beta-cell function. After beta-cell insulin granulation (intracellular storage form of insulin) is lost the beta-cell acute (prandial) insulin response is lost. That was what had happened when you first got diagnosed. That is what leads to first diagnosis of almost ALL diabetics – especially those with the two acquired forms (T1DM and T2DM).
    I strongly recommend using insulin Regular (e.g. Novolin R) – in many or most states this is sold over-the-counter at Walmart pharmacies for $25 per vial. This is what you need.
    Of secondary importance to bolus insulin to cover meals is some form of basal insulin. I recommend insulin NPH (also a synthetic insulin based upon human-identical hormone and a synthetic porcine peptide acting as the release-rate slowing agent) for this, also sold by Walmart for 25 bucks per vial. You can use one of the long-acting expensive insulin analogs if you want, but I don’t by choice (I have, and they are less effective for me). In many ways, since you might retain at least 5% beta-cell function, you could be more like me as a diabetic phenotype than like most T1Ds who have ~0% beta-cell function. This changes the ballgame and causes alpha-cell degeneration of function.
    There is absolutely no reason to use any non-hormone diabetes drugs, except to enrich MDs and drug companies. These are dangerous to health, ineffective for BG control, and generally very bad news. But you are going to have to learn how to take care of yourself, and to ignore most or all advice from MDs who generally understand little to nothing about biology, and are trained by rote with mostly biologically incorrect material.
  4. I am 62 by the way, so about your age. I have three rare genetic conditions, and the most serious of the three is a severe form of a polygenic condition named CVID. This is a condition of genetic mutations of the B cells (lymphocytes responsible for making antibodies, and the so-called “humoral” immune response). Most with CVID have less than normal B-cell function. I have none at all for almost all antigens, including proteins (viruses) and polysaccharides (most bacteria).
    Those with CVID and other so-called “primary/genetic immunodeficiencies” all, to varying degrees depending upon the severity of their condition, develop more and more autoimmunities with age as they “walk backward in evolutionary time”. In my case I can no longer tolerate any plant-derived foods at all without dangerous and powerful acute inflammatory response in small intestine and in large intestine.
    The important thing to recognize is that, while my severe case of CVID amplifies the response to non-evolutionary foods, all members of our species are relatively incompletely and poorly adapted to eating plant (i.e. agricultural) foods. There have not been enough generations of ancestry for any of us to adapt. Required number is ~ 1000. Those with ancestries going back all the way to the beginnings of civilization in China, Persia and southern Europe (the three earliest centers of agriculture) have only about half the required number of generations of ancestors for good adaptation, at most.
  5. I can explain the theory behind all of this, but that would require one or more long books. And I might author such eventually, because nobody else has put the info together that I can, collecting an understanding of many different fields of basic research in human biology and endocrine function and cellular metabolism and genetics and so forth. But suffice it to say that I can explain or teach the underlying theory, and I also have a lot of experience testing these theories on my own body with my three rare conditions (and a lot of ultra-rare biomarkers underpinned by these genetic condtions), and this “testing” is all consistent with those theories derived from a large number of basic researchers in many fields of human biology.
  6. So in summary:
    a. learn to use insulin, bolus most importantly to compensate for hyperglucagonemic response to meals (this is fundamental to almost all forms of diabetes) and basal less importantly to control (i.e. crudely compensate for) the smaller non-prandial instability
    b. get rid of all the other diabetes drugs
    c. correct your diet, and learn to eat (and prepare for yourself) food that is human/species-compatible in the evolutionary context – e.g. meat (including fish) supplemented with eggs and maybe highly-aged cheese (if you tolerate this type of diary) and bone broths and so forth. This is all that I eat and I have a very rich and highly diversified diet. I can tolerate mushrooms (neither plant nor animal, but from the other/third eukaryotic subkingdom of fungi) still, and so I garnish dishes with these sometimes for a little different textural component in the mix.
    d. don’t listen to any mainstream advice and propaganda from unknowledgeable sources with various political and commercial and academic (i.e. reputational) interests – and that means almost ALL sources (sorry about that, but that is the reality)
    e. learn to be self-reliant, almost completely

P.S. Ken, if you want to talk to me on the phone let me know. I have helped many others with various conditions (not all or mostly diabetes, and including various cancers and neurological conditions and immunological conditions, etc.). We can figure out some way to exchange phone #s and connect if you want.


Thanks Ken for taking the time to explain all that! I used to be a heavy meat eater but generally the kind that’s really bad for you, like sausage and bacon. I went vegan after watching many videos from MDs who showed scientific evidence that this type of diet could reverse insulin resistance and atherosclerosis among other issues. They proved that type 2 diabetics could go into remission with this type of diet. Half the world eats this way and cardiovascular disease and type 2 diabetes is virtually nonexistent in those areas such as central Africa. I don’t doubt that you have seen equally compelling evidence for the opposite argument. Unfortunately in my case, there appears to be too much damage to my beta cells to go into remission on my own and I will almost certainly be starting insulin soon. I’ll post here when I see what my ends is going to recommend.


Ken I’m 70 with type 2 on Victoza and Humalog.
The best thing I’ve done for myself was 2019 I applied for and got a Dexcom continues grouse monitor. Before this I was doing finger stick 4-6 times a day. And not sure when I was going to be high or low. With the continues monitor I can watch my trends and adjust my insulin as need taking more when it was going high and less when reading were low.
You can go to Dexcom.com to get the process started.
It is covered by most insurance companies. And in my case covered full by Medicare

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Most important is the bolus insulin – i.e. that to “cover” or adequately compensate for meals. Minimize the carb’s for sure, these CANNOT be predictably compensated for by any form of insulin. Dietary protein CAN be predictably compensated for by insulin. The paracrine islets endocrinology for portal glucose and portal amino acids is very different, and that is the reason. I can explain in much more detail if you are interested.
You can reverse beta cell loss, and regenerate, but only with excellent BG control and avoidance of prandial hyperglycemic transients. I has NOTHING to do with plant foods or animal foods – it has to do strictly with overstress and overstimulation of the beta cells from continuous nonevolutionary foods, and most especially carb’s. All of what you have read and heard from MDs is BS if they claim otherwise, and most do. But the endocrinology for BG regulation for nondiabetics and diabetics has been well understood and tested and retested since the early 1970s. The clinicians know nothing about it because they have not read the basic research and it is not important to their business model either. It is only important for the likes of you and me, and not the medical industry.
The hyperglucagonemic response to meals (deficiency of acute insulin response) is intrinsic to diabetes (except only for MODY-2 or glucokinase monogenic diabetes which is a rate-limiting enzyme deficiency underpinning BG sensing by beta/alpha cells), and only restoration of 100% beta-cell function will totally eliminate that excessive glucagon response due to the deficient insulin response – same thing for the non-prandial or basal regulation but this is much less cytotoxic to the beta cells. So name of the game is to cover your meals and include insignificant carb content, so that your bolus insulin dose is dominated by the dietary protein. You will steadily regenerate beta cells year by year if you accomplish good control, or compensation, with a time profile and proper amount of bolus insulin so as to drive the excess hepatic glucose production (a response to the acute and excessive glucagon signal) delivered via hepatic artery into the portally peripheral tissues (e.g. muscle, brain, adipose, kidney, and some other insulin-expressing/regulated tissues quickly enough to prevent BG from spiking. The spike, with every meal eaten, causes the overstress and loss of beta cells in T2DM. Believe me – that and nothing else. Every other theory that you may hear or read of is BS. The cellular biology is well understood, and has been for a half century now.
You may not live long enough to regain full / 100% beta-cell function – few do, but few do what I am advising. Those who do are guaranteed steady but gradual regeneration. The loss via excessive chronic apoptosis is ALSO slow, and for most T2Ds it takes a decade or more to go from 100% down to 20% beta-cell function (i.e. time to get first diagnosis).
All of the plant-eating propaganda is commercial-interest driven, with no valid technical basis whatsoever. But with my PID I have much larger intolerance of plant foods, and you can eat some without including a lot of carb’s, and control BGs as a T2D (most cases). But you cannot eat any starchy plant foods, nor refined plant foods which are all starchy and sugary. You just cannot do this and control BG with insulin. There is a positive feedback (if you understand engineering and control loops – evolved biological systems are the same) to portal glucose in a diabetic, and hence the prandial interval (aka nutrient/meal absorptive period) is UNSTABLE or oscillatory in nature, fundamentally. So you cannot compensate with insulin. If you try you will get both hyperglycemia and hypoglycemia during the same prandial interval. That is the best you can do if you include signficant carb’s in meal. That’s the way the biology in a diabetic works – that is the defect that results from severe deficiency of acute/prandial insulin response IN THE ISLETS (aka endocrine pancreas). PERIPHERAL insulin (i.e. self-administered) CANNOT prevent islets hyperglucagonemic response in an insulin-deficient diabetic. And all T2Ds and T1Ds and almost all genetic forms also are insulin-deficient in islets / beta cells.


P.S. And good luck. End of lecture, but I occasionally pop onto the forum and try to write a bit about BG regulation and endocrinology for others to read, in case they can benefit. Most do not of course.


You are a miracle. The Doctors I am stuck with are pompous, detrimental and apathetic. I am type 2 and have managed to get from a A1c of 12 to 5.6 morbidly obese to overweight and quit smoking . This was all done from searching beyond the lies s you had to do . Now I am seeking a solution to menopause hell . Do you know of this ?

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I read you loud and clear ! I was ridiculed by doctors for these theories . The complex carbs, oat fiber /bran ,sweet potato dark leafy greens sparingly with meats that are not processed and cooking all at home has been working out great

It seems so simple unless I’m missing something. Get an insulin pump and BG sensor. When you eat a sensible diet you enter the carbs and it pumps fast acting insulin. In between that it pumps fast acting insulin based on you blood glucose level. High blood glucose it pumps more. Normal BG it pumps less. Low BG it pumps nothing. Guardian angle while you sleep. It just works and T2D’s can get it now. I’m using the Medtronic 770G