Adding insulin to type 2 treatment regime

Hi some very helpful advice/information from my last post and I'm hoping for more of the same this time around.

I've been dealing with my type 2 diabetes for 12 years, with the help of medication and diet. For the most part, my readings have been fine...normally below 185 at the highest and A1C averages around 5.9-6.1

Over the past year, though, things have gone a bit wonky with my health and I've had to deal with chronic sickness (This will finally be addressed by an infectious disease doctor hopefully within the month), depression and more foot problems (corrective surgery 3 times and a fourth due this week). Is it any wonder my daily blood readings are all over the place?!

After a long talk with my doctor, we've decided to add insulin to my treatment in the evening/overnight, along with Amaryl and Janumet throughout the day. My readings have been between 185-265 over this past month and although I'm not pleased with the idea of going on insulin, I understand why it might just be the best plan of attack.

I have zero experience/knowledge of insulin useage and am unsure what I'll need to prepare myself for which leads me to my questions. What questions should I ask my doctor prior to my first insulin shot? What are the chances of eventually getting off insulin once I've started (a big fear of mine as health insurance may not always be available)? Any suggestions/words of advice of a noob?

I'm really trying to not see this as a step back...which is proving to be difficult.

Thanks for any and all replies!

Well, don’t see going onto insulin as a “failure” in your diabetes treatment. You will feel better with insulin because it will give you better numbers. For a type 2 going on insulin, in my eyes that just proves the person cares about his or her health rather than just sticking with the pills and diet which just doesn’t do the trick for everyone.

And I’m btw not a confirmed diabetic, but I may be pre-diabetic. Should I be full blown diabetic one day (it’s more a when than if), I’d rather take insulin than oral meds from day one!

I agree with Jennie. For a Type 2 diabetic, options such as diet, exercise, weight loss and oral meds work for quite awhile. (In your case 12 years). After awhile your pancreas stops producing sufficient insulin on its own (just like us type 1’s) and you need to implement your treatment with insulin as well as possible meds for your resistance. It doesn’t mean you failed, it’s a natural progression. If your body is no longer producing sufficient insulin (a c-peptide test can determine this), you will not be able to get off insulin once you’ve started. If you are still producing enough but just have resistance, weight loss and lowering of carbs in addition to the insulin and meds might give your pancreas a boost for awhile and then you might be able to stop insulin for awhile.

I highly recommend the book Using Insulin. Your doctor may start you on just a long-acting insulin but in time add a mealtime fast acting insulin. The book will explain how that all works. There is a lot to learn, but in time it will seem no big deal and you will feel better with lower numbers.

I came to terms with the idea that I would be moving to insulin some years ago. I’ve actually been unable to obtain a prescription of insulin myself, my doctors have been the ones that are “Insulin Resistant.” I actually look forward to it, it will certainly take some of the pressure off me. A show was actually made with some of the patients from my local diabetes center on this subject that you might find helpful ( If your blood sugar control gets better, there is no reason you can’t get off insulin. As to insurance, you need to understand that actually insulin can end up being a mere fraction of the cost of some of these alternate medications.

And I have the books “Using Insulin” and “Think Like a Pancreas,” and recommend them both.

I’ll do what is necessary to keep my blood sugar under control and insulin is just one of thing in the bag of tricks.

I am type 2 and in March of 2009 my ENDO started me on MDI Lantus/Novolog when I finally got under control I was at 85 unit Lantus and 20 to 25 units each meal. I knew this was alot and decided to go no carb/very low carb and I had my Lantus down to 35 units and less than 20 units of Novolog all week. By Enod recently put me on Victoza and I immediately stopped the Lantus and use less than 20 units of Novolog all week.
Since Insulin will make you gain weight it is to your advantage to use a little insulin as you can get by with. I was very pleased with my results but was having trouble loosing weight. I have lost 5lbs in less than 4 weeks since starting Victoza.
Good Luck

Thanks so very much to everyone for all the great replies thus far!

I’ll admit, accepting the move to insulin has been dificult because my exposure to it is over 30 years old. My dad was type 2 and I only remember his drive to get off it by weightloss alone. He always said insulin was the “kiss of death”…I now know otherwise.

I’m planning to order both books recommended…thanks. It’s like being educated all over again and starting from square one.

I’m thankful to this site and the people here who are willing to share.

Update…I spoke to my doctor this evening and it looks like I’ll be going in the morning to be taught how to inject and discuss use and side effects of Lantus. Anyone else use this and have any advice to offer?

Thanks again.

You might also check out Dr. Bernstein’s book, his information on insulin is pretty in depth as I recall.

Good luck, I am sure you will get better control. From what I have read this is not unusual for a person that has had T-2 diabetes 12 years and is something many of us will face someday.

Your current readings 185 to 265 are skyhigh so adding insulin is a good idea. For best results you need a basal slow acting insulin like lantus or levemir and a bolus fast acting insulin for meals like novo------- something or apidra. You will feel much better and will not get gangrened feet like my brother did with uncontrolled BG in his old folks home.

I would not take amaryl with insulin it will make control difficult.

Best of luck.

Adding metformin with the insulin is a good idea if you are insulin resistant. This would help to minimize weight gain the main downside of insulin.

It is improtant to minimize the external insulin with a slightly hypocaloric diet and/or a low carb one and exercise.

You’re right, 185-265 is too high and I’m glad we (the doctor and I) decided to go this route. Tonight is my first dose of 15 units of Levemir to be raised as needed every three days until I get morning readings below 150.

As for metformin…I’m on Janumet which is a combination of Januvia and Metformin. The Amaryl will remain for now and will be readdressed in 4 weeks.

I’m sorry to hear about the foot issues your brother had. I’ve dealt with Charcot and numerous surgeries (as mentioned in my original post), another of which will take place in two days. It has made exercise almost impossible at times but I understand the need to get back into a workout/fitness regime.

I really do feel as though I’m starting all over again only this time my support system is next to nil. Frustrating to say the least.

Thanks to everyone for all the good luck wishes…I’ll gladly take them!

Emmy, you mentioned the South Beach diet…funny thing, for the past 4-5 months I’ve been following a low carb/high protien eating plan similar to Paleo diet and lost some weight but my A1c went from 6.8 to 7.6 over that time. I’m a bit stumped.

I’ll have to do a bit more research on this.

Thanks for the advice and words of support.

He was unable to walk because of hydrocephalus. the combo of diabetes and no exercise is deadly.

Hi Varena, I understand the frustration with the “be patient” line…it’s hard when I’m getting such high readings, feel exhasted all the time, can’t focus and all the other issues that come with high readings. 2 days into this and I was hoping for some change. Patience…my new mantra.

Best of luck to you as you try to make heads or tails of this and thanks for the reply.

Do read the books, Using Insulin and Think Like a Pancreas. They are excellent and both may be in your local Library and or can be acquired from Amazon for a small price.

High readings are no fun…, Do you have a Certified diabetes Educator to help you… Is there a ADA American Diabetes Association in your town,… I do not suggest waiting around for blood sugars in the 200’s to lower… I am type 1 on inuslin infused through a pump, and I do understand that it takes a while for the oral diabetic medications to “take” in your system. My understanding is that the insulin should begin to work right away, within a few hours time, Does it not work this way for type 2’s as well?.. Do keep a journal of your carb intake and your medication dosages to take to your CDE…
Remember, YOU are yourownscience experiment…

Hope and pray you feel better soon.

God Bless,

God Bless,

Brunetta…I love that line, “YOU are your own science experiment”…that’s how I’m starting to approach this whole diabetes thing. I have an appointment (my 1st) with a Diabetes Educator the beginning of Sept. and I’ve started to write down everything…meals, blood readings, insulin.

I started with 15cc of Levemir 3 days ago and was still getting readings above 200. Last night I raised it to 20cc and this morning I was 179. Of course the surgery yesterday is going to affect my readings but I feel things are starting to go in the right direction.

The books are on order and I’m thankful for any prayers.

It is one of those well known myths but going back on Insulin is definitely not a failure on your part, it is just an adjustment and we do what works

This was a concern of mine, which is why I called my endo to verify the directions given. She was the one who wanted me to raise the dosage…15units to start, if fasting bs is over 150 after 3 days raise to 20 units and if it’s still above 150 (which it is…230 this morning) raise it to 24 units. I’m going to be calling her again today because my after meal readings are staying high also (between 180-200 2 hrs. after eating).

I have neuropathy in my feet which isn’t helping with healing after surgery and I’m painfully aware of the possibility of other complications.

I’m so amazingly frustrated and feel pretty much on my own with this. Thanks for any input offered.