I have an Endo name Dr David Morris, who is the sought-after endo here in Montreal. I asked the very same question as you, and he told me that in the end it doesn’t matter, as almost every diabetic ends up on insulin anyway. I trust him, as he has somewhere near 45 years experience.
Don’t let the moniker bug you. Take control of your disease, and who cares what some dumbass PA has to say?
I have an Endo name Dr David Morris, who is the sought-after endo here in Montreal. I asked the very same question as you, and he told me that in the end it doesn't matter, as almost every diabetic ends up on insulin anyway. I trust him, as he has somewhere near 45 years experience..
Possibly a better way for Dr Morris to word that is "almost all of my diabetic patients end up on insulin". In which case I'm glad he is your endo and not mine.
To be fair, in this country well-controlled type 2s do not usually see an endo. I have never seen one. If that is similar in your country then your endo's sample of the type 2 diabetes population may be skewed to the poorly-controlled set and his comment may be quite valid in that case.
Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter
Alan: That was a great point! My aunt was diagnosed with T2 more than 20 years ago. She still manages with diet and exercise at age 82. She had excellent medical care and training when first diagnosed. I agree, the type of medical care one receives can make a huge difference.
Judging by the insane wait times to see the guy, (My wait time was 18 months!) he sees his fair share of all types of diabetics. I cornered him on what he was saying, and he explained it like so:
“To be honest it matters hardly at all what sort of diabetes you have, since Type 2 diabetics almost always end up insulin deficient! The truth is that ALL diabetics are insulin deficient, and that many Type 1 diabetics are now developing a parallel type 2 diabetes through weight gain!”
Thing is, the big D is a degenerative disease. Sure, many people will never see an endo until it is too late, and they need to get under insulin. I understand the fear of insulin, and thinking that it is a failure, but in the end, insulin is what has extended my honeymoon period.
I know a good number of T2’s now, (since my diagnosis, its like I was blind to them before) that end up going on insulin therapy to preserve their beta cell function.
I’m glad to have Dr. Morris on my team, I have fired a good many endos to get to him…
Be well.
Jason: When I read your last post I had a lump in my throat. After all, if one of the leading Canadian endos believes that all T2’s will need to go on insulin “in the end” what hope is there? The “in the end” is the most important part of the message. Before that “end” Type 2’s will be tortured with a variety of cocktails which ,for many, result in nothing but weight gain, horrible side effects and rapidly increasing numbers. I personally begged for insulin when my numbers went out of control and I was denied. I have complications now!! I have some hope after reading bsc’s story as I know I can buy the insulin for myself if I need it. Please read bsc’s story and some of the T2s posts here and you will learn that many T2s had to talk their doctors into insulin and then go it alone. BTW I dropped one of the drugs I was taking and I am now getting readings of 4-7 throughout the day without insulin. The protocol for T2s in Canada is the same as in the US…drugs first…then drugs + a little insulin… then insulin. Sorry for the rant. I just wanted you to know that many T2s would do anything for insulin it’s just not in the protocol!
Oh, I hear you. I guess I got “lucky” that the meds didn’t take. (After all, I am a LADA. That was a fun month or two.)
The protocol right now is rediculous, I agree. There is a slow movement among endocrinologists to start a T2 at least on Basal insulin. Doctors (I am assuming general practicioners here…) like to cover their butts, and since they are not equipped to deal with the complexities of insulin therapy, they just like to err on the side of caution - and that means going with the drugs first.
My recommendation? Get a referral to an endo. Go with the waiting times. I am lucky because here in Quebec there are diabetes centers that you go to, and they helped out during my wait. I have seen 3 endos so far before Dr. Morris. One I fired out of hand, because she was just too much.
Please, don’t think that hope is lost. THe best thing to do is to take control of the conversation with the doctors, and don’t take no for an answer. Pointedly ask them their reasoning for denying you, and ask if they want to be held responsible for your complications. Be assertive with your doctor in your wishes to aggressively control your condition. If nothing else, FIRE them.
We have a huge shortage of doctors here, and I am lucky to have a decent GP. I needed to fire 2 others to get to him though. He works well with me. He got me in to see Dr. Morris, and got me off the anxiety meds. (I am totally drug free now!) The hardest part is remembering that the GP is just a person too, who when pushed the right way, will at least give you a referral to someone who is more suited to dealing with them.
Another exception as it goes with this disease : I have lady a friend here in BC , Canada , type 2 , NO meds , diabetes for about 45 years. …she just turned 86.She has never had the need to be seen by an Endo .Possibly a bigger concern is those blood pressure numbers. …
I think it is great that your endo does so much for you. Getting off anxiety meds is a real accomplishment… congrats. I have read many stories on here about PWDs with LADA being treated as T2s. It’s great that you were able to be proactive and advocate for yourself.
We have a huge shortage of GPs here in Ontario too. I was actually seeing an endo when I begged for the insulin. I have a new GP now who seems to be great. (Unfortunately he is close to retirement.) Finally someone is treating the complications and not pushing drugs.
As my numbers are normal now without the drugs, I am truly questioning this idea that this disease is always progressive. I mean is it the progression of the disease or the progression of the drugs?
Thanks so much for your positive response to my rant. I wish you continued success. Cheers!
That’s a great example Nel! 
Sorry, I misspoke, it was my GP that is against the anxiety meds. LOL
I am sure there are exceptions to the rules, but from my understanding, (and I am geeked out for sure, because I can’t stand not knowing something…) diabetes is progressive.
The goal is to hold off that progression as long as you can. It is different for everyone. I know of a 93 year old T2 that never took any drugs, did the exercise, and was happy. I know a 30 year old that followed suit, but ended up on insulin anyway. It all has to do with the individual, and the progression of the pancreas’s ability to produce insulin.
The key is to accept, and soldier on.
Hi Peetie : from the CDA’s 2008 Clinical Guidelines : I copied and the way I read the last sentence of the key message is to initiate insulin …I do know folks , whose choice it is not to use insulin or have put it off .
http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf
page S53
KEY MESSAGES
Pharmacologic Management of Type 2 Diabetes
• If glycemic targets are not achieved within 2 to 3 months of lifestyle management,antihyperglycemic pharmacotherapy should be initiated.
• Timely adjustments to and/or additions of antihyperglycemic agents should be made to attain target A1C within 6 to 12 months.
• In patients with marked hyperglycemia (A1C ≥9.0%),
antihyperglycemic agents should be initiated concomitantly with lifestyle management, and consideration should be given to either initiating combination therapy with 2 agents or initiating insulin.
A mention is made under Introduction : type 2 diabetes : an ongoing decline in beta cell function will have glucose levels likely worsen over time …more under recommendations on page S57
These Guidelines are available to everyone on line and in hard copies as well .
Nel: Please know that I’m not arguing with you personally.
My problem is the fact that one must take these drugs for years enduring the side effects and fighting the weight gain until the numbers are so high that one develops complications. Many of these drugs are new and hold potential dangers. Last summer I weighed 155 pounds the same weight I’d had since a month after diagnosis in 2004. Then… the drugs were ramped up and I ballooned up to 176 where I was at the end of May when I stopped that drug. Two months later I am 153. I swear I did not overeat and in fact during May, I was so ill that I ate very little at all. Still I went to work every day until the end of May when I just couldn’t fight it anymore. As I had no lows and only consistent highs I was never hungry. Still the weight went up and up. Then… I stopped the pills.
Most Type 2s that I know are taking so many pills that they have no idea what they are for. If you read the posts, you will see that many truly despise these drugs. There is absolutely no control with them and yet the PWD is blamed for the rising sugars and weight gain. Side effects go unreported and everyone just carries on. All I can say is that it felt like I was being systematically poisoned and there was nothing I could do. I know this sounds terrible and I keep complaining but it is just so wrong!!! If it wasn’t for TuD, and the support I’ve had here I would never have had the courage to stop that drug! The problem is that most T2s in this situation blame themselves…why not…everyone else does? I for one am tired of watching my friends sicken and even die.
I know that you have nothing to do with the protocols so please don’t take this personally. When I read that, I just got so angry! The assertion that T2 is progressive removes any accountability for treatment.
Sorry I’m finished ranting now. I guess I’d better stay off the site for awhile.
Peetie, I never had a sense that you were arguing and with me specifically .
I do know that you are very pro-active and you will continue …
I in my almost 30 years with D have fired some Doc’s along the way … My Hubby , not living with d has done the same …a typical reason : bed side manners, rather the lack there off…
I hear you there! I like to question everything the doc does. You need to remember that they are not infallible. They have a responsibility to do whats best for YOU the patient. (As per their Hippocratic oath.)
Fact is, T2 is progressive. How long you hold off on that progression really is up to you, and your doctor.
I am not into doctors blaming patients, or patients taking the blame. The disease is what it is, and by taking control of the situation - you will succeed. Don’t just take the doc’s prescription. ASK what it is for.
A lot of GPs are pressed for time, but too bad. They want their money for the service, they can explain the whys and hows. If not, FIRE THEM.
Canada has a shortage of doctors, (Quebec especially!) but it is no excuse. The point is take control today, and live the best life you can.
My disease is degenerative. I will eventually lose my pancreatic function, but I plan to extend it as far as I can, by any means neccesary. If that means insulin, then so be it.
I actually was chatting with my doctor today and she said that the protocol now is to start all Type 2’s on insulin. I was really glad to hear that - the medical profession does change, just slooowly. I live in a large metropolitan area in California, so I’m not sure if this is the case yet in more rural areas of the U.S. or in other countries.
It is slowly getting this way in Canada. I guess I was “Lucky” that my BG numbers were 24 mmol (430ish) when I first started out, and I didn’t respond well to the Metformin. I was put on the Basal right away, and a couple weeks later onto the Novo-Rapid. Then my numbers crashed.
I was lucky enough to lose my vision for a couple of weeks. Fun times. I knew it was going to happen, because it was all explained to me. Much to the chagrin of my doctor and D nurse. I made sure I left there with all the info.
Thanks to TuDiabetes, I have other information as well.
Wow, they actually recognized LADA! (heavy sarcasm, I hope that too is getting more common). But if they are also doing that for Type 2’s that’s great!
Whew, totally losing your vision for 2 weeks? Yikes! I often think what I would do if that happened suddenly! How would I go anywhere for help? How would I even dial the phone? I guess it is (marginally) better if you know it’s coming and can plan for it.
Just a lateral thought.
Most Type 2s that I know are taking so many pills that they have no idea what they are for. If you read the posts, you will see that many truly despise these drugs. There is absolutely no control with them and yet the PWD is blamed for the rising sugars and weight gain. Side effects go unreported and everyone just carries on. All I can say is that it felt like I was being systematically poisoned and there was nothing I could do.
I have to wonder how many of the "Most Type 2s" you refer to are following the low-fat high-whole-grains lots-of-healthy-fruit dietary advice, or no dietary advice at all. And are also discouraged from testing at peak times after meals.
Which leads me to wonder how many of them may not need that expanding drugs cocktail if they followed a different way of eating.
Over the past eight years I have seen quite dramatic changes in meds, insulin and diabetic health when long-term type 2s have changed their way of eating using guidance from their meter.
Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter
I was “discouraged” from testing so much by a diabetes nurse. I laughed at her and told her in no uncertain terms that I was in charge, and I woul test as much as I liked. It was because of that my GP figured put the metformin wasn’t working. Hard to argue with post prandial numbers!
I’m probably jumping into a vat of hot water, but why are the labels so important. I think wearing the label of a diabetic is enough. the one and the two are ways of showing treatment and what is happening with your body…do they really matter in the end, if you are on pills or insulin, the numbers aren’t the most important to know. I have many friends who wear a type 2 sign, that are using insulin…that’ doesn’t make them a type I…it makes them a diabetic who occassionally uses insulin. I guess I don’t get off on labels, unless they are of great import, and at this time, I don’t think they are except to say you are a diabetic who is/was using insulin.