Most definitely. Sage advice David.
That was his stance to some extent, but I disagree at least in part. Now he wasn't concerned with access to pumps, but a T1 diagnosis gives you all the tools and likely more strips. Second, it gets them to stop pushing T2 meds on you. I mean I was on basal/bolus with Metformin at the end there, and the Metformin really did a number on me. The diagnosis does matter.
I read Dr Bs book early, and concluded that if metformin and cutting carbs/exercise didn't work, then I needed/wanted insulin. But really if you've cut back to normal weight, are exercising, and eating low carb, and metformin isn't getting enough of a boost, then it means your body isn't producing jack in terms of insulin.
I didn't know about the Walmart OTC option. It took me a pretty long time to get someone to put me on it. Because I had gone low carb (maybe even low food) to try and manage the BG, my A1C was below 6.5 and the new GP I had pretty much laughed at me when I wanted to change things. Then I had to wait months for a endocrinologist, and I was lucky to find one who followed my wishes. The walk in clinic people wouldn't manage diabetes. Then the metformin ended up causing all sorts of problems.
And I was lucky! A lot of late onset T1s and T2s get put on a chemical coctail of meds that makes BG management impossible.
Quite true. I have very little insulin. Last c-pep came in at 0.3, which isn't quite zero but it's awfully deficient. Personally I'm convinced that it was 16 years of pushing my beta cells into overdrive with sulfonylureas that did it, but I'll never be able to prove it.
Since reading T2 comments like this for the last several years, I’m disturbed at how slowly the medical community is reacting to these issues. I read that the Joslin clinic is no moving T2s much more quickly to insulin.
Quite so, Terry. The medical community -- which really has no excuse for not knowing better -- still, by and large, views insulin as a last resort rather than a first response. So of course, by the time it's prescribed, it's often very late in the game, and too late to avoid complications that could have been prevented. Had I waited for someone to recommend insulin instead of going after it myself, I have no doubt I would be in much worse shape.
And yes, Joslin now puts newly diagnosed T2s on insulin right away, even if only as a temporary expedient to bring things back into line.
To defend docs -- at least mine -- when I was first diagnosed with T2D, I begged not to get injections. Not afraid of them, just annoyed at them. I'm on insulin now (after a really stupid phase of my life when I thought the exercise I wasn't doing would take care of the crap food I was eating -- I ended up with an A1C >10) but I entertain the thoughts frequently that at some point I'll get my A1C's consistently down and beg to go back on oral meds.
When I was originally diagnosed, my A1C was 6.8… went on a strict low to no-carb diet, testing BG 5 -6 times a day, and got it down to 5.8 in three months. Stayed off meds for 2 years, and even got undiagnosed.
A year or so later my A1C was a whopping 8.2, and it’s been a battle ever since. I’m 43, and I’ve been on increasing doses of Metformin-XR 500. Once a day, then twice a day, then three months ago it was 1000 in the day time, 500 at bedtime, and just this past Monday my doctor increased it to 1000 in the morning and 1000 at night. I have constant diarrhea. This week I am even getting up in the night to run to the bathroom. (sorry, TMI, probably).
I feel like the Metformin just doesn’t work, and I’m damaging my long term health with crazy spiking blood sugars.
A1C’s have been 7.6, then 7.2.
I eat practically NOTHING, and since adding Topamax for migraine control in January, I’ve been losing a pound a week on average, currently at 112 lbs - which is less than HIGH SCHOOL weight. I’m 5’0" - I look great, but I can’t afford to lose much more, and honestly, I don’t feel very great. I need to eat more, but my BG are still just terrible. This week I’m noticing muscle aches and weakness. Yesterday I managed 2 slices of toast, some crackers, 1/2 cup of gulosh, and 1/2 cup of raspberries and blueberries in milk, and my FBG this morning was STILL 154. My doctor asks why I never test - I don’t test because it makes me cry. If I test an hour after eating, it’ll be in the 200s, even if I eat NO CARBS at all. If I test 2 hours after eating it’ll be 160. It’s absolutely disheartening.
The only time I ever see a BG test anywhere near normal is when I decide my meter must be broken and test my husband.
So the truth is, I prefer to eat as best as I know how and wait for my A1C.
As far as the topic - are we just completely ignorant about Type 2?
I’m starting to wonder, honestly. I had gestational diabetes when I was pregnant, controlled my BG wonderfully with lantus at bedtime and humalog to cover meals, and delivered a 6 and a half pound baby.
Why can’t I use the same (or similar) insulin to control BG now? Because insurance won’t cover it for T2? And what do I have to do to convince my doctor (PCP, by the way) - maybe go back to testing a gazillion times a day and just show her that eating food makes my BG really high, despite the increasing doses of Metformin?
As an aside, I stopped seeing my CDE - she was a cute perky peppy little thing who probably runs a marathon every week and only ever wanted to cheerlead me into quitting smoking, and, frankly, I know exactly how that would effect my meter readings. I’m not going to pay money for that lecture from a 19 year old every single visit when the co-pays and co-insurance for everything else already has me fending off the collection agency.
(Okay, she’s probably older than 19, but still, I’m older than 40 and of course I know that smoking is bad bad bad, can we please move on and talk about something useful? But no, my healthcare system seems to have a policy to withhold further education until one agrees to contract to smoking cessation and accept a script for a drug or patch or gum, a problem I’ve had with other providers within the system as well, which is a whole different rant).
Today I am particularly crabby about my diabetes because I actually tested this morning and got that 154. Usually I roam around my life fairly cheerfully, I swear : )
Your doctor knows nothing. Obviously you should be on insulin. I started insulin 7 years ago when pregnant with my oldest. After the delivery the Dr. told me I could stop taking insulin and no need to test any more. I ignored his advice and quickly found that my blood sugar would not stay on target (my target is very narrow), and insisted on staying on insulin.
I live in Philippines and can buy insulin otc. I think you can do the same from wallmart. Maybe time for a new dr???
I met a type 2 older guy yesterday. His hba1c is about 10, and still he is not considering going on insulin. I told him he won’t be around to see his grandchild for much longer if he didn’t… that was after I revealed that I was diabetic…
@SM_Johnson, Having T2 can be really hard. It seems everybody including our healthcare team think that we can control our diabetes just by making lifestyle changes. But in truth T2 is much more complicated and for some of us it was never about lifestyle and it just get’s worse. I fought for literally years with my doctors cycling through medications and eventually I forced the insulin issue. My story about starting insulin is here in the forums, search for it and if you can’t find it post asking me to give a link.
And yes, I think there is a huge amount of ignorance about T2. I can be patient with someone in the public who just doesn’t understand but I get really irate when it is a medical professional who should know better.
ps. You should also be given appropriate tests to diagnose your diabetes. Having had GD you are at higher risk of LADA (adult onset T1) which can emerge slowly even over a period of several years.
Who is the “we” Dave? If the “we” is doctors and endos, then yes -a lot are ignorant.The number of factors and variables make it impossible to treat Type 2’s with the “one size fits all” approach, but that doesn’t stop it from happening.
The phrase “Your Diabetes May Vary” (YDMV) isn’t accurate. If you are a type 2, your diabetes WILL vary. In truth there is no “we”, so the question should be, “Am I ignorant about my type 2 diabetes?”. 
@SM_Johnson . Type 2 diabetes is extremely variable, heck sometime it isn’t even type 2 but rather misdiagnosed type 1.
What concerns me here is that you are continuing to lose weight even as your BG is high. Has you doctor considered antibody testing. It may be a long shot but you would not be the first person to be diagnosed incorrectly. Its worth testing if for nothing more than to eliminate it.
My doctor seems to have considered nothing except A1C, yearly fasting BG, and Metformin. I am going to ask around for who is considered an excellent doctor to see for diabetes, and am thinking of emailing the endo I see for thyroid follow up and ask if he will see me for diabetes follow up. My pre-supper test was 116 and my two hours post-prandial was 235. I have been making an assumption based on marginally falling A1C that Metformin is working, but these numbers say otherwise.
@Stemwinder_Gary - some of the weight loss is due to taking topamax to control migraines (it suppresses appetite), but there is a point where I need to be able to take in enough calories to maintain weight without completely blowing my BG, yes. I’m not great at eating anyway, which is one reason I worry about long-acting insulin and would love it if I could cover meals with bolus. I had a couple of lows while I was pregnant, yikes, scary times, boys and girls.
Finally got my login issues resolved (thanks Mike!).
So, where I was going with this is, as several have figured out, INSULIN.
Diabetes is a problem of insufficient insulin. Not insufficient GLP-1, DPP, sulfonylureas, acarbose, or any number of other drugs that screw with sugar metabolism, the pancreas, liver, and other tissues in the body to compensate for high blood sugars.
My own experience with T2 has me convinced beyond civility (almost) that every diabetic – that is willing – should be treated with insulin from the start. Any T2 that is willing to be agressive in monitoring BG and managing with insulin should be given that opportunity with strong, enthusiastic support from the medical community.
We do so much to AVOID treating T2 diabetes with insulin. The result, most of the time, is poor control, deteriorating disease condition, almost guaranteed moderate complications like neuropathy, and on and on. This is because the diet and lifestyle constraints necessary to maintain good control are like a straightjacket for most people, and they simply won’t wear it. They want to actually live a life, like everyone else.
I disagree that IR justifies those other drugs. In my research about all of this, I’ve found very little (almost nothing) “bad” about insulin – even lots of it – as compared to all those other pharmaceuticals. Metformin seems to about the only diabetes drug that is basically “safe”, with no long-term issues.
All the others have various potential long-term problems.
In my opinion, the main reason insulin isn’t used as a first and long-term treatment for T2 is because of social and cultural issues: Stigma, feeling of failure, doctor encouraging you to feel like you failed, issues with injections themselves, doctors’ fears over patients getting in trouble with things like hypos, and on and on.
I am a Rn , retired, that has had diabetes T2 since 1974. Originally controlled with diet, then pills. Then insulin with metformin. While taking the metformin, I was diagnosed with IBS, that cleared when I stopped the metrformin. I have had gastric bypass to assist with the management of diabetes, and currently weigh 125 at 5’1’’. I have had a huge reduction in insulin requirement, from 100 units a day, to no more than 20. My doc tried me on victoza last fall, lost about 10 lbs in a month, but there was no bg control improvement. Victoza was fine at first on the small dose, I felt like my ravenous appetite was soothed, and calm. After increasing the dose to about the maximum my brain felt numb, and I needed to sleep much more. Finally I was unable to function, or feel safe driving so stopped the med.
My frustration is with insurance and the negative connotation I feel from having the diagnosis of T2 diabetes. I have controlled my weight and appetite but still require insulin to maintain a 7.2 A1c There must be another diagnosis that fits, as I am not just overeating, or negligent in my self care and exercise.
I like your comment on the complexity and variables that no one is addressing.
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