@ Fraser70 Thank you for your response.
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I was diagnosed in March of 1998 with an hba1c of 8.6 and fasting bg 7.8.
I did my research and settled for a few strict lifestyle changes - only low GI carbs like squash and barley and a 40 minute brisk walk three times a day, right after each major meal.
I was able to follow that regime faithfully for 12 years, and my hba1c stayed in the 4.9-6.0 range.
After a cardiac arrest in 2010 I had limited mobility for a couple of years, and never managed to get back on track.
I am now focusing on low to no carb combined with walking.
Yes diabetes type 2 is progressive and will eventually get you, but I a proud of the 12 years I managed to keep it at bay without medications.
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Thank you. Fear keeps me going. Iām sure you could do it, as the parent of a type 1, you deal with harder things than I.
Donāt like the part about it will eventually get you, but you did great for a long time.
When I started on my diet and exercise routine in 1998 (that was prior to Tudiabetes,org, but the Joslin website had an excellent forum) people were constantly telling me āwhatās the use, it will get you eventually anywayā.
I chose to ignore that and I am certainly not one to want to discourage anyone from trying their best today to manage without meds. I guess itās just an issue of being aware of the fact that diabetes type 2 tends to be progressive in that as years go by it becomes more difficult to manage, eventually requiring sacrifices that are difficult for many to make. But if hadnāt been for my cardiac arrest I think I could easily have pulled off at least another 10 years, and thanks to the time I did keep my blood sugars at bay, my goal of living to 90 like my parents both did is not unachievable.
As an example of those sacrifices Iāll mention that at one stage I found that walking two hours a day was no longer enough to keep my bgs down, so I replaced one of those walking hours with an hour of walking up and down a flight of 81 stairs. Quite strenuous to begin with but I got used to it. Then when that was not enough I started using a gym twice a week for workouts.
So now I am looking at going on a ketogenic carb free diet which I hope will buy me even more time.
Bottom line, the fight against diabetes type 2, for me, has been not a battle but a war with successive battles. As an eternal optimist, I hope I will win this one.
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I too control by diet and exercise. I was diagnosed in late 2008 and it was caught early. I was put on metformin and got off in 3 months. I am still doing well. I lost all the weight and have kept it off ever since. I exercise at least a half hour every day and watch my diet.
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That being said, I think it is very important to remember that for many folks with Type 2, all the improvement in diet, exercise, and weight loss in the world will not obviate the need for medication. So requiring medication should NOT be viewed as a failure! In other words, exercising a great deal and losing a significant amount of weight (even if the weight is kept off) does not remove the need for medication for everyone.
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wow!! so hostile sounding. I am well aware of that!! I was simply sharing my story. I am going to delete. I donāt want to be here.
Iām confused as to why you find my post hostileā¦
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I heard that a million times from others online, and always told myself that if I couldnāt manage with only diet and exercise, that I would ask for insulin. However, I had such a resounding success early on that it was nearly impossible for me to wrap my head around the idea that regardless of how hard I tried, diabetes is often progressive.
As things that used to workā¦ stopped working, I ended up restricting more and trying out a dozen different things. I kept thinking (which was often reinforced by the blogs I read and the forums I frequented at the time), that I just āwasnāt doing it rightā. The few times I asked for help, people would question if I was really eating as low-carb as I said, suggest that I should also be low-protein, throw out fasting as an option, give me more food to eliminate (dairy, gluten, sweeteners), etcā¦
I donāt remember anyone suggesting that maybe I had done enough, and that the next step was insulin. Perhaps someone did and I just didnāt want to hear it. Either way, instead of seeking help I developed an eating disorder.
Very long story short, I was so relieved when I finally got access to insulin! Itās made me much happier, and less stressed, to not have to magically control this disease all by myself.
Just sharing in case anyone else is in the same situation now as I was back then, when what I really needed to hear was that itās okay to say that I have tried enough.
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Thanks so much for sharing your experience!
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My simple way is to cut the sugars and starches, eat everything else. So far (touch wood) I have an A1c of 5.3% and choose to continue with metformin because of the other benefits.
If you are on 20-50g of carbs a day for a month or 2 and still have high BG, I would think itās time for meds. Your bathroom scales are another good guide. being overweight means you still have plenty of insulin.
10% of T2ās are misdiagnosed and are T1ās
Itās not that hard, a simple c-peptide test will tell you what insulin your pancreas is putting out and if you need to move onto more meds.
Soā¦ there can be some complications, although I know Iām not Type 2 so take what Iām about to say with a massive heap of salt. I suppose I was in that 10% (initially diagnosed as T2, re-diagnosed as slow-onset T1).
Iām still not taking insulin. Iām on 2,000 mg of Metformin ER a day, which does wonders for Dawn Phenomenon. Independent of diet, for me itās the difference between fasting BG in the 90-105 range (where I am now) and 110-125 range (what happens when I stop taking Metformin for more than five days consecutively). I eat 50-85g of carbs a day, and 99% of the time eat fewer than 50g net carbs. I exercise frequently (weightlifting 3 times a week, cardio 2-5 days a week, active everyday, mobility/flexibility workouts 7 days a week) and intensely. Those three combined (Metformin, low-carb eating, and exercise) keep me in a very nice BG range (last A1c was 4.8, although my next will be higher).
So, that all sounds great, right? Wellā¦ the drawback is that Iām below 17% bodyfat and canāt stop losing weight. Whatever my endogenous production capacity is, eating low-carb means that my actual insulin production is more or less non-existent (makes sense, I donāt show signs of insulin resistance). Iām currently eating almost 3,000 calories a day, have cut out cardio, and still struggle to maintain weight. And Metformin and high fat diet is wreaking havoc on my GI tract (more or less bowel problems all day). Last week I was in DC for work, managed to keep my BG in line by eating nuts, salads, and meat and veg, and still managed to lose 5 lbs in a single week because I couldnāt manage to eat 3,000 calories a day on the road (without exceeding my carb limits).
So, it leaves me in a weird space: I can (for now) control my BG successfully with low-carb eating, orals, and exercise. However, the cost for that isnāt just the inconvenience of eating low-carb (which, unlike some people, I donāt particularly enjoy). Iām having to spend an inordinate amount of my day planning my calorie intake, calorie expenditure, and exercise type and timing and still canāt successfully manage my weight. Which is pretty ridiculous, considering most people have the opposite problem (do everything right, canāt lose weightā¦ I do everything āright,ā canāt gain weight).
Anyhow, all of that leads me to this point: how long do I keep plugging along with good BG but an unmanageable weight and diet issue before seeking different treatment options? From an enormous amount of reading, I seriously wonder whether I wouldnāt be really well suited on a Metformin, diet, exercise, and Afrezza regimen (so I could eat a moderate amount of carbs, reduce fats in my diet, and hopefully gain some weight without sacrificing my BG). But who on earth uses orals and Afrezza without basal?
In short, my weird little space in the diabetes world is getting a bit cramped and uncomfortable, and Iām not entirely sure what the next steps are. Try other Type 2 meds even though I seem to have hard limits on how much insulin my body can produce? Sacrifice my ānormalā A1c and just eat more carbs but try to keep it under the 6.0 ācap?ā Demand insulin regimen? Struggle on in with a decent BG but horrible GI issues and keep losing weight until I waste away?
Iāve never been able to keep weight on since I got the 'betesā¦ even with insulin therapyā¦ I suspect just not eating the standard American diet amounts of junk carbs causes a significant change in your bodyās desired shape and compositionā¦ thatās why the Atkins diet is so popular tooā¦
The ironic thing is that America is so overweight and unhealthy that when someone loses weight, particularly a man, to a very lean and healthy state they are made to feel self conscious and unhealthy about their weight
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Yeah, I have considered that possibility. Iām wondering what would happen if I was able to eat, say, 150g of carbs per day rather than the 50g net I eat now (and keep my A1c roughly the same). Or, because Iām not producing as much insulin as I used to, am I pretty much doomed to get skinnier and skinnier over time? Itās just very weird to me as a former athlete who has always been large framed and muscular.
Iām unable to put on muscle for the first time in my life (I suppose that might be a joint effect of aging and not having enough insulin), so I canāt even compensate for the unintended fat loss 
Again, talk about first world problemsā¦
You may have explained this in previous posts, but is there a reason youāre not taking insulin? As a T1, I would think it would make your life far simpler, especially if youāre having trouble keeping on weight.
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There are a couple of reasons, although I freely admit none of them are particularly good reasons from a crowd-sourced wisdom and experience sort of perspective In order, they go something like this:
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The GP who diagnosed me as Type 2, and my wife who listened closely to what he said, was afraid of insulin (lows, death, etc.) and thought it completely inappropriate for someone in my situation.
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My current GP and metabolic specialist wonāt prescribe insulin, and the closest endo is about a two hour drive (and my old insurance wouldnāt cover seeing an endo unless I was in DKA or some other nonsense).
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My BG control has been excellent (last A1c was 4.8), and I have just enough endogenous insulin production that I can go low (true low) during and after exercise even without exogenous insulin.
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The costs. Metformin and strips cost me about $50.00 a month after insurance covers their part.
Thatās really about it. Iām not really entirely sure I need insulin, and Iām quite certain I donāt need basal insulin at this point. My body does a perfectly fine job of keeping my BG stable as long as I eat carbs while exercising and donāt eat carbs otherwise. DP is well-controlled with Metformin. Anyways, thatās really it. Iām technically a Type 1 who presents more like a weird Type 2. My A1c at diagnosis was low for a diabetic (7.5%), I got down to 5.8% very quickly, now down below 5.0%. So by external measures, Iām doing fine. Just this weight loss issue and I fear a true very low carb diet isnāt working out for me. Iām also more than a bit worried about DKA, since I apparently donāt have much circulating insulin.
I guess the question is whether or not youāre continuing to accelerate the underlying issues and tax an already weakened system by not supplementing insulin early onā¦ seems to me that most of the forward thinking wisdom is to supplement with insulin as early as possible with type 1ā¦ even if itās ultra tiny doses or just 2 units of basal or whatever, even if you donāt āneed itā yetā¦ it might be worth following up with someone who treats t1 diabetesā¦
I went for a couple years in which I probably could have gotten by without insulin, but my docs wanted me on it and in hindsight Iām glad I was.
I suspect your gp might be willing to prescribe insulin and manage your prescriptions after youāve been evaluated by an endo and theyāre kept in the loop, or might just ask you to see an endo 1x/ year or whateverā¦ there are many t1 diabetics who live in rural areas away from endos and their docs make it work
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I think youāre right. My GP wants me to see an endo, and I think it might just be time to do that. Iām sure I could do a very small amount of basal if I were to increase my carb consumption back to āmoderateā levels. Seems a bit weird to eat more carbs so as not to go low, but it would definitely help with the weight loss issue.
I thought it was something like that. I didnāt need basal for 18 months after diagnosis, but I will say that needing bolus right out of the gate was the best thing that ever happened to me. Itās a huge relief being able to eat what I want, which also means I can still choose to eat lower carb if I feel like it, but I donāt have to be a slave to it.
Iāve now been on basal/bolus for a number of years. I also have huge BG dives from exercising, so I do my cardio immediately upon waking when I have a natural rise in BG anyway or I have to get my BG fairly high before starting.
It seems like youāre keeping your BG levels in control by walking a razor thin line. It would drive me insane, but if it works for you, I wish you all the best!