How do you know when you need insulin?

I was dx’d with Type 2 in February 2007. I was normal weight and very active and a vegetarian. I went on a LC/HF diet and am now 113 pounds. I currently take 2550 mg of metformin. My meter readings are good, fastings around 100 and after meal around 130 or under. My HbA1 c is much higher thsn my meter average, 6.6. It wouldn’t bother me but this past month Inwas dx’d with Retinopothy and Diabetic macukar Edema and Diabetic Mastopathy. My Endo wants to add Januvia. I am not sure another Type 2 drug is what I need. i can’t figure out what time of day I might be spiking to give me a 6.6. is it time for Insulin?

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Wow, you must be frustrated! You’re doing all the right things, yet complications have emerged. Good thing that you are vigilant and have caught these changes.
I cannot say, obviously, when you need insulin. But you should definitely read up & push your doctor to consider adding it to your regimen. I’m in my 6th month with a once-a-day dose (Levemir) and have been pleased with its effects on lowering my blood sugar. And no negative side effects!

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I’m really pleased to see you here Jeannie. We have known each other a long time and I think you know my story. I know that many of us “celebrate” our diagnosis with our “Diaversary,” but as I look back I realize this month is my “Insulinversary.” It was five years ago this month that I started insulin. It wasn’t my doctor’s decision, it was my decision. And since that time I have dropped my A1c from struggling in the 6s down to consistently in the 5s. Insulin was by far much more effective than any medication.

The plain fact is that you have diabetes complications and your current level of diabetes control was not good enough to reduce/eliminate the risks of these complications. You have every right to demand access to better control. And I believe we should be able to start insulin when it is warranted for our treatment. We should not have to demonstrate failure on all other treatments. Whatever your meter says or your A1c says (and they both may well be off) it should be clear, better control is needed to help you avoid further and worsening complications.

In my case, medications were almost always pretty useless and I had to not only be insistent about insulin I had to force the decision. I hope that is helpful.


Oh my, @Jeannie_Wagner, that’s awful and frustration. I was also active and at a good weight at diagnosis (though I’m definitely a carnivore! :smile: ). Been on insulin since near the beginning because I could not tolerate any of the orals I tried. I have had good control with insulin, though I do have some spikes that worry me – it’s work in progress (like it is for all of us!).

A1c of 6.6 is good by the standards of the medical community, but with your issues, it sounds like you want to improve that. It also sounds like you test frequently, but when do you test after meals? I found that I spiked fairly high around 1 hour after eating, then drop back somewhat by the 2-hour or 3-hour mark – most of the time; however, but meals with more fat in them, I might be normal for the first 2 hours after eating, then have a big spike at the 4-5 hour point. I’ve been fortunate to be able to use a CGM to spot those trends and have been working to fix them. You might want to experiment with testing at several points after eating to try and get the full picture. (If you could manage a 1-week trial of a CGM, the information you get might be golden!)

Just my $0.02 - good luck!

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That is why it is so frustrating. I am doing everything right and they assume you are not. My hisband has had Type 2 for 20 years and takes ACTOS. his HbA1 c is in the 5’s, no complications. He doesn’t count carbs or test his bg at all. i really think there are so many types of diabetes and our Endos are stuck on Type 1 or Type 2.


I have been a member of Tudiabetes for years just not very active. I domthink the folks here a better understanding of LADA then the other forums. I don’t know if I am LADA or not, but I am not a typical Type 2. I am sure there is inflammation going on in my body that might be causing the higher glucation. I think it might be adrenal related, but how do you convince yiur doctor to test?

I am with @Brian_BSC, I think early insulin use can be important for many, and it doesn’t matter what type (1 or 2). I wouldn’t ask for more testing, I would insist on exogenous insulin.

i did email my ENDO on My Chart last night and asked about the additional tests. I will demand the tests if she refuses before I add any medications. I don’t know why doctors are so hesitant tomadd insulin. When I was dx’d I had an HbA1 c of almost 11 and was not put on any meds, just told to exercise more and lose weight. I was 146 pounds at the time, so not fat. I am now 113 pounds and scrawny.

So sorry to hear about your complications.

Sadly in the diabetes realm, I think some people are more prone to some complications in spite of good control. Everything health related is a little more to a lot more difficult because of the diabetes monkey wrench.

I think the latest AACE info recommends insulin earlier for T2Ds, or at least it doesn’t frame it as a “last resort” option.

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I am with Brian on this one. Our cases are quite similar in that we each became dissatisfied with the level of control we could achieve without insulin, and decided for ourselves that it was the right answer. Even the numbers are fairly similar: I was stuck in the sixes for a long time, and when my A1c touched 7, I said to my doctor (in effect), “I want insulin and I want it now.” And like Brian, I’ve been in the fives ever since.

To dust off one of my favorite analogies, if you had a broken leg you would want a cast and you’d want it right now. You wouldn’t take a “wait and see” stance. It’s a question of the right tool for the job. Insulin is the most direct, powerful weapon we have. Why not use it?

[Note: The Joslin Diabetes Center agrees with us on this. Their policy for a few years now has been to start all newly diagnosed PWD on insulin right away–both T1 and T2. Conceivably they know something.]


When I was dx’d almost 9 years ago, I probably wasn’t ready for insulin. Now that I am seeing complications I am. I just hope they don’t try to keep pushing oral drugs on me. I think a small amount of basal may be all I need for awhile, as long as I eat low carb.

I agree with the others that insulin may be right for you, right now. However, before starting I recommend you figure out when the highs are occurring. You might want to start checking you BG around the clock for a few days, maybe 12 times per day, day and night. Maybe your husband could help you with this. Of course, a CGM for a week or so should give you these answers, but if your doctor is not on board, I don’t know how you could get one. Keep at it, though, your health is so precious.

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I think you are right Michelle. I have to figure when the highs are occurring. I still think I must have some underlying inflammation thwt is causing my HbA1 c to be higher. In 2009 I was a very muscular 136 pounds. i played tennis, hiked, bsckpacked and lifted weights. My doctor put me on statins because he said all D’s need to be on them. So I caved and went on prevastatin. Over the next 18 months I developped tons of aches and pains in my muscles. Leg swelling and memory loss. I had to give up all exercise because my muscles were so weak. All my muscles shrivelled and My weight went down to 110. I took myself off statins and most of the symptoms went away but I can’t build any muscle. I have a hard time lifting weights and I coukd only gain a few pounds back. I have been telling different doctors for the past 6 years about my muscle loss and all they say is exercise. I really do think the statins had something to do with this. I think it set me up for an autoimmune reaction in my muscles. I am wondering if thst has something to do withmy high HbA1 c. Often as diabetics we have multiple things going on at the same time. i would like to find the cause fir my spikes not just twke meds to eliminate them.

Or maybe try a couple different meters… It sounds like the one that’s showing fasting levels at 100 and post prandial around 130s might not be giving her particularly good data…


I would say that 6.6 is an average bg of 158–you should test for c-peptide and GAD anti-bodies, and you should go on insulin. statins aren’t effective on women, they do make your muscles weak, and the heart is a muscle. the group of people that are helped by statins are men who have experienced a cardiac event. new supporting research now supports the notion that high bg is a big contributing factor to chd, not cholesterol. there are plenty of studies supporting this on pub-med.

I just bought a new meter and am getting the same results. I checked it at the lab when they drew blood and there was an 8 point difference. My c-peptide is 1.1 and the GAD results were reported normal as <5.

8 points is probably negligible. What was your glucose level when they checked the c-peptide?

It seems that your meter numbers aren’t matching your a1c, but I think that’s far from a perfect science.

I did the lab test at 9:30 in the morning. My meter said 142 and the lab said it was 150. At home I will be 100 when I wake up and up to 140-150 if I don’t eat right away. I did up my carbs the week before the c-peptide so low carb wouldn’t skew the results.

Have you ever considered that your meter(s) may not be accurate. I mean systematically biased. There are a variety of things that can cause interference in glucose meter readings. There are drugs like Tylenol or Vitamin C which can mess with the chemistry of the strips. Also if you suffer from anemia or it’s arch nemesis polycythemia (high hematocrit) that can also mess things up. And there are blood variants which are known to mess with the A1c. Have you ever had a fructosamine test as an alternative measure of blood sugar control?

I have never had the Fructosamine test. My last labs were in October

hemocrit 37.8
RBC 4.34
WBC. 4.69
Platlet. 228
Hemoglobin. 12.4
MCV. 87.9
MCH 28.8
MCHC 32.8
RDW-CV 13.6
Vit B-12 816 High

I am not sure all those tests mean but none were flagged. I usually do not use Tylenol. I had to use it before surgery because they wouldn’t allow Alleve. I take Alleve about once or twice a month.