I don’t know if it’s a good thing to overthink some situations or not, as I’ve only had Diabetes ‘officially’ for about 4 months now. (Unofficially, I think I’ve had this for at least a year.) Everywhere you read, you read how Diabetes is a degenerative disease, and how eventually, it’s no longer enough to keep control with diet and exercise. I’ve done wonderfully, so far, lowering an A1C from 10.5% to around 5.3% (and I get my official lab test today.) I eat reasonably low carb, though nowhere near what Dr. Bernstein recommends, and I don’t take any medications or insulin. I don’t have any complications, at this time, either.
Now, my question is... if I do get to the point diet and exercise are not enough (even if I go even lower carb)... I wonder if I can skip the pills, and ask immediately for insulin? I *don't* trust medications. I have GI issues, from my Hypothyroidism, etc, and I just... don't want to deal with things like metmorfin, or the potential for liver damage. (My diagnostic lab work had also shown some higher liver enzymes going on.) I low carb, as it is, so I wouldn't be using a lot of insulin anyway... But I'm not sure if that would be possible? To skip the pills? I mean, insulin is a natural thing the body uses, and a lot healthier than some pill. Maybe I will never need to... but somehow, I just want to have these decisions made before I get to that intersection, you know? Any thoughts? Advice?
I don’t have any expertise in the area, but I don’t see why you couldn’t. I was on insulin for my pregnancy and I found that it worked great (especially with tightly controlled carb intake). A downside to consider is that you’ll probably experience more low blood sugar events.
think you can go right to insulin but my endo advicsed when/if I graduate to insulin i’d be testing more (and i test a lot already) think chances of lows are worse w/ insulin but i’m just assuming here
Yeah, I think I’d rather test a little more, and deal with low prevention… or treatment… than have liver and kidney damage, or higher cholesterol… or extreme diarrhea and nausea…
You could ask, it does not hurt to ask. I told my doc that when metformin stops working I would rather go to insulin so I dont deal with stomach issues from other meds.
Yeah… I don’t think it’s without downsides, I just sort of want to weigh out which one has the less evil side effects… Because the damage meds cause to organs and lipid profiles just scare me to death… so I dunno.
I think that when used in very small doses to cover meals or for your fastings its fine.
You have a great A1C Lizmari. Wow congratulations.
My new Doctor said he is willing to give it to me but warns of weight gain and then progressing to mega doses of industrial strength insulin. I am sure you have seen those posts. On the other hand he recognizes post meal spikes and wants my BG under 100 after two hours.
He has one woman, who is very small, use it for meals and has for the past 15 years. She is very respectful of what she is doing with insulin and her diet. I do agree though, these pills after while are not the greatest and cause numerous side effects. I had issues with my thyroid hurting for awhile along with stomach upset with Metformin.
I think talk to your doctor and see if he/she will do it for a month and see how it goes since you have alot of reactions to pills. May I ask what is your goal A1C and what are your goal spikes after meals?
Well, I am not having any problems right now, in controlling my numbers. I just thought I would ask people what they thought, because well… Meds seem to me like a detour that goes into Complication Land, and arrives at Insulin Ville. So… I thought to myself… why even bother wasting some years on meds that might hurt my liver or my kidneys, or even my thyroid…? And go straight to insulin, when the time comes?
I really do not need it right now. My goal for my A1C was to be below 6%, and today, my labs confirmed my A1C to be at 5.5%. (A little higher than it was a month ago, but mostly because I was trying to figure out why my morning sugars were above 100 mg/dL all of a sudden, and now that I’ve fixed that, it should go right back down to 5.3% or less.) My goal is to always be below 100 mg/dL in the mornings, preferably in the 80s, and to be below 100 fasting before meals… Post meals, I shoot for less than 140 after 1 hour, and less than 120 after 2 hours… In reality, I usually do not exceed 120 after the 1 hour mark. Usually slightly under 100 at 2 hours. I’m doing ok. My lipid profile came perfect, and nothing was out of order… Except getting my good cholesterol a little higher, and that might be hard to do, because of my Polycystic Ovarian Syndrome – the progesteron/estrogen imbalance makes it hard to raise the good cholesterol, or so said the Doc. I consume a TON of Omega 3’s… but… I guess that’s not enough. lol
I think you are on he right track. don’t be afraid of metformin it is effective in lowering bs and a terrific stool sofener. the down side for me is about twice a week it gave me “dry heaves” doc then had to prescribe omiprazol (spelling) to control the nausea. now, the down side t o metformin is it is hard on the kidneys so kidney function needs to be watched closely and I found out last summer metformin will react with the iodine dye they use in MRI’s to immediately kill kidney function. Invest in a medical alert braclet with metformin etched on it so if you are every unable to talk you have a better chnce of avoiding harm.
now, whenmy diabetes progressed my doc tried adding glipizide to my meds. I found out if you glipizide is an herbicide. it is a terrific weed killer…seriously. mix it with a little water and pour it on some weeds see what happens yourself. it made my pancreas pump out insulin, but I had to conform to that pill. late for a meal or not eat enough and I would be in the 50’s to quick. I think it further damaged my pancreas, because at the end of two weeks I stopped taking it and my BS stayed high even after fasting all night. my morning BS was 200ish. andother side effect is it makes you more sensitive to sunlight. I am fair skined and was still working as a carpenter. the last thing i needed was a bad sunburn. so, i complained to doc and she put me on insulin. at first just NPH then regular was added. let me tell you right now that has proven the best choice for me. I modify my doses according to my activities and carb intake. I’ve only had two occasions where It made me go low and both times were my fault. the first time i mixed up the bottles the second time I went through a phase and tried to convince myself I wasn’t diabetic…I ate pizza and drank a coke. I spent two days chasing highs and lows. normally, by adjusting (within limits) my insulin to food has given me terrific control and no side effects other than. the only trick to using insulin (especially for a t2) is to use the smallest dose that works. you will know if you are taking too much because it will make youFAT no matter how little you eat. try a starting dose of 7 units nph twice a day for a week. keep vigil on bs and weight. after a week adjust as necessary. when you start gaining weight back off a notch or two. the metformin will allow for small doses. Last month my doc told me my pancreas is on its way to toatl failure, so I will be watching bs closely. I think that is what put me in my recent depression. but I;m over it now. anyway, watch out for the blues. cry on a few sholders here. your welcome to cry on mine any time.
Hi Lizmari,
Sure you may have had D unofficially for a year or so…
Question is how long was it ‘out of control’ where it may have done some damage?
Insulin resistance (leading to T2D) is usually there for about 7-12 years before ‘full blown’ T2D actually occurs.
Typically, any ‘serious’ previous damage which is done before diagnosis occurrs when sugars are high (HbA1c >7). This probably occurred for a couple of years, as the insulin release from the pancreas was seriously impacted.
Insulin therapy.
Some radical thinkers believe insulin therapy should be started straight away.
Main issue of course is with dosing levels (and risk of hypogylycaemia).
My mother (T2) has been on insulin 15 years, and never has had a serious hypo (she makes sure she always has some food; and adjusts her activities /exercise/workload, knowing that this may add to a hypo situation).
The ‘natural’ argument for insulin doesn’t really hold for me (as a BIG argument to start it straight away), as you are introducing it externally or unnaturally. What can be said is that there may be fewer side effects or unknown/unexpected adverse effects than oral meds (as it is a naturally ocurring hormone in the body).
It is probably not a bad thing to go straight to insulin (and you may even get better HbA1c management than with oral meds).
It is the hypos and the titration of dose that is the issue.
These guys cover alot of this sort of discussion on their podacsts http://diabetespowershow.com/
I’ve been on metformin for 3 years and have not side effects except great bgs numbers and some weight loss which I like. Actually they are finding metformin may prevent some cancers, now. Your numbers seem great I don’t forsee you will have to use insulin. I want to stay with pills as long as possible because of the cost of insulin. The new insulin and those pens and very expensive. You do have to test a lot more, too which means more of those pricey test strips. On metformin I don’t have to worry about highs or lows. On insulin you do.
Yes, you can go to injections. Talk with your doctor and see what he/she says. Pills did not work for me. It was much easier for me to regulate my glucose levels once I started injections. Check with your insurance company and see if they will cover a pump for you. You do not have to be a type one to be on a pump.
I wish I was still able to control with pills. I take both now. I was able to control with pills for years…I was a distance runner (at least 36 miles a week) and suffered an injury that forced me to stop running. Eventually, this reduction in exercise made it necessary for me to start using insulin.
When I started using insulin, I gained 30 pounds. Not to mention that if you have bad insurance or no insurance, some insulins are very expensive. And once you start using it, I don’t think you can ever go back to just pills.
Ummm… Lots of people have been able to go back to pills, or even no pills and no insulin, with an adequate diet. But it depends a lot on how well our bodies are still working. I know insulin isn’t without some things to keep in mind: like the slight weight gain (depends a lot on how many carbs consumed and how much insulin required) and the potential for lows… but I’d much rather have those things to consider, than a damaged liver, potential heart problems, and struggling kidneys… and then end up needing cholesterol meds, too… It just seems to me like an unnecessary detour to something more inevitable, that only leads to more damage… But that’s just my opinion, right now.
Very interesting perspective, Varena, and thanks for sharing… I don’t think I have heard of anyone being hungrier while they were on insulin… Do you think it might have to do with the menopause, instead? – It slows down metabolism a lot, from what I’ve heard, making it even harder to stay trim…
My lipid profile came perfect, and nothing was out of order… Except getting my good cholesterol a little higher, and that might be hard to do, because of my Polycystic Ovarian Syndrome – the progesteron/estrogen imbalance makes it hard to raise the good cholesterol, or so said the Doc. I consume a TON of Omega 3’s… but… I guess that’s not enough. lol