Insulin?

1

(For the record, I didn't realize how long this post would be. I apologize in advance.)

I hate asking this. I truly do. I've been torturing myself with this question for about two years, and I figure that if I can bring this up anywhere, it'll be here.

Am I better off just going on insulin and getting it over with?

I NEVER talk to people about this, but while on the phone with a friend tonight I admitted that I don't care if I'm put on insulin, because it truly doesn't scare me and anything is better than what I've been experiencing lately.

I know I just upped my dose of Met, but honestly I don't expect that to do much. The Met worked "well" originally, or maybe I was so happy with the way I was feeling that I didn't mind the actual numbers. Then it wasn't working so well, and I wasn't feeling so great anymore. So my endo told me to up the dose.

I don't like this runaround. My BG control has been getting progressively worse over the last three or so years, but this past year has been the worst.

I don't want to change things again and again and know I'll probably have to change them again. I don't think this is going to be a matter of changing the meds until we get it "right"--because, honestly, that hasn't been my experience. Januvia worked fine for the month and a half I was taking it, and then everything went to hell once I stopped. (And knowing what I know now about Januvia, I wouldn't go on it again.) I was on Met 500mg for less than three months before things got worse again (not that they were all that great to begin with). Why should I expect anything different from Met 1000mg? Or any other drug?

I understand that if I do have MODY (which, given my research, actually seems likely), then I'm just not on the right kind of medication. But I'll always be waiting for the day when my BG rises again, and I'll constantly be on edge because, based on how things work out for me in general, it seems like that's the only way this will end. Also, I don't like the look of the side effects of the sulfonylureas (specifically weight gain and constant hunger--I can deal with the hypos).

I know that, technically, my BG on Met isn't "that high", but I'm still at my wit's end. And, as I've said before, if it weren't for that darned c-peptide, I'd have been begging for insulin in October. I was ready to beg for insulin, actually, before I heard how high my c-peptide was.

I'm also frustrated with the fact that I don't have much control over the foods I eat and when. Today was the kind of day where I had a protein bar for lunch on the train. Sometimes I'll run in to Target for a yogurt. Sometimes it's tuna and crackers, and sometimes it's pizza. (For the record, tuna and crackers, about half the carbs of pizza, with like 10 times more protein, annoys my BG more than pizza does. That tells me that pizza is the better option?) I feel like insulin might give me a little more freedom (and maybe a little less guilt) on days where the choice is between a yogurt (and then being hungry all day) and a grilled chicken sandwich (where at least I stand a chance but will ordinarily wreak havoc on my BG).

Has anyone else felt like this, long before they maxed out the doses on all (or most) of the available options for oral meds? Is it "weird" that I feel like this?

2

I was on several different oral meds and they just stopped working (or my pancreas did) and I couldn't control on the pills. I told the doctor I wanted insulin and that did the trick.

I feel soooo much better on insulin. You do have to watch out for going too low. That was the problem in the beginning for me.

But yest, I personally feel you should discuss/tell your doctor you want to try insulin.

3

You need to see your doctor to start insulin anyway, so it makes sense to me that when you see your doctor you should first find out what type of diabetes you have (mody is rare and you don't have a family history of it so it is very unlikely you have it but who knows, you might).

You're young and if you have recent-onset T2, and not LADA-T1 or MODY, then in my humble opinion you are lucky. With recent-onset T2, decreasing your insulin resistance may be all you need to get your BG back to normal (for at least some significant amount of time). So GO FOR IT. Increasing exercise and losing weight sounds a lot better to me than starting on insulin forever.

I say this as someone who has been injecting insulin every day for the past 38 years and it is a constant balancing act. It is manageable, of course, but it isn't something I would choose if I had another option.

Now if you're already past that point, and you have T2 that doesn't respond to exercise and weight loss, or you have LADA-T1 or MODY, then by all means get your diabetes diagnosed and start on insulin.

4

My father was diagnosed with reactive hypoglycemia about ten years ago. It took longer for him than for me, but he has also progressed to highs rather than lows. He has a normal BMI, too. I took the same route, but much younger and much faster. No one else in my family has diabetes, but I also have a very small family--both of my father's parents had no siblings, and my father has one sibling himself. I have one sibling, who doesn't show any symptoms, but she's younger than I am, so who knows?

I don't see an impact on my BG with exercise, even this past summer when I walked five miles every morning. I used to, before March of last year. About 90% of my lows (several per week) were from walking home from school. Despite maintaining the same amount of exercise (and even when I added more), I've seen one low in the last six months, and that wasn't even caused by exercise. The only thing exercise does now is minimize my breakfast spike.

For some reason, my body is seemingly incapable of losing weight, but when I finally lost the weight I gained last summer (for no good reason that I can think of), my BG went up, not down. I'm not blaming the weight loss, I'm just pointing out the disconnect in my body between weight and BG.

5

To help me form an intelligent answer to your question, bear with me to answer this hypothetical scenario. Say you want to a birthday party and ate multiple slices of pizza, a big glass of regular soda, and then cake and ice cream. How high do you think your bg would get 2 hours later? How high do you think it would be the next morning? I’m just curious…

6

On the Metformin or off?

On Metformin, I'd say I'd be over 200, maybe 300. Heck, for all I know, maybe 400, since I can't even begin to contemplate how many carbs that is. And I'd be high for hours and hours later. The next day? Who knows? I've never had a high last for more than four hours (maybe four and a half).

Off Metformin I can guarantee over 300, but most likely over 400. I've never been over 210, but with that number of carbs? Ouch doesn't even begin to cover it. And I'd probably be high the next morning, considering how "well" my body reacts to carbs without the Met, though I couldn't guess how high. (In the month before starting the Met, there were a few times when I "cheated" and ate maybe 30g of carbs. I was between 160 and 180 for hours. If I exercised, I'd drop to about 120, and then I'd come back up within 20 minutes and remain there for hours. I stayed there for hours without exercise, too, and the exercise had zero impact on the duration of the high.)

Just to be clear, these answers are the veriest tips of guesses here, since I've never been in that kind of situation and can't imagine myself stupid or burnt-out enough to do so.

7

I take it back. On Metformin I'd definitely be over 300. Last week I was 193 at two hours because of a SANDWICH. (Okay, it wasn't on sliced bread, it was on a whole wheat baguette thing and that's usually more carbs than I ever eat in one sitting, but it still couldn't have been more than about 50g for the whole thing...like I said, more than I ever eat in a sitting, and sometimes in a day.)

As I said before, total guesses.

8

I have always been an advocate for aggressive blood sugar goals and treatment. I personally forced the issue so that I had access to insulin early (at least earlier than my doctors would have granted). But insulin is not a panacea. A basal insulin can bring down a constantly elevated fasting blood sugar and a meal time insulin can help offset a meal time rise. But it isn't a magic bullet. All of us on insulin still have highs and lows. As a T2 on insulin, I have eaten a single whole wheat wrap sandwich that I thought I had properly bolused for and I was till 230 mg/dl at 2 hours. That should have been about 25-30 g of carbs. Who knows, if I did exactly the same thing again, perhaps I would have a hypo at 2 hours. In the end, insulin can help, but you need to be very clear about what you expect it to do (lower fasting or help with meals) and it won't be a silver bullet.

9

And I have spiked to 140 from a Greek Yogurt that has 19g of carbs in it. I'm looking for help with meals; my current fastings are fine (75-96). I understand that insulin isn't perfect, but neither are the pills. Given the option of switching from pill to pill and still being unable to eat more than 20g of carbs in a sitting or going on insulin and potentially getting it right 90% of the time and being able to eat, I'd choose the insulin.

The other thing is, different foods affect me VERY differently. There's one place I like to eat that never makes me high, unless it's french fries. There's another place where it seems like I can't eat anything. And in general, cookies, cake, and chocolate don't have much of an affect on me, but the same (or less) carbs when eaten in cracker form, even with protein and fat, still bring me high. I wonder how this would translate if I were to start insulin?

10

Personally, I would go with your gut which seems to be saying your body could benefit from insulin. I was misdiagnosed type 2 and the meds worked for 15 months, then, no matter how they changed them they didn't work and I knew I needed insulin I just didn't know why. (Till I found out I was actually Type 1/LADA).

The circumstances and causes might be different but the feeling might be the same. I KNEW I needed insulin. What have you got to lose? You can always change your mind. The only caution I get is not to expect it to solve all your problems...I laughed when I read that "potentially getting it right 90% of the time". Few of us get that. But more often than not is reasonable.

11

Your situation sounds a lot like mine but I may be a little further along in the progress than you.

I started out with morning fastings about 80 - 100 (3 years ago) and now in the range of 110 - 130. I cant have the amount of carbs you have in one go. 10g of carbs will take me over 140. I'm currently on Met (500g x 2) but honestly don't think it does anything at all.

I am waiting to see a specialist (here in Ontario) but have already been waiting a month with no call for an appointment and not holding my breath (could take up to 4 months).

Right now I want to go on insulin but I'm not sure any Doc here will prescribe me with an a1c of 6.3. I haven't had a sandwich, pizza, bagel etc etc in over 2 years and know my a1c would probably be 7 or higher if I wasn't on such a low carb diet and exercising 3-5 times a week...

Insulin isn't available without a prescription here so there's not much I can do...

If I were you I would definitely talk to a doctor about insulin but I would also think about some of the food choices you are having and come to grips that your numbers (on insulin or not) will be better without them...

Paul

12

I really feel for Paul. This is the type of stuff I had to go through. I think we do need to advocate for ourselves. An A1c of 6.3 is not normal. And if you follow a very low carb diet and take medication and all you got is an A1c of 6.3%, then following ADA/CDA guidance would give you an a1c of 7% or even higher. And you should not really expect that just using insulin is going to make you carb tolerant. We do need to fight against the doctors who only want to give insulin to diagnosed T2s when they are clearly out of control. So we need to be our own champions for our care. I just think you need to have reasonable expectations. You can start insulin (as Paul can as well), but it won't suddenly mean that you can just bolus and eat a half a pizza and not have consequences.

13

By "right", I meant something reasonable, not between 80 and 120 all the time.

14

Well said Brian... My first step in self advocacy is getting that appointment but my GP said to expect a wait time of 4-6 months... While Ontario may have OHIP if you want to see a specialist of any kind there are lengthy wait times and some Canadians have gone south to seek alternative treatments...

Keep up the great work you do on here Brian!

Paul

15

Personally I'm an advocate of insulin for Type 2's. I realize that you are not yet diagnosed with T2 but since you are on Met it seems they are treating you that way.

To me insulin is the most natural approach to controlling out of control BG. It is not the easiest to use and requires a lot of effort to do safely and successfully but the rewards in my opinion are worth it. Insulin requires a level of self discipline that is not necessary with oral meds. For me as a T2 discipline is something I need.

16

i'm a type 1 but isn't 500 met simply a 'starting dose', not even a therapeutic dose? IDK, if I had a choice I'd up my met to see if it worked, low carb, exercise and not be eating pizza, etc...

17

Hey, I feel your frstration! I am a thin type 2 on amaryl and am maxed out on it, I am on the highest dose of it and also take onglyza, blood glucose is worsening and dont know when they are going to finally give in and start insulin. I am in no hurry for it but am tired of always popping pills and eating so little. Hope you can get some better meds :)

18

Have you had antibody testing, momto3 to see if you are, in fact, a Type 1?

19

I'm now on Met 1,000, and even though it's been only a few days, I'm seeing the same pattern I did when I started the 500. It worked beautifully for the first two to three days, and now I'm still high but I don't feel it as much. I know it takes a few weeks to kick in, but seeing exactly what I saw before isn't inducing any hope for the higher dose.

Exercise is a given, since I walk at least two miles a day for school alone, plus the rest of getting around. (I walk a lot.)

As for low carb, I eat about 90g a day, less if I'm home (I have school 4 days a week). Pizza is a last resort--I think I've had 5 slices since I went off the crazy no carb diet--two and a half months or so. And it annoys me that some foods with MUCH less carbs make me higher than pizza.

20

yeah i did and they came back negative,so i'm being treated as a type 2. It's frusterating explaining to people that i'm type 2, because I dont meet any of the criteria. Who knows :)