I have been on oral meds for almost a decade now, but due to severe side effects that they cause I have lowered my doze. The result grrrrr sugars not coming down. My fasting is almost never normal and PP is like just borderline. The doc now recommends I go on insulin, that is scaring the living lights out of me. Can some body please advise, is my fear valid? What am I getting myself into by taking insulin?
Help!!!!
Of course your fear is valid. Your feelings are always valid. And you are not the only one who has been afraid of starting insulin.
But it is also true that we often fear things we do not know. My bet is that in hindsight you will have an entirely different view of insulin injection.
I started more than three years ago. I don't find insulin injection painful. In fact, I find lancing for blood tests more painful. And I've never had a bad reaction to insulin and actually never had a bad hypo that required assistance. When properly used insulin is safe and really pretty easy to use. And I have to tell you after being on all kinds of medications which never tightly controlled my blood sugar, insulin finally allowed me to bring my A1c down into the 5s and I've maintained that level of control since I started.
ps. And don't ever believe that starting insulin is a failure. It is your body that failed, insulin is just another treatment and it is a treatment that really works.
pps. And insulin doesn't have to mean weight gain, I'm still the same weight as when I started.
Thank you Brian, this is the answer that I was looking for. My core aim is control my blood sugar, and meds have NOT been able to do that. If insulin does that, than I don't need anything else. Thank you for response.
LemonJuice, you need not fear insulin.
At all.
I'm T2 for 15 years. I decided to start using insulin last June voluntarily, because I wanted to achieve non-diabetic BG profiles. It's an involved story, but the conclusion was that I was on the Omnipod insulin pump by the end of July, with a Dexcom G4 Continuous Glucose Monitor too.
It has literally changed my life. So much so, I am a rabid advocate of insulin therapy for all T2 diabetics, starting from diagnosis.
You have no idea what you're missing out on. Feeling great, almost all the time. Lots of energy. Clear, sharp thinking. More libido. Much more flexibility in how food fits in with your life. The ability to be much more "normal" in how you carry on your life as a T2.
I know this all sounds paradoxical, because my goodness, how can (for example) having to always carry around an insulin pen, needles, emergency sugar (I used skittles), and then having to does yourself before you eat be liberating?
Simply because it will free you from most of the restrictions that T2 places on you, that remind you in a negative way (usually by denying you participation -- i.e. that once-in-a-great-while cake and ice cream at a birthday party, for example). Or, you're hungry and need to eat (it's been 5 hours since breakfast), but your BG is 150. What to do?
As a T2 without insulin, you have few choices. With a pen of Humalog, you have almost no limitations. Inject the right amount to correct that 150 and cover whatever carbs you plan to eat for lunch, put it away, and go forward with a smile.
Injecting insulin has a social stigma in our culture that one has failed. That they are further enfeebled by now being dependent on insulin.
It's a myth, and an awful one. Nothing could be further from the truth. It is not enfeebling, it's empowering. Massively so. You will find plenty of other T2's like me on this site that are using insulin to help manager their T2, and you'll find that we all wish we had started sooner. Much sooner.
ADVICE: You doctor is probably going to suggest you just start with a long-acting like Lantus or Levimir, 1x a day. This is the standard protocol these days, and it is completely wrong.
Learn about carb counting, I:C ratios, correction factors, insulin stacking first. It's not complicated once you get up to speed. Then, tell your doctor what you want to do is be able to bolus for meal-time carbs, and corrections when your BG is high. For this you need a short-acting analog, like Humalog, Novolog, or Apidra.
Get on that program, and you don't need a long-acting basal. Your existing beta cells in your pancreas will continue to cover that for you. What you need as a T2 is a way to cover food carbs, and get your BG down when it's persistently high.
Ditto on every thing Brian has said. Fear is not irrational because it is an unknown. Once you start and grow accustomed to insulin you will realize that your fears were unnecessary.
Using insulin is safe, there are possible issues such as low blood glucose but those issues are unlikely if you give it the proper attention. Insulin use requires some attention to details and is no cakewalk but it is worth it in my opinion. It is the best tool I have found for controlling my BG.
I also want to repeat another point that Brian has made, insulin is not a failure, you have not lost the battle but rather you will have picked up a new powerful weapon to use in the war against this disease.
LemonJuice, please join this group
http://www.tudiabetes.org/group/insulin_dependent_type2
Gary is one of the admins there
Here's some other good discussions on the subject
https://forum.tudiabetes.org/topics/type-ii-new-to-insulin
https://forum.tudiabetes.org/topics/going-for-insulin
I've met quite a few type2s here on insulin, and not a single one regrets it. most say they wish they'd done it sooner. let us know how everything goes!
Thank you all for the encouragement. I can say I am now not as scared (I'll be lying if I say its completely gone.) Dave, I have printed your email, and will discuss all options with my physician. Since I am in Canada, I am not sure what she is going to prescribe.
Good luck!
Key to getting your health team on-board is doing work up-front to be well-educated, have a plan with goals, and advocate for yourself.
The thing is, the doctors are probably more scared of you taking insulin than you are. They have to deal with the "lowest common denominator", and unfortunately among T2's that basically someone that ignores their condition, doesn't follow treatment advice, and the disease progresses.
That's what doctors are used to with far too many (maybe even a majority) of T2 diabetics.
So, given their bad experience with (dare I use the term) "noncompliant" diabetic patients, they are understandably very reluctant to approve a powerful tool like insulin.
As such, if you clearly have thought this through, researched and learned, already know what and how, are eager and motivated, the doc is much more likely to work with you. "I want insulin because I want to get my BG down" will not be enough.
Do some poking around here for a week or so. Honestly, you can learn pretty much everything you need to on this site. There are pointers to other stuff on the internet throughout these various discussions.
Go for it, you'll never regret it. One more factoid for your discussion with your doc:
"I read about this guy on TuD who has had T2 for 15 years, went wildly out of control for a year+, wound up in the ER with a BG over 500. He decided then and there he was going to do a 180 and control his BG like he wasn't a diabetic. Researched, learned, and then convinced his team to add insulin to his set of tools to control his diabetes.
Today, with insulin and a CGM, he keeps his BG between 80-100 most of the time. Rarely goes over 140 after eating. Any early complications, like foot pain, neuropathy, etc. have completely disappeared. His a1c that fateful day 8 months ago was 11%. Today it's 5.6%
I want to be like that!"
Dave says, "ADVICE: You doctor is probably going to suggest you just start with a long-acting like Lantus or Levimir, 1x a day. This is the standard protocol these days, and it is completely wrong."
Why is this completely wrong? Not that I am questioning your knowledge, just had never heard this or read about it. I would love to know why. Thank you.
Well, "completely wrong" is a bit of hyperbole.
This approach is fine if one is willing to be rather restrictive about diet, eating schedule, and some precautions to ensure no hypoglycemia at night. Pretty much the same issues with treating with oral insulin secretatory agents like glipizide.
A far better approach is to monitor and treat the high BG directly, as well as head carbs off at the pass with bolus insulin before eating. This would mean an entirely different protocol than that with a long-acting like lantus, but will achieve much tighter control, and give the PWD a lot more flexibility to live a normal, enjoyable life.
Being in a situation where you must eat around noon (example), regardless of what you're doing, can really put a crimp in one's activities.
Interesting. When diagnosed I was put on lantus and met. It has been very effective for me; however, to make it work, I eat less than 30 gms of carbs a day. Like you said, I do have to eat sometimes even if not hungry or I go low (<60) and there have been times I woke in the night to lows I had to treat. I think you are right, I would have more freedom with less restrictions if I boloused rather than did the basal. Never really thought of it but I wouldn't have tight or even good control with this method if I didn't eat very restrictively. Thank you for the explanation.
Sounds like standard treatment. it's not right that you can't have a piece on cake on your birthday, when you can if only you be allowed to truly treat your condition closer to "normal" -- when that option exists.
You make a good point.
The bolus/basal combination approach IMHO is the only one that offers the possibility of really tight control along with the flexibility to allow having a life at the same time.
$0.02
Don't be scared of insulin! It'll help you! I'm sure. I mean I'm not a type 2, but I didn't immediately get started on insulin due to some misdiagnosis fun, but when I started it I felt sooo much better and I have pretty much control with it. I"ve heard Type 2's that feel entirely the same way and it really helped a lot of how I felt and made me feel better like immediately. Hopfully they'll start you on both the basal (Lantus or Levemir) and fast acting/meal time/bolus insulin (Novolog, Humalog, or Apidra) because that's really the best approach. I was started on lantus alone at first and it was not enough though it brought my fasting down to normal, I'd climb as the day went on without novolog. Granted I'm not a type 2 so this is a different thing but even then, it was a dramatic difference and made me feel a lot better. I've really had nothing too negative other than some mild easily treated hypoglycemia from using too much at one time, but it is avoidable I just am kind stupid about it lol.
Oh my. Bear with me here.
Insulin is not something to be afraid of. It's magic.
I was on oral meds for longer than you, and it was getting harder and harder to maintain a healthy A1c. So I started reading and studying, rather than just blindly following medical advice by rote. Pretty soon I figured out that insulin was the only thing out there that would give me the ability to achieve real, genuine, lifelong control. So I went in and demanded it.
And it has been truly life-changing. My A1c is the lowest it has ever been, and stable. I could write several paragraphs describing all the other physical improvements I've seen, but this is long enough already.
Most people's fears of insulin are based on one or both of the following:
(1) Most people have either known (or been told about) someone who was put on insulin as a "last resort" and then faded out quickly. So insulin is associated in the popular mind with failure. Those cases are not the insulin's fault; they are the fault of prescribing it when it's too late to do any good. The tragedy is that if it had been prescribed soon enough, the person probably would never have reached that state in the first place.
One of the BIG problems with the medical establishment is that too many doctors consider insulin a "last resort" and won't prescribe it in time to make a difference. I have an enormous problem with that "last resort" mentality. It's insane, IMHO. If you have a problem, you choose the right tool to fix that problem. If you had a broken leg, would you put off having a cast as long as possible? Would you consider it a "last resort"? Of course not! You'd want it and you'd want it RIGHT NOW. It would be the correct answer to the problem.
My last word on this subject: the world famous Joslin Diabetes Clinic now starts many newly diagnosed Type 2s on insulin right away. Perhaps they know something???
(2) Some (many) people are afraid not of insulin itself, but rather of needles. 20 or 30 years ago, that made a lot more sense than it does now. Modern syringes and pens use needles so fine that they're not a whole lot bigger than a human hair. Add to that the fact that insulin is injected into fat -- not muscle like a tetanus shot or something of the kind -- and the result is that there is very little sensation at all. You may find this hard to believe, but a finger stick is considerably more uncomfortable than an insulin injection using current technology.
So . . . bottom line. The key to good control is using the most appropriate tool available. For you, perhaps that's insulin and perhaps it's not. But it most definitely is not something to fear. If it's the right solution, it's a gift. Pure and simple.
Among the flood of diabetes books out there, here are two truly outstanding ones that cover this subject thoroughly and well:
Richard K. Bernstein, Dr. Bernstein's Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)
Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)
Good luck! And please let us know how you're doing. This is a community of people who take care of each other. We really want to know. ☺
- David