I’m on Metformin, Invokana and, Januvia. I DO not like the side affects. I’m thinking about talking with my doctor about starting insulin. Does anyone have some advice for me? A long lasting insulin? Testing and shots? Thanks for your thoughts!

I would think BG readings both in terms of fasting as well as 2 and 4 hours after various types of meals would be another good data element to bring to your doctor. Potentially this could assist with your decision making process.

Thanks Tim, I will discuss those numbers with him also.

Never hurts to experiment with a new method. I would be more wary if you live alone or in an isolated environment out in the woods. I would get a land line so you have the option of calling for help (reliably) if needed. You might want to stay with a friend for several weeks when you start (if you live alone). Those are just some safeguards for starting any new med. Consider a Dexcom. Always test before driving.

We have many type2s here on insulin, @Brian_BSC, @Stemwinder_Gary, and @David_dns all say they wished they’d started on it earlier. I have a close family member who saw his a1c rising after 25+ years on metformin, and instead of adding another drug, asked to go on tresiba. a1c dropped from 7.6 to 6.3 in 3 months. and no serious lows. he takes one shot before bedtime.


Tresiba is the best long acting insulin out there IMO, no peak and my BG doesn’t drop suddenly like with Lantus. If you’re going to need a mealtime insulin consider Afrezza inhaled insulin. It’s easy to use and controls BG’s incredibly well without causing severe lows. Its dosage is not like other insulin’s. For instance with Humalog you might only need 1 or 2 units of insulin to cover a meal with Afrezza you’ll need a much higher dose ( they shouldn’t have used units as a measurement because it just seems to confuse people) think of the 4, 8 and 12 unit cartridges as small, medium and large doses instead and you’ll have way more success. Good luck!


Thank you, thank you, MarieB and Firenza your information is most helpful and encouraging!


Victoza, with or without insulin. I was on Victoza for about 6 years prior to a change in diagnosis. If you do try Victoza, I recommend taking extra fiber and cutting food intake from the beginning to avoid or minimize nausea and constipation. Vicotza really slows down the digestive system.

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As I’ve said many times . . . with all the progress made in recent years and the great variety of new meds out there, insulin remains the most powerful weapon in the arsenal, hands down—full stop. Personally I’m not interested in messing around with second best.


I agree with what @David_dns says, Insulin is the most effective medication. Going to insulin is the normal progression when your diabetes has progressed to where orals are no longer doing the job. I believe it should start sooner. I’m not sure I would go back to multiple oral meds even if I could.

My T2 has progressed to the point that I must have both basal and bolus insulin. I like that I can vary my insulin to match my needs instead of hitting it with a blunt object like with oral medications.

If your doctor approves you will most likely be started on basal insulin.

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Many thanks to all! I stopped taking Januvia for one week, my vision seems to be blurry most of the time. By the way I have joint and muscle pain, some times so severe that I am bed ridden for days. My Endo will not listen to me about the side affects of the oral meds. His answer was to put me on Lyrica and Cymbalta to deal with the pain. Which really just masks and fools the brain not to acknowledge the pain receptors.

All that being said, I am so glad I asked you folks for advise. I have an appointment with my regular doctor early February, I will not be seeing my endo doctor anymore,maybe a new one but, not this one. Thanks to everyone’s input. I am grateful!

My BG is fine, A1c 6.1 first of the year. However, I’m really ready to move forward to something that works to treat the real problem (my pancreas)!
Thanks again folks!

Jamey - I had a posting here the other day but it mentioned a monomer human insulin which is inhaled and requires no shots. Some people complained because they felt it was an advertisement for this monomer human insulin so it was removed.

Why someone would not want you to know about it I clearly do not understand. From the AAEC page 8 of the pdf

“Insulin is the most potent antihyperglycemic agent.”

If that’s true why is insulin the last resort? One word “hypoglycemia” but then it goes deeper. If you had an insulin which was shown to work just like a healthy pancreas would hypoglycemia still be an issue? Clearly not, as healthy people don’t get hypos. This human insulin which is not an analog has a minimal chance of causing hypos when not being used in combination with a basal like Lantus or Tresiba.

The bigger issue is if insulin is the best way to control high BG and the AAEC clearly says it is and you have one which has limited hypo risk, why not insulin first? Why do we continue to put people on the metformin and the rest of the T2 meds and then after all beta cell function is lost put them on insulin? Unfortunately diabetes and T2 meds is a huge business.

If you want to stop T2 progression you have to keep near non-diabetic time in range. To do this you need to control the post meal spikes. The only things which will do this is insulin and hands down the best is the human monomer insulin which is inhaled since it mimics healthy pancreatic insulin release.


Alright, thanks George44. I did see your original post, and I did take a look at the while paper. I admit I am still on orals and have a lot to learn before I have a handle on the insulin side of T2 diabetes. I will consider your information George, your post makes a lot of sense to me. I’ll discuss the issue with my doctor. Thank you for your passion on the subject and for caring about others with diabetes!

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After 3+ years on Metformin (& gradually raising numbers), I added a once a day Levemir. It was a surprisingly easy, effective addition to my regimen.

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I have to say, it is inappropriate to suggest that someone with T2 move to using a bolus insulin as a way of initiating insulin treatment. I know of no healthcare professional who would suggest such a move. The consensus from the “AACE” is to move to a basal insulin. Please don’t suggest that someone should move to a bolus insulin as a way of initiating insulin as a way managing their diabetes. I would recommend that you carefully reread the recommendations from the AACE.

ps. I know you have good success with Afrezza, but please carefully read the prescribing information, “Afrezza must be used with a basal insulin.”


I have to say as someone who made my own choice to move to insulin, this is a very brave thing to do. You should feel empowered that this is your choice. I have to relate to you my choice to move to insulin as someone with T2. You can read my story here. I encountered significant “insulin resistance” to my starting insulin. No doctor wanted to “own” the decision to start insulin. In the end, I made my own decision. But I did so carefully and with conservatively. Insulin is powerful. Never underestimate it. It is safest to follow the recommended path, start a basal insulin. A good insulin would be Tresiba which is very long acting and isn’t prone to hypos. You can be very successful with insulin even if your doctor is “insulin resistant”


Not trying to be a PITA but I have read studies that have examined whether Afrezza in combination with oral meds for Type 2 patients results in a lower A1c. To me, that would imply that it is a reasonable question to ask and is a valid area of study?

On the label of Afrezza, I do see that it should be used with basal for Type 1 but I do not see the same wording for Type 2. Certainly a drug can be used off-label if a doctor feels it is proper and there is no FDA restricting specifically to the contrary although it always makes sense to know the label and be fully aware if you are taking something off-label. The wording I saw that sounds to be relevant is:
“In patients with type 1 diabetes, must use with a long-acting insulin.”

Looking further at the Afrezza labeling, I don’t even see where it mentions basal in regards to Type 2. The more detailed information discusses Type 2 patients using Afrezza in conjunction with oral meds. No mention of additional basal insulin at all.

A total of 479 adult patients with type 2 diabetes inadequately controlled on
optimal/maximally tolerated doses of metformin only, or 2 or more oral antidiabetic (OAD)
agents participated in a 24-week, double-blind, placebo-controlled study. Following a 6­
week run-in period, 353 patients were randomized to AFREZZA (n=177) or an inhaled
placebo powder without insulin (n=176). Insulin doses were titrated for the first 12 weeks
and kept stable for the last 12 weeks of the study. OADs doses were kept stable. At Week
24, treatment with AFREZZA plus OADs provided a mean reduction in HbA1c that was
statistically significantly greater compared to the HbA1c reduction observed in the placebo
group (Table 5).

[Note. I just realized this is the slightly older label dated 05/2015 which I was looking at. Apologies if the recent label change is inconsistent with anything I posted.]


Thanks @Tim35 , it is important to note that the prescribing information says that Afrezza isn’t indicated for T2 and even for T1, a basal insulin is a must.

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I plan to act on my the recommendation of my doctor. My motivation for posting a query here, is informational. I have followed posts here and know there is wisdom and as is evidence in this thread, caution.
I was diagnosed in 2014 T2, high blood pressure and, Hashimoto hypo-thyroidism. So 10 oral meds everyday, well it’s a lot. My primary issue Brian, is the joint, muscle pain, and fatigue caused by the diabetes meds.

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Brian - For starters the 175 Study did not use basal. It was the medformin/afrezza study and was for the T2s. You are miss reading the label. Additionally, anyone taking afrezza should discontinue metformin as it affects the liver and you want the natural state between the liver and pancreas with affrezza to prevent any chance of hypo. However the FDA designed the 175 study.

Now the issue T2s have is not during fasting. They lose the robust first phase insulin release. If you treat at meals with afrezza you will blunt the spike and get the PWD back to a non-diabetic TIR. Thats a fact.

Why the AAEC currently recommends basal first is fear of hypos and who wants to take 3 shots a day. The problem is if you want to stop the progression as Ralph DeFronza is showing in his Qatar study is you need to keep TIR.

In the AAEC they lump afrezza in with other insulin categories. Inhaleable insulin should have had its own category. Why? Its not about the insulin. Its about the delivery. Its the fact it gets into your blood immediately. afrezza is not a miracle “drug”. Its human insulin. Thats all it is. At the molecule level it is the exact same insulin the pancreas releases. However, because afrezza gets into the blood immediately it is NOT subq. The body sees it like the pancreas is releasing it.

The AAEC should have two categories now for insulin. Subq and inhaled. They are very different and have very different outcomes. Lumping them together is doing a dis-service to the uninformed.