As some of you know, I am still in the stages of getting to know my new medical provider, so our relationship is not one (yet) where I feel comfortable saying “I want…” But I am wondering about insulin for T2’s…I’ve tried to stay away from it for as long as I can, but I am not getting the results I want from the metformin, amaryl and januvia that I want. I am on 2500 mg of Met; 8 mg Amaryl; and 100 mg of Januvia…of course these are taken at various times during the day. I am counting carbs 45 / meal and 15/snack three meals a day, three snacks a day. I swim for 90 minutes (or am supposed to) I admit, I haven’t been there all month…bad me. And my eating habits have been hit and miss this month…so I am probably not picking the right thing to do right now.
Tell me about T2’s starting insulin, how did it work for you? Is this something that once you start you are on it forever, I worry that I am using up my options before I have to…and later there won’t be anything left to do…
Talk to me please
Maybe before giving up on your current treatment you may consider lowering your carb intake…?
But hey if you are brave enough to do the insulin more power to ya! I have no experience with it but it wouldn’t hurt mentioning it to your Dr. it is YOUR body and your decision. I’ve actually read that early intervention with insulin for type 2 can save your remaining beta cells.
Once you start on insulin as T2 you’re not on it forever, if you choose to go off it. Maybe better to view it as exploring options to have the best success, rather than using up options.
Lowering carbs would be a thing to try. 180 carbs a day is lot. Maybe forgo the three, 15 carb snacks to see if that brings your numbers in range. Never understood the ADA stuff about eating constantly, but then I don’t get their recommendations to begin with.
Wow, such a different view. I guess I just look at things differently. To me, I’ll do what I have to in order to control my blood sugars. In my view, I feel comforted by the knowledge that “I’ll always have insulin.” Insulin is my lifesaver. I am on three medications, just like you. I follow a strict low carb diet, just like Gerri recommends and I exercise. And I can see that the medication is not working. But I don’t see insulin as a failure. My failure is in my body, and it already failed. The only failure I would have is if I made choices to “not” properly control my blood sugar.
There was a video made by discovery health on T2s starting insulin that used members of my local support group that talks about this topic you may find helpful (http://discoveryhealthcme.discovery.com/insulin-truth/insulin-truth…). A lot of people are wrongly convinced that their diabetes is their “fault” and that using insulin is a “failure.” That is just not true.
You need to figure this stuff out yourself. But in my view, insulin is just another treatment option, just like all the meds. Except insulin is very effective and it works. One day in the near future, insulin is going to save my life. I’m not really going to care if I go off insulin. I’m not going to consider taking insulin a failure, instead I am going to be happy that it is there.
Hey Cathy,
From everything I have read on posts and listening to all of Dr B’s web casts the biggest issue for a T-2 and insulin is weight gain. Too many physicians give industrial doses of insulin which results on packing on the weight. The very thing a T-2 does not want.
The less insulin you can use to get your target A1C and fasting numbers the better. This requires a strong willed mindset that one will have to really watch the carbs, eat a low carb diet, and exercise to reduce insulin resistance.
Having said that there are many who have great success too and have obtained the results they want. Some T-2’s are so insulin deficient that they are on pumps and are T-2 insulin dependent. So there is a whole spectrum of use for T-2’s
My Dr has a patient that is a T-2 that takes a very small dose of mealtime insulin for control and she has been for the past 10 years. He is not opposed to it but warns of weight gain and knows it has to be used prudently for a T-2.
I agree with Geri though. Try a month of a very low carb diet and see what happens and what your BG does. If nothing changes then I would explore insulin. And dont blame yourself. T-2 is progressive and many T-2’s (40%) make the transition to insulin after 5 years.
Has your A1C and fasting numbers been creeping up?
The thing is, the way I understand it, is that type 2s, with our insulin resistance, would need a lot of insulin in order to get any into the cells, which would flood the body and thus cause weight gain, just like it did before we were diagnosed as diabetics.
So when we go on insulin, it seems to me we should still be taking metformin or the like to fight the insulin resistance at the same time we take insulin to make up for the fact that our bodies have burned out on making our own.
I expect to take metformin for the rest of my life, even when my pancreas is no longer able to create insulin and I have to take insulin.
Hi Cathy,
I’ve been on Lantus and Byetta for 7 years now and when my Dr said she wanted to put me on insulin I was horrified. I was sure that I had failed miserably and was depressed for several months. But, after a while I came to realize I had better control and I got control of the weight gain and I felt better all around. I have to agree with bsc, I don’t consider being on insulin as a failure, I see it has a valuable tool I can use to deal with my “D”.
Insulin is nothing to be afraid of. Insulin, when used cautiously, is going to be safer for you than all those medications you are on, right now. And while weight gain may happen, you can seriously minimize the amount of insulin you need by cutting back on the carbs you eat. I see insulin as a way to be safe, and continue having good control, not as a failure. EVERYONE is supposed to make insulin… So why not take some in, when our bodies quit making it, well?
I honestly don’t know why more Diabetic patients are not simply told to cut back on the carbs… Many, many women with PCOS (which is pretty much Diabetes) get told this every day, without doubt or the bat of an eye, by their healthcare professionals… So why is it so hard to tell a Diabetic “Hey, those carbohydrates are NOT good to have in big amounts…” ? I just don’t get it… And THIS is the kind of grief that an ADA diet leads to: poor, degrading control, and second doubting yourself all the time that you’re a failure when things go bad, and when you need insulin. It’s not fair. 
What do you consider a very low carb intake? My 3 -45’s and 3 - 15’s are the top of the chart, not the ideal. If I make that, it’s a very different day. Normally, I will have a carb intake in the 30’s per meal and maybe single digits for a snack. Fortunately, I knew a lot about proper nutrition before switching over to carb counting which made the whole thing much easier. I have lost 50+ lbs and intend to lose at least another 50. I am not afraid of insulin, sorry if I gave that impression, but I also don’t want to go there is there are other things that I can be doing. I figure that going to insulin is going to be a help, but let’s not use the help if there are tweaks I can do before going that route.
So what do you consider a very lo carb intake?
I eat 30-35 carbs daily & am T1. I’ve been following Dr. Bernstein’s recommendations for over 2 years & never felt better.
Agree that if you can try a different route with success, why use insulin.
Congrats on the weight loss!
If you have not dialed down your carb intake, then perhaps you have not explored all the options. Also, some people believe that the sulfonylurea drugs like Amaryl may not be the best long-term option and that there are other more effective regimes. DeFronzo recommends a regime with Metformin, Actos and a GLP (Byetta or Victoza). You could talk to a dr about a new regime and see if that helps. That combined with tightening up your diet may actually help a lot.
But you need to also realize, you have lost 50 lbs, a real achievement.
Do you get the metallic taste in your mouth from the low carb dieting? I am just starting to experience it and is is driving me NUTS!
You are probably burning ketones from fat loss and experiencing that wonderful Atkins Breath. I get it all the time.
ugh my mouth tastes horrible!! lol I even made a dentist appt bc I was thinking one of my fillings were leaking haha thanks! does it go away?? I’m already eating 80 carbs day…but I have read that anything under 100 you are still in ketosis.
The best thing to do is buy some ketone sticks at the drug store. They are around 10 bucks. You can then see the range of Ketones you are burning. Good to have around anyways when you get sick too. The more I burn the worse it tastes.
Every person’s carb intake is going to vary tremendously, depending on how their glucose meter is responding. Right now, I respond well to about 14 grams at breakfast (when I am most insulin resistant) at the most if it’s Rye Wasa Crackers, usually 10 grams or less then… 30-40 or less, usually 25 or so, for lunch, about the same for dinner. For snacks, I try to stick to 10 or less, and usually all fiber. Give or take, I’d say I have about 60-80 grams of carbs in a day, total. If this were not working for me, I’d probably go lower… Even if I had to hit Bernstein levels.
I’ve never had this happen. I drink a lot of water, so maybe that helps.
Thanks! I actually have some and have tested but it only shows trace ketones…but I’ve read that exercise can use up the ketones so I’m guessing thats why mine aren;t high…lol diabetes is such a guessing game! Thanks for the advice 
Nope, never had that happen…maybe it’s a reaction of meds you are taking.
No to the Actos, I gained 29 lbs on that in three months, and won’t go back to it for the world. I think I am safe in saying that we all react differently to different meds and regimes. So far this has been working, and is still working, but I am impatient and a perfectionist. I want it all right now, and done correctly.
As I said, 30- 45 each meal is a high…along with the 15 for snacks,(3)…and I hit much lower normally.
Sorry to say, I will be the last person to be supporting Bernstein’s books or ideas because frankly they haven’t proven to work for me. Since the Doc is new to me, and I to her, we will be having many such conversations about changes, but not when things are working in the way we want them to