I’m 73, T2 for 10 yrs., AM fasting BG 105 +/-, seldom see BG’s above 150 2 hrs post meal, currently on Glipizide x2. I’m slightly overweight, exercise on treadmill 1,2x per week. My A1C is 5.9, it had inched up to 6.3 early in the year, but my GP increased my glipizide to second dose in pm and the A1C dropped back to 5.9 My concern is foot neuropathy. Neurologist tested feet for circulation issues OK, diagnosed condition as due to diabetes. I sleep with warm socks on, feet tingle, never really warm up. My basic questions:
* I’m surprised at my neuropathy issues, I thought they were typical of much higher A1C’s?
* Does my early onset of neuropathy indicate I’m sliding to T1
* I’m following the several discussions about insulin therapy for T2 (thank you david_dns). Do I need to start the LADA testing to evaluate where I am on the T2-T! continuum?
* Is it time to leave my GP and get to an Endo?
Love the TU site!!
Yes on the endo, just on basic principles. Every diabetic should have an endo managing their diabetes.
Your numbers look very good. Unfortunately, because of this, you’re unlikely to get relief from neuropathy by improving BG control.
Frustratingly, neuropathy is one of those things that just seems to happen to diabetics sometimes no matter how good they’ve been managing and controlling their BG. It goes with the territory. This may be your situation.
Still, you should follow up with an endo. They may be able to help. Also, neuropathy isn’t a diabetes-only issue – seems to me your GP was just using your diabetes as a convenient excuse not to do the harder work to get to the bottom of it. Yet, with control like you have, diabetes should NOT be the first suspect.
It is not uncommon to start having complications of diabetes when you have had elevated blood sugars for many years. Some people believe that all diabetes complications are simply due to high blood sugars, but some complications such as retinopathy and CVD have been found to occur even in patients who have had A1cs in the 5s.
You can have the tests to see if you are T1, but the really important question is what is the most appropriate treatment. Glipizide has been found to not be very durable, namely that it doesn’t work over time. Other treatments may be more effective and insulin will “absolutely” reduce your blood sugars. But as long as your blood sugars are well controlled in the 5s as you have indicated there is no reason to think that any treatment will reduce your rate of complications by much.
And as to whether you should see an endo. My opinion is that everyone deserves the best health care they can obtain. If you can afford and see an endo then go for it.
we recently had a live event on this very subject
glad you’re enjoying the community!
And just to be clear, I refused to allow my healthcare team to keep my blood sugars elevated for years in order to justify my need for insulin. I started insulin more than six years ago and my blood sugars went from borderline uncontrolled to very well controlled. My endo considers me a model patient. Sometimes our diabetes fails us and we just need insulin. It isn’t a failure to start insulin, rather it is a decision to take control into your own hands. One should celebrated the decision and celebrate finally being able to do something about high blood sugars.
Brian- I agree completely that someone with type 2 should never, ever feel like they have failed because they have to take insulin. Taking insulin is just how the disease progresses with some people. And the people I’ve meet who did finally start taking insulin, felt so much better once they started using it. That shame and blame makes it so hard for people to get the treatment they deserve.
There is a school of thought, controversial in some quarters but held by some highly credentialed people, that drugs such as glipizide, which function by stimulating the beta cells extra hard to produce additional insulin, eventually result in the beta cells failing progressively over time, in effect “burning out”. Whether that is the reason or not, it’s an empirical fact that they do lose their effectiveness over time for the great majority of patients.
Like Brian, I elected not to let that process continue. My control was slipping steadily despite doing all the right things. I decided that if insulin was the most powerful weapon in the armory (which it is), then I wanted it. I’ve been in the 5s ever since and I wish I had demanded it a decade earlier.
The idea that insulin is somehow an indication of “failure” is ridiculous. You use the right tool for the job. If that happens to be insulin, then that’s what you use. Too many people have suffered or even died because their doctors waited to prescribe insulin until it was too late to do much good.
I think what I’m reading here on this thread is that while my A1C @ 5.9 is technically “under control” and my goal “to keep it under 6.0” is common, the new thinking is to be more proactive and shoot for A1C’s in the low 5’s. And that my GP may not be the Dr. to get me there. He certainly didn’t advise me about the loss of effectiveness issue of glipizide when I rose to 6.3. He just increased my dosage. This kind of information is what I like most about TU
To be fair, diabetes management with insulin is a complex task that must be specifically tailored to each individual to achieve best results, and a GP—who must be reasonably knowlegeable about an enormous number of areas—has neither the detailed training, experience, nor, usually, time to do that job properly. That’s why endos who specialize in diabetes exist, and why a vast number of insulin users seek out or are referred to them.
BUT: it’s also why it’s imperative that we become our own individual “experts”. No one knows your body like you do, and no one else is there 24x7 to do the job.
And BTW, a 5.9 A1c is quite good, regardless of how achieved.
First of all, a T2 doesn’t slide to T1 (unless they were mis-Dx’d with T2 - the person just “slides” into being a T2 using insulin in their tool kit). I think the suggestion that you have the antibody/GAD tests to confirm T2 or LADA is a great idea. How long ago were you Dx’d with T2?
The people I know with T2 who were proactive and started on insulin are very glad they did. They have better control and are feeling much better. It takes some training and learning, and working with an Endo/CDE. Check out “Think Like a Pancreas” by Gary Scheiner and “Using Insulin” by John Walsh - both CDE’s extraordinaire.
The comment about not beating yourself up, seeing you has having failed because you are using insulin is great advice. T2 is progressive, and most people would benefit from insulin eventually, being proactive can mean avoiding a lot of the complications.
Get yourself to an Endo and be sure to ask if they have a patient base that is mostly dealing with diabetes and try to get a feel for how much they respect their patients. That is very important if you want to be in the driver’s seat in your diabetes life-mobile.
Edited to add: further down in the list of topics is an announcement about a Master Chat about T2 starting insulinb. May be a great place to check out.
here’s a link to that video
oops sorry I posted this without seeing I’d already done it
COFFEE NEEDED URGENTLY