JI just finished an interesting discussion about Dr Bernstien
Now I would like to talk about managing t2
I was dx with an a1c of 12. I had a great doctor who admitted all she could do was to give me pills, not a great option in 2009
But she gave me a great prescription for an education course at Suburban Hospital in Bethesda, a course that is no longer offered
I really learned to count carbs, exercise, etc.
so now 7 years later A1c of 5.6 no meds.
I have many ask for recommendations about getting off of meds.
My answer it is not a goal but a journey to understand how you can work with the body and what you have to work with.
For me I make insulin, plus my liver seems t work well, but if I over carb it just all falls apart. Insulin resistance?
So for me carb control is paramount.
When people ask, my only recommended goal is to have an A1c less than 6.
Your thoughts?
At what levels of carb intake do you see it starting to fall apart? At those levels do you see a gradual worsening relationship between carb intake and blood sugar control? Or do you see more of a tipping point?
I boil things down to their essence…Minimize carbs however you can As diabetics, we are just plain carb-intolerant…
At some point, if you sincerely want to “live long and prosper”, you need to deal with your carb intake. Period…
If you are insulin-dependent, your adjustments will be profoundly different than if you are not insulin dependent…
Figuring out what works for your very individual metabolism is a life and death matter of self education and self management and lots of testing of your blood sugar in relation to Everything that goes in your mouth—Everything—and then also relating that to your exercise after eating…You have to take charge…
Blessings all…You CAN do it!..Judith in Portland…
i typically control my carb intake to keep my spike under 120 if I can. As one of those could I eat that food again thoughts I did a test and ate a medium bagel!
Totally over loaded my system. One hour I was at 180 four hours 240 and ended up over 300. Won’t do that again, took several days to get back to my usual levels.
I basically eat 5 times a day and small amounts of carbs, (5-15) Which my body seems to process.
Plus exercise I don’t have a car, so I walk everywhere and all the time. I do take public transportation when I need to. )
The problem with talking about T2 in broad terms is that it’s not a single entity. There are different subtypes and patterns, so the management technique has to be suited to the individual’s particular variety of T2. Your method works spectacularly well for you, but it wouldn’t for me because I have practically no endogenous insulin to work with.
This article casts an interesting new light on the whole classification issue.
Yes I am well aware that you don’t make insulin, as you noticed I prefaced in that for me I make insulin which is what a based my comments on.
Anyone can add comments about how they manage t2.
I beleive, not backed by research, is that you limit the amount of insulin you need to produce, that hopefully my pancreas won’t burn out as soon,
Maybe or maybe not similar to adding insulin to lesson the strain.
I agree. If I had gotten off those sulfonylureas sooner, I would have more beta cell function remaining now. Unfortunately none of my doctors thought that way and my journey of self-education was still in the future.
I changed the title of the post to avoid any confusion.
I would just like to see discussions on this site that don’t include the use of insulin. There are a good percentage out there managing well on limited or no meds.
Especially with the new " pre diabetes " diagnosis ( what ever that really means)
I am basically doing a similar thing, Fraser, eating 3-5x a day and limiting the carbs to 5-10 grams per meal. My upper limit spike goal is 110. I haven’t challenged this as yet–doing my best to stay in these guidelines.
I was insulin free for many years. Again had good education in the beginning from a great PA. This is so e important. Read,read,read. I like to be busy so exercise is not a major issue for me. I go to the pool as much as I can. This morning we hiked ffor 40 minutes with the family. I carried my granddaughter all the way. I then went and did garden work for 2 hours. Etc. I pay attention to what I eat. But 23 years later I am on Victoza and lantus. But life is great!! Nancy
C23 years what a great record. Congratulations! Also understanding when it is time to make the switch to insulin, )
I am sure you have some great tips on how you did it?
Determining the time to switch seemed pretty straightforward. When I was doing everything right and my A1c kept climbing inexorably to unacceptable levels regardless of anything I did, it seemed pretty clear. But even then, I had to instigate it. My doctor wouldn’t.
I had a similar switch over. Everything that worked nicely before… just stopped working. When I was spending all day over 140, I demanded basal insulin. Then when I realized that I needed to correct for my DP and bolus for meals as well, I demanded fast acting insulin too. Heh, it really was a demand as the doc wasn’t keen on giving me insulin, wanted to try everything else under the sun first, including revisiting my current diet/exercise.
All told it took 1 year to get a Metformin prescription, 9 months to get a Levemir prescription and 6 months to get the Novolog prescription. When I said I wanted a CGM, my GP said she wouldn’t and that I would have to see an endo for that.
Though if I wanted a statin, I could get that with a one minute phone call. facepalm
I’m curious what was behind that reluctance. Did the doctor feel responsible for every decision based on CGM data that you would make? I’m guessing that is what motivated it. If I buy a hammer from a hardware store and proceed to hammer one of my fingers accidentally, is it the legal liability of the store or even the store clerk? Would the same doctor refuse to write an Rx for a home blood glucose meter?
She only has experience with telling her patients to diet and exercise, then giving them Metformin I guess. I’m a weirdo T2 who needs insulin? shrug
I don’t think that she had ever prescribed insulin before (she prescribed just a vial and not syringes). Perhaps she felt that she would have no idea how to prescribe the CGM responsibly or help me use it. So from that prescriptive, I kind of understand while at the same time it has left me waiting 3 months to see another doctor who I hope will prescribe it.
I am not good at being patient and waiting while my BG’s are all over the place. 
You’ve made an excellent point, Terry.
I’d like to add that in today’s litigious society, for better or for worse, the liability most often lies with the physician. In addition to offering the best care possible to my patients, I have to worry about covering my butt all too often because regardless of the actual cause of a bad outcome, the physician is the one held responsible in the overwhelmingly vast majority of cases.
While it is unfortunate that daytona will have to wait so long to see an endo in order to be prescribed a CGM, I respect daytona’s primary care provider’s decision to not prescribe a device with which she is not familiar enough to help manage.
And I hear your frustration, daytona. I am far from being a patient patient.
I’m afraid Rose is right. One of my best friends from college made his career defending doctors in court. And that was decades ago; it’s worse now. Much worse.
@daytona , forgive me in advance for nitpicking, but do you live where syringes are available without a scrip? They are in many places (including where I live).
In any case, if you are going to be using insulin—with or without serious professional guidance—you need to become your own self educated expert. Using insulin safely and effectively demands that. Two of the very best places to get that sort of education are here in this community, and from books like these:
Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)
Richard K. Bernstein, Dr. Bernstein’s Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)
John Walsh et al., Using Insulin (San Diego: Torrey Pines Press, 2003)
Please forgive me if I’m telling you what you already know. 
@David_dns A prescription was required for insurance to pay for pen needles or syringes, either way it was pretty clear that she’s never prescribed insulin before. But we talked about which ones I wanted, and it all worked out in the end.
Thank you for the tips and I whole-heartedly agree that the best way to manage is to learn it for yourself and be analytical about it. I have all three books (been diagnosed with T2 for 6 years) and have read some of them multiple times because the first few reads, not all of it applied. When I started insulin, I gave them all a reread. I’ve also picked up Sugar Surfing and Practical CGM, because I am hopeful to get a CGM this year, so why not start learning now. 