Should I push for Insulin?

I was diagnosed as a type 2 diabetic on January 18th 2012. However, after reading about LADA, I pushed for the antibody test...My body does have the antibodies which means I am slowly but surely going to be insulin dependent someday.
Okay, right now I am on Metformin. So far my diet, exercise, and medicine is keeping my diabetes under control. Occasionally I will have a spike but I know why (when I eat something in excess)...
But I was wondering should I push my doctors for insulin?
I dropped my first doctor because I have a horrible insurance plan (the deductible kind) which will leave me broke. So now I see a doctor at a local clinic and she's really good. But she told me the same thing...she does not want me to start insulin at the moment because I'm controlling it on my own.
But I know this is just a honey moon stage...
So should I push for it anyway?

If your ok on the Metformin it’s up to you. I wish I went to insulin sooner but that’s only because the Metformin made me feel crappy all the time, ruined my stomach and gave me chest pains. It worked great controlling my diabetes but all those side effects forced me to go on Lantus. I wish I did it sooner because it’s really no big deal taking injections and it was a relief to finally tackle the fear. I will say that it’s tough keeping weight off on insulin and Metformin was great at helping me maintain and even lose weight.

I am the opposite, which is weird. I have a fear of swallowing pills (I crush my Metformins)but can sit and watch someone draw blood from a needle. So doing the insulin thing will be no big deal for me. And I actually need to gain some weight (when I was put into the hospital my BG was over 400 and I had lost fifteen pounds off of my formerly 155 pound body).
I am just worrying about the whole BETA cell thing and if I should just go ahead with small doses of insulin.
Also, do they teach you how to use the insulin once you are prescribed it?

Some of the research and thinking regarding the prevention of T1 during the early stages of autoimmune attack is based on the premise that extremely tight control early on is helpful in “shielding” other clusters of pancreatic beta cells from autoimmune attack… with use of supplemental insulin such as could be delivered via a pump. I once worked with a father whose daughter had T1, who recognized and saw his symptoms of diabetes VERY early on. The Endo I was working with had me put him on a pump from day one, and he was able to use a very low basal rate, watched his diet, and did not require a bolus unless he ate more than 30 grams of CHO. From what I have heard and seen in the area of research, I’d most definitely consider the use of insulin… preferably via a pump.

I don't know the answer because I am in the same spot as you are. I've been exercising and eating extremely low carb for almost three years. The highest my A1c has been is 5.6 with a lot of stress in my life, so Endo won't give me insulin. I tried Metaformin and Onglyza and at most, I'll see a ten point drop. My bg is really better controlled by exercise, but I mean intense exercise. I have ice packs on my knees and hip right now, but the bg will be wonderful. Endo and I agreed that I might take Onglyza on my hump days where I can't get to the gym. I hate big pills, too, and I have the added problem that I have a corn allergy and can't tolerate big pills with a lot of methyl cellulose to bind them together.

There is a fair amount of good scientific research that shows that early, intensive insulin therapy preserves remnant beta cells. For some people, "intensive insulin therapy" may mean 5 units of Lantus or Levermir a day! But preserving beta cells and prolonging the honeymoon period means way better outcomes. Researchers such as Bruce Buckingham MD at Stanford put newly diagnosed Type 1s on insulin pumps from day one, and his results have been spectacular. If it were me, I would insist on insulin.

But is it the added insulin that preserves beta cell function or keeping your blood sugar in check and low (using diet and exercise and other meds)? I am curious. Not that insulin is a big deal (I take it myself), but just as a matter of understanding the whole 'preserving beta cell function thing'.

I recently switched from Metformin to Lantus and my bg numbers aren't nearly as good. Back in in December when I was on Metformin my A1C was 5.3. I have not gotten my A1C checked since switching to Lantus two months ago but I am going in on April 5th and I would be willing to bet it's going to be around 6-6.5. Insulin is a bit more tricky to manage than Metformin due to the lows especially when you're honeymooning. If you get too aggressive you get lows and if you're not aggressive enough you get highs but it fluctuates because the insulin gives your beta cells a break and they start producing more and you get a yo yo effect. I am constantly adjusting the number of units I take up and down trying to find the right balance. Keep in mind it takes about three days to adjust to the new level of units and three days to adjust back down if you find you're taking too much.

Exercise is also very tricky on insulin. I very often have lows three to four hours after I exercise. I usually run three or four miles so it's only 40 mins or less. Same issue if I bike although I usually bike for at least an hour. If you are exercising longer than an hour you will also need some sugar to keep you're bg levels up.

At the end of the day I say do whatever helps you keep your A1C lower with the least amount of side effects.

First of all Kudos for you for pushing for more testing and a correct diagnosis. I wish more people would do their research and push for a complete diagnosis. Your Dr. and their staff are more informed because of you.

I wish I had never gone on Metformin. The first doctor that suggested it tossed me a sample set of Glucophage (the name brand pre Metformin) from across the room and said, "use it if you want, but it does cause stomach upset and diarrhea." I put it off until a Dr. later put me on the generic version. After 3 years as a 1.5 and no metformin I am just now getting my digestive track working correctly.

Ultimately the choice is yours, but your doing the right thing by examining the options and discussing them with your Dr.

It also depends on the type of exercise and something I've seen in one of the diabetes books, forget which one, called "perceived effort." Resistance training burns glucose differently, etc. I'm 58yo, and last night, the teacher put me on stage doing a fast salsa routine. This am, my fasting glucose was 85. I will have to be careful the rest of today WITHOUT insulin, metaformin or any other meds. If I go on insulin, I have to be careful, not just the day of, but the day after because I eat so low carb. I bring four carbs of an anti-oxidant drink if I do two classes in a row as well as a cheese stick. Metaformin lowers my fasting bg to 95.

It's funny, Justin, that you mention the lows at 3-4 hours. That is exactly what happens to me. I start to get very cold.

I quit taking the Metformin after nine months of taking it, I have been "clean" for 7 months now but still have the digestive issues from it. The issues are slowly going away.
I have had better numbers since discontinuing the type 2 meds, and am going to a different Endo in May to get a second opinion and start on Insulin. I am going to push right away for a pump so as to get it over with.
Thanks for the original post, I thought I would have to do MDI for a while before the pump, but now I know I can push to start the therapy the right way right out of the box.



I have never seen any studies that do not use intensive insulin therapy to preserve beta cell mass in newly diagnosed Type 1s, so I don't know. I have read that exogenous insulin gives the remnant beta cells a "rest."

I've always felt the evidence is pretty clear, high blood sugars kill your beta cells. There is lots of research to support that. And by high blood sugars, I mean anything over 140 mg/dl starts to be toxic (so called glucotoxicity). If you are safely under this number, that is fine, but if you are 140 mg/dl 2 hrs after meals and in particular if your fastings are rising and you are having readings above 140 mg/dl you should push for insulin.

Almost every LADA/T1 will still have some beta cells working for the rest of their lives. Those that preserve more beta cell function will have an "easier" time controlling their blood sugar. Richard Bernstein argues for aggressive control of blood sugar for these very reasons.

I never had much luck getting the right tests, but I was aggressive about moving to insulin early. Many doctors only want to prescribe insulin as a "last resort," when you have totally uncontrolled blood sugars and perhaps only when you are in the ER. I refuse to volunteer my body for such as stupid and damaging display. I chose to start insulin early. It is my body, it is my choice.

Thank you for the input bsc, I am angry that the ancient Endo has a Insulin last resort mentality. I will be going to see him ONE MORE TIME, only to get a fresh A1C done as well as my current c-peptide level to take to my new Endo. One other local T1 had to end up in the hospital to get started on the pump/cgm therapy, I will stress that this seems like a bass akwards way to manage a chronic condition. I have all my bloodwork labs. 2 months of meal/carb count sheets ready and all my excercise is stored via a Garmin 800 GPS. I will have copies for the Endo and do not plan to take no for an answer. I will go to Orlando or Tampa if I cannot get the local Endo to go to bat for me.

Bottom line, the only treatment for Type 1 autoimmune diabetes is exogenous insulin. Good for you for pushing for the correct treatment!

I am probably a LADA. It's uncertain because I can't afford to pay for the thorough antibodies test that's required for a firm diagnosis. It has to be sent to a lab in Utah, apparently, but the provincial health insurance doesn't cover the cost. However, after several yeas of regular physicals and complete blood tests including A1cs all completely normal, I developed diabetes symptoms very rapidly in the late summer and had a dramatically high A1c in October. I also have a high IgA count with no, but my c-peptides aren't seriously out of line.

What was most important to me, however, was that even though I immediately went on a low-carb diet, following Dr. Bernstein's plan, my BG levels would elevate after I ate or exercised and wouldn't come back down for four or five hours. I was concerned about beta cell burnout and developing other complications. I was also concerned that I was spending so much time waiting for my BG to come down low enough to be able to eat a meal that it was seriously interfering with the rest of my life since, if I ate when my BG was high, it only went higher and stayed there for a long time, too.

I asked my endocrinologist to put me on insulin in December and then began to take Humalog with meals after Christmas. My BG came down quickly when I got the hang of doing the calculations and doses for the time of day. I feel terrific. I look good. I'm sleeping beautifully. Life is great.

Many doctors would have wanted me to try taking a sulfonylurea drug before switching to insulin, but my endo doesn't like those drugs. I'm glad about that because they seem to speed up the death of beta cells which I want to avoid.

Insulin is a great thing. You only need to take as much of it as you need, when you need it, unlike oral medications that are much less specific. I don't need a lot of insulin--about 15 units a day--and my BG is averaging under 5.0 mmol/L these days. I may eventually need a basal insulin, but for now, Humalog is doing wonderfully for me.