T2s on insulin watch out!

I picked up this study published in “The Lancet” It’s called "patient centred treatment for type 2 diabetes. I I can’t really figure out why the study was done. 2 large groups of patients on insulin and oral hypoglycaemic medication were studied for 44 days. One group on a single injection of slow acting insulin and one group on one injection per meal of a rapid insulin.
HbA1cs were compared nd the one dose people were as good if not slightly betterr. the after meal spikes were better for several injections. If the study was to track longterm health and complications, then the spikes matter. If only to save on injections, then the A1cs matter. however the study didn’t reveal anything about the swings of BG readings. 90;90;110;70 would be a perfectly satisfactory set of BGs in a day. the average is 90. 115;110;80;55 would not be so good, but the average is still 90 and would result in a similar A1c These numbers are overly simple, but I didn’t want to spend all day doing math to get my point.

I am sorry Hana. I really don’t get the point. I realize we are all different. I know that a lot of us type 2’s can be controlled very well on oral meds. I also know that some of us require insulin for good control. We tried oral meds for me and they really did not work, but did make my kidney function far worse. My A1C on orals was very bad. On insulin, I have great blood sugar control and my A1C is down to 5.6. Yes it took a lot of work on my part and commitment. But working at it and commitment to our long term goals is what it is all about. I am never really sure what these “studies” are all about. A lot of them seem really counter-productive to me and I would rather see the money spent on doing something constructive instead. I guess it is a good thing I don’t have control over who gets grant money for a study.

What I was getting at was that since the study only aimed to get A1cs down and ignored postprandial spikes, It could prompt all doctors to put t2s who use insulin onto 1 shot a day. For many this would lead to more spikes and hence more complications. Did you low carb, whilst just on orals? I firmly believe that since I can’t metabolise carbs, I shouldn’t eat them. I do slip up a little and use some Starlix, but otherwise I find the low carb works for me.( with some Metformin) I have some retinopathy and it’s been perfectly stable since I started low carbs. I have evidence from a doctor that patients on low carbs can sometimes heal their complications. That doesn’t happen on medications.
Type 2 diabetes is usually caused when the body becomes resistant to it’s own insulin. Most type 2s make it by the bucketful( at least for some years) Sulphonylureas and some other meds cause more insulin to be produced. enough to overcome the resistance. Injected insulin is also supposed to overcome the resistance. I feel everyone should know this. If you keep stoking up the insulin producion, you increase the resistance and eventually, it is thought, burn out the beta cells, which make it. then you have only injected insulin to depend on. Avoiding carbs in the diet can prevent this. Dr. Richard Bernstein has proved this many times in a lifetime of treating diabetic patients.
As to this study, I can’t see how the results can help patients, since A1c alone isn’t an indicator of who will get complications.

Thanks for the response Hana. I completely agree that low carb is a very healthy way to go. i have two type 1 kids and we have low carbed for years. The problem was that I had some kidney problems for several years and all of a sudden they just went nuts. We really worked to help them out, but they just didn’t respond. Then I went to see a different doctor and he ran some tests and found out I was a type 2 insulin resistant diabetic. We tried the pills and during the months I was on them I lost a lot more of my kidney function and developed some really bad retinopathy. I have had one laser surgery and the doctor has told me that the damage done while I was on those pills is extensive and I will need maybe three more surgeries. I have been low carbing faithfully but as my doctor explained to me, apparently the insulin I make is just not avaiable to me at all. So he put me on insulin and I feel much better. My blood pressure is now under control and I haven’t lost any more kidney function. The one thing I found out also is that i had to cut down on the amount of protein I took in as well. In the form of meats I mean. I can still do cheese and some peanut butter and it doesn’t seem to have the same effect as the meats. I can also eat a lot of vegetables that are low carb to fill me up. And they are all my favorites vegetables too. I don’t do potatoes or white rice or even pastas. And I have to be very careful with the amount of potassium I take in also because of the kidneys. But I definitely agree that low carb is the best for us. If it was enough for me, I wouldn’t mind doing without the shots But we are unable to control my blood sugar without the insulin. I am hoping that keeping my blood sugars under very tight control and watching eveything that I take in and following everything my doctor says will keep me holding on. So far I feel much better than before.

What you mean to say, Hana, is that one should look also at deviation from the mean values: the lower it is, the closer you are to the mean value. Technically this is called “standard deviation” and I must say I regret to see that even my favourite meter, the OneTouch Ultra 2, is totally unaware of it. Of course I could have recourse to the many softs out there, but that’s far more fastidious than simply pressing a button or two on your meter that you have (often) in your pocket and that needs no computer.

I’m glad you are keeping well. I eat loads of cheese and some nuts, but I hate peanut butter. I’m convinced that tight control is best. the levels of BG recommended in Britain are too high. 7 mmol/l(126mg) is far too high. Essentially I try to eat as little as I really need, but obviously I go wrong sometimes. the trick seems to be Never to get hungry. I adore Brussells sprouts and broccolli. If kidneys are not good, they like you to reduce protein, I know. I’m insulin resistant too, probably, which is the reason for the Metformin. No-one does an insulin level test here any more. they just assume and although the NHS is wonderful, you don’t really get much say in what tests are done. the doctors go by what the Primary Care Trust will pay for.
I’d really like to know what my insulin levels are, but hinting hasn’t got me the tests.

Certainly deviations are a key to complications. Listen to Dr. Jovanovic on the Diabetes-symposium. Website

I have a personal target of under 5.5(99) at any time and just look to see if I’m there. I use a Freestyle Mini( Ithink called the Flash in some countries). Nevertheless, I’m afraid that some care teams will use the study to cut patients from prandial injections to a single Lantus. I myself don’t use insulin, Mainly I rely on Metformin, diet and exercise with a little help from Starlix… I have to admit I do go off the rails occasionally on diet. I went swimming this morning, without eating breakfast and ended up eating a nut bar afterwards, which warranted a Starlix. I aim NEVER to allow readings above 7 (126) and have kept to this since one"accident" before Christmas. Of course, my Mini gives me a running average of 14 days readings. it’s at 5.4 at the moment. I would like to keep below 5, but I’m limited on strips(2 per week!) and it’s difficult without testing several times a day

Ah, Hana,

But it is so much CHEAPER to deny Type 2s intensive insulin regimens.

And that IS what this is about, as were the studies purporting to show that measuring blood sugar with a doesn’t improve control.

The real problem here is that most Type 2s on intensive therapy are not taught how to use insulin with a carb/insulin ratio, nor are they controlling carbs, so they are still getting mediocre post meal numbers, because doctors give them doses that are too low to actually control the meal. They do that to avoid hypo, because it takes education and a certain amount of intelligence for patients to learn to use meal time insulin properly.

I realised that and that’s why I started to worry about those on insulin. When will the bean counters realise that complications would cost so much More? What does a kidney transplant cost? or a course of dialysis or even a single laser treatment of the retina? My husband’s (Type 1) poor control lead to Charcot feet and now he has to have shoes made for him and podiatry treatment at least twice a month. If he’d had better advice sooner, that money could have been saved. along with the several lasers and the kidney investigations.
They treat us as if we were naughty children who develop this condition as a result of what we did to ourselves and we must take the consequential punishment… The only thing we can do is to pass on the low carb message. and use this forum and others, to show everybody how to work things out. Having said that I know about it and got it wrong today. I let myself get hungry, and I’m also waiting for my only daughter to have her baby. It’s nearly 2 weeks overdue and she’s been in hospital all that time, because her pelvis has given up. These lapses ought to be rare though. I’m sure there are loads of people out there who cannot keep BG under control, because they don’t understand what happens and don’t know the food groups etc and plenty of people who don’t care what they do until it’s too late.
We each have to take charge of our own health and learn what we can.

The problem it seems to me (type 2 on insulin) is when you go to the doctor they hand you the “list” the diabetic diet and when I told them I was on a low carb diet I was told “Oh no it’s not a god diet for anyone” well I lost about 200 on it and I was feeling fine…better than I had in years. I think the best way is the one you feel your best at. If it’s counting carbs or doing the “list”…I just think for type2 it’s just push it in the corner and eventually it will wind up broken and THEN we’ll fix it…SIGH

Sometimes it isn’t always the doctor’s fault either. A lot of people who have been diagnoses are just plain not willing to change their habits because that means they have to work at things and lets face it, in this day and age a lot of people don’t want to put the work in it takes to change. They want everything handed to them.

I am in corespondance with a doctor who puts all her diabetic patients on to low-carb. She’s the only one I know and she’s in Scotland, while I’m in the South of England. I found her when hunting for any doctors, who believe in it. She’s taking part in a conference in Paris and using stuff she and I have discussed.
My care team have given up telling me low carb isn’t good. They have someone else who found it and we are both Very fit and well. In fact, whe I asked for more test strips, I was told I don’t need them and that I’m a “worried Well” patient.
Even my pharmacist doesn’t think I need to try to keep so tight. I aim for under 6.5(117) at all times and below 5 (90) most of the time. It’s hard to do on a ration of 3 packs of strips a year!! My husband’s a type 1 and I resort to stealing. Type 1s are not rationed. Congratulations on losing so much weight. I have lost a little over 30lb. I was never over 210. I would say “If it ain’t broke. Don’t fix it.” keep on the low carb and keep the insulin requirement right down. Exercise helps increase your sensitivity to your own insulin. I’ve walked about 4 miles with a group of friends this morning. It was slippery mud underfoot a lot of the way, which makes the walking harder. Keep you Bernstein book by your side and wave it at the doctor if he argues with you. One thing this condition does to you, is to make you strong minded.

There are some people who cannot be helped, but as many who would be if they knew what we do.