Taking Control and Starting Insulin

Well, it has been a long time coming, but I've decided that I'm going to start an insulin regime. Some of you may have thought that I've been on insulin for quite some time, I'm sorry if I left you with an incorrect impression. I decided a while ago that I would be moving to insulin and that in order to be successful, I needed to be smart about it. I've been asking to start insulin for three years and been repeatedly denied. Most recently changes in my triple medication regime failed again to show any long-term improvement in my blood sugar control. I had my c-peptide tested and found that I appear to be insulin deficient (not enough yet to meet pump criteria). And after a series of "unfortunate" events, I've had to leave my endo who never gave me the care I sought. Given that I have to start with a new endo and my regular doctor long ago threw up her hands at being able to help me, it seems like the perfect timing.

I've been repeatedly told that the reason I can't use insulin is that I will have hypos and it will cause me to be fat. Yes, insulin can cause hypos and it can cause weight gain. But in truth, I think my doctors have been "insulin resistant" declining to prescribe insulin because my blood sugar has not gotten out of control. They don't want to be the doctor that did the nasty deed of first prescribing insulin and be held liable for something going wrong. Well I follow a strict regime, a very low carb diet and take good care of myself. I will only reach the thresholds that will enable my doctors to act (A1c of 8-9%) after some serious extended time with poor control and I will not let that happen to myself.

So I've concluded that I need to take the matters into my own hands. I have purchased insulin and syringes and am starting a regime. I've known for some time all that I need to know in order to implement my insulin regime. I'm not asking anyone for help with this, this post is about me announcing my decision. I've already told my family and a number of friends. I will tell my doctor(s), but not for three months. I'll not give them the opportunity to intervene in what is "my" decision. I will tell them at my next quarterly appointment, but at that time, the decision to go on insulin will be "moot," it will have been taken out of their hands.

I would certainly appreciate your comments. If you want to call me a bonehead, that is fine. In the end, we need to be responsible for our own care.

You may not be kidding. Although there has been no change in my blood sugar readings, I was suddenly up two lbs this morning. I am usually very stable in my weight. I have heard from a number of people that insulin initiation can be accompanied by immediate weight gain, as though suddenly your body can actually use the nutrients. Time will tell.

Perhaps your body is stockpiling the weight in case you try to starve it again? I sort of overshot for years and ate to catch up? I still like to do this in the evening, bolus for 55G of carbs and eat about 40 and have a couple of brewskis or whatever? If I'm not doing much, that usually works out very pleasantly, I'll end up in the 80s w/ a shade (.5U?) floating around 'on board' and wake up 60-80, right where I want to be. N, on the other hand, can lead to a peak that could be at midnight or 6:00 AM for a 5:00 PM shot (I took it at bedtime though...) so you have a wide range of outcomes. My solution was pretty much always to hit any high w/ a couple of U of R, sometimes running up and down the stairs w/ a shot in the legs, to make it work faster? This tossed an, or perhaps several, R peaks into the mix too? It would have been intriguing to have had a CGM to see what was actually going on but I didn't have one, just tested a lot. I always refused to write anything down. W/ that much variability in the peaking, I'm not sure notes would have had value or not? I look forward to watching yours though!

I have to wonder about your doc not giving up the 'log? Do we need to go play a round in his parking lot?

Insulin may also cause some edema in the beginning. Water weight that will come off pretty soon. I hope!

What was your c-peptide, if you do not mind me asking?

Wish you the best of luck! Keep us updated!! When are you starting??

Well, I record everything. Right now I'm recording all the tests, carbs/protein in what I eat and all the injections. I am just working on a basal and I haven't recorded any numbers below 100 mg/dl yet and only seen two readings over 180 mg/dl so it has been pretty even. I do like the idea of ending the evening having a couple beers for a smooth landing, it has been a while since I've really had beer. Before I became the brand new D "me," I actually brewed my own beer.

And I don't want to talk about my last doc, I still have some lingering anger issues.

ps. Thanks Natalie, it may just be water.

Hi bsc...

I applaud you!!! I will definitely like to know how this works out for you over the next few weeks/months so please keep me in touch. If I continue to get the same blank stares from Drs here I too could be forced to this kind of self care ;)

Good luck and Happy Holidays!


My first test (unmedicated) was 1.8 with a reference interval of 1.1-4.4 ng/mL at a blood sugar of 130 mg/dl. With escalated medication and injections, my subsequent measured c-peptide was higher, mid-range and then top range, all with similar elevated blood sugars.

Thanks Paul.

The only downside to insulin is that it is a make fat drug. But in all outcomes it is important to keep your own pancreas alive as long as possible and many people with early insulin treatment achieve that. If you let it die then you will need a lot of insulin and it is a lot of weight gain.

NPH is the nastiest insulin out there, BSC. I mean it. I wouldn't recommend it for my worst enemy. It tends to have an unpredictible onset, a sharp peak, and can last far longer or shorter than published data indicate. Because it is considered a "long acting" insulin (of sorts), you cannot use it to correct for immediate highs. That is, if you wake up and you notice your bgs are 170 mg/dl, you won't be able to bring them down with a shot of NPH. If you're using a mix (70/30, for instance), you still cannot use it to correct, since you would be injecting an additional few units of NPH, which could leave you quite low 12 hours later.

If you need to correct for highs, I would recommend picking up a vial of R and using it. Keep in mind, though, that when using R, you have to wait 1/2 hour after injecting before you can eat. That's the usual onset for R, though YMMV.

I agree with Jacky: Initially limit your NPH doses to 2x/day. Start with the lowest dose possible and work your way up to a higher dose. It's far safer to start with small doses and work your way up. Good luck with this.

Thanks Angela, I take it you have sort of a “hate-hate” relationship with NPH. I am going to try to use the NPH to get my fasting down and down expect to use it at all for correction, my biggest issue right now is chronic impaired fasting. I do have a vial of R for correction, but am not really using it right now. I’m starting slow and working up. So far, I’ve not really seen any effect on my blood sugars, but I did gain 2 lbs.

I have to agree about the NPH. I would really try to get your hand on lantus/levemir or some short acting. R was okay for me (i was not on it long), not great but not awful, but N caused terrible highs and lows virtually EVERY DAY . I would go from 200 to 80 in about half hour at the time N peaked (and I had to eat then to not go lower). I had to eat very regularly The day I started lantus was literally one of the best days on my life. I would never recommend N to anyone, unless they would immediately die without it.

Not that you asked but this is my 2 cents.:)

I know everyone says it’s a make fat drug - but I didn’t experience this. YDMV.

I forgot about the lengthy ‘suprises’ too? The duration is supposed to be like 12 hours for 2 shots but I think that I had stuff floating around 18 hours sometimes, particularly during my more inactive phase? 4 shots sounds like a clever idea but having 4x shots w/ a potential peak of 6-18 hours will put little peaks all over your ‘graph’? If you are proactive, you can treat these but there’s the tendency to treat lows that occur along with highs that occur when doses are late. This gets into a cycle of sort of chasing your tail (and the insulins have tails of course…wag wag)? My tendency was to always figure “oops, I $%^@*^ up again” but, in retrospect, I think a lot of it was the variability of the insulin. It also was extremely difficult to beat up DP. I have to wonder about the doctors not rxing the shizzle for you? That bugs me!

Well, it isn't the insulin that makes you gain weight. It's what you eat, and whether it's being processed by the body. Classic Type 1's get skinny before diagnosis, so they need to gain weight, and insulin makes that happen. But overweight or obese Type 2's who go on insulin really need to examine their meal plans, and cut down on the calories.

That leads to the issue of hunger. You can't go around being hungry all the time, any more than you can hold your breath all the time! So the issue is to eat foods that are filling and keep the hunger at bay as long as possible. I have found that by cutting out carbs, and eating more meat, cheese and eggs, as well as low-carb veggies and salads, I am much less hungry than I used to be. And I have lost weight in the process. Given that I don't have much to lose, and it is a different problem for the truly obese, I still think that considering cutting out some or most carbs really makes sense.

Also, when I went on insulin, I DIDN'T gain weight -- I lost it.

I lost several pounds when pumping , start 2001 ...prior to pumping I had too many lows to feed

( NPH !!! )

How long have you been using insulin?

Regular could be used overnight because it tends to last around 5 hours & starts to work in about 45 minutes. If you're consistently at around the same fasting number, you could figure how much R to take before bed. I had a vial of Lantus go bad & took R before bed. I set the alarm to test. It's not as good as basal, but it worked.

Sure you know this, but just in case... Not eating at least 5 hours before bed helps fasting. Eating a dinner meal with a good deal of fat & protein can cause high fasting if it's still digesting when you go to sleep.

Im often baffled by doctors that wait till control requires intervention as opposed to taking preventive measures. I think what youve sought and are now proceeding with is a good idea.

Wow...you DO need insulin thats crazy!! Your c-peptide increased instead of decreased?? Is this because of meds?

My first test (of course inmedicated as well and still am) was 2.6 and my blood sugar was 130 as well!! I'm pretty sure my c-peptide is much lower now because my blood sugars just continue to get worse.