Taking Control and Starting Insulin

That was then in the last 10 years the Docs have become very insulin resistant.

A1cs are increasingly being standardized, so lab to lab results shouldn't be so different if done within days of each other.

Plus they're now talking about using the A1c as diagnostic if >6.5. Which I adamantly oppose (not that it matters) because when I first had diagnosable fasting BG's, my A1c was 4.8. Before my coma, highest I EVER had was 7.1, and 10.7 was enough to kill me, whereas I know people who were walking and talking at 12, 13, 14!

I am not in the U.S., but I believe the A1c criteria is to be used in conjunction with one of the other criteria (fasting or random BG, for example) and not just on its own. So it means that someone with a high A1c but a normal fasting BG can be diagnosed, but so can someone with a high fasting BG but a normal A1c. Or at least that's the way I understand it.

I sure hope you're right. It was bad enough that I had to get sick before I got on insulin -- I hate it when I hear of Type 2's having complications already when they're first diagnosed. Complications, (as you know!) are the pits!

Take care,

Natalie ._c-

ooooh, I have some interesting scars, none of them are big though…

I have no proof of that Anthony :" Docs have become very insulin resistant" …and I repeat: I credit my then GP …it worked for me…thank the diabetes Gods.

Not the same situation as yours, but my PCP perscribed insulin & supplies because I waited months for an endo appointment. After going through three endos in two years, my PCP is now my diabetic person. He's a lot less conservative than the endos I had.

Agree about docs being overly cautious about insulin. Most are over the top about lows. Liability & also that it takes their time to instruct dosing & guide patients in fine tuning doses. Their idea of good control often conflicts with ours. Exasperating!

I was not sure about risk of Type 2s and lows. Not really sure if the alpha cells (glucagon secretion) worked normally with Type 2. Only have experience with dosing Type 1 child; in our case, insulin necessary for survival but lows must be closely monitored after each bolus, in fact. Caution necessary; I both respect and fear insulin’s power. You answered my question re Type 2 and I am glad the risk of lows is not serious.

All I can express is my observation of asking four doctors over three years, many, many times and receiving the same message. I have heard the same from others as well as CDE's in my diabetes center who have made the same observation. Ralph Defronzo in his 2008 Banting lecture suggested to the ADA that new T2 patients should be put on the most effective medication regime immediately because they had already lost beta cell function, and if that failed, they should start insulin, no waiting. That lecture cause quite a stir, because the current ADA model is called stepwise for a reason, you slightly increase the medication regime to follow a patients failure at control until you have fully demonstrated uncontrolled blood sugars that all possible medication regimes. The can mean years of poorly controlled blood sugars. I am glad Nel found a forward thinking GP. He sounds like a gem. But I do think there is "insulin resistance" in the US medical community.

It is a formal US treatment guideline to only initiate insulin when no possible medication alternatives can keep blood sugar controlled. To deviate from the guidelines requires stepping out on a limb and many doctor's won't do that.

I agree that a GP can be a good workaround? I would say that BSC would likely demonstrate a significant level of expertise and that the doc would likely provide what they are asked for? I went to GPs for years, although this was when I was a bit heavier a few years ago. They always asked if I wanted to try 'Log/ Lantus/ etc. and were supportive. At the point where I finally said “I want a pump” he immediately “punted” me over to an endo but I think that may very well be an angle to work there, if the R/N doesn’t work as smoothly for you as you are hoping?

We buy our expensive meds from a British Colombia pharmacy. You can get most insulins like Lantus without a Rx, including the pens. Just google Northwest Pharmacy. We save about 60% on my husbands Actos.

Thanks for the suggestion. But I believe that the reputable canadian pharmacies all require a prescription for all the insulin analogs, just like in the US. They are a bit cheaper, but Lantus is still about $95/vial. My hope is that my use of NPH is temporary and that I’ll be allowed to move onto a modern regime in a few months.

Same here 10 years ago. Probably nothing has changed since. The CMA treatment protocol only allowed insulin when all else failed by then your own pancreas is toast.

BSC lantus = $60 canadian at safeway. In alberta pharmacist can prescribe but may only do so if you have a valid US prescription. Not sure what the law is in British Columbia. Sending by mail in winter could be a problem because of freezing.

Anthony , please help me , where did you get this information in writing and maybe it is updated to 2010 ?

It was the Canadian medical association treatment protocol for type 2 diabetes that my doctor friend gave me, it is many years old by now I am not sure I kept the copy since it was of little us and much harm. I will ask him is he can get updated version.

It's not just the physicians, BSC. It's the insurance companies, too. Keep in mind that the insurance companies are the ones who've been after doctors to give proof that the regimen they're prescribing actually has some benefit and that the drawbacks are minimal. Think about it from the pont of view of the insurance company: If they're going to pick up $80 of the $100 it costs to purchase your test strips, they want to know that there's some benefit having you test x number of times/day. If it's shown that testing 10 times per day does little or nothing for someone who is diet and exercise controlled and has had virtually the same A1c (in target) for 2 years, then that's a huge waste of money for the company. Would you want your company putting out huge dollar amounts for something that has not been shown to have a definite benefit?

As for DeFronzo and that debate, without reading the report, I actually agree with both: First, the patient needs to be placed on a regimen that is most effective. If that means insulin, then that's what needs to be done. And this has to be done on an individual basis. Second, there is good cause to have a stepwise program of medications for type 2s. As I have said for the better part of 2 decades, the term "type 2 diabetes" is really a junk term, since anyone who does not show autoimmune destruction of beta cells has been classified as "type 2". Type 2 diabetics are NOT a homogenous group and the etiology of one person's type 2 is likely to differ from others. If the cause of my diabetes is different than your's, there is also the possibility that what works for you may not work for me. How is the average doctor to know? There aren't exacting, perfect ways to know if the right drug for you is metformin, starlix, or Byetta, or some combination thereof. The only way to know for certain is to try and to allow the drug to fail. Where I think doctors go wrong is that they allow the duration of the experiment to go on too long. I suspect this is because they are still operating in the "Yeah, that diabetic is going to be non-compliant" mode and are trying to give the drug the maximum amount of time to work while trying to get the patient to be compliant in other areas (i.e. diet and exercise). On its face, quite nobel, but in the end, IMO, counterproductive.

I don't know why anyone would call you a bonehead, but I must say I am astounded that one can buy insulin without a Rx.

Had cheese latkes again this week. Yum, yum.

Good lord BSC. You're not a bone head at all. It's the smartest thing you could ever do.

I know how to make them give you insulin (he he). Let me know if you are interested.

I got mine to give it to me and I had an a1c of 5.3 . Doc gave me FOUR kinds to try & use. And I have 3 other kinds she doesn't know about. I am like you. Go into the exam with knowledge and see if they concur. You already know the answers before even going.

Insulin will return your previous lifestyle to a point. Not only are you going to have better control, you can actually live a better life.

Now that you are using your own insulin, you no longer need an endo or any other doctor for your diabetes treatment.

You can buy your own A1c tester for home use. Bayer is about the best one.

I control my own destiny with diabetes, not blindly follow a doctor's suggestion. I will do it WITH or WITHOUT them.

Doctors don't care. They are businessmen out to make money.

I lived in Guatemla for two years and you could buy any medication without a prescription. The first time I went in to a farmacia and handed them my prescription they used it to get all my meds and then handed it back to me. The second time I handed it to them when I only needed a couple things on there they asked if I wanted everything. After that I just wrote down or told them the things that I needed. I would assume other undeveloped countries are the same.