Talk to me about type II's on insulin

I guess I started quite a bee’s hive over at the type I forum for asking this question of them. So I am moving it here, and hoping that you all can help me with some information for my friend. She was a type II and they have changed her diagnosis to type I…since she is totally dependent on her injections of insulin. But they gave her NO education about this switch or what she is to do…as you will read.
thanks for any help you can give me to give to her.

'll be the first to admit, I know nothing about insulin and diabetes. So bear with my ignorance, please.

My friend, started on insulin once a day last week, Lantus? Don’t ask how much, I have no clue. She is taking her metformin 1000 mg / day also. She now has higher BS’s than when she was on metformin only…is this an adjustment period for her. She is feeling physically as if she isn’t doing anything for her diabetes, tired, thirsty, hungry, weak, etc. Her BS’s have been in the high 200’s. She got little or no education on insulin and diabetes when she started a week ago…NOTHING. Well, I guess they did show her how to give herself in injection…that’s it! Share with me, so I can share with her about insulin reactions, what if they are too high, what does she do? What are the basic important things she needs to know? Can she eat anything she wants as long as she injects herself…see I told you I was ignorant about insulin.

thanks for the education in advance…

She needs to get to a proper endo now! Generally type 1’s can eat what they want and cover for insulin. However type 2s I believe are encourage to limit their carb intake even if they are fully insulin dependent (I could be wrong on this). If she is running high BS and doesn’t know how many units to take she could be hospitalized for running ketones (continuous high blood sugars). This is serious business. Every diabetic is different. There is no tried and true formula as to how much insulin one should take. Her endo should have figured out a carb ratio for her (like 1 unit for every 20 carbs eaten for rapid acting insulin/and then a number of units of background insulin like her lantus every 24 hours)) but like I said, don’t use this as a guideline, everyone is different. If she is sick you should have her go to the ER and at least get some professional help now until they can get a proper endo’s advice and calculations.

Adrienne, she was at the ER on Friday night…and the doc there was furious that she had no “D” education when going on insulin. FERIOUS! she has been dealing with “D” for about two years now, and doing it half heartedly because she like most is afraid and wnats to forget it. But, now she thinks she can eat anything and she’s on insulin. Our nearest endo is about 200 miles away…a long trip and an appointment isn’t available right away, usually out of town patients take about two months to get in. Yep we are in the boonies. So, we have an excellent diabetic program at the clinic I go to, and she doesn’t have to switch docs to attend their educational sessions or even set up an appt with the CDE…the ER doc recommended it, and I am just hoping that she takes advantage of it. I’d go with her, but somethings, people have to decide to do for themselves, and then have help. Thanks for your support and help.

Generally an insulin dependent diabetic has their carb ratio they follow. they check their blood, from that number they calculate if they need to eat (low blood sugar), or correct (high bs). their carb ratio will help determine how much they need to eat with a low to bring them up to a normal number, and there will be a correction ratio as well telling how much insulin to take depending on how high they are. don’t worry about offending type 1s, the important thing is that you are trying to help your friend. this is very rudimentary in explanation, but thats it in a nutshell.

we live in the boonies too so totally understand where you are coming from. usually though if its an ER admittance or emergency the Dr. can slip you in for an appt. I think the biggest thing to understand about a diabetic is that when their bs are high or low they’ll be emotional - its not a bad thing, its just understanding the disease. my son is type 1 but when he’s high and doesn’t want to get checked thats usually when he needs it the most (the lows are that way too). i think you are doing a good job as a friend. you are right in that she needs to come to a decision on her own, but it might be hard for her to come to the decision to want to help herself if shes not managing well because he emotions might be heightened. you can’t be her mother and force her to check, but she might need some hand-holding on this one. whether she likes it or not, it would be beneficial to her if you were there to support her through this big change. i’m just offering some suggestions but don’t feel obligated to take my advice :wink: maybe if you offered to check her bs and help with calculations when you two do something together. show an active part in helping her learn. i know when my son was diagnosed, it went a long way to me to have a friend really honestly wanting to learn how to do everything with me. there’s no way I would have asked anyone to learn the details, but she just stepped in and asked questions. she has been my saving grace and she doesn’t even have a diabetic in her family. it was just that one person to talk to, to help me sluff off my frustrations with trying to learn everything and to help me be positive for my son. I’m glad you finally got some help in the ER and that you are on the road to meeting with a CDE. what a good friend!

The problem is more that there was NO education on any of this for her. NONE. They showed her how to give herself an injection, one a day, and sent her on her way, according to what she told me. And now she is having some problems and there is nothing that she can do about it…unless she decides to make the effort to do so.
I worry for her health, I worry for her family, without her, it would be very hard on them. But, the problem is basically the lack of education AND the idea that she is walking in the dark, and taking advice from people who know nothing.
Makes me sick to think about it.

I happen to be a type 2 diabetic and went along a similar path. I was able to take a diabetic education course and I’ve been reading a little here and there. First I was on lantus along with some oral meds and later I dropped the oral meds and added a faster acting insulin, novolog. I’ve done some searching on the net also. There are books available at Amazon .com (and at the American Diabetes Association website also) too searching “Type 2 diabetes and Insulin”. I regret that I can’t give a strong recomendation for any one of them in particular. At the Amazon site you can sometimes read reviews of the books and then form an opinion for yourself. The key thing is exactly as you put it “She has to make some effort to acquire the knowledge that she needs”. All you can do is point her in the right direction.

Cathy, i have learned over time that other people cant make us diabetics follow a path to better health wether its taking your insulin, eating right, or getting education about our condition. Maybe your friend should be here at the site trying to gather information about what she can and cant do. You can bring the horse to the well but you cant make it drink water. Educating one’s self about the condition they are in should start with the person. I am a type 2 on meds now but when i was first diagnosed I was at the E.R. with 1000 blood sugar. I stayed in icu for 3 days while they brought my BG down. I was given a prescription for Lantus and Humalog and a piece of paper explaining the step scale I was to follow. My education consited of a piece of paper with the step scale and a 30 minute conversation with a dietician. My will to stay healthy and want to get better is what led me to want to understand what I had to do to make my self better.

Your friend is probably scared about the condition she is in so it sound like she is ignoring what needs to be done. Insulin is not a magical potion that allows you to eat anything you want.

I dont think you stirred the bee hive its that people here take the condition seriously. We want to learn from each other. I think that is why we are all here we want to learn from each other and its like the lecture you receive from a parent. It comes from a good place.

One thing I learned about eating right and taking insulin is that it gives you predictability. That is why a good diet should be followed. I dont think you will get justication from here for her to go and eat any type of food and insulin makes it good. Just because one doc did not give you information does not mean you should not seek it. Was she at the E.R. or at her general practioner. The general practioner is a good person to go to if you have thing under control. But if you need more information is better to find an endo because they have more resources to help out.

take care and hope your friends finds the information she is looking for

Cathy, first, I want to thank you for being such a good friend to your friend. It’s not everyone who would do so much to help as you are doing. I know you’re working very hard to find good information for your friend and you should be lauded for it. So, here’s a pat on the back for you!

I was misdiagnosed as a type 2 and placed on metformin, then Lantus, then finally taken off the metformin (which wasn’t doing anything for me) and then correctly diagnosed as a type 1, taken off the metformin and placed on Humalog and Lantus. So, I do have some understanding of what she is going through, though most likely her diabetes and my diabetes are not alike.

I cannot explain why her blood glucose levels are higher now than before she started the Lantus. When I started Lantus, my fasting numbers fell, though it did nothing for my post meal numbers and this effect was immediate – I added the Lantus, and the next day’s fastings were lower. Insulin is not like oral meds like Metformin: You do not have to take it for several weeks for it to become fully effective. I saw someone else who mentioned that she might be having lows and her 200s might be explained by her having episodes of hypoglycemia. It’s entirely possible, especially if she’s not testing her blood sugars at the very least 4 times a day. It’s also possible that she’s feeling as if she’s hypoglycemic, even though she isn’t, then eats a snack and ends up with those bgs. If she is not testing but simply guessing at her bg levels, then it’s much more likely mistakes WILL happen.

Because Lantus is a basal (long acting, aka “background”) insulin, if your friend is high (180+), additional Lantus will not bring down her high bgs in a reasonable amount of time. Metformin ER (or XL) will also not bring down a high bg. High bgs can leave you feeling tired, thirsty, hungry, etc and for a type 2 using metformin and Lantus, exercise is perhaps the best way to bring down the bgs, in as much as they are not in excess of 250 (or 300, depending on who you listen to) and she is not showing moderate to large ketones (unlikely in type 2s). For most, aerobic exercise (dancing, walking, jumping rope, etc) will bring down the numbers quite nicely; however, I have known some who’ve used anaerobic exercise (weight lifting, resistance training) and who also claim this form can bring down bgs. Remaining hydrated during prolonged highs (over the course of several days) is also important – she should drink plenty of water and other no/low calorie (diet sodas, drink mixes such as Crystal Light, herbal teas, etc) beverages.

I am curious about your friend and her regimen. Is she overweight or obese? Metformin is the gold standard for type 2s who are overweight or obese, but is controversial for those who are normal weight and definitely not recommended for underweight type 2s. These days, metformin is prescribed in the long-acting form and the maximum dosage is 2550 mg. You say she’s only taking 1000 mg; she could be taking twice that amount to manage her bgs. Is she on any other drugs besides metformin and Lantus to help her manage her bgs? Most doctors follow a series of steps when adding medications to manage their patients’ type 2 dm. Generally, most type 2s will start with metformin, then add a sulfonylurea, a DPP-IV inhibitor (Januvia), an incretin mimetic (Byetta), a TZD (i.e. Actos), an alpha-glucosidase inhibitor (i.e. Acarbose), and/or a meglitinide (i.e. Starlix) before they add any insulins. Usually, the person is on some combination of three of these drugs before the doctor will add insulin unless there is very good evidence that these drugs are unlikely to help or will have some detrimental effect. If, for instance, she has had a c-peptide test and it reveals she makes less insulin than normal, then most of these drugs will be ineffective and insulin is the treatment of choice. From what you’ve said, it’s not clear that your friend has gone through the multiple drug approach or had tests that would help show that the type 2 oral meds wouldn’t be helpful. She may want to talk to her doctor about her options, so she can make a more informed decisions.

I would encourage her to find a proper endo, a CDE (diabetes educator) and a nutritionist. I read elsewhere you’re going to be taking classes together (GOOD FOR YOU!), so that is a step in the right direction. However, a private or semi-private meeting with a nutritionist and the CDE can be very helpful. Group education classes are good for giving you a foundation and a theoretical basis from which to operate, but a private meeting with a nutritionist will allow her (and you) to develop your own meal plan based on your needs, your food choices, and your preferences. Instead of a pre-printed sheet, you’ll get a plan that fits your life. The CDE can make sure she is injecting correctly, discuss her feelings about her diabetes, and help her use her bg readings more effectively. An endo should help set bg goals, review prescription and non-prescription medications, and screen for any complications – a very important part of any doctor appointment for type 2s, who often have complications from diagnosis.

BTW, just because she’s “on insulin” does not mean she can eat whatever she wants. She is on a LONG-ACTING insulin analog. That means it dribbles out tiny bits of insulin over a 24 hour period. It’s the same amount of insulin, no matter if she’s eating or if she’s simply sitting around, watching TV. It will not respond to the rise in bgs from eating a meal or snack. If she were on a rapid acting insulin, then she would be able to “cover” her food with insulin, as Adrienne says. This is where a nutritionist can be helpful. A nutritionist can help her design a meal plan which minimizes rises in bgs but which does not allow her to go too low, for instance.

To put it simply, getting some diabetes education with an endo, a CDE, and a nutritionist is important – regardless of whether she’s on insulin or not! I hope this helps.