I worked very hard to try to get good control as a T2. I had all these books and followed Bernstein since 2006, but I couldn't achieve what I considered my target. But my doctors were basically happy if I was at 7-8%. I kept pushing my GP for insulin as the medications, diet and exercise were not enough, but no go. My GP absolutely refused to be the one to initiate insulin. So I was referred to an endo after more than a year of asking for insulin. And my endo turned out to be just as bad, constantly changing medications, the latest greatest drug, some costing me $200/month. But still refusing my request for insulin. In the end, I just threw up my hands and started insulin on my own. I did it smartly, I own all the books David S. mentioned, plus more. It has been two years, I dropped my A1c like 1% and have never had a serious hypo. Even more surprising, I have not gained any weight since starting insulin.
After starting, I made an appointment with a new endo and just presented myself at her door already having started insulin. She has no problem with it. In the end, I think that no doctor wanted to be "liable" for the decision to initiate insulin. Frankly, this is "my" diabetes and it is my decision, I just acted on it.
Brian -- so much good information there. Thanks for posting your experience.
Being satisfied with 7 or 8 percent A1c's is absurd, as you recognized. I don't think there can be any question that the fear of liability is a major factor in the reluctance of some doctors to prescribe insulin.
Everyone's experience is their own. My GP was very willing to cooperate, in part I think because it was evident to him how much homework I had done. It wasn't all luck, though -- I ended up with this doctor because I went shopping. I interviewed doctors, told them what I wanted to do, and gauged the reactions. I picked the one who seemed least doctrinaire and most willing to work with me, and as it turned out, I chose well. He deals with me like a partner, not a boss.
The moral of all of that is, if your doctor isn't willing to do what's needed to normalize your blood sugar, you need a different doctor.
But the final, absolute bottom line is perfectly encapsulated in your last sentence. For each of us, it's our disease, our life, and our responsibility. You can get all the advice in the world, from doctors or anyone else, but achieving control -- the actual doing of it -- is up to you and NOBODY else.
In the end we have to take control of our own bodies. If we are very lucky we will find a doc/endo who will be willing to work with us, trust what we are feeling, not what the drug sellers are telling them is the "latest and greatest". Keep records of your numbers, your diet, your exercise, your emotions, etc and present that info to your providers. It IS our disease and we are responsible for taking care of us. I don't know about putting yourself on a med, how did you get your insulin without a script? But if that's what it took, you are lucky to not have done more harm....and to have such good results. I applaud you!
I think we owe it to ourselves to be "smart" patients, so I have always done a lot of reading and learning about diabetes. I bought and owned many books, including those listed by David S. above. When I started insulin, I was already very experienced counting carbs and knew everything I needed for intensive insulin management. I even asked Dr. Bernstein himself whether insulin was an appropriate step on one of his teleconferences. You are of course right, it can be foolish and dangerous to just start insulin, but I tried very hard to make sure I did it safely and smartly and I only did it as a last resort when it became clear that I was going to continue being denied it as an option.
And we are fortunate that human insulin remains an over the counter drug. In most of the US, you can walk right into Walmart and ask for Relion NPH and R without a prescription.
I am happy to have moved to insulin. No oral medication ever dropped my A1c more than a couple 0.1%. Finally, I have the control I want.
In my state you can buy R over the counter at any pharmacy. In fact, I already had some on hand when I went to my doc to ask for a Novolog scrip. As mentioned earlier, he was happy to oblige.
Like you, I was already counting carbs and keeping records. And like you, insulin gave me a degree of control I simply had not been able to achieve any other way.