Yes, obviously a Type 2 on insulin would find material on insulin use and carbs useful. I don’t know the stats on how many type 2’s are on insulin, but I would venture to say a large number are not. Also, even then, nutritional needs are different because Type 2’s need to consider insulin resistance and most (not all) type 1’s don’t.
The point really was that it was not so much a T1 vs T2 issue but exogenous insulin-users vs those not on insulin. Lifestyle-wise, a T2 on insulin has a lot more in common with a T1 than with a T2 not on insulin.
I agree with this, Lila, and I don’t think it’s a versus thing at all, just differing outlooks. Interestingly, you know what I sometimes see as the biggest divide between diabetics? Their level of knowledge and proactivity in their own treatment. I find that I make certain assumptions about what diabetics of both types know and do from being an active part of the DOC community. In real life I’ve met people who didn’t know which Type they were, didn’t know that food other than “sweets” affected blood sugar, tested once or twice a day if at all, wouldn’t know an I:C ratio if it bit them in the ■■■, etc. Obviously I hold the medical profession to account as much as anybody for this situation.
But that difference is one reason I asked Gretchen what level of knowledge she was aiming her book at.
Excellent, so we agree that we agree. Cool!
I totally agree with what you said about the divide. At my Dafne (insulin+carb course) week, I met a 20-something young woman who’d had T1 since the age of 7. I was flabbergasted when she proudly pronounced, ‘I have never counted carbs, only calories.’
I could not make it out of the hospital post dx before obsessing about carbs. But her priority was counting calories because she wanted to lose weight ahead of her wedding!
My own view is that more T2s should be Rx’d insulin sooner than is being done so currently in the U.S. I don’t know if Big Pharma is behind the pill-pushing effort or not, but I only wish I had been Rx’d insulin years before. As a T2 for 11 years, I struggled with the side effects of oral diabetes medications for many years, and there was (and still is) a persuasive stigma within the public and within medical offices that taking insulin was a bad thing and to be avoided altogether. I was warned on more than one occasion that poor diabetes management would lead to having to go on insulin and having to take shots everyday for the rest of my life, and that such therapy was to be avoided at all costs. What nonsense! Diabetes management is important at every stage of the disease, and if using insulin makes it easier to bring about such control for T2s, then please bring it on!
I didn’t have to go on insulin; I chose to take that path. I am so glad that I did. Insulin use has benefited me in many ways: (1) the oral-med side effects are gone; (2) my BGLs are much, much better; (3) I have lost weight. With result like those that I have obtained with insulin use, I will continue to sing its praises.
As for differences in the nutritional needs of T1s and T2s, I agree with Lila. I’m not convinced that that is where the real difference is found. The same foods that cause the BGLs of T1s to rise do the same in T2s. Carbohydrates and portion control are the two Achilles heels for both types of diabetic. T2s often have to watch out for fats as well, but fats are not near the issue as are carbs.
The real difference between T1s and T2s has to do with exercise. T2s (most) need to exercise and lose excess weight in order to lower insulin resistance since insulin resistance is one of biggest hurdles with T2s.
Interestingly, Lila, and this one I need to say is definitely a generalization and not applicable to most people who are active on here: I find that some Type 1’s who were diagnosed many years ago learned about their care in a very different era, and have not updated their knowledge as much, perhaps because they are used to how they do things, and have certainly undergone lots of changes already. I was diagnosed 4 years ago, but didn’t start insulin (and recognize I was type 1) until 2 years ago. So my natural instinct in 2009 was to come to the internet and I found myself here. It feels a bit uncomfortable at times when I talk to people who have been dealing with their D decades longer than me but I know far more current information.
As for Type 2’s who are on insulin feeling like they are in a different category, I’d still be interested in knowing the percentages which might explain the non-inclusive emphasis on type 1’s as " the insulin users", despite that brief interval where they realized age was an inaccurate differentiator and started talking about “insulin dependent and non-insulin dependent.” Numbers based on majorities, unfortunately, are by nature not inclusive, and thus never fair. I’m reminded of that whenever I see ads on TV for for “people with diabetes” that are nearly always geared to type 2’s. This board is odd because the majority on here (please someone tell me if this is not true) seem to be type 1’s. I alway hesitate to talk about differences, because it seems to quickly turn into a versus thing. But I think some of that can be alleviated by honest dialogue about the differences that do exist.
I think the reason she did not want to put me on Byetta is that I am rather thin and people tend to lose weight on Byetta…don’t they? I have to look into the other options before my visit. My A1C initially dropped 5.5% on the Onglyza…BUT, that was WITH my being able to ADD a bunch of carbs back into my diet. I’d say at least 40 per day… To get a bit more variety. I still keep it under 75-100 though…
Sadly…the labels mean NOTHING to some of us.
I am technically classified (for insurance reasons? because I have to be called SOMETHING??? by process of elimination? because they don’t have a name for me???) a Type 2…because I do not have any antibodies that indicate my diabetes is caused by an autoimmune condition.
However, it has been determined by C-peptide testing by my Endo, that I am NOT insulin resistant. My diabetes is caused by insulin insufficiency.
And that insufficiency seems to be getting worse, so I may soon be going on insulin.
I mention this only because…as I read this discussion…the terms really don’t fit me and would like those who use the terms to realize this.
The more I read and the more I listen to people on this forum and others, the more I come to realize that there are so many variables to the this disease it is almost impossible to put people into set categories. The variations are endless!
Amen!!! Especially the “lording insulin over the T2’s” as though it were the “Black Death!” Nonsense! I’m looking forward to the possibility of having a bit more flexibility of dosing (situationally, for example, at some point!)…
For sure there are differences, only those differences can be cut many ways, and not simply in a straight T1/T2 dichotomy.
Just off the top of my head:
- juvenile onset vs late onset
- rapid onset vs slow onset
- pump vs MDI
So for example a T2 on a pump would have lots of commonalities with a T1 on a pump, probably more than with another T2 on MDI.
I did a quick google search and got stats that about 27% of Type 2s are on insulin?
An important T2 insulin use distinction would be between those on basal/bolus regimes versus those on basal only.
Many T2s using insulin are on doses that would kill many T1s which makes it more difficult to trade insulin tips.
Maurie
Thanks for the stats, Lila! A bit higher than I would have guessed, but not by much. I have a feeling that those numbers have been going up and will continue to do so as the baby boomers get older.
I’m not sure what you were trying to say with ‘doses that would kill many T1s’?
Were you trying to say that T2s on basal only use only small amounts of insulin, which would be insufficient for T1s?
I was always under the impression that those T2s who do use insulin use a much higher TDD than most T1s, because of insulin resistance.
If so, I was under the impression that it is actually quite hard to kill yourself with too much insulin.
So I’m unsure what the ‘kill’ was meant to refer to?
A lot of T2s take over 100 units of basal and 30-50 units bolus per meal. If someone injected 30 units of fast acting insulin into me all at one time, unless they were standing there with a dextrose injection, I sincerely doubt that I would survive that.
Diabetes is such a struggle, and not being either a classic Type 1 OR a classic Type 2 makes it so much worse!!
Bruce, doctors who practice what they call Evidence Based Medicine (EBM) have reasons for using orals before going to insulin, primarily in people who are very insulin-resistant, producing gobs of their own insulin, and who therefore need help USING their OWN insulin, rather than introducing more into their systems. These are the people who are most likely to gain weight on insulin.
But not all so-called Type 2’s fit into this category. Some are insulin-resistant AND insulin-deficient, and some are primarily insulin-deficient, for whatever reason. These are the people who are often mis-treated, because the orals may not work all that well for them, and they really DO need exogenous insulin, even if they do produce enough to avoid DKA. They really ARE somewhere in the middle (if not off in left-field) and they have not been lucky enough to get their own category which would help doctors treat them appropriately. They are NOT LADA, because they lack antibodies, but they are also NOT classic Type 2. They tend NOT to be significantly overweight, do NOT gain weight on insulin, and there are really a significant number of them! They make up my Type Weird category! 
The biggest issue for us Type Weirds is to get appropriate treatment. Some doctors are flexible, and some are not. I was extremely lucky, because when it became apparent that Glucotrol (a sulfonylurea) was not working 5 months after my formal diagnosis, my endo was receptive to my going on insulin. This was before Metformin, but I don’t think Metformin would have made much difference anyway. On the other hand, bsc struggled and struggled to get his doc to put him on insulin and never succeeded, so he put HIMSELF on insulin, with excellent results. It’s a shame that he had to do it that way, but he was simply unable to get appropriate cooperation.
There ARE real differences between Type 1’s and Type 2’s and Type Weirds, one of them being that Type 2’s and Weirds, having at least some of their own insulin production, and having mostly unimpaired glucagon production, are less prone to severe unconscious and seizure-causing lows. That’s a biggie.
But I do agree with you that if you need insulin, and have a doc that cooperates with you, it’s a far better way to go than to struggle with orals when they just aren’t doing the job. And it’s really important that if you need to go in the hospital, that you either be treated by your own doc OR say that you are Type 1, because if they think you are Type 2, you can get into deep horse-sh*t trouble with Type 2 protocols. (Been there, done that, survived to tell the tale).
Here’s wishing you what I wish ALL diabetics – the appropriate care, regardless of label!!
Insulin resistance varies in a bell-shaped curved somewhat skewed to the right over the whole population, including Type 1’s. So a very insulin-sensitive person on the left side of the curve will see a marked BG response to just a little bit of insulin, whereas an extremely insulin-resistant person on the right could take quite a lot without seeing much of a result.
Highly insulin-resistant people may take a lot of insulin every day in order to control their BGs – in the 100’s of units. Whereas highly insulin-sensitive people make take as little as 10 units a day. Notice, I did NOT divide into Type 1’s or 2’s, because there ARE insulin-sensitive Type 2’s and insulin-resistant Type 1’s. The only indisputable boundary between the types is autoimmunity, and not insulin-resistance.
Insulin-resistance IS more common in Type 2’s though, because it is part of the definition of a syndrome. But the metabolic syndrome affects a significant portion of the general population who do not have diabetes, too.
And it’s really easy to kill yourself with too much insulin if you’re insulin-sensitive – just don’t try it!!!
Hi…responding to Super Sally and Natalie…
Natalie, I am quite curious…how did BSC put himself on insulin? I’m curious. Is he a physician? Just curious.
And, Super Sally…good for you for taking control and managing your situation.
Natalie, I hear what you’re saying. I guess the problem that I have had in my history as a T2 is that therapy via medication was emphasized over other alternative therapies. For example, if a T2’s HbA1C is in the 10+ range, oral meds are going to have a very limited effect in bringing such high numbers into an acceptable range. However, many endos and PCPs will still Rx oral medications in those cases. Why do so??
Lowering insulin resistance definitely should be emphasized when and where possible for the T2. However, the point is that oral medications are pushed by the medical community in the U.S., and insulin usage for the T2 is often demonized. I would like to see a more balanced approach to treating T2s. Quite often insulin is the smart choice of therapy.
As nutrition goes, when I was first dx’d, I was given a Xeroxed calorie guide and told to target 1,800 calories per day and to try 1,500 if I could manage it. That calorie guide included sample meals that were high carb. I was also Rx’d Glipizide. There was no mention of insulin as part of the therapy. In fact, I was told that I would end up on insulin if I didn’t manage my diabetes.
Even though some T2s require obscenely high amounts of insulin to bring their BGLs in line, I honestly believe that for many of these T2s, insulin + exercise + proper nutrition would be better than the current push of oral medications. BGL management is easier with insulin, and it affords a better opportunity for a T2 to focus on exercise and diet in reducing insulin resistance and reducing the amount of insulin needed per injection.
At the end of the day, each one of us still has to do our part in sticking to a therapy that works for us. Even the very best therapy will fail if a patient doesn’t at least try. However, I believe that the medical community should also do its part in providing the best paths possible for each diabetic, not pushing us into therapies that are less efficacious.
BTW, the T-weirds often fall through the cracks and have to figure things out on their own. I know diagnosis can be difficult. God bless them!
Sally, best of luck on getting pregnant. As far as insulin, it sounds like you have some experience with it, so you should be OK. Hoping for good health for you!
Sally, my PCP continued to Rx oral medications for over two years as I struggled with bothersome side effects and BGL management. I quit her practice and found a smart endo who was only all too happy to get me started on insulin. The funny thing is that I thought I was going to have to convince him to start me on insulin, yet he was the one who was so relieved that I wanted to go on insulin. He told me, “You know, I wish I had more patients like you. I often have to really work hard to persuade patients to start insulin.”
When it comes to diabetes, my endo gets it. I wish there were more who did. It’s a real shame when a patient has to plead for health care such as bsc has had to do.