I still remember how ghastly I felt before I was put on insulin in 1984. I was 5’ 10" or so and had gone from 150 to 120 lbs along with all the other symptoms but it took a while to figure it out. I gained weight on insulin and lost weight on insulin but I am very certain that I am glad to have had it available. I suspect that the best “weigh” to avoid gaining weight is to avoid dieticians. Unfortunately, in my experience, any mention of food to doctors usually results in an attempt to rx a dietician.
I sure hope you didn’t have to ASK for it, AR! It’s one thing for the diagnosis to be obvious, which I hope yours was, and another thing to have to beg for insulin because current treatment is not working. Remember how bsc had to beg and was turned down and had to put HIMSELF on insulin? No one should have to do that, even if they are a Type 2. People shouldn’t be victims of doctors’ poor diagnostic and treatment skills!
10-4 and fully agree.
It is not all Doctors fault. Current diagnosis technique should be done with a loner portable CGMS pack plus chenical analysis that can track body for 2 to 3 days through all cycles of sleep, digestion, meals, liver action, kidneys, thyroid., pancreas, gut/intestine and signalling hormones. Then data can be analyzed by computer and Doctor gets full picture of issues, marginal operation and intermittent ops as well as suggested diet and exercise needed to resolve.
My take is that the present one shot lab tests and failure to fully check all organs is the key problem in solving this nasty type 2 insulin resistant diabetes that results on orchestral playing off key of the multi organs complex system mentioned.
The failure to look at only pancreas and ignore other factors suggests that educated guess’s, order of Merlin and divening rod are not up to task as cases explode and double.
Type 2 is not a monolithic single organ failure but a web of issues from medicine , diet and exercise.
No we are not in 23rd century with Dr. McCoy of star treck and his magic wand and the computers on the bridge of the Starship Enterprise backing up Doctor. But we sure as hell could do better.
Most Doctors and patients are simply working with insufficient data and analysisand trying to solve serially in time at 15 minutes at each visit to doctor and one shot lab tests when what this needs is a full picture complex adjusting of multi-factors in parallel to get patient back rolling fast and cost effectively.
I have worked on complex digital systems and debugged and at first time of trouble - out come the detailed test gear of logic analyzers, scopes and meters all being pressed to collect fast detailed data pictures, analyze the issue and solve the problem.
Show me a diabetes case for type 2 - a multi-organ - multi hormone complex human system where the human gets as detailed a check as the digital computer gear with a problem gets. Then we wonder why type 2 diabetes cases are exploding.
Put me down as fed up with the nonsense with dark ages thinking and approach in this day of modern computers and testing capability.
There are a lot of hormone and gut enzyme abnormalities for which there is as yet no practical test. However, even the now abandoned OGTT gives a clearer picture than a simple fasting glucose, or worse yet, an A1c. Add in a C-peptide and antibody tests, and you get a pretty good picture of where to start. The reason for abandoning the OGTT was that it was a hassle for the people getting tested, and for the doc. But when it comes to early diagnosis of Type 2, isn’t that better than waiting for complications to happen before diagnosis? One day of hassle is better than years, or a lifetime of misery!
Personally, I’m in favor of eliminating the “prediabetes” label, and aggressively treating those people who are at risk BEFORE they develop full-fledged Type 2 with complications. Support for effective diet (which is a distant dream at the moment) and a supervised exercise program would be a start. Preventing complications and keeping people in the workforce (as long as there are jobs!) is surely better than supporting them on disability!
We, as a country, are rich enough to start wars, but not rich enough to take care of our own people?
Agree the pre diabetes label should be dropped. This is the best time to get aggressive in treating although, I’m skeptical about how many would take it seriously, even with a new label. Unfortunately restricting carbs is the approach that works best, but most are very resistant to the idea.
Re gut enzyme abnormalities: I recently started Victoza which is an artificial gut enzyme (GLP-1) It has made a huge difference in my control, which had been deteriorating. So apparently part of my diabetes has something to do with GLP-1. I went into my last appointment having decided to ask to be put on insulin but my Dr. wanted to try Victoza first. For me I think it was the right choice, because I have lost some weight, which is another effect of Victoza, in some people. In the end this should help with insulin resistance.
It’s ok. I have a new endo now. I ended up losing 40 pounds during the whole thing.
Natalie:
Excellent informed and detailed response.
Agressive treating early is key and usually carbs control and hearty exercise can usually pull one back into line.
Leave it like me 28 years later, agressive meds help, super carbs control and yes rot stopped.
All cannnot be fixed though even though body does herculean effort to cure when given chance.
Carbs control is extremely important but unfortuantely food police have beat the crap out of the fork knife and plate bad habits with no useful effect.
I believe big issue is that many of us are stuck with the 10,000 year old hunter gatherer gene digestive system optimized to pull out every possible calorie when food quality was low, scarce and scrawny and the body was optimized to prevent starvation under such circumstances.
Today with the incredible farming operations generating such huge volume of the grains/carbs, our old bodies cannot handle calorie overload each and every day. Thus carbs control is absolutely key.
Yes , one can eat the fun foods but it is key to manage energy input today. Only about 33 % of population has systems appropriate to preventing type 2 insulin resistant diabetes. The rest of us have to be careful and get sufficient exercise.
Blaming type 2 insulin resistant diabetes on excess weight and fat while of interest is too far down the body glucose chain while lap band, bariatric surgery, starvation tight diets suggest something else as those folks get results well before any obvious fat loss.
I did not do any of those BUT after getting leaky liver shut off and diet to 1200 calories and 1 to 2 miles walking each day, my body also threw off the excess insulin -75/25 humalog-26 units, starluix/glyburide and that other fun party actos all after about 6 months. Foks doing the tick stuff usually get results in 8 weeks.
This is for me after 30 years of wrong crap and handling. Yes I use some humalog lispro - 2 to 4 units each meal and one shot of 8 units of lantus to beef up basil insulin. AT age 64 , it is logical that I might need boost of insulin due to aging.
That I found my own pancreas kicking ■■■ after all this and watch on my cgms after eating each meal is even more curious when it should be withered and out of puzzle after 30 years as type 2.
With numbers such as yours, it’s not likely you’re going to be approved for insulin. Your bgs are considered to be 'adequately" controlled with the medications you’re currently using, even if you’re not entirely happy with your numbers. In 2007, my A1c was up to 8% and I was placed on Metformin ER (extended release). My fasting numbers went from 180 down to 90 fairly quickly, but it did nothing for my post meal (docs call them “post-prandial”) numbers, which would still be over 200 even 3 hours after eating. I even tried eating meals composed mainly of low-carb vegetables and meat and I’d still have bgs over 180 three hours later. When I pointed this out to my doctor, he dismissed it and upped the metformin from 500 mg/day to 1000 mg/day. The change still didn’t do anything and worse, it wrecked havoc with my appetite. I started losing weight I could ill-afford to lose. Still, my post-prandial numbers were through the roof and I was an unhappy camper. I didn’t just ask to go on insulin; I BEGGED. I was continually denied and essentially told that my poor performance on metformin must be my fault. It took changing doctors and finally getting a c-peptide test (an indirect measure of your insulin production) before I was able to convince anyone that insulin was necessary. If my experiences are to be taken as a guideline, then I would think it would be unlikely, given your success at managing your diabetes with oral medications, that you would be prescribed insulin. The risks outweigh the benefits.
I would offer a different response. Being adequetly controlled and stopping the body rot are not same thing.
Marginally controlling BG can lead to being condemmed to body rot, eye and kidney complications. It leads to same dumb excuse - we do not fix liver leaks - tough ■■■■.
My read is that calorie load needs to be on average lower than the actual body need long enouigh with sufficient exercise to prevent body muscle cells being topped off with glucose each and every day/.
Get average glucose low enough so that any excess laying around body is burned off enables body to get back in control.
and bg pulls into spec on type 2 diabetes insulin resistant.
It is high time for a change and to stop the doubling of this disease.
Inadequete diagnostic tools lead to failure by Doctor and patient alike and then ends up Doctor thinks patient isn’t doing his job or following instructions.
I’m not sure the risks of insulin outweigh the benefits for Cathy. As a Type 2, her risk of hypoglycemia is much lower than for a Type 1 (although not nonexistent), and with a low-carb diet and consistent exercise, weight gain shouldn’t be a problem, either. On the other hand, since Januvia (part of Janumet) is pretty new, no one knows the cancer or heart-disease risks associated with it nor what other side effects it might cause down the line. Plus I’ve never heard of any definitive answer as to whether a sulfonylurea, like Amaryl, actually causes faster decline of beta cell function.
I do agree, as I said earlier, that the doc may be unwilling to put her on insulin, since her numbers are relatively good. The problem for her is wanting tighter control than the doctor thinks is necessary. Studies like ACCORD didn’t help the tight control viewpoint, especially in older people, even though there has been a lot of criticism of its flaws.
In the end, I think the Type 2 patient should have the choice, because only they can decide what risks they are or are not willing to take. Studies only deal with populations and statistics, not individuals, and any given individual may NOT fall under the bell curve of the study. And insulin DOES allow for more precise fine-tuning than any oral med.
The manufactuers af the newer generations of sulfonylurea’s including Glimeperide contend that the beta cell destruction is NOT affected by the medication. Take that with a grain of salt because I am not sure there is a whole lot of data out on that and of course they have a vested interest in saying that it doesn’t.
If I were a Type 2 I would avoid sulfonylurea’s like the plauge but I truly believe that they make the Doc’s job of maintaining glycemic control in the early to mid stages of Type 2 a bunch easier. The positive’s and negatives for the patient are a little more uncertain.
Ralph Defronzo has been critical of sulfonylureas. One can argue about whether they “cause” beta cell destruction or not, but the data seems pretty clear, they don’t “preserve” beta cells. Defronzo presents a bunch of data on current (second generation) sulfonylurea’s. None of the therapies involving sulfonylureas have any durability. In contrast, Defronzo shows that the TZDs are durable (although their safety may be in question) and further that the GLP-1s may even promote beta cell restoration.
I do not believe that the manufacturers of sulfonylureas can be trusted to give an objective view of whether they destroy or preserve beta cells. I was always clear in my refusal to take sulfonylureas.
Please know that I stood up and shouted “HURRAH” about us being a country…etc.
Unfortunately, Met and my arthritis formula didn’t work well together, I didn’t mind the met because it did work. But the Janumet is doing it’s job…I just do not want to wait until we are at the door of problems to get an answer. I would rather be a little more proactive with my treatment, that wait and see.
Natalie,
I do agree that people should be informed of their options and allowed to make their own decisions, based on relative risks and benefits. However, people don’t always make good decisions. My neighbor’s ex-boyfriend, for instance, was diagnosed with stage III-IV bladder cancer earlier this year and the “gold standard” treatment for that stage cancer is a short dose of chemo, surgery to remove the tumor, and then more chemo and radiation. It ensures the best chance of survival, according to most medical experts I read. The doctor recommended surgery and chemo/radiation. What did he choose? He chose chemo and radiation only, which is substantially less effective when cancer is at that stage.
That’s not to say that Cathy is not making a reasonable decision. Perhaps she is; I don’t know. What I can say is that, based on my experiences, it is likely she will have a difficult time being placed on insulin. Her A1c, while not ideal by AACE standards, is within the standard set by the ADA, which many GPs follow, and it strongly suggests her doctor may be reluctant to change her regimen. One thing working in her favor is the AACE/ACE Diabetes Algorithm for Glycemic Control, which shows a stepwise treatment plan for people with type 2 dm that goes from monotherapy to triple therapy to insulin therapy in a series of steps. Now, she is at triple therapy (Januvia, Metformin, and Amaryl), so if she cannot get her numbers down under 6.5, insulin is the next step and the first insulin docs will prescribe is one of the long-acting insulins, either Lantus or Levemir, one shot per day. If that does not bring down her bgs, then she’ll be taken off of the Amaryl and started on Humalog, Novolog, or Apidra.
FWIW, Humalog, Lantus, and the other insulins that are prescribed technically aren’t insulins, but are insulin analogs. That is, our lovely injectibles are genetically engineered, or as Wikipedia defines it: An insulin analog is an altered form of insulin, different from any occurring in nature, but still available to the human body for performing the same action as human insulin in terms of glycemic control. They’re not as “natural” as people think they are and the impact of injecting something that’s not quite insulin into ourselves isn’t truly fully known yet. At the same time, I will continue to take my Humalog and Lantus.
You bring up an interesting question about the analogs. From what I’ve read, in lispro (Humalog), lysine and proline at positions 28 and 29 are switched, and the reason it still works is because that is an inactive area of the molecule. Apparently, there is something similar in both Novolog and Apidra in the same place. So I wonder if that means that there truly is no biological difference between them and natural human insulin. Obviously we can use insulin that is not identical to our own, or pork and beef wouldn’t have worked, and while there were effects like lipodystrophy and hypertrophy, I don’t THINK there were any other long-term harmful effects. I could be wrong. But I wonder if that does justify the position that the analogs are safe.
great response.
fact is we are all on insulin.
when help is needed - boost of insulin; using needle with complete variability beats crap out of pills.
For me needle and insulin really provides extra degree of freedom and timing and abilityt to diet and lose weight.
pills absolute pain in ■■■ like taking hammer to flies.
+1 I’m T2 diagnosed in 96 my a1cs run 6.5-7.0 for the last couple years and i asked about going on insulin to get off all the oral meds I take now and he said I could but would require more testing and more precautions against lows. my exercise, diet and meds are working for me now so I’m going to stick with it but if this plan starts failing i’m ready to move onto whatever does work
very interesting argument.
Worst lows I ever had were on starlix pills and watching my diet closely and pill plus my body over produced the insulin.
I suspect your comments plus many other good folks like youself are pointing out the lack of decent knowledge
and control data for typ2 insulin resistant diabetics. I too had to dig like hell to get my hands around.
Interestingly in Europe, Doctors got to insulin for patients well before pills.
As a layman after 30 years of crap, I suspect the unfortunate " Insulin solves all" and just hammer with pills really does not help all type2 insulin resistant diabetics and industry needs to catch up and get better data. and realize type 1 approaches while critical and necessary for type 1’s is really not the overall answer for type 2.
Type 2 insulin resistant diabetes is not a single organ pancreatic disease that hammering with insulin does not really fix even if you could use some boosting of your body’s insulin production.
And if all you need is some boosting of insulin pills are useless.
Good luck with your doctor and best wishes in your search.