Agree 100% about the GP being VERY unlikely to prescribe insulin at this point. Maybe just a touch of Lantus/Levemir but not enough to even work for most Type 1’s (that is what I see GP’s do around here anyways)
Re: Insulin Analogs-
Anyone concerned about this certainly has the option of using Regular and NPH. As for me, I do not think it is likely this could be a problem but if it is? Oh well got to die from something…
My feeling is if you are doing as well as you describe, I would think for a very long time before going on insulin. Especially, since you are the one thinking about asking the doctor to put you on it, and not the other way around. I have not yet had to be on insulin, and my doctors have always suggested to me to avoid taking insulin for as long as possible.
Hi neilin,
Did your doctors ever give you a reason for avoiding insulin as long as possible?
I have noticed in my limited experience that people who still produce small but significant amounts of insulin have an easier ( I REALLY hesitate to use this word because none of it is easy) time with highs and lows than someone who produces little to none. If you think about it, the body then is able to help some when you have screwed up, which even the most controlled of us does on occasion. The thought is also that by using insulin earler you may be able to extend the amount of time your body can produce insulin.
In the end this is a personal decision as is most of diabetes management but I would hate for a Doc’s preconceived notions about waiting to start insulin paint a bad picture of needing insulin for you. There are likely good theories on why to delay insulin (although honestly any reason escapes me right now) but just like my paragraph above, these are only theories.
As one who has a pancreas adding lots of insulin and I am on a CGMS due to all the fracas of an overdumping liver, use of the correc t insulin has been rewarding and saved a lot of grieft with following comments:
a) oral pills simply cause pancreas to boot up pancreas output. One is still on insulin.
b) oral pills are a slege hammer approach and my worst lows where on starlix plus my pancreas.
c) liquid insulin allows for the finest garularity to boost one’s pancreas and injust injection time for best
d) since one has body insulin still working, I watch body bolus after eating lunch or dinner and only inject after gut/intestine starts putting out its glucose and bg has lifted above 140. Based on carbs eaten. I add a 2 to 4 unit
dose. If I inject before meal, dose adds to body bolus and takes bg down further before digestion completes.
As my liver wakes up with a vengence after waking up and any metformin has been exhausted, I insert dose of 4 units and this is sufficient for breakfast and keep liver under control. Wake up bg is usually 122 to 133 and after 4 unit dose in am, BG rises to 140 and sometimes peaks at 150. I eat breakfast shortly and bg stays pretty stable.
Until I had CGMS, I was unaware of any pancreatic action after 30 years on the dam oral drugs which I think are inappropriate for a type 2 trying to maintain diet unless ones pancreas is nearly exausted or at bottom.
I originally ended up on insulin due to a dam liver dawn effect that would shoot BG to 238 every morning reliably.
I was put on 26 units of 75/25 that was terrible. AFter shutting down liver dawn effect with 500mg does of metformin at 10:00pm and 12:00 am; bg was 122 to 133 at midnight and remained same at wakeup.
After fixing liver on metformin and now using hunalog lispro - 4 units in am; 3 units at lunch and 2 to 3 at dinner; bg now moves like slow waves on a placid lake and predictable. Previous 30 years - all over the map and unpredictable.
A1c went from 13.3 to 6.4 today.
On the other side of this mess one wants to control carbs closely and get heratyexercise - equivalent of 1 to 2 miles walking a day.
I’m wondering about the cost of insulin. Would an insurance company cover insulin treatment of Type 2 if oral medications are accomplishing the very low standard that insurance companies appear to have when it comes to control? My insurance company is happy to pay for the inexpensive metformin, but not so happy to pay for testing supplies. There standard of care is no more than twice a day. At this point in my diabetes, I can manage on two tests a day, but prefer to know more, like how new foods affect my glucose, and whether or not there have been any gradual changes over the last ten years. Testing four times a day, espeically if I’m feeling ‘off’ helps me keep tabs.
So how have insurance companies reponded to requests for insulin over oral meds? Just curious what others’ experience has been.
Talvie
First thing to do is see if your doc will write you a prescription. It’s really the doc’s call, not the ins. co. Some docs are willing to use insulin early in Type 2’s, and others are not. Good luck!
In my opinion, there is nothing wrong with your numbers. Although my A1c has been 6.0% for the past two years, my daily numbers are pretty much like yours, except that my fasting BG is 130-155. I have to be more concerned with lows than highs. I get severe low symptoms whenever I’m near 100. We’re all different. My sister feels perfectly fine at 42. I haven’t used any medication or insulin for three years. I’m sure I eat more than 80 carbs/day but I rarely eat any processed foods. Unlike what I’ve heard, my numbers did not get lower after losing 75 lbs.
It’s my understanding that insulin will cause weight gain only if you use it to allow you more dietary freedom - eat too much of the things you shouldn’t.
I was always told that insulin would make me gain weight and that hypos posed a serious health risk. I just had an appointment with my endo last week. She has only known me as an insulin dependent patient. She looked at my A1C and said maybe I don’t need insulin and that maybe medications would work. So we went through my discussion of how I was on three medications and could not reach target. And the truth is that my targets have always been more aggressive than the ADA and hence more aggressive than many doctors. She was concerned about hypos. She might have general concerns about weight, but I am not overweight and I have lost weight since starting insulin.
But my experience with insulin is as MossDog describes. I actually am blessed with easyy control since I have remaining insulin production. And having blood sugars that are almost always < 140 mg/dl means that I am doing everything to preserve my remaining insulin production. I take a long-term view and I’m very happy with my move to insulin.
My insurance company has no problem covering the cost of insulin if prescribed. It actually saves them a great deal of money. I had been on three medications when I moved to insulin, and one of those medications (Victoza) cost $400/month. I’ve alson not had any issue with test strips, I got a prescription for 8 times a day, but actually have reduced my needs to 3-6 times a day.
The real issue is for pumps, where the medicare and insurance criteria are biased against type 2s.
I think this is all relative. I have been very strict about diet and exercise and always suffered from chronic high fasting blood sugars, 120-140 mg/dl, no matter what I did. With numbers like that, I could never bring my after meal numbers down below 140 mg/dl no matter what I did. I don’t consider a fasting blood sugar like Cathy’s or yours to be “ok.” I am surprised that your A1c is so low, in fact I might suggest that your A1c may not be a good measure of your blood sugar control (an A1c of 6% corresponds to an eAG of 126 mg/dl, inconsistent with your fasting numbers).
Once you get your blood sugar normalized, your body will adjust to the new numbers within a week or two. Don’t be fooled into thinking that high blood sugars are ok because you feel fine with high blood sugars. I suspect that if you got your fasting numbers down to 80-90 mg/dl for 1-2 weeks your feelings of being low would totally dissappear.
It’s as if the health care industry is comfortable institutionally “marketing” the general aversion to injections and transforming it into complacency about the 120-140 range as in “oh, it’s not that bad”. I can’t help but think that is where a lot of the damage can be done? I look at BG as sort of like a bank and that “banking” generally good BG may help offset/ balance/ clean up some of the damage from when things go awry? I don’t get that sense in T2 patients. We occasionally “run into” them at work and I’m generally sort of mortified by some of the stuff I read. It also amazes me how little detail generally goes into the doctor’s reports, vitals, dosages that’s about it in a lot of cases. If you smoke, you get about 20 pages of brochures about how much smoking suxx but diabetes seems to be a different paradigm entirely? Sometimes I wonder what is in my medical records but not enough to bother getting them.
Super_sally on sept 22/2011 provides ecellent comment and catches the correct response to this mess.
My experience catches the same response and operation.
Why are we taking hammers to hitting flies when liquid injections allows one pancrease to do as much as possible and then add a small boost to keepfinal better control.
Pills for a lot are unhelpful
Get them for sure AR. You would be suprised at what you see. I have read dictations about my medical care that had nothing to do with what me and that Doc had talked about. I actually called him on it (I was afraid of someone accessing my info to determine eligibility for life insurance or some such craziness) and actually got the dictation changed to include an addendum.
There is a systemic dysfunction in the treatment of Type 2’s. It is considered by FAR too many people in the medical field, the media and the public, to be the “mild” kind of diabetes, because they’re not subject to the pressures of DKA and extreme hypoglycemia. Plus they’re “fat, old and ugly” people, not like the cute little kids who pull everyone’s heartstrings, or the rock stars and beautiful, thin celebrities and athletes we always see in advertisements and media articles. So they suffer much callousness, blame and shame, and discrimination. They don’t get the in-depth education they need, nor the support to keep with the program. In some states, CDE appts are not approved at all; in others, covered at such low rates that CDEs can’t even afford to stay in the program. And we all know that neither endos nor GPs have the time to really discuss the realities of diabetes with these people, much less encourage them to achieve truly healthy BG goals. So they get their education from the over-simplified media, and where does THAT get them? I feel so sorry for these people, because I think MOST of them really WOULD like to take care of themselves, and do follow advice such as they’re given – it’s just too bad that the quality of the advice is so poor!
Way to go Natalie:! You whacked the ball right out of the park on the issues. Thanks for writing and excellent descriptive response dealing with this.
All diabetes is deadly and dangerous.
Your comments highlite why I missed the seriousness of my diabetes 30 years ago and for my stupidity got stroke. I spent last 4 years cleaning up mess and getting monster back in cage.
For reasons you so eloquently describe and write, one can take the early days and issues less importantly when in fact one really needs to jump on full force, learn all one can, and get under control and understand how that is done. Meds, Carb Control and exercise and regular frequent metering are absolutely necessary to tame the monster, early and as soon as possible.
Ater being 28 years on extra insulin pills and treatment rather than catching my liver and now getting it under control, I too have my beef with the treatment of type 2 insulin resistant diabetes that is trying to ride too hard on all that is known from type 1 issues and problems. Yes, one has to start somewhere but its time to get on to solve the problems of type 2 diabetes and stop the doubling, tripling of type 2 diabetes rates that only proves we are not treating this problem correctly and threatens to bankrupt medicine, care and our ourselves individually and our country.
This is only worse due to the high price of test strips at $ 77 dollars for 50 strips and then Insurance company’s/medicare authorizing one strip a day.
WOW, I don’t know any more than when I started, except I must shop at a very good pharmacy and have a state that pays for parts of my diabetic care, more so than others.
I have my appt on Thursday of this week, and will definitely bring it up. However, that doesn’t mean I am going to press the issue. I usually do whatever it is I want to do as far as treatment for anything. My docs know that I research everything before making up my mind, from pain pills to procedures…so they do trust my thoughts and reactions and ideas a lot.
But thanks for your input. It just shows me that just as diabetes is one disease, but many in different people so is our treatment. It’s not rocket science, it’s taking care of ourselves for our own sakes.
Wow!!! Natalie you hit that one outta the park. Thank you!!!.Type 2’s are often blamed for their diabetes. Your right about the lack of education and support for T2’s. It seems all I ever got was a handfull of pills and advice to diet and exercise. I’ve been T2 for 25 years and have never seen or been offered an appointment with a CDE. I did once see a dietician and all I got was don’t eat this and don’t eat that but no constructive advice about what to eat.
Through their own ingorance most T2’s are their own worst critics and that creates a feeling of low self esteem which only compounds their problems.
Thank Goodness I have found a good GP that realized the pills were not working and put me on MDI’s
Hi Cathy:
Have you looked into naturally improving insulin sensitivity? What I’m talking about has less to do with limiting carbs and more to do with improving the nutrient to Calorie ratio by limiting or eliminating refined carbs and replacing them with more natural raw fruits and vegetables which give your pancreas a break while nourishing it back to health right along with the rest of your cells. It can make a significant reduction in your insulin needs while improving organ health. I quit taking Metformin several years ago and now rely on regular exercise and a super healthy, natural foods based diet along with a few well chosen supplements to give my body the nutrients that have been slowly removed from our diets by commercialized farming which has depleted the soil of many important nutrients (which is quite an intriguing story in and of itself). I posted a a link to an interesting article here yesterday on this very subject: Benefits Of Eating Almonds
I also posted a thought provoking blog with my thoughts on reducing insulin resistance here: Craig’s blog on insulin resistance
Craig
I agree. While I don’t find fruits contain much in terms of nutrients, meat and seafood are packed with nutrients and have about the highest nutrient to calorie ratio around. Almonds and other nuts are really good as is dairy, particularly cheese. But when it comes to nutrient dense food, particularly ones that don’t impact my blood sugar, I go for meat and seafood.
I find that fruits give me a distinct rise in BG to unacceptable levels, even though I take insulin to cover. The BG response to fruits is more rapid, and finishes quicker than the insulin action, so I peak high, and plunge low. So to me, it isn’t worth it. But, as usual, YMMV. If you have enough beta cell function to handle them, there ARE good reasons to eat fruit.