Re: Type 2s: Insulin Early is Easy, Insulin Late is Not

[Guest guest]

Thank you !

This message is a definite keeper, and since I run a diabetes support group

in my community with approximately 17 members,I am going to print out this

message and give it to every one. I have four or five pumbers in the group.

The others are all type 2's.

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

Thank you !

This message is a definite keeper, and since I run a diabetes support group

in my community with approximately 17 members,I am going to print out this

message and give it to every one. I have four or five pumbers in the group.

The others are all type 2's.

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

Hi Jen,

This was a great read.

thanks for posting,

Brett.

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

Hi Jen,

This was a great read.

thanks for posting,

Brett.

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

Hi Jen,

This was a great read.

thanks for posting,

Brett.

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

That's a very good article about type 2's using insulin. As a type 2, I

typically have good fasting sugars between 78 and 90, unless I eat an

evening snack too late in the evening the night before, then I pay for it.

With that in mind though, how would I know if I'm insulin resistant or if

it's not going to help me? I might consider insulin even though I am not

having any real problems right now, but I want to know as much as I can

before I make the switch.

Also, on a side note, since I don't use insulin, I don't know the answer to

the question of how much would insurance pay for the insulin and other

necessary stuff? I use SCAN insurance (which is a California nonprofit

insurer) which covers my Part D Medicare. What might I be getting into from

the money standpoint?

I guess I'm kind of leary both from the concept of poking myself with more

needles, but also from being stuck with high costs from people like Liberty

Medical, who in my opinion were just way too expensive and troublesome. Any

info is extremely welcomed.

Thanks,

Bill Powers

[Guest guest]

, this was absolutely an education for me. Thank you so much.

Vicki

When you are DOWN to nothing... God is UP to something!

Type 2s: Insulin Early is Easy, Insulin Late is

Not

>I do not think this is the same article about insulin for type 2 diabetics

> as I posted a few months ago, but I found this online and thought it was

> fitting given some of the conversations going on lately. I do not know a

> whole lot about type 2, but I think many of them should be on insulin who

> are not. I also think that type 2s on insulin do not have the same kind of

> risk for hypoglycemia as type 1s, which might be what keeps a lot of

> people

> from trying it. This is a post from a diabetes blog called Diabetes

> Update,

> written by a woman who has MODY diabetes (not type 1 or type 2), but who

> writes a lot about type 2 issues. I will try to find the other article I

> posted a while ago and re-post that here as well.

>

> Jen

>

> Type 2s: Insulin Early is Easy, Insulin Late is Not

>

> I keep reading postings here and there on the web from people with Type 2

> diabetes that say something like, " My A1c was 11.5% even with Metformin,

> so

> my doctor told me it was time to go on insulin. "

>

> It is postings like this that bring home to me why so many Type 2s develop

> terrible complications, and even more importantly, why even those who are

> taking insulin often have dangerously high blood sugars.

>

> The most conservative of medical groups--the ADA--tells doctors that an

> A1c

> over 7% is going to cause serious diabetic complications like blindness

> and

> kidney failure. Yet these people's doctors have encouraged them to dick

> around with oral drugs when their A1cs were 10% or higher!

>

> The years they've spent at those dangerously high blood sugar levels

> waiting

> for oral drugs to do what all the research evidence shows oral drugs

> cannot

> do have wreaked havoc on their organs that may not be completely

> reversible,

> no matter what their blood sugars might be in the future.

>

> In fact, a recent survey I read somewhere on the web found that most

> family

> doctors don't put their patients on even an oral drug until the patient

> has

> spent a year with an A1c of 8% or higher. That is a whole, long year where

> dangerously high blood sugars are producing early retinopathy, advancing

> neuropathy, and making small changes that lead to kidney failure.

>

> Since none of the oral drugs is capable of lowering A1c much more than 1%,

> this kind of treatment is criminal. A patient whose A1c is 11.5% on

> metformin probably started out with an A1c of 12% or even higher. If you

> don't believe me, go read the Prescribing Information for each of the

> common

> diabetes drugs. They show exactly what the median change in A1c is that

> their drugs can achieve, and you'll see it is rarely much more than a 1%

> drop in A1c. For a patient with a 12% A1c, even a 3% drop would be

> pitifully

> insufficient. But that is how these people's doctors are treating them.

>

> All that unnecessary suffering. It makes me want to weep!

>

> For patients with an A1c over 8.5% there are only two therapies that will

> reliably bring blood sugars into the safe zone. Let's look at them now,

> very carefully.

>

> Carb Restriction

>

> Many newly diagnosed Type 2s with surprisingly high A1cs have reported

> online that they have been able to bring their A1cs down from 10% or

> higher

> to the safe 5% range by cutting the carbohydrates out of their meals until

> they were able to get a blood sugar under 140 mg/dl at one hour and 120

> mg/dl a two hours after eating.

>

> Though doctors pay lip service to the idea that their patients can control

> diabetes with " diet " a depressingly high proportion of these doctors seem

> to

> think that " diet " means " weight loss diet " rather than " Carb control diet "

> so their patients end up starving on high carb/low fat meals that push up

> their blood sugars to levels guaranteed to destroy eyes, nerves and

> kidneys.

>

>

> Cutting out the carbs that raise blood sugar is the only " diabetes " diet

> that will improve blood sugars for every person diagnosed with Type 2

> diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

> tried cutting way back on their starch and sugar intake, a stint of eating

> a

> true diabetes diet, one that avoids all starchy foods, no matter how full

> of

> " whole grains " they might be, a diet made up almost entirely of healthy

> greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

> all that is needed to perform blood sugar rescue.

>

> But if cutting your carbs doesn't make a dramatic difference in your A1c

> within a few months, there is only one sane therapy to consider, and the

> faster you demand it, the less likely you are to end up as another tragic

> diabetes disaster story.

>

> That therapy involves insulin.

>

> Insulin

>

> Unlike every other diabetes drug you may read about, insulin, prescribed

> properly (and those words are key) always works. Insulin is the only drug

> that will lower blood sugar in every critter that has a blood stream with

> glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

> lower the blood sugar. And insulin can lower blood sugar however much you

> need it lowered, if--and it is a big if--you learn how to use it

> correctly.

>

> This is such a simple concept, you have to wonder why most doctors treat

> insulin like it was devil's blood, trying every other possible

> treatment--some of them quite dangerous--before putting their patients on

> the one treatment that is capable of giving them normal blood sugars.

>

> In the past, doctors seem to have assumed that needles were so terrifying

> to

> patients that they would not use them unless faced with immanent death,

> and

> as a result, insulin wasn't prescribed until Type 2s were on death's

> doorstep. (Which, unfortunately, has made a new generation of diabetics

> assume that if you get prescribed insulin, you are on your way out.)

>

> But look what happened when Big Pharma came up with a new treatment,

> Byetta,

> that was rumored to cause weight loss. Despite the fact that Byetta

> treatment requires not one but two needles a day and can cause projectile

> vomiting, patients lined up demanding it and thousands of Type 2s are

> happily injecting themselves and whoopsing their way to happiness. So

> clearly when patients perceive a benefit in a treatment, they'll put up

> with

> needles.

>

> The benefit of insulin can be much greater, since Byetta only works to

> lower

> blood sugar significantly for a subset of those who take it. Insulin

> always

> works.

>

> Insulin Early is Easy, Insulin Late is Hard

>

> My belief--and this is how I treat my own diabetes--is that if diet

> (defined

> as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

> don't give you normal blood sugars, it is time to move to insulin

> while the beta cells still have enough life in them to make insulin safe

> and

> easy to use.

>

> This is a huge point many doctors miss. If your pancreas is a mess of

> scar

> tissue, you probably have lost your alpha cells too, and this means that

> you

> may have little or no ability to secrete glucagon to raise your blood

> sugar

> if it goes too low.

>

> If, on the other hand, you start using insulin when you still have 20-30%

> of

> your beta cells living, you can use

> lower doses of insulin

> and if you take too much your body will push your blood sugar out of the

> hypo range, because it still has the other pancreas-produced hormone it

> needs to do so.

>

> People with no beta cells have a much tougher time using insulin,

> especially

> when they use it to control post-meal blood sugars. The stories you hear

> from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some

> idea

> of what it can be like to use insulin when you have a dead pancreas.

>

> But most Type 2s don't have a dead pancreas, and though only a few of us

> have pioneered the " insulin early, not insulin late " strategy, those of us

> who have find that it makes living with diabetes far easier than we ever

> thought possible. Insulin supplementation takes the burden off our

> struggling beta cells. It can let us fine tune our blood sugars to where

> they stay relatively flat and do not ever go near the zone where glucose

> floods into nerves, eyes, and clogs up tiny kidney filtration units.

>

> As Dr. Bernstein points out, small inputs make for small mistakes, and

> when

> a Type 2 starts insulin early, the doses are much smaller than later, when

> they have no beta cells, and the mistakes are much smaller too.

>

> Here are some things your doctor might tell you if you want to start

> insulin

> that you might want to question.

>

> Insulin Myths

>

> 1. You'll gain weight.

>

> This is what kept me from starting insulin for years, when I should have

> been on it all along. It turned out NOT to be true as long as I use

> insulin

> in a way that matches my carbohydrate input.

>

> If you take more insulin than you need, you will get hungry. " Feeding the

> insulin " will pack weight on you. But if you learn how to determine your

> " insulin/carb " ratio, and inject an amount of insulin that matches your

> food, you should not gain weight. If you are taking a basal insulin,

> Levemir is also reputed to avoid weight gain.

>

> And I also find that for me, the analog insulins seem to provoke hunger.

> But

> R insulin (the cheap kind) does not, and I even managed to lose a couple

> pounds last year while injecting R insulin 3 times a day.

>

> 2. You'll have hypos.

>

> Using insulin requires using your brain. If you just want the doctor to

> tell

> you how many units to inject, and blindly do whatever you are told, hypos

> are a possibility.

>

> But if you read up on how to use insulin--using the books and materials

> intended for Type 1s who, unlike Type 2s, get training in how to use

> insulin

> properly, you won't. I have not had a blood sugar reading under 60 mg/dl

> fifteen months of using insulin with my meals.

>

> 3. Needles are Painful

>

> The shots don't hurt. I was as needlephobic as anyone, but it took about a

> day to figure out that my lancet for testing my blood sugar is a lot more

> painful than the hair thin needles I use for injecting. The first time I

> stuck myself with one, it was so painless I had to look down to make sure

> I

> really had stuck myself!

>

> Right now one company is marketing an inhalable insulin, one that isn't

> very

> easy to use and which is very tough to match to carbs, by playing on

> people's fears of needles. It is much more expensive than even the most

> expensive injectibles, and it may harm the lungs. It is completely

> unnecessary.

>

> Give yourself a few days to get over your needle phobia, and you'll end up

> laughing at how huge it used to loom in your mind. Injecting insulin

> really

> is No Big Deal.

>

> 4. All you need is one shot of basal insulin

>

> There are two kinds of insulin. One lowers your fasting blood sugar and

> runs

> slowly in the background. Lantus, Levemir, and to a lesser extent NPH

> insulin are in this category. This kind of insulin does NOT bring down

> high

> post-meal blood sugars, it just lowers the point from which the post-meal

> spike begins.

>

> Most Type 2s get put on basal insulin, because it is easy to use. But if

> your diabetes is mostly about very high post-meal blood sugars, a basal

> may

> not solve your problems. So you may think that insulin doesn't work for

> you,

> when in fact, the problem is you are using the wrong kind of insulin.

>

> The meal-time insulin or " bolus " insulin is the insulin you match to your

> carb intake. The key for a Type 2 to making meal-time insulin work well is

> to keep your carb intake reasonable. Type 2s still have a small bit of

> homemade stuff that kicks in after a few hours, unlike a Type 1. It is

> not

> realistic to think you can eat 100 grams of carbs and match it with

> insulin,

> because the variations in timing of all that carb hitting your system,

> mixed

> up with your " sputtering pancreas " occasionally throwing a dollop of the

> homemade stuff, are too complex to calculate. And if you dump huge amounts

> of insulin into your system and it misses those huge amounts of

> carbohdyrate, well, yes, you do have a problem--one that can, worst case,

> put you in the ER.

>

> But most people with Type 2 can match 30 grams of carb or even 40 with

> insulin without problems, especially after some practice, and possibly by

> using the slower R insulin which is more gradual in its effect.

>

> It may take you a lot of cautious experimentation to figure out exactly

> how

> much carb and insulin you can use safely--starting out with a very low

> dose

> and a small amount of carbs and carefully adjusting carbs and insulin

> until

> you reach a level you can live with that gives you blood sugars that are

> safe and normal.

>

> When Is Insulin NOT Useful

>

> The only people for whom insulin is not a good idea are those who are

> still

> producing high levels of insulin, whose diabetes is caused entirely by

> insulin resistance, not beta cell failure. Many of these people are very,

> very large.

>

> Typically, if your diabetes is caused by insulin resistance, your blood

> sugar will drop to normal levels very quickly as soon as you cut out most

> carbs. By " normal " I mean fasting blood sugars in the 80s or better. But

> if

> your diabetes is caused by beta cell problems, though your blood sugar

> will

> drop in response to a low carb diet, your fasting blood sugar may still be

> over 100 or worse no matter how low your carbohydrate intake.

>

> You may also be able to determine if you are highly insulin resistant by

> having your insulin levels tested. If they are much higher than normal

> while

> fasting, then you may be seriously insulin resistant and adding insulin

> may

> not be the answer for you since your problem is that your body isn't using

> insulin, not that you don't have enough.

>

> Doctors often seem to believe that all Type 2s are seriously insulin

> resistant, but in practice, this turns out not to be true. Mine told me I

> " obviously " was insulin resistant, but when I finally started taking

> insulin, my response was that of a Type 1 not a Type 2, showing I had very

> little insulin resistance

> at all--and that I really needed insulin supplementation.

>

> That's enough for now. We'll come back to this topic again, though!

>

> Internal Virus Database is out-of-date.

> Checked by AVG.

> Version: 7.5.524 / Virus Database: 269.23.16/1429 - Release Date:

> 5/12/2008

> 6:14 PM

>

>

>

> ------------------------------------

>

>

[Guest guest]

If you docator prescribes insulin and say 6 strips a day, your insurance

should pay for it. I know several people on SCAN who have complete

coverage-although I don't know if they have recently approved the meter or

strips for the Prodigy.

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

That's a very good article about type 2's using insulin. As a type 2, I

typically have good fasting sugars between 78 and 90, unless I eat an

evening snack too late in the evening the night before, then I pay for it.

With that in mind though, how would I know if I'm insulin resistant or if

it's not going to help me? I might consider insulin even though I am not

having any real problems right now, but I want to know as much as I can

before I make the switch.

Also, on a side note, since I don't use insulin, I don't know the answer to

the question of how much would insurance pay for the insulin and other

necessary stuff? I use SCAN insurance (which is a California nonprofit

insurer) which covers my Part D Medicare. What might I be getting into from

the money standpoint?

I guess I'm kind of leary both from the concept of poking myself with more

needles, but also from being stuck with high costs from people like Liberty

Medical, who in my opinion were just way too expensive and troublesome. Any

info is extremely welcomed.

Thanks,

Bill Powers

__________ NOD32 3263 (20080711) Information __________

This message was checked by NOD32 antivirus system.

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[Guest guest]

If you docator prescribes insulin and say 6 strips a day, your insurance

should pay for it. I know several people on SCAN who have complete

coverage-although I don't know if they have recently approved the meter or

strips for the Prodigy.

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

That's a very good article about type 2's using insulin. As a type 2, I

typically have good fasting sugars between 78 and 90, unless I eat an

evening snack too late in the evening the night before, then I pay for it.

With that in mind though, how would I know if I'm insulin resistant or if

it's not going to help me? I might consider insulin even though I am not

having any real problems right now, but I want to know as much as I can

before I make the switch.

Also, on a side note, since I don't use insulin, I don't know the answer to

the question of how much would insurance pay for the insulin and other

necessary stuff? I use SCAN insurance (which is a California nonprofit

insurer) which covers my Part D Medicare. What might I be getting into from

the money standpoint?

I guess I'm kind of leary both from the concept of poking myself with more

needles, but also from being stuck with high costs from people like Liberty

Medical, who in my opinion were just way too expensive and troublesome. Any

info is extremely welcomed.

Thanks,

Bill Powers

__________ NOD32 3263 (20080711) Information __________

This message was checked by NOD32 antivirus system.

http://www.eset.com

[Guest guest]

Pat,

I'm going to be asking my doctor about possibly going on insulin. Yes to me

it is scary because I've heard all the stuff about insulin making you gain

weight, which I have been fighting so hard NOT to do, but at the same time I

would like even better control than I'm getting with oral meds. Knowing that

oral med control will one day just not cut it, does give me incentive to

switch before I would HAVE to switch.

Bill Powers

[Guest guest]

Have no fear about gaining weight on insulin. This will not happen if the carb

intake matches the insulin injected.

RE: Type 2s: Insulin Early is Easy, Insulin Late is

Not

Pat,

I'm going to be asking my doctor about possibly going on insulin. Yes to me

it is scary because I've heard all the stuff about insulin making you gain

weight, which I have been fighting so hard NOT to do, but at the same time I

would like even better control than I'm getting with oral meds. Knowing that

oral med control will one day just not cut it, does give me incentive to

switch before I would HAVE to switch.

Bill Powers

[Guest guest]

Have no fear about gaining weight on insulin. This will not happen if the carb

intake matches the insulin injected.

RE: Type 2s: Insulin Early is Easy, Insulin Late is

Not

Pat,

I'm going to be asking my doctor about possibly going on insulin. Yes to me

it is scary because I've heard all the stuff about insulin making you gain

weight, which I have been fighting so hard NOT to do, but at the same time I

would like even better control than I'm getting with oral meds. Knowing that

oral med control will one day just not cut it, does give me incentive to

switch before I would HAVE to switch.

Bill Powers

[Guest guest]

I am with Bill. I am also going to talk with my doctors about why I should

not be on insulin for optimal control and to preserve what function I have

for as long as I can. I contacted a few dietitians/diabetes educators today

for some consultation.

I would like if someone could go through a description of what insulin and

its tools are like. What are the seringes like and what is the process for

a blind person for preparing and giving injections. Where do we need

assistance with what, if anything. I've never seen anything more than play

seringes from kids' doctor kits.

Thanks!

[Guest guest]

As far as needle length, as long as you are not overweight, you can use the

shorter ones. You can ask the pharmacist. These are only 3 sixteenths of an

inch long, and very thin. Admittedly, they do sometimes sting, but more times

than not, you really don't feel much. If you can tolerate a finger prick,

taking an injection will be a cakewalk.

Dave

Victim of a crime? Know someone who was?

http://victimsheart.blogspot.com

RE: Type 2s: Insulin Early is Easy, Insulin Late is

Not

I am with Bill. I am also going to talk with my doctors about why I should

not be on insulin for optimal control and to preserve what function I have

for as long as I can. I contacted a few dietitians/diabetes educators today

for some consultation.

I would like if someone could go through a description of what insulin and

its tools are like. What are the seringes like and what is the process for

a blind person for preparing and giving injections. Where do we need

assistance with what, if anything. I've never seen anything more than play

seringes from kids' doctor kits.

Thanks!

[Guest guest]

The syringes in a kid's doctor kitt is pretty similar to the real thing-only

the real thing is usually smaller and the needle shorter andmuch thinner. I

seem to think that most docs nowadays are prescribing insulin pens, which

are easier to use as you do not need a separte insulin measuring device. I

have a pump, but on the rare occasion my pump has not worked correctly I

still use the count-a-dose machine, wheich uses half cc syringes (BD brand)

to inject. Harry gave aaccurate description of how to nject with a syringe.

I have never used a pen, so can't ell you exactly how they work-I have only

see them demonstrated.

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

I am with Bill. I am also going to talk with my doctors about why I should

not be on insulin for optimal control and to preserve what function I have

for as long as I can. I contacted a few dietitians/diabetes educators today

for some consultation.

I would like if someone could go through a description of what insulin and

its tools are like. What are the seringes like and what is the process for

a blind person for preparing and giving injections. Where do we need

assistance with what, if anything. I've never seen anything more than play

seringes from kids' doctor kits.

Thanks!

__________ NOD32 3266 (20080714) Information __________

This message was checked by NOD32 antivirus system.

http://www.eset.com

[Guest guest]

Usually they start you out on a low dosage of either levemer or lantis,

which should not cause you to loose weight and they will cut down the

gliberade. I have several type 2's who started on insulin and gained

wight, but the docs (not endos unfortunately) put htem on high dosages

insulin, so they had toeat more to keep up the insulin. What is your A1 C

running Bill? I doubt they will put you insulin unless you are running a

high A1C. Do you do BG's during the day -say 2 hours after eating? Those

levels can tell the doc if you need insulin more than just fasting BG's I

know lots of type 2's who have good fasting BG's, but then run high most of

the rest of day-but they won't do BG's after meals to know this-only their

high A1C's tell them!

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

Pat,

I'm going to be asking my doctor about possibly going on insulin. Yes to me

it is scary because I've heard all the stuff about insulin making you gain

weight, which I have been fighting so hard NOT to do, but at the same time I

would like even better control than I'm getting with oral meds. Knowing that

oral med control will one day just not cut it, does give me incentive to

switch before I would HAVE to switch.

Bill Powers

[Guest guest]

, my A 1 C has been pretty constant the last 6 years, 5.1. I think

once it was actually 5.2, but it's been 5.1 for the longest time.

Postprandial readings about 2-1/2 hours, I'm between 100-120 at the most. If

I take a reading earlier than 2-1/2 hours it can be almost 130. So for

whatever reason it is, I find that 2-1/2 hours works for me to see a

reasonable level.

I suspect that I will have an uphill fight to even get started on insulin

because generally my lab work is very good and I do have good control of my

sugars, but I'm not even going to say I'm close enough to being " normal "

either. I'd rather err on the side of caution even though I do have

generally good sugars because having a false sense of security is a very

dangerous thing and can lead to real problems. We all know that since the

docs are ruled by insurers, even people like SCAN, they're going to side on

the cheaper modalities, i.e., pills. This will be interesting to test how

well my doc is willing to go to bat for me when I present him with my

arguments for going on insulin as a preemptive measure rather than waiting

until it becomes necessary. I'll need all the luck I can get.

Bill Powers

[Guest guest]

, my A 1 C has been pretty constant the last 6 years, 5.1. I think

once it was actually 5.2, but it's been 5.1 for the longest time.

Postprandial readings about 2-1/2 hours, I'm between 100-120 at the most. If

I take a reading earlier than 2-1/2 hours it can be almost 130. So for

whatever reason it is, I find that 2-1/2 hours works for me to see a

reasonable level.

I suspect that I will have an uphill fight to even get started on insulin

because generally my lab work is very good and I do have good control of my

sugars, but I'm not even going to say I'm close enough to being " normal "

either. I'd rather err on the side of caution even though I do have

generally good sugars because having a false sense of security is a very

dangerous thing and can lead to real problems. We all know that since the

docs are ruled by insurers, even people like SCAN, they're going to side on

the cheaper modalities, i.e., pills. This will be interesting to test how

well my doc is willing to go to bat for me when I present him with my

arguments for going on insulin as a preemptive measure rather than waiting

until it becomes necessary. I'll need all the luck I can get.

Bill Powers

[Guest guest]

, my A 1 C has been pretty constant the last 6 years, 5.1. I think

once it was actually 5.2, but it's been 5.1 for the longest time.

Postprandial readings about 2-1/2 hours, I'm between 100-120 at the most. If

I take a reading earlier than 2-1/2 hours it can be almost 130. So for

whatever reason it is, I find that 2-1/2 hours works for me to see a

reasonable level.

I suspect that I will have an uphill fight to even get started on insulin

because generally my lab work is very good and I do have good control of my

sugars, but I'm not even going to say I'm close enough to being " normal "

either. I'd rather err on the side of caution even though I do have

generally good sugars because having a false sense of security is a very

dangerous thing and can lead to real problems. We all know that since the

docs are ruled by insurers, even people like SCAN, they're going to side on

the cheaper modalities, i.e., pills. This will be interesting to test how

well my doc is willing to go to bat for me when I present him with my

arguments for going on insulin as a preemptive measure rather than waiting

until it becomes necessary. I'll need all the luck I can get.

Bill Powers

[Guest guest]

If it ain't broke, don't fix it. Most people would do most any thing to have an

A1C of 5.1. This is in the range of a non-diabetic.

RE: Type 2s: Insulin Early is Easy, Insulin Late is

Not

, my A 1 C has been pretty constant the last 6 years, 5.1. I think

once it was actually 5.2, but it's been 5.1 for the longest time.

Postprandial readings about 2-1/2 hours, I'm between 100-120 at the most. If

I take a reading earlier than 2-1/2 hours it can be almost 130. So for

whatever reason it is, I find that 2-1/2 hours works for me to see a

reasonable level.

I suspect that I will have an uphill fight to even get started on insulin

because generally my lab work is very good and I do have good control of my

sugars, but I'm not even going to say I'm close enough to being " normal "

either. I'd rather err on the side of caution even though I do have

generally good sugars because having a false sense of security is a very

dangerous thing and can lead to real problems. We all know that since the

docs are ruled by insurers, even people like SCAN, they're going to side on

the cheaper modalities, i.e., pills. This will be interesting to test how

well my doc is willing to go to bat for me when I present him with my

arguments for going on insulin as a preemptive measure rather than waiting

until it becomes necessary. I'll need all the luck I can get.

Bill Powers

[Guest guest]

Dave, your observation is well stated. Relizing the fact I have diabetes and

can't get around it, I'm very lucky to be as well off as I am. My plan is to

keep it that way. I never did go through that stage where I would kid myself

into thinking I could be healed from diabetes, I just accepted it and moved

right along. For me, it was actually a relief that the doctor finally

diagnosed me with the disease, I had suspected it for 30 years but always,

always fell through the cracks for whatever reason. I was just lucky to have

had a very good doctor back in Baltimore who had some real savvy to spot the

problem and he nailed it. Now the rest is up to me.

Bill Powers

[Guest guest]

The idea that " if it ain't broke, don't fix it " is good, but I know in the

back of my mind that some time down the road, which could be next year, five

years, or maybe next month, the pills could start to slip in their

effectiveness setting off forced change. Knowing this ahead of time, I would

rather be proactive and keep my good health rather than letting it slip and

then having to recover. That's why I'm seeking to better myself now rather

than later. If it's inevitable why wait until I'm backed up against a wall?

Bill Powers

[Guest guest]

The idea that " if it ain't broke, don't fix it " is good, but I know in the

back of my mind that some time down the road, which could be next year, five

years, or maybe next month, the pills could start to slip in their

effectiveness setting off forced change. Knowing this ahead of time, I would

rather be proactive and keep my good health rather than letting it slip and

then having to recover. That's why I'm seeking to better myself now rather

than later. If it's inevitable why wait until I'm backed up against a wall?

Bill Powers

[Guest guest]

Bill,

If your A1C stays at 5.1 or 5.2, it will be difficult to convince your

doctor or endocrinologist that you need to switch to insulin. Your control

seems to be very good with the regimen that you are on. If you monitor your

blood sugar regularly and have bloodwork done to check your A1C, you will

know quickly when things change. At that point, it may be necessary to

switch to insulin and you have all the necessary information to make the

switch.

One other thing you may want to consider is that for some diabetics, the

switch to insulin from pills can be difficult. It may take some time to

find the correct regimen that will work for you and this transition period

can be difficult for some people. Finding the right insulin and dosage may

not take much time for you in your situation, but you should be aware, that

for some people, it can be difficult.

If I were in your situation, I would continue with my current medications

and only make the change when you start to lose good control of your blood

sugars. Ultimately, you will have to decide which approach works best for

you.

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

The idea that " if it ain't broke, don't fix it " is good, but I know in the

back of my mind that some time down the road, which could be next year, five

years, or maybe next month, the pills could start to slip in their

effectiveness setting off forced change. Knowing this ahead of time, I would

rather be proactive and keep my good health rather than letting it slip and

then having to recover. That's why I'm seeking to better myself now rather

than later. If it's inevitable why wait until I'm backed up against a wall?

Bill Powers

[Guest guest]

Bill,

If your A1C stays at 5.1 or 5.2, it will be difficult to convince your

doctor or endocrinologist that you need to switch to insulin. Your control

seems to be very good with the regimen that you are on. If you monitor your

blood sugar regularly and have bloodwork done to check your A1C, you will

know quickly when things change. At that point, it may be necessary to

switch to insulin and you have all the necessary information to make the

switch.

One other thing you may want to consider is that for some diabetics, the

switch to insulin from pills can be difficult. It may take some time to

find the correct regimen that will work for you and this transition period

can be difficult for some people. Finding the right insulin and dosage may

not take much time for you in your situation, but you should be aware, that

for some people, it can be difficult.

If I were in your situation, I would continue with my current medications

and only make the change when you start to lose good control of your blood

sugars. Ultimately, you will have to decide which approach works best for

you.

RE: Type 2s: Insulin Early is Easy, Insulin Late

is Not

The idea that " if it ain't broke, don't fix it " is good, but I know in the

back of my mind that some time down the road, which could be next year, five

years, or maybe next month, the pills could start to slip in their

effectiveness setting off forced change. Knowing this ahead of time, I would

rather be proactive and keep my good health rather than letting it slip and

then having to recover. That's why I'm seeking to better myself now rather

than later. If it's inevitable why wait until I'm backed up against a wall?

Bill Powers