repost-Fw: Type 2's have got it made!

[Guest guest]

Type 2's have got it made!

Type 2's: 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 2's 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 2's 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 2's 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 1's who, unlike Type 2's, 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 2's 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 2's 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

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

put you in the ER.

Emergency room

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 80's 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 2's 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.