After 10 years its seems I now need to take insulin to keep in control. Anyone out there ever discontinue their oral meds once they hit that point? If you can keep yourself in control on insulin alone and you have to take it anyway, why tax your liver and kidneys with the pills?
I started on my OmniPod pump 12-1-11 and am so 'normal' now it is exciting. Love it.
I started insulin in May 1994, when, after 5 months, it became apparent that Glucotrol (a sulfonylurea) wasn't doing a bloody thing. About 6 months after that, metformin came on the market, but I was doing so well on insulin alone, I couldn't see any reason to try anything else.
The lesson I took away from that is do what works. Each of us is different, and even among T1's there are some that benefit from metformin. IMHO, all the others are too new to know whether the risks are worth the benefits, except if nothing else works. You should talk to your doc and CDE if possible and think it through for yourself.
I use both Insulin and metformin.
Metformin's role in my mind is needed if ones liver is leaking - throwing back excess glucose when it should be fasting.
If that is not issue, then metformin may not have large benefit.
In my case Metformin is the heavy hitter and the liquid insulin is the boost item on pancreas effort.
I hate the oral pills as they simply cause the pancreas to slam in extra insulin willy nilly and one better eat enough or suffer the lows.
Stemwinder has captured it well. In Europe, Doctors go to liquid insulin quickly and do not prefer the oral stuff.
If ones Pancreas is still working, the liquid insulin is variable, controllable and can complement pancrease effort nicely without blasting the body.
AFtre 30 years , I see no value to the oral crap and wish I had gone on liquid insulin sooner. In the end, for T2's; I do not see the sense and use of the oral stuff except to wear out the pancreas sooner.
I was dx'd in October and started taking insulin after Christmas, at my own request. My post-prandial BG numbers were high and often stayed elevated for hours. I was grateful that my endocrinologist doesn't like sulfonylureas and so I didn't have to deal with that. I'd read a lot about those drugs and the endo told me that he's convinced they burn out beta cells prematurely and may actually damage pancreases more than the body will without their help.
I take Humalog with meals. It's been a struggle to figure out dosages, particularly in terms of calculating my needs at breakfast or anytime I eat a meal that has very little or no carbohydrates. Protein raises my BG slowly. Humalog is a fast-acting insulin that peaks, for me, at about 90 minutes post-injection and seems to be out of my system in about three or three and a half hours. Figuring out how much insulin to take, when to take it and whether to divide doses is an ongoing puzzle, in some ways, but I think I'm getting the hang of it at last.
I'm delighted to be using insulin because it's not the scary thing I thought it was before I was diagnosed and because I can see the results within an hour or two. I have a reasonable idea of why my BG goes up and down in response to what I eat or my activity level and I have a way to correct it if it goes too high. I've continued to follow a low-carb way of eating, with about 20 grams of carb per day and I haven't gained any weight. I'm also taking 2000 mg of the extended release form of Metformin. It does help with dawn phenomenon, but doesn't prevent it entirely.
I'm the kind of person that finds information comforting. Insulin seems to be giving me a great degree of control and that helps reduce my anxiety. I believe that I will be able to manage my diabetes well, be healthy and live a good, long life. It may be that I will be able to stop taking Metformin and insulin at some point. That would be great, but I'm not worrying about it right now. I'm celebrating how good I feel!
I'm still on oral meds after 5 years but with carb restriction and exercise I keep pretty much normal bgs close to 100. I prefer never to spike over 120. I am trying to stay away from insulin basically because my high deductible insurance won't cover the cost until we hit an unbelievable $11,000 per year. I have 4 years until Medicare and then I will re-assess the situation. My husband has been D for 15 years and is still on oral meds and can keep HbA1c in the 5's. I don't think anyone should let their bgs go above 140, ever. But lots of time adjusting diet should be the first thing you try. If that doesn't work then consider insulin. I do think Insulin does add another set of side effects and complications. I hear lots of stories of people on insulin who still aren't well controlled because they haven't addressed the diet issue.
Jeannie, I commend you and your husband for all your hard work! You've set yourself high standards, and I think it's impressive that you, and especially your husband have done so well for so long! :-)
Of course, in T2, there are many different possible disorders, so depending on the individual, the course and treatment needs will be different, but I think the message is that you do your absolute best with the cards you've been dealt.
I think the most important treatment modality is a good attitude, and boy, you folks have really got it! :-)
I would be interested to know if those of you who are taking insulin received training and/or monitoring or if you had to figure it out yourself?
My only training was one shot of saline several months before I went on insulin. It was during a class I went to whose goal at the time was to get me off the oral med I had just started by diet and exercise (didn't work), but they had everyone give themselves a shot of saline, just so people could experience what an injection felt like.
When I actually went on insulin, the doc just wrote me a prescription, and that was it. However, there are/were instructions in the package, and I had seen and read enough that I actually did know how to do it. It WAS nerve-wracking to take my first shot of real insulin, but ultimately entirely worth it! LOL!
My oncologist was the one who started me on insulin. They sent a visiting nurse to my home to teach me how to give myself injections, even though I'd already done it with another med. The instruction took a minute or two, then we had a cup of coffee and a nice conversation.
I was started on a sliding scale (*shudder*) and told to call if I went over 400. I woke up a bunch of on-call oncologists a bunch of times ;)
What exactly is the sliding scale? Sounds like it's not a good idea? Do they still put people on a sliding scale?
Peetie, I found this wonderful (partial explanation) on wikipedia: What physicians typically refer to as sliding-scale insulin is fast- or rapid-acting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold, usually 10 mmol/L. No basal insulin is given, usually resulting in an elevated blood glucose each morning, which is then chased throughout the day, with the cycle repeated the next day.
Basically, you do a fingeretick and give a fixed amount of a -log insulin depending on the results before meals. My opinion - it's useful for docs who don't know what they're doing (like oncologists) but know they need to do something. Sure didn't work for me!
Raising hand to say "Me, too!" ANYONE who is on insulin at all, and many people who usually take orals, should, if hospitalized, AT the very LEAST be given coverage for meals (some people's bodies can handle their basal needs themselves). Basals and corrections if needed, and and frequent BG checks at appropriate times to SEE if basals and corrections are needed. Having diabetes (either type) in a hospital or nursing home is DANGEROUS!!