My fasting blood sugar is continuously higher than it should be, ranging from 6.5(117) to 8.5 (153).

I'm on metformin with breakfast and supper, but it doesn't seem to have an effect on my fasting numbers. Probably because I have minimal self-discipline and love a bedtime snack, but even with taking that into account I am generally more insulin resistant in the morning.

So to tackle this problem I decided to try apple cider vinegar. I've used it for the last two nights, mixing 2 teaspoons in a large glass of water. So far it appears to have had no effect on my fasting numbers.

It's main effect has been to make me hate the taste of apple cider vinegar with a passion. I suppose I could increase the amount I'm taking (yuck!) or give it up as a bad job.

I'm heading back to the lab in two months time for another HbA1C. If there hasn't been a major improvement I think I'm going to advocate for changing treatment.

I think perhaps a low dose of a long-acting insulin taken at night might be the answer. I'm fearful of going low particularly during the night, but I guess if I start with one unit and keep some glucose tabs right next to the bad it couldn't be too bad. My doctor of course is horrified at the thought of insulin, but she's not the person who will have to live with the complications....

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Comment by David (dns) on March 24, 2014 at 8:53am

I'm going to climb onto a soapbox here. Please bear with me. :)

Insulin is not something to be afraid of. But people (and doctors, who are supposed to know better!) are reluctant to use it for a lot of reasons.

One huge point of resistance comes from the fact that nearly everyone knows, or knows of, someone who had serious complications, was put on insulin and then declined rapidly. So they associate the failure with insulin, which is nonsense. The rapid decline in such a case is due not to the insulin but to the fact that it was prescribed too late to do any good. The appalling tragedy of cases like this is that if insulin had been prescribed early enough, the patient's condition probably would never have gotten that bad to begin with. An outrage, IMHO.

Many doctors are reluctant to prescribe insulin because they think patients are terrified of injections. And some people do have this phobia, no question. But the disparity between the number of people who actually are afraid of injections, and the number of people who doctors think are afraid, is great. I've seen surveys in which both doctors and patients were asked about their attitudes. Upwards of 60% of the doctors said they don't prescribe insulin because patients fear injections. But only around 20% to 25% of the patients in those surveys said they feared them. That's a lot of people who could be benefiting and aren't.

The crux of the issue is that both doctors and patients view insulin as a "last resort". Which is utterly absurd. Insulin is just a tool, like metformin or physical therapy for an injury. The key to solving a problem effectively and efficiently is to use the right tool for the job.

If you had a broken leg, would you put off the hassle of having a cast? Would you look on it as a "last resort" and delay as long as possible? Obviously not. You'd want it and you'd want it RIGHT NOW. Right tool for the job. That's all.

When I realized I was never going to get the control I wanted with pills, I went in and demanded insulin. To say it has been life-changing is an understatement. My control is better by an order of magnitude than it's ever been. In hindsight I wish I had done it years sooner.

I'll end this with one simple thought. The world renowned Joslin clinic now starts every newly diagnosed diabetic on insulin right away. Hmmmm. Perhaps they know something?

Comment by Stemwinder (Gary) on March 24, 2014 at 9:37am

I want to second what David said. If done correctly insulin is safe and is nothing to create Horror. The only thing scaring this doctor is his own lack of knowledge.

Insulin does have it challenges and it requires effort to use it safely but it is the most powerful and most natural thing for controlling BG. I hate it when people consider insulin in T2 to be a failure, it is not, it is a failure to not start insulin when it is needed.

I would suggest to your doctor that it is his own lack of knowledge that scares him. If insulin is what you need I would suggest to him that he concur his fears and if he is not willing then find another doctor. An endocrinologist might be a good way to go at this point.

Comment by Lloyd on March 24, 2014 at 9:39am

After 12 years of oral medications, my A1c went from 7.1 to 8.7 quite rapidly. Insulin has made a very solid impact in my life. I am on a pump, and my last 6 1/2 years my A1c has been in the low 5's. That's the normal non-diabetic level.

Best wishes,

-Lloyd

Comment by Neil on March 24, 2014 at 11:19am

My story. I have not had the luxury of doctors advice. I have been on metformin for over a year. On my last trip home I got myself insulin Apidra and Lantus. The first few months I was fine and then my fating BG levels started getting worse and worse. I am very active and run a lot so they had been low. HbA1c was 6.2. I then started using the Lantus at night. Started on one unit and over the time I have got too 4 units at night and everything is back in since. I use the Aprida as I do not have control over the dinning and not sure what is in the food. So if it high I normally take maximum 2 units. I now feel a lot more relaxed the before. `only having the meds was very tough for me and the life style I live. So yes i am a believer that you have to do what works for you. I think the thing is to be consistent with what you do and to have a log that can guide you with useful information.

Comment by Ila on March 25, 2014 at 6:38am

I was on metformin and drs became concerned about my kidneys. Started me on Levemir at night. Scare about kidneys turned out to be nothing, but still on insulin. Some people see going on insulin for Type 2 as a failure, but you do what you have to do. If diet and other meds always work, then T2s would never have to use insulin. But they don't always work. As individuals, we have to do what is right for us,

Comment by Lloyd on March 25, 2014 at 6:43am

Insulin is a powerful tool which allows you to manage your diabetes, rather than the other way around.

Comment by Megan S on March 25, 2014 at 11:55am

Thanks for the replies. When I was first diagnosed (was diagnosed years ago, then 1 year later told the diagnosis was wrong) I was put on insulin. When I was first rediagnosed last year I was told to try diet and exercise, then put on metformin. I asked for insulin, and the doctors (general practitioners) told me I need to stop reading things on the Internet and let them be the experts.

I think it might be time to head back to the endocrinologist I went to when I was first diagnosed....

Comment by David (dns) on March 25, 2014 at 1:54pm

Editorial:

In my experience, very few doctors are "experts" where diabetes is concerned. The appalling prevalence of misdiagnosis is sufficient proof of that. (And very few will actually listen to you, either).

And it's not really surprising, or shouldn't be. Doctors are trained to deal with acute illness. They are taught next to nothing about day-in, day-out management of chronic conditions.

5% of what I know about managing diabetes came from the medical profession and 95% from self study and the online community. Right now my control is the best it has ever been, by an order of magnitude. QED. I rest my case.

End of editorial.

Comment by Lloyd on March 25, 2014 at 2:38pm

I've had to deal with 2 new doctors in the past 2 years. The first thing I did is present them with proof on paper (test results) that I am expert at managing my diabetes, and they have left me alone to do it.

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