What's it like to use insulin?

I am type II diabetic and I am on 3 meds now. My Dr. may very well suggest I use insulin next week. I think he said Lantus would be his choice. He said I would start with a dose and then increase it until I get to the right levels.

Does this mean I will stop all my pills or just some of them? I use glipizide, metformin and Januvia. I have been on pills for 10 years. My weight is normal if that matters. Not thrilled about insulin but if I need it I can deal with it.

speaking as a physician, I’ll say that when it’s time for a typical patient to go on insulin after being on the meds you list, I’ll generally continue the metformin (it makes your body use the insulin that is there more effectively), possibly continue the januvia (but not usually), & usually discontinue the glipizide (since it just whips the pancreas to make more insulin, and if we are now adding insulin that’s usually because the pancreas has finally said to hell with it). And I’ll start them on a once a day dose of NPH or Lantus in the evening and see if we can achieve the target goals that way.

But precisely what I’d do would depend on the individual patient.

How often do type II people go on insulin? And if I were to exercise more could I get back off insulin in the future? I am normal weight but I am at the top end of normal so I hope to lose 20 lbs or so. I lost 20 in the past but recently gained it back so I am pretty sure I can lose it again.

The thing about Type II diabetes is that it is a progressive disease. Eventually the pancreas will reach a point where it burns out and stops insulin production. I am not your doctor and I can’t say where you are with your disease. Losing weight, exercising, and eating healthy can delay this progression by a long time. It certainly can’t hurt.

I deal with many patients who are started on Lantus and remain on some of their oral meds (usually metformin). Lantus is a basal insulin; that means it is only meant to provide insulin coverage for basic metabolism, i.e, what you need to just exist and breathe. Coverage for glucose control for meals has to come from somewhere else, either oral meds or another type of insulin.

If you haven’t had some instruction about using insulin safely and where this is all headed for you individually, talk to your doctor, or, if they have one they work with, a nurse practitioner or CDE associated with their office. (Disclaimer: I am a RN CDE, but I am not YOUR CDE. Please speak with your doctor.)

I expect they will send me to another round of diabetes classes which I am fine with. I went when I was diagnosed 10 years ago.

Often. Overall, it’s due to the natural progression of the disease. Failure to make modifications in one’s diet and lifestyle can certainly make it happen sooner. But needing to go on insulin doesn’t mean a person has failed to manage their disease appropriately. One can make the best choices and still get less than ideal outcomes.

Maybe. But don’t bet the farm on it. Give it your best shot (no pun intended) and see what happens. But many diabetics find that the judicious use of insulin with diet and exercise really makes it easier to manage their blood sugars.

In my opinion, the worst thing about using insulin is having to be very careful with your carb counting. It is much easier to get extremely low glucose levels when taking insulin, which is a very scary feeling and quite dangerous. I tend to get low blood sugar in the middle of the night or very early in the morning. Thankfully I have always woke when it was getting to danger levels but where I was still coherent enough to get some carbs in me. It’s a bad feeling, though, so just something to be aware of.

True, but most patients who’ve been on glipizide are not unfamiliar with low blood sugar symptoms, at least on occasion.

Oh, Ok. I’m not familiar with that particular drug, as I’m a type 1. My husband was type 2 but never used it either.

Very much this, and I should have said that more clearly - thanks, QtM!

From what I’ve read, many Type 2s who are progressing to a point where they need insulin often delay as long as possible. The idea of sticking a NEEDLE into yourself is off-putting.

Once they start the insulin, they do a huge forehead slap, and realize the superfine needles of today make the injections a non-issue.

And they FEEL so much better than they ever dreamed possible!
~VOW

The first time I woke up with blood sugar <200 was the day after I went on Lantus, so overall, I liked it. I’d struggled for about a month on Metformin and eating next to no carbs and never saw decent numbers, so I was very open to starting on Insulin.

That said, it is rather sobering to face the fact that I Am On Insulin. It was always something that someone else had to do, and I had a hard time getting used to having to do it myself. And yeah, that first time you have to stick a needle in yourself is hard.

Heck, it’s still hard. I’m on a pump now, but it broke a few months ago and it took 3 days to get a replacement, so I had to do the syringe routine for a while. I’m needle-phobic, so it’s not fun at all.

As far as the whole mechanics of it, I’d strongly recommend going with a pen instead of syringe-and-vial. Lantus sometimes stings when you inject it, that seems to get better if it’s at room temperature. Assuming your doctor agrees, experiment with your dose until your numbers are where you want them to be. Start small and work up (which incidentally is what made me fire my endocrinologist - he told me the typical dose for someone like me was 50 units a day and to start with that. That seemed like a huge amount, so we started with 15. As it turns out, I need about 13 units a day for basal. I’m pretty sure had we done what he said, I’d’ve ended up in the ER).

Take your blood sugar often during the day to see what it’s doing to you.

Minor sidetrack.

I’m also a needlephobic. I went on Humira for my arthritis (I was actually one of their guinea pigs in the initial human trials) and the first day that I had to inject myself, I was terrified. At least until I actually did the injection; then I got pissed because it didn’t hurt compared to all the shots in my butt and my shoulders that I had gotten in the years leading up to then.

[/sidetrack]

He also mentioned Victoza but from what I have read about that drug it seems like there are too many possible problems and it’s very new on the market. It is injectable. The other option is Byetta which is also injectable.

Doesn’t insulin tend to lead to weight gain? That’s my main concern about it.

Insulin can lead to weight gain if you don’t track your carbs and continue to exercise. Just insulin all by itself cannot put on pounds. CALORIES put on pounds.
~VOW

If Bijou Drain is only on Lantus, I’m guess he (she?) is probably not carb-counting. You only need to carb-count if you’re on a basal/bolus program. Lantus is just basal.

That said, my docs agree with what VOW said. The way it was explained to me was that a lot of diabetics get used to eating more than they should if their blood sugars aren’t in control. High blood sugar = you piss away a lot of calories, so you don’t gain weight even when overeating.

Once you get your blood sugar in control, if you don’t adjust your eating, you’ll gain weight. But if you eat a normal diet for your height/build/exercise level, you won’t gain weight any more than a non-insulin user would.

I know for me, I lost 20 pounds before I was diagnosed. Once I got my blood sugar in control, I gained back about 8-10 of those. That was about 2.5 years ago, and my weight has stayed steady enough since then that my doc always remarks on it when I go for my twice-a-year visits.

The weight gain was definitely due to just eating. Once I added a moderate amount of carbs back into my diet, the weight came right back. I’m determined not to gain back the other 10 pounds, though, so I exercise and moderately watch what I eat. It hasn’t been that hard to stay at the weight I’m at.

Pretty much what Athena said re: insulin and weight gain. Also, some weight gain in the short term is preferable by far to your blood sugar being out of control for any amount of time. Weight gain can be dealt with with changes in diet and activity. (I believe anyone being started on insulin should get a refresher on diet and carb management, because insulin changes the game.) Once type 2 diabetes is advanced enough, insulin is the -only- way to control blood sugar levels that works well enough - and the long-term effects of even moderately high blood sugar are not pretty.

Insulin has advantages in that it can be dosed precisely in a way pills and other medications can’t. It has few side effects, and is more natural to the way the body works. Many people do delay starting on insulin too long, sadly, and do themselves damage in the meantime.

Holy crap, I use 12 units [and will occasionally tweak up a unit or two if I end up carb heavy like wedding cake or birthday cake.]

Careful with the byetta, it is not insulin based, it is synthetic gila monster spit … it changes how the body metabolizes foods by slowing down the digestive track and can cause nausea issues [and in me it did a lulu! I lost food groups, first pig products caused nausea, then beef, then chicken … so I stopped and got the ability to eat the different animals back mostly, though I can still get a nausea reaction to food sort of randomly - like today the smell of baked chicken for lunch salad turned my stomach, but the roasted duck for dinner was just fine. Some days the smell of pork will turn my stomach, then the next day I can eat it just fine. However, I would still recommend that if your endo wants you to try it, give it a go. I used it for about 18 months before I started having food issues and it did an excellent job combined with metformin and januvia.]

I don’t know, that seems somewhat melodramatic to me (and I say that as someone that has been Type 1 since 1993). Everyone has their warning signals and, frankly, it is EXTREMELY unusual to sleep so long that it is going to be dangerous. You always wake up in time to do something about it.

Most hypos are more mildly unpleasant and if you are regularly going EXTREMELY low then, to be honest, you’re not doing it right and it is time to go back and see your doctor/nurse.

You just learn to always have a packet of sugar tablets on you just in case. Hell I currently have … goes to check … six in my bag at work. Here, have a look:

http://dl.dropbox.com/u/2346328/Photo%2029-05-2012%2014%2004%2057.jpg

(Note the Lantus hiding in there as well). That’s what being on Insulin is like. You always remember to do that. You get very used to injections very quickly, the first one is scary but pretty soon after that it is second nature.

That’s obviously a fake staged bag. I can tell, because a REAL diabetic’s bag has at least 30 used glucose test strips stuck in the seams and linings. :smiley: