What may seem like a stupid question.

[Kubilee]

I wanted to make a new post about this because I didn't want to hijack the "Why don't you use insullin poll" thread.

PLEASE keep in mind that I am so new to this, was just diagnosed on May 11th. I started out then at nearly 400 on my meter and am down to right around a 100 average, give or take a few depending on time of day and so on.

NOW, here comes the crazy part, and again, I am very new to this, so don't hammer me over my head.

1) WHY on earth would I WANT to use insulin, which to me means shots, and I am horrified of needles..

2) If I needed it, wouldn't my Doctor perscribe it to me?

3) I keep seeing this, and from what MY nurse told me, since she was the one that really did the talking to me, but she told me I was lucky I had Type II because Type I is worse, that is when I'd be in real trouble. But now I am curious about this. From what I am seeing, is Type II worse or Type I, I am very confused on this.

Please know I am not a complete idiot, but there are some things I am still more than the extreme side of confusion on. Any help would be hugely helpful to me, as I am sure to other newly diagnosed Diabetics with tons of questions. ;)

[Kubilee]

I am on Actoplus Met, so I am not sure if this is insulin or not, or maybe or in the middle or down the side....... what? :T

[hannahanne]

Actos is a medicine for people with type 2 diabetes and actos plus I believe also has metformin in it.

With type 2, a doctor will try to see if diet and exercise will be enough.

However, if your blood glucose level is high like yours when you are diagnosed (and mine was very similar when I was diagnosed) then he or she will often give medicine from the start.

Your doctor will give you weeks to a couple of months to see if you can control your blood glucose with Actosplus.

From what you've said, you blood glucose is down within acceptable levels, so you medicine seems to working for now.

As long as your medicine works, I doubt if your doctor will put you on insulin.

It's only at some time in the future when these medicines may not be able to control your blood glucose levels that you may need to take insulin.

Please don't worry about knowing things; the only way you'll learn is to ask.

It took me quite some time to wrap my head around the idea of having diabetes, and I'm learning new things all the time.

P.S. Please remember that the more you keep your diabetes under control through diet, exercise, and taking your medicine, the less likely it will be that you'll need to use insulin at a future date.

It's not mentioned as much but controlling stress and getting enough sleep also help to keep blood glucose under control.

As another post says, diabetes stinks, but the good news is that it can be controlled.:)

[owlyn]

Answers to 1 & 2: You would want to use insulin because it allows you to lead a more "normal" life in terms of what you can eat. You are simply replacing the function of your pancreas by injecting insulin. You can eat the same things as everyone else, and just take enough insulin to compensate for it. But- this also means that, just like everyone else, if you eat too much of the wrong things (and inject to compensate), you will gain weight- just like everyone else. So, you can either eat less, or exercise more (or both). Just like everyone else.

Doctors tend to not prescribe insulin for Type 2s. Why? One reason is that doctors assume that people would rather take pills than use a needle. After all, who isn't afraid of needles? Well, I'm not, at least not after taking my first injection many years ago. The BG finger prick hurts way more than the usually painless (usually can't even feel a thing) insulin injection. Also, there may be medical reasons having to do with insulin resistance, I believe (Type 2s can answer this part better). Other possible reasons (mostly logistical or psychological)- the doctor doesn't want to have to go through the discussion/argument/training issues with the patient that would occur if he prescribes insulin. It's just easier to go "here, take a pill, see me in 3 months" than to try to convince you that it doesn't hurt, it doesn't mean that you (or the doctor!) failed or are in some way more defective, and then to have to show you how to use a syringe (most don't have pens on hand), dispose of it, and all the other training issues. Sure, they can send you to a class, but then you have to go to the class. Patient compliance is one of the biggest problems in medicine. So, "take a pill and follow a diet..." is a really easy option. Plus, sometimes this actually works, so why go through all that hassle (the doctor is thinking)... we can always switch to insulin later if this doesn't work. BTW, for many (not all) T2s, insulin is a matter of when, not if. Before you T2s start arguing, I have been told this by three GPs and a top endocrinologist. So, if that is true, IMO, you may as well go on insulin now and start eating what you want (once your weight is under control!)

Answer to question 3: Your nurse is a moron. Get another one. Soon. And you may want to report her to her supervisor. Maybe she was trying to make you feel better, but what she said is incorrect. You can make all kinds of arguments that one is "worse" than the other, but the only thing that is true is that uncontrolled diabetes is worse than controlled diabetes. T1 or T2 makes no difference if it is not controlled. IMO, and it really is just an opinion, T1 is easier to control than T2, so there's my argument for T1. Run that by her and see what she says.

[Lloyd]

1) WHY on earth would I WANT to use insulin, which to me means shots, and I am horrified of needles..

2) If I needed it, wouldn't my Doctor perscribe it to me?

3) I keep seeing this, and from what MY nurse told me, since she was the one that really did the talking to me, but she told me I was lucky I had Type II because Type I is worse, that is when I'd be in real trouble. But now I am curious about this. From what I am seeing, is Type II worse or Type I, I am very confused on this.



1. Type 1's must take insulin.

Type 2's have a number of methods of keeping glucose control. Diet, exercise, oral medications to increase insulin sensitivity, oral medications to reduce the output of sugar by your liver, oral medications to slow your digestive process down to reduce peaks in sugar level, oral meds to induce your pancreas to produce more insulin; and taking insulin by needle, pump or inhaling it.

The lower your average glucose level, and the fewer and shorter the peaks in your blood sugar, the lower the risks of diabetes complications such as amputation, kidney problems, eye problems and heart problems.

About 30% of type 2's are on insulin, estimates are another 30% should be.


2. For type 2's the tendency is to wait and not go on insulin until the above methods do not get the job done. Not many patients want insulin, but it does work, there are no side effects except weight gain if you do not reduce your carbohydrate intake. Pills are so much easier, but how well they work and for how long varies, much of it is dependent on how well you take care of yourself.

3. Type 1 and Type 2 are different, which is worse can depend on your point of view.

Type 1's take insulin, the problem is getting the right amount to balance the food you eat without going too low, or too high. Some type 1's are very sensitive to insulin, so a tiny bit has a huge effect on them. It can be a very touchy thing.
Other factors like illness or infections can make good control extremely difficult or impossible.

Type 2's have a much smaller chance of going too low, their body is still doing some of the regulation and they are resistant to insulin, not sensitive at all. Regulation on oral medications is fairly easy in comparison, in many cases.
But Diabetes is a progressive disease. Often, in time, your pancreas can no longer meet your insulin needs, even with the help of oral medications, no mater how well you have taken care of yourself. So then you take insulin in addition to the oral medications, to get the job done.

When comparing the two, there is another huge factor that some people don't even think about (including the above mentioned uninformed nurse).

Offen type 2 is just one part of Metabolic Syndrome. Some of the other parts are high blood pressure, high tryglicerides, high colesterol, sleep apnea. These are usually genetic, or the result of the excess weight that triggered (not caused, triggered) the type 2. Then there is often the neverending struggle to keep your weight down as well.

So, when comparing Type 1 and Type 2 and asking which is worse, all I can say is take your pick. This may well be one of those "grass is greener" cases.

-Lloyd

[MJB]

Owlyn, I think you have a tendency to look at T2's from a T1 point of view.

You must bear in mind that T2's are insulin resistant and for many they already have enough insulin, they just can't use it effectively. Therefore, injecting even more insulin is not a panacea for their high BG levels.

The notion that a T2 can eat what they want and cover it with insulin does nothing to address their IR problems.

The simple answer, for a T2, is you will be prescribed insulin if and when you can no longer make enough of your own. If you're making enough on your own there is no reason to add more.

I'm not a doctor but this is my understanding.

BTW, if I needed insulin I would not hesitate at all to use it. But I'm running A1c's of 5.6 last 2 checks so why would I even want to consider it?

[owlyn]

Owlyn, I think you have a tendency to look at T2's from a T1 point of view.

You must bear in mind that T2's are insulin resistant and for many they already have enough insulin, they just can't use it effectively. Therefore, injecting even more insulin is not a panacea for their high BG levels.

I agree with you! Note that I did mention the insulin resistance issue, and that a T2 could address that issue better. Many T2s could be on insulin, though. IMO, they are missing out. IOW, if you can take it, you should. besides, i hate taking medications that work, but we don't know why...

[ladytaz]

The others have given some very good explanations and made some very good points!

As to which one is worse ... I don't think one is worse than the other. They're different, but with the same end result [high BG] if uncontrolled.

I don't think insulin needs to be given as long as meds (pills), diet and exercise are doing the job! It's when those things stop doing the job, that I feel insulin needs to be taken.

However, I do feel that all T2's should be given the option (patient's choice, not doc's choice - or lack of even offering it) to take a shot of fast acting insulin in the event they are having a high BG moment!

It is SO very stressful to have a high BG and not be able to do a thing about it, but sit and wait it out! I KNOW! Been there done that more than I care to have been!

No question is ever stupid! If you don't ask, how ever are you to learn?? :wink:

[Gary_W]

I'll only re-inforce what others have said on your 3rd point. It isn't a case of one type being worse than another. It is high blood glucose that causes the damage with diabetes, not which type it is. That just makes the difference of how you manage it.

Type 2 tends to have a more restrictive diet than type 1 (though some type 1's beleive that eating really low carb is better for control). Type 1 will always have to inject.

I am guessing it is the fear of injecting that caused the nurse to make her comment; it's pretty typical for someone who is not in this club to believe that the shots are the worst bit. As a severe needle phobic, I can tell you now that you soon get over it as shaking in fear for 30 mins before injecting gets old reaaly fast. Within 2 weeks I was cured. I believe a shrink would call it flooding therapy and charge me handsomely :D I think for most people that the shots are the least of your worries with diabetes.

Gary

[Kubilee]

I am guessing it is the fear of injecting that caused the nurse to make her comment; it's pretty typical for someone who is not in this club to believe that the shots are the worst bit. As a severe needle phobic, I can tell you now that you soon get over it as shaking in fear for 30 mins before injecting gets old reaaly fast. Within 2 weeks I was cured. I believe a shrink would call it flooding therapy and charge me handsomely :D I think for most people that the shots are the least of your worries with diabetes.

Gary


You hit it right on the head with this point I think. They all know up there that I am horrifiedof needles, even when they give my kids shots, I shake, I just can't stand them. If there is a movie on TV and they pull out a needle, I have to turn my head and fast or I'll get chills down my back.

She knows this and maybe this is why she said that. She being a diabetic herself, she was pretty straight forward with me and she said she didn't much like needles either, so maybe this was a personal preference and knowing me on top of that.

When they took blood from me, I jumped so hard that I had to have it redone, which was stupid and I knew it, but I knew what was coming somewhere in the back of my mind and I wanted to just start getting used to seeing it right there and then.... and when it touched my arm, I almost jumped out of my chair.

I just knew I was going to have **** poking my own finger 3 times a day, but I knew it was something I had to do so I just psyched myself out on it and did it and it doesn't bother me in the least now, I know I HAVE to for my own survival.

And in my head, you eithe rhave diabetes or you don't, the whole needle thing is what scared me about all of this, and I knew it was coming since 90% of my mother's family has or has died from complications from this, but THEY never once looked after it, not one of them that I remember growing up around even would act like they had it, do what needed to be done or anything and I watched them struggle and die off like flies because of it. And I knew at some point, I would be where they were/are and I have always feared it like I fear needles themselves... but it actually isn't near as bad as I have had in my head and I actually FEEL better, I am eating better, taking care of myself better and all of that, so as horrible as it sounds, it's almost like a blessing in disguise, it forced me to look after me and provide my KIDS, most of all, with the idea that it is coming to them, and I need to set an example for THEM, a better one than I had.

You have all been so very great to me and I am so glad I am here, you have helped me, been straight with me, not pulled any punches with me and I respect this, and I am so grateful for it. THANK YOU!!

I do and will have more questions and I know some will come off so stupid, but I want/NEED to know every spec of info I can on this... NOT the info I was armed with beforew *I* had to face it, but CORRECT info, for me as well as for my kids futures.

[tanyatype1]

The needle phobia thing is kinda funny eh? I think back to before being diagnosed, ..... how many times the thought had run through my head, about how horrible it must be for diabetics that have to use needles everyday. Never in a MILLION years thinking that I'd end up one of them! After diagnosis - tough luck baby! Suck it up - you have ZERO choice in the matter. Still seems so bizarre to me,... to be insulin dependant. All I can say now is, Thank God! for the insulin pump. :) (One needle every three days is sooooo much sweeter than numerous needles DAILY.)

[Kubilee]

The needle phobia thing is kinda funny eh? I think back to before being diagnosed, ..... how many times the thought had run through my head, about how horrible it must be for diabetics that have to use needles everyday. Never in a MILLION years thinking that I'd end up one of them! After diagnosis - tough luck baby! Suck it up - you have ZERO choice in the matter. Still seems so bizarre to me,... to be insulin dependant. All I can say now is, Thank God! for the insulin pump. :) (One needle every three days is sooooo much sweeter than numerous needles DAILY.)


Insulin Pump?

Ok, ok, ok, next question.... I am seeing that one alot now too. Logic tells me what it is, but can you tell me how that works? And why is it once every few days as opposed to daily?

You guys keep saying that poking my finger is way more painful than a needle, I am not saying you don't knowwhat you are talking about, but that doesn't make sense to me. How can one little prick be less painful than ramming a needle into my skin and so on? Seems like a fast poke would be better than a full on injection?

See? I warned you guys of getting into my head, it's quite the mess in there. :T

I am so hoping this is helping someone else besides just me... and I am not the only one with these crazy ideas in my head. lol

[Dervish]

Insulin Pump?

Ok, ok, ok, next question.... I am seeing that one alot now too. Logic tells me what it is, but can you tell me how that works? And why is it once every few days as opposed to daily?

You guys keep saying that poking my finger is way more painful than a needle, I am not saying you don't knowwhat you are talking about, but that doesn't make sense to me. How can one little prick be less painful than ramming a needle into my skin and so on? Seems like a fast poke would be better than a full on injection?

The pump is a pager- or deck-of-cards-sized device containing an insulin reservoir and attached by flexible tubing to an infusion site where the insulin actually enters your body. It delivers a slow, steady supply of "basal" insulin and can be told to deliver an additional "bolus" dose when you eat or your glucose level is high. The infusion set needs to be replaced every three days, which is why you only have to stab yourself that rarely - the same needle stays in place for the full three days, constantly delivering insulin.

I'll agree that the fingerpricks are more painful than injections. I suppose this is probably a combination of the lancet being a thicker needle (the insulin syringe needles are fine enough that I frequently don't even feel them at all), people being more likely to reuse lancets than syringes (allowing the tip to become bent and the lubricant to wear off), a higher density of nerve endings in your fingers than at injection sites, and just plain wear and tear (I test twice as often as I inject, but have fewer usable places for tests, so they get used more often). Did I miss anything?

[Gary_W]

Insulin Pump?

Ok, ok, ok, next question.... I am seeing that one alot now too. Logic tells me what it is, but can you tell me how that works? And why is it once every few days as opposed to daily?

You guys keep saying that poking my finger is way more painful than a needle, I am not saying you don't knowwhat you are talking about, but that doesn't make sense to me. How can one little prick be less painful than ramming a needle into my skin and so on? Seems like a fast poke would be better than a full on injection?

See? I warned you guys of getting into my head, it's quite the mess in there. :T

I am so hoping this is helping someone else besides just me... and I am not the only one with these crazy ideas in my head. lol


The whole point of a lancet needle (excuse the pun) is to break the skin enough to cause it to bleed. If you look at it close up, it's actually quite broad like a little blade. A lot of the lancet devices have adjustable depth settings to make it more comfortable. I must say that I rarely feel it any more (I test at least 7 times a day, and I only use 2 differnt fingers for 99% of the time).

The insulin needle is very fine indeed. You get the odd one that catches you, but even then it isn't painful. And that's only because I re-use them until they are blunt.... You have to be pretty unlucky to feel them when they are brand new.

[barko]

finger sticks are more painful for sure ;-)

There is a good selection of small, thin-gauge injection needles like the 5mm, 31 gauge mini, etc. - doesn't even require pinching up skin. It's not like the movies with some 8 inch long nail, usually delivered by a nurse who looks alot like Dracula.

Check this link to learn more about needles, gauges, etc (http://www.bddiabetes.com/us/main.aspx?cat=2&id=409)