Insulin for Type 2's. How much?

[matingara]

this has been bugging me for a while.

my GP said he would prescribe insulin for me if i want him to.

being as i have achieved a 5.9% A1c on diet, exercise and a very small dose of a sulfonylurea drug - i decided that i don't need to do this yet.

my question is if i stay on my diet (restricted carb 30-60 grams/day) how much insulin would i take?

for example, i woke this AM with a BGL of 95 mg/dl (5.3 mmol/l).

would i inject a small amount of insulin at that level?

or would i only inject before meals (i.e. let my system handle its own basal BGL).

thanks!

-- Joel.

[TomB]

Joel,
If I'm not mistaken, an A1c at 5.9% is within the normal range for humans without diabetes. And a fasting BGL of 95mg is also under the maximum of 100 for the normal range. Perhaps you don't want to fix it if it isn't broke and just keep on doing whatever you have been. Sure looks like it's working to me.

FYI, American Diabetes Association Home Page (http://www.diabetes.org) web site and might have more info for you. They say that normal fasting glucose should be 70-100mg.
Tom

[matingara]

Joel,
If I'm not mistaken, an A1c at 5.9% is within the normal range for humans without diabetes. And a fasting BGL of 95mg is also under the maximum of 100 for the normal range. Perhaps you don't want to fix it if it isn't broke and just keep on doing whatever you have been. Sure looks like it's working to me.

FYI, American Diabetes Association Home Page (http://www.diabetes.org) web site and might have more info for you. They say that normal fasting glucose should be 70-100mg.
Tom

thanks Tom!

i understand what you are saying. my question was more theoretical than anything else.

i.e. if my numbers were slightly higher - an A1c of 6.5 and an average fasting BGL of 126 (7.0). what amounts of insuli would you inject and when?

-- Joel.

[Jill-O]

That's just impossible to answer.

How insulin resistant are you? 30-60 grams of carbs a day might mean one amount of insulin for me, another for you and something different still for someone else.

It's almost like saying how many gallons of gas does it take you to drive 50 miles and expecting us to have a uniform answer (when we all drive different vehicles and in different conditions).

But, since I know you are wanting numbers, I take 6, 8, and 14 units of Humalog before breakfast, lunch and dinner. I take 30 units of Lantus at night. My numbers are very good and I eat probably 125 or so of carbs a day.

[xMenace]

TCOYD: Insulin Therapy for Type 1 and Type 2 Diabetes (http://video.google.com/videoplay?docid=-4101282707002944749&q=starting+on+insulin&total=11&start=0&num=10&so=0&type=search&plindex=1) This might be the good video I posted last year. Maybe not.

[pdxdennisj]

The ADA and the Amer Soc Of Endo's suggest that A1c's below 7.0 are desirable. My Endo and Lipid specialist are VERY happy with mine at it's current 6.1 and were content when I was at 6.5. I eat less than 180 carbs a day - I try to hold it to 40 per meal. There are a few docs out there who think lower readings are necessary for good health. I think that is fine for those who want to live that way but do not think the evidence shows it is necessary. Different insulins work in different ways so that is a choice entirely up to the treatment regimen your doc develops.
I can so absolutely no reason for doing insulin now. I was on oral meds for 15 years before it was necessary to go on insulin.

[Alice]

That's difficult to say since there are two types of insulin...one that is slow acting to cover your basal levels and the second one...fast-acting to cover meals.

If your having problems more with overall basals...then probably Lantus.

If your having good fastings and before meals but having problems with eating...then Humalog or something identical.

It depends on your type of insulin problem...supply or resistance.

[matingara]

thanks everyone for your thoughtful and informative answers.

i am certain that i am insulin deficient and not insulin resistant. next time i do my A1c (June) i am also getting a c-peptide/GAD test to see what my insulin production is like.

i am 5'10" and my weight varies from 175-180lbs. since i have added anaerobic exercise (as recommended by Dr. Bernstein) to my aerobic exercise i am starting to see the definition of my stomach muscles (i should post a pic :D :D :D ).

my weight is not really an issue. that is why i think i am deficient - not resistant.

[matingara]

That's just impossible to answer.

How insulin resistant are you? 30-60 grams of carbs a day might mean one amount of insulin for me, another for you and something different still for someone else.

It's almost like saying how many gallons of gas does it take you to drive 50 miles and expecting us to have a uniform answer (when we all drive different vehicles and in different conditions).

But, since I know you are wanting numbers, I take 6, 8, and 14 units of Humalog before breakfast, lunch and dinner. I take 30 units of Lantus at night. My numbers are very good and I eat probably 125 or so of carbs a day.

i wasn't really asking for specifics - just general theory on what type and how to work out how much and when to take it.

your example gives me excellent input. thank you.

i know from experimentation that 1 gram of carbs will raise my BGL about 1.8-3.6 mg/dl.

so, if i eat 50 grams i will expect a 2 hour post prandial excursion of between 90-180 mg/dl (5-10 mmol/l).

so - therefore i try to limit my grams of carbs per meal to 15-30 grams.

-- Joel.

[matingara]

The ADA and the Amer Soc Of Endo's suggest that A1c's below 7.0 are desirable. My Endo and Lipid specialist are VERY happy with mine at it's current 6.1 and were content when I was at 6.5. I eat less than 180 carbs a day - I try to hold it to 40 per meal. There are a few docs out there who think lower readings are necessary for good health. I think that is fine for those who want to live that way but do not think the evidence shows it is necessary. Different insulins work in different ways so that is a choice entirely up to the treatment regimen your doc develops.
I can so absolutely no reason for doing insulin now. I was on oral meds for 15 years before it was necessary to go on insulin.

interesting input! doctors i have spoken to have mentioned that the oral solution could last as long as 12-15 years.

i really cut down on the carbs because i had a keen desire to get an A1c <6%.

i like the low carb lifestyle. i have been a lifelong salad nut and now i have an excuse to eat them all the time!!!

:)

-- Joel.

[ant hill]

my GP said he would prescribe insulin for me if i want him to.

being as i have achieved a 5.9% A1c on diet, exercise and a very small dose of a sulfonylurea drug - i decided that i don't need to do this yet.
Is this a Doctor or an Endocrinologist is telling you this??

my question is if i stay on my diet (restricted carb 30-60 grams/day) how much insulin would i take?
None!!! I would keep the regime that you have. :)

for example, i woke this AM with a BGL of 95 mg/dl (5.3 mmol/l).

would i inject a small amount of insulin at that level?
NO!!

or would i only inject before meals (i.e. let my system handle its own basal BGL).
Again no, As you have a working Pancreas (you lucky thing) why have a injectable source of insulin? As this will make control so much more difficult to manage and you will not like the lows ether. Are you on metaformin Joel?

[dacruzer]

Those are really good numbers:)

[matingara]

Is this a Doctor or an Endocrinologist is telling you this??

Are you on metaformin Joel?

This is a Doctor. a GP. he is pretty young - mid 30's.

i am not on metformin. i take only Diamicron MR. This is a sulfonylurea. i only take half of the max dose.

Thanks Peter.
:)

[ant hill]

Heh, I wonder if the doc is nice looking. :) But then the idea to take insulin is not for you Joel so you can have a sundae and not have to calculate the carbs so that you need insulin to cover the snack. :(

[marcia87]

Do you eat after taking your Lantus at night? I increased my nightly dose to 20u at 9:00 pm and woke up at 5:00 this morning sweating and feeling odd. I checked my bs and it was 42. Can you wait until breakfast to eat? I'm thinking of switching to mornings for the Lantus. What do you think?

[Emm]

TCOYD: Insulin Therapy for Type 1 and Type 2 Diabetes (http://video.google.com/videoplay?docid=-4101282707002944749&q=starting+on+insulin&total=11&start=0&num=10&so=0&type=search&plindex=1) This might be the good video I posted last year. Maybe not.

Good vid, thanks XM
There's a guy in it towards the end who is meant to be a type 2 who started insulin. Surely he's a T1? Not that its any of my business, nor does it really make a difference, but this guy is being a role model for T2s who need to start insulin yet he screams of LADA to me!

[Jill-O]

Do you eat after taking your Lantus at night? I increased my nightly dose to 20u at 9:00 pm and woke up at 5:00 this morning sweating and feeling odd. I checked my bs and it was 42. Can you wait until breakfast to eat? I'm thinking of switching to mornings for the Lantus. What do you think?

NO, at 42 you need to EAT right then. That is too low.

I take my Lantus after dinner. It doesn't really have a peak like the rapid insulins do. For a sudden low, I would not blame Lantus.