Type 2 diabeties

[Uf035]

Hi
Well my husband is on metformin and glicazide for type 2 diabeties and he has been loosing lot of weight since past 5 years and I'm done looking at that metabolism he has its just washing off his system.so we decided to ask our GP for insulin so thankful to her she already advice it herself to give a try basically for a bit of weight stability and control on sugar levels so I want to ask would this be the good idea to go for its difficult in this busy life to eat carefully though he does eat decent. Appreciate any replies similar experiences on Insulin.

I'm not sure from your post but are you seeing that he's always got high blood sugar readings? Is that why you think he's being loosing weight? Extended periods of hyperglycaemia can cause weight loss, as well as many other health issues.

Do you know what his hba1c blood test result is like? How often is he checking his blood sugar levels with a home meter?

I'm asking because the hba1c is going to be useful for knowing how well controlled his diabetes has been over an extended period of time. In general the doctor wouldn't start someone on insulin, unless they aren't achieving reasonable control.

The next thing they will need to know is what the difference between before food, after food and night time blood sugar readings are. So they can determine the best type of insulin, short acting, long acting or a mix that will suit him. He may require to test 8 times a day, during the initial period of starting and adjusting the dose.

When you are taking insulin you have to get used to making sure you are eating at regular times and avoiding things like binge drinking. There's more concerns about watching out for low blood sugar (hypoglycemia) and knowing how to treat it. If your husband drives, he will have to inform DVLA, have a medical condition licence that renews after 3 years and he will have to comply with their requirements for monitoring blood sugar levels before and during driving. There are also jobs where it might be an issue.

However that said, if he needs better control than he's got at the moment, then he's likely to require insulin or another injectable medication like a glp-1. Getting good control is essential to not ending up with other serious life affecting illnesses. It will take time and education but once he gets stabilised, he's going to feel much better. Especially if he's had 5 years of poor control, which I think is what you were alluding to in your post?

Why do you think random people on mumsnet reading this secondhand story can give you better advice than an actual doctor?

Appreciate your reply!
Wow wow thankyou so much u made really really strong advice here he is a pco licende holder and a driver and taking insulin ( which is basically our choice)may effect his license thankyou so much completely forgot that thing
Well yes he is 76 now they told him to monitor on a testing thing small machine which is somewhat crazy it shows 24 sometimes attimes 14 but he is monitoring somehow.every 3months he has bloods done for his diabetic review and thsi time is high!
Will speak to GP about the other options

Ah just an advice moving if anyone done similar to moving from oral to injectable for diabeties definitely being in 🇬🇧 it's the GP WHO RULES ! NOT US keeping this in mind just educating myself to get knowldge to speak front of her

Just saying that insulin isn't a magic bullet and he'll still need to be very aware of his eating/drinking habits. It's not a "cure all" to continue eating crap foods etc. At some point, he'll have to start taking his consumption seriously and do something about any poor choices he's making.

Before going down the insulin route, why don't you try using the Libre constant blood monitoring sensors which give real time readings to his smart phone every minute of the day. They're not cheap, but they can be very effective in highlighting what foods/drinks are causing his blood sugars to be so high and for some people who actually want to take control, they bring in the accountability and control that they need to give them a kind of "reset".

Have you considered Mounjaro?

I was on 8 units of insulin morning and evening and 2000mg metformin. Asked for and was prescribed Mounjaro and was able to come off of all the insulin and metformin.

Also have been losing weight.

I self fund the Freestyle Libre sensors which I found really useful for identifying which foods are triggering high sugar levels and since about week 2 of Mounjaro I've been within the recommended range of under 10n/mol 99% of the time.

If you go to the Abbott UK website you can request a free trial Libre freestyle 2 Plus. The you just download the free app and apply the sensor and have 2 weeks of constant readings sent direct to your phone.

Does he have access to a Diabetes Nursing team? I've found them much more helpful and knowledgeable than the GP to be honest.

Yes he does see the diabetic nurse once in 3months.

Just be careful with insulin, he's now prone to proper hypos which can obviously kill quickly.
My advice is get him a CGM if he's definitely going down the insulin route, my son is type one and uses a Dexcom g6 he'll need a smart phone to get his readings, we use an IOS phone that has the Sugarmate app on that rings up when our son drops into a hypo so we can attend to him immediately on the night as they can be pretty nasty.

That said you have more control with a CGM and his blood sugars will be much better controlled.

Also the wonderful thing about insulin is you can eat whatever you want long as you dose correctly.

Appreciate this advice inwill note this too

I really want him go less number 2(sorry) because of the metformins etc
I really wnat to see him gain some weight being on insulin with low metabolism"may be as it direct to blood not through stomach unlike oral medicines

We really want to try and see I will surely update next what would happen.
Qe will try to fix eating habit aswell we are mostly carb eaters with meats chicken non alcoholic though less oil forsure.

Lower carb (doesn't have to be full keto) should help.

Those numbers - even at the lower end of the scale - are very high and that will account for the no.2s. Metformin helps the body get rid of excess blood glucose and that is how. I always find when I am eating better (and by better I mean type 2 better and fat loss - not what society tells us we should eat for weight loss) the whole - ahem - output situation is a lot better.

Does he exercise? Whilst cardio is great, strength training is what will help get the BG down. Build muscle to absorb some of those excess sugars.

As previous poster has said those are very high blood sugar readings and definitely will lead to long term problems. He probably will feel quite unwell when he has readings over 20 too.

Going onto insulin isn't an excuse to eat whatever you like though and you shouldn't be increasing insulin to eat more or poorly. The first thing any diabetic needs to change is their diet and reducing carbs will be beneficial, as carbs get converted to sugars by the body. It's also useful to change the type of carbs to complex carbs because they take longer to get metabolised. So changing white bread to brown, white rice to wholegrain rice and so forth. Diabetes UK has a course for helping with the change in diet and I believe that you can get a code from the doctor to be able to access it cheaper or free.

Regarding driving when using insulin, you also need to inform DVLA but also your insurance provider or your insurance won't be valid. There are certain classes of drivers who won't be able to continue their job, purely because they are on insulin. If your husband has a PCO licence this may affect him, as he will need to be demonstrating his blood sugar levels are in control and he's complying with all the testing that DVLA requires. My consultant made me aware that even though I require insulin to be healthy, if I had an accident and hadn't proof of my test results that showed it wasn't caused by low blood sugar, I would be charged as driving under the influence of drugs! https://www.diabetes.co.uk/driving-for-work-and-blue-light-services.html#:~:text=If%20your%20diabetes%20is%20treated,%2Dcarrying%20vehicle%20(PCV).

You will also have to have a conversation with the doctor to give him enough test strips each month, to enable him to do that, as some practices restrict the number of test strips given. A continuous glucose monitor or libre would help him with learning how his blood sugar levels change but you still are required to have a finger prick blood sugar meter to check the results it's giving you. At the moment type 2 diabetics aren't prescribed a continuous glucose monitor, except for those who fit a strict criteria and still many people aren't allowed to get them on the NHS. It doesn't stop you from self funding and there is a free trial to get one from Libre.

If using insulin is going to affect your husband's ability to keep his job, there are GLP-1 medication that may be better for him to try first. One of them, Rybelsus is taken in tablet form.
https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/treatments/tablets-and-medication/semaglutide#:~:text=to%20weight%20loss.-,How%20many%20types%20of%20semaglutide%20are%20there?,NHS%20to%20support%20weight%20management.

Metformin is known to sometimes cause gastric issues. In many people it's just an unpleasant side effect but for others it can cause an intolerance that progressively gets worse the longer you take it. It can often be managed by reducing the dose but then that would increase his blood sugar levels. In a very small number of people, it causes intolerance to change to an allergy and you can't tolerate It any more.Talk about it when he sees the diabetic nurse and they will be able to assess if it is causing him the bowel issues or if it's down to his high blood sugar levels.

There is going to be a treatment plan that suits his needs and protects himself from the other risks that come with being diabetic. Working closely with the diabetic nurse and discussing his situation and how the medication is working is key. So is gaining knowledge of diabetes, learning about the things he can do to help himself. Make sure you are careful about getting any online education from legitimate sources such as the diabetes UK website.

How hard has he tried to change his diet? I only ask because from your responses it sounds like he’s been relying heavily on the medication whilst still eating high carb.

It isn’t a case of trying to eat a bit better it’s a complete overhaul of the food that comes into your house and makes up your meals and snacks and adding some exercise too.

I would do the free trial with continuous glucose Monitor and very intensely change his diet look up Keto diet and see how much of a difference it makes to his levels.

It might be just enough to get things back under control without the need for insulin.

You’ve been very poorly advised if you have not made serious attempts to address your diet as the first and most important step for controlling type 2 and instead are going down the route of adding more and more medication whilst continuing to eat a carb heavy diet. His blood sugar readings and hba1c are very high and will be causing ongoing damage to his eyes and nerves. It’s possible for many people to reverse type 2 completely or at least drastically improve their blood sugar levels and reduce their reliance on medication with low carb diet alone - have a look at the Giancarlo Caldesi cookbooks for a very clear explanation from Dr Unwin on how this works and some recipes to get you started. My husband was diagnosed in 2020 with Hba1c of 60 and he’s been in diabetic remission (levels are normal) for the last 4 years without meds.
I hope this doesn’t come across as patronising, if we had listened to the woeful NHS advice offered (it was during Covid pandemic but still…) we’d be in exactly the same position now.

@Miloarmadillo2

I hope this doesn’t come across as patronising, if we had listened to the woeful NHS advice offered (it was during Covid pandemic but still…) we’d be in exactly the same position now.

Sad to say I have to agree. Even supposedly "specialist" diabetic nurses often havn't a clue and just parrot off the NHS leaflet. I've lost count of the times I've been patronised by such a nurse telling me to reduce the number of mangoes I eat - they never ask whether I eat mangoes - I don't!. Even when once consulting our practice's "specialist" diabetic GP (they no longer have one), when discussing my binge eating, he had no advice nor support and glibly told me to go on Facebook and search for "binge eating" facebook support groups - that was it!! The NHS guide leaflets are poor and wrong in places - the nurses and GPs only follow those leaflets, so are basically wasting their time and the patient's time.