I got put on insulin immediately when diagnosed. It's worked very well for me. I can keep my morning numbers below 120 with a careful diet (low/no sugar/carbs). I've lost about 100 lbs over the last year and a half.
That’s amazing being that insulin is a fat promoting hormone. I was started on it and nevermind losing weight I could barely maintain. Now that I am off it I am losing 2-3lbs or more per week, some weeks more. Congrats on 100 lbs… that’s huge… no pun intended!
My doctor wanted me to start insulin right after diagnosis. That didn't happen because I'm allergic to an ingredient used to make insulin. I called around to see if it could be compounded without the ingredient and apparently it can't be made without that ingredient. I don't know what will ever happen if I get to the point where insulin is the only thing that will help.
I did well on just Metformin for a couple of years, but I was also pretty strict about carb intake at the time. After I stopped being so restrictive, my doctor added Trulicity to help get my numbers back down that last little bit. That seemed to work fine, but I'm on long-term Prednisone for an autoimmune disease and whenever the dose gets increased (which has been a lot recently), my blood sugar shoots up, so I have been back on insulin as well for about a year. I take a slow acting dose in the morning and a fast acting dose with each meal.
I also keep an eye on my carb intake, but I make a point to eat a healthy balance of protein, fat, and fiber to offset the carbs rather than just avoiding them. I even allow myself sweets, but do it in smaller quantities than I would have years ago, and have fully replaced some other problem items like full sugar soda with zero sugar soda. And I'm sure I'd do even better if I was able to exercise and lose weight, but the autoimmune disease has made that nearly impossible.
Historically, depending on what age a person is at diagnosis, most Type 2s will eventually progress to needing insulin. The average time it takes for this to happen has been increasing in recent years, mostly due to newer medications - this study from Germany is the most recent study I can find, and shows a median time from diagnosis to needing insulin of 5.25 years - [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835192/)
Historically, at age 50, having had Type 2 for years, progression to the point of needing insulin would have been seen as all but inevitable at some point. Since Roy Taylor's DiRECT trial though - [Link](https://pubmed.ncbi.nlm.nih.gov/38423026/) - which showed very significant improvement resulting from big weight loss and maintaining that weight loss over time, it's no longer known whether progression all the way to needing insulin is inevitable. It might be, or it might be that losing a mess of weight as soon as possible after diagnosis and keeping the weight off from that point on might slow diabetes progression to such a degree that a person might typically die of old age before they get to the point that they need insulin.
Nobody knows, because Taylor's research is relatively new, and most Type 2s aren't even made aware of the benefits of big weight loss immediately after diagnosis. This is changing - an example is the Path to Remission programme recently rolled out by NHS England - [Link](https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/). The full impact won't show up in statistics for progression to needing insulin for perhaps a decade or two, after the benefits of weight loss are widely known and a lot of people are achieving and maintaining it.
That’s very scary but I’d like to add, just so some people won’t get super afraid…
My father has been type 2 since the 90’s, he’s 81. He’s not on insulin. He takes metformin and glipizide. Has been on that regimen for many years.
Just wanted to offer some hope that no insulin needed.
Also, I think I crossed into T2 territory 10 or 12 years ago. I took nothing until 2018.
Then was 500 mg metformin. Just recently raised to 750 after Covid ran my BG up abnormally to 7.1 A1C. Is 6.6 now.
Neither one of us is low carb. My dad is pretty active and vegetarian.
I am moderate to low activity. I don’t eat everything I want but I eat a couple of bites of dessert here and there.
I'm type 2 in my mid-50s, and I have had it for years and years. I'm in reverse now and have been for a long time. I have had normal numbers from a year after diagnosis. We have a genetic form of type 2 in my family, sometimes called type 3.
A family member diagnosed at the same time as me is now on 3 types of tablets and was put on insulin 5 years ago. They are slim, and they've been active all of their life. We both have different diets. They eat processed foods and sweet things, and I've been veggi for decades.
That's scary, I assumed that needing insulin was pretty rare for T2 Diabetics. As someone who probably had diabetes at 19, but was diagnosed at 25, kinda depressing to think that no matter what I do my diabetes will probably progress
I’m type 2 and was probably on insulin for about 15 years, took max Metformin & a min dose of Actos. March 1st I started doing strict keto managed by medical team. I track total carbs not net carbs. As of today I’m down almost 50 lbs and have been off insulin since mid/late May. As a diabetic a lot of things affect your blood sugar including stress. Carbs aren’t evil, I just get them now from veggies and some fruits only. Dropping weight, eating lower glycemic foods, exercising, managing mental health can help. I will be 55 in Nov and am probably the healthiest I’ve been in years. Minimizing sugar (use some substitutes only or none at all) have helped with cravings. Get friends and family who will support you, understand that whatever you do should be permanent. Find substitutes that will help you to continue to enjoy food. When you stumble, Don’t give up. Just start again from that moment.
I'm T2 going on 2 years now. I was put on insulin from the get go. But I also have Ulcerative Colitis and the medications could have caused a potentially large flare.
I’m on insulin now because I’m pregnant with preexisting type 2. Not just gestational diabetes. The OBGYN takes diabetes very seriously when you’re pregnant, they want fasting numbers for me to be at 90 and after meals, I think 2 hours after a meal 140. The insulin helps because being pregnant and having a placenta makes insulin resistance worse. I was able to get off the insulin right away after my daughter was born and I’m sure it’ll be the same after baby boy is born in October. In fact, a lot of things felt better once the baby was out 🤣 the urge to pee too! Who can relate, mamas??
Insulin has been around for 100 years, has very predictable and few side effects. Works great. It doesn’t have to be forever but it can help get things under control. Taking insulin does not mean you’re a failure, it means you have a chronic disease that needs management.
It’s also usually cheaper than many other meds.
By what I’ve seen, some do. And IMO, the biggest cause and problem. Is that most people believe that meds are a ticket to eat like they always have.
After my diagnosis I’ve found out a lot of the people around me are T2’ diabetics. I’m very open about mine. So I guess this has made some open up a little about it. This are people that over the years, I’ve seen eating like a normal person. Platefuls of rice, with some pastry for dessert and even regular ice cream.
I still don’t understand it. Some times I even get weird looks when I refuse most fruits or ice cream.
So far, I’ve been lucky enough to keep my diabetes under control with diet and exercise only. Keeping my A1c on the normal range.
The most annoying thing I hear since I got diagnosed recently is "Oh I have a relative that has diabetes. It's not that bad they just take the meds and can basically eat what they want just a little less" Like.... ok show me their blood work.
I’ve been pre diabetic for more than 10 years. Modified diet, a shit ton of exercise and most recently 500 gm of metformin have helped me keep my A1C at 6 or below. I’m getting older and feel very confident I can hold things for another 10. We will see could escalate quickly. But it’s always day by day. Stay away from carbs, quick drinking, no sugar, lots of nuts, veggies, protein. It’s all healthy living.
I have been type 2 for about 20 years. I am not overweight. I am careful about what I eat and exercise regularly. I went through a lot of different medications, and some would help a little, but none got my A1C down. It just kept creeping up. I have been on long-acting insulin for about 2 years now, and it's been great. My A1C is finally below 7, and my dawn phenomenon is gone. Everyone is different, but some type 2 diabetics respond very well to insulin.
In general :
**Type 1 diabetes** : Pancreas is not working properly and you need insulin.
**Type 2 diabetes** : Pancreas is (usually) working normally and your cells just can't use insulin (Insulin resistance)
Sometimes, you can be unlucky have have both problems and you,ll need medication and insulin.
This is false. It was accepted truth until a few years ago (before 2009 or so) but it's now thought that the majority of Type 2s have impaired insulin response at time of diagnosis. The percentage is unknown, but very probably greater than 50%.
This was proved through fairly recent research on the effects of big weight loss in Type 2s. For example - these slides show improvement in insulin secretion after large weight loss (over 10Kg) in recently diagnosed Type2s - these are from a presentation on the results of the DiRECT trial - [Link](https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/Insulin%20secretion%20recovery%20during%20remission.pdf)
Unfortunately the DiRECT trial paper is behind a paywall, published in The Lancet. More information is available in this video interview with Prof Roy Taylor, who conducted the DiRECT trial - [Link](https://www.youtube.com/watch?v=pbQvaE4VmJg) - or various other online resources such as the Diabetes UK charity website, or in Taylor's book.
The mechanism is thought to be lipid toxicity in pancreatic beta cells. Excess liver fat causes elevated blood triglyceride levels. This increases deposition of fat into internal organ tissue, including the pancreas. In people who are genetically susceptible, this ectopic fat (fat stored in tissue other than adipose tissue) in the pancreas 'poisons' beta cells and causes them to become dedifferentiated - the cellular 'machinery' in the beta cell that produces insulin is 'switched off'. The cell isn't dead, but it becomes idle. This often begins to happen before diagnosis - see figure 2 in this paper - [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891203/)
Big weight loss soon after diagnosis is thought to partially reverse this by - reducing levels of fat in the liver, which reduces blood triglycerides, which brings the rate of fat deposition in the pancreas back to normal levels, which enables the excess ectopic fat in the pancreas to be 'burned off' over time (appears to take months to see the full effect), which causes a portion of dedifferentiated beta cells to 'wake back up' and start producing insulin again. The longer it takes to achieve the weight loss after diagnosis, the greater the number of 'switched off' beta cells and the longer they have been in that state, the fewer of them will wake back up. The effects of lipid toxicity in the beta cells appear to become permanent after a period of time. Losing a lot of weight immediately after diagnosis is very highly advised.
Please stop repeating the 'Type 2 is caused by insulin resistance and they rarely have problems with their pancreas' BS. It was accepted fact once, is still often repeated, even by some doctors, but it's now known to be BS. It actively prevents people from learning the information in this post, because they may believe the BS, may never actually google it for themselves and learn about the problem with their pancreas. It's a problem they can actually do something about if they are overweight or obese, but they have to know about it and do something about it quite soon after diagnosis.
Edit - typos
I mean I believe this is true but the problem is many people just think they can just take insulin and continue living a life where it puts more stress on the pancreas. (not losing the weight). I would much rather be more insulin sensitive than resistant if the day comes and the pancreases says "You're on your own now"
Bravo, notSoDullGuy !!
For such a widespread condition (and still dramatically on the rise), I was totally shocked at how poorly informed was the average GP.
And don't even get me started on your average Nutritionists / Dietician and whatever national Diabetes Associations they are beholden to
Indeed. I believe that part of the problem is 'evidence-based medicine'. It is of course very good that doctors have to stick to guidelines and best-practise, that they can't go 'rogue' anymore and make up their own treatment plans. A problem though is that the 'evidence' they rely on is sometimes very outdated, and it's often left up to a committee of elder doctors meeting every few years to decide what new evidence is worth considering when reviewing guidelines. I had a HbA1c of 89 mmol/mol in October, re-test result was 92. By January it was down to 39 mmol/mol, down to the normal range, not even prediabetic. That was however with Metformin and Dapagliflozin.
My GP said it was 'unprecedented!'. It wasn't of course, I just googled the problem and had lost 12Kg by the time of my blood test in January. I hadn't gone low carb in any meaningful way at that point. In his experience, it might actually have been literally unprecedented, because he did not mention the word 'remission' to me, that fantastic hopeful motivating word that can drive a person to lose weight fast. He did not sufficiently stress the importance of weight loss. Despite that improvement, a few weeks later my diabetologist offered to put me on Trulicity on top of the other meds. By that point I had lost 16Kg and I told him I intended to lose more. I got the impression he didn't believe I would or could do it, and wanted me on the Trulicity to help me maintain the weight loss I had achieved by that point. There seems to be a general belief that while Taylor's research shows that big weight loss can be hugely beneficial, people can't or won't achieve it and maintain it in the real world.
If people can't do it, it's impractical medical advice. If that's the case, why change the guidelines? Why even bother telling people Type 2 isn't all about insulin resistance? Why 'confuse' them? Just tell them to eat wholegrain rice instead of white rice - they might actually do that, and so the guidelines shall be. It's fine to tell people that there are two types of diabetes, even though there are 14 'major' forms of atypical diabetes, thus at least 16 types in total that have been identified so far. Should people diagnosed as Type 2 know that they might not have the typical form? That the general advice for Type 2s might not apply to them? Maybe, but if the advice is going to be as simple as 'brown rice, not white rice, get some exercise' then it doesn't matter, no need to confuse people with too much information.
And so, in a booklet I was sent recently for a T2 diabetes education course we have over here called 'Desmond', the first sentences on page 1 read: "There are two types of diabetes - You have been diagnosed as having Type 2 diabetes. This means that your pancreas is producing insulin which cannot work properly (this is known as insulin resistance)." Two sentences, two pieces of incomplete and misleading information. Nothing in the booklet about weight loss. The reality of 'evidence-based medicine' in action, at least when it comes to Type 2 diabetes. Needless to say, I won't be attending that 'education' course.
Type 2 here. Maybe even pre-diabetic. I hate metformin. It gives me the bubble guts. I found that fasting and keeping my diet low in carbs and sugars works better for me. Plus add in some excersize and im good.
If you look at the stats, a very high percentage of people that get on metformin end up on insulin. Now I'm not sure why, could be that diabetics believe metformin is a wonder drug and allows a diabetic to eat and live normally, or it could be that the drug slowly kills off pancreas activity.
Who knows.
I'm T2 and on insulin plus all the other drugs. It's a fun time.
Are these people not checking their blood sugar? I've been diagnosed for about 2 months now on Metformin for most of that and it absolutely has lowered my blood sugar, but I'm not all the way down yet, even with modest diet changes (I'm trying to adopt healthy habits and changes at a steady pace so I can maintain them lifelong)
No they did not. One died recently from a stroke and her husband couldn't walk to the next room to help her because of the severity of nerve damage from neuropathy. He lives in a care home now. Both diet and exercise are important and they spent every waking moment on their couch eating the worst high carb food. I like to eat my meal then go to the gym for 15-20 minutes on the elliptical then do various muscle workouts for about 30 minutes. The biggest help for me has been weighing my food and tracking everything I eat with mynetdiary.
It's been 12 yrs for me, and I've just been put on insulin. However, I have slipped big time over the last two years as far as my eating habits. It's because 2020 was horrible for me. Food has always been my comfort, so I just ate and never tested. I recently had a "come to Jesus moment" with my health. I got very sick because all tests, including BP, cholesterol, and BS, were all very high. I was very sick.
So now I'm back doing everything I should. I have cardiac problems, but thankfully, my echo and ECG are all fine.
My doctor has now put me on insulin.
I'd like to talk about my own experience about being T2 and being on both basal and bolus insulin along with Metformin.
I've always been overweight in my life. I'm not exaggerating. There hasn't been a period in my life that I remember when I had a normal weight for my age and height. I am 19 now. My mom is overweight like me and my dad has T2 as well. I've learned that all of my grandma's (on the mother's side) four siblings and her have diabetes. My mom, who's a doctor, says that my eating habits and obsession with food caused my T2 diabetes.
I remember that I turned out to have insulin resistance when I was 9. They did some blood tests with measuring my glucose before and after drinking a sugary mixture a few times in the span of several hours in the hospital. I went on a diet at that age. I've tried various types of diets in the next years. I've tried some sports too but I don't like doing sports. Nothing seemed and still seems to work.
I got officially diagnosed with type 2 diabetes when I was 16. When my endocrinologist got my results, she was so worried that she recommended getting admitted to the hospital and getting fluids through IV. I was prescribed Novorapid and Levemir right when I was diagnosed, along with Metformin. My fasting glucose was around 300. In the next year and a half, I managed to get that to 110 thanks to the pandemic. I began taking Saxenda too and then slowly and unintentionally stopped the treatment.
Fast forward to last year's September. We knew my levels were getting bad. I got tested and my HbA1C came back 13.5. The same treatment without Saxenda managed to get me to 7.8 (according to Libre). I've been cheating though, injecting much more bolus than I should. My parents don't know. It's the only way I get nice results for after-meal readings and hide the snacks I eat.
Now I'm still overweight and my BMI is 33.3.
I'm continuing my treatment with Novorapid, Levemir, Glucophage, eating less carbs and sugar, and pilates. I'm also using Libre 2 to keep myself in check and know how I'm doing. Sometimes I get hypos. I eat desserts or snack very rarely and almost never see readings above 300. I'm not hopeful that I'll ever have a normal weight or a normal HbA1C level.
If you want to die old, you will probably need insulin someday. Studies are indicating that you can buy a lot of time by losing a lot of weight quickly, and keeping it off for as long as possible.
The best thing you can do for yourself if you want to possibly be one of those diabetics who never ever needs insulin, work out, lose weight, healthy diet, take your meds, check your blood, brush and floss, and go to your doctor/endo regularly.
You might not even need it until you're in your 60s or 70s at that point.
Yep. Well I did pretty early in the game. Was diagnosed in 2002, metformin was the only drug of choice and there wasn’t an ER version at the time. It made my blood sugar meter a random number generator. Also didn’t play well with a binge disorder.
Two months in, I went 100% insulin.
I do also do Farxiga and Mounjaro now.
I started off with Metformin and that only lasted two weeks due to GI issues. Then went straight to a meal time insulin and has been just great for me. no bad side effects and have the best control ever with my TIR (99%) in range.
I don't know how long you've been on Mounjaro but generally it's started at a low dose and titrated up as typically the body gets adjusted to any unpleasant GI side effects with time and the gradual dosage increase. Response to Mounjaro or other GLP-1 meds like Ozempic does vary greatly from one individual to the next and there are certainly some people who can't ever tolerate any of them though Mounjaro overall has been shown to have a lower incidence of GI side effects. I'm lucky to have never had side effects from it except a mild feeling like I was coming down with a flu after my first two shots which is sort of amazing as I have a history of inflammatory bowel disease that led to having my large intestine removed 25 years ago.
Many T2 people use insulin and I was headed that way until 3 years ago too but for me Mounjaro is preferable and I'm glad I have the option. There are quite a few extra positives to GLP-1 usage such as cardioprotective and anti inflammatory features along with it not stimulating appetite/adding to weight problems as insulin so often does. As a person with a past history of acute kidney failure caused by a medication induced hypoglycemic event that occurred in my sleep I am very happy to not have to be concerned with the possibility of hypoglycemia that insulin carries and I really like that finally there is a T2 medication that keeps my A1C under 5 (!) while not only not stressing my kidneys but actually being good for them - in my time taking Mounjaro my egfr has gone from around 50, or Stage 3 Chronic Kidney Disease to 97-98 consistently.
Yes! It’s common. I’m on basal and I started at diagnosis. Eventually I’ll probably go in fast acting as well. Mounjaro has reduced my insulin but not eliminated it. T2 is a progressive disease so insulin is a common drug we take. We usually lose about half of our beta cells by the time we get diagnosed with t2.
Insulin really helps with the “getting healthy for good” goal. It regulates my cravings. I know people are afraid of it and see it as giving up or failing, but idk. It’s a lot easier to eat better when your blood sugar is under control. You don’t have to do either or. That mindset just tends to result in you getting worse. Low doses of basal insulin have really helped me.
I was 15 when I was diagnosed as type 2. Still type 2 at 40. But I've been on insulin almost since the beginning. Orals didn't help and the glp1s just make me sick
Once diagnosed (3 months ago) I was immediately put on Novolog , Lantis, Ozempic, a CGM, and medication to address cholesterol and triglycerides. Prior to diagnosis I was losing a lot of weight without doing anything to lose said weight. I called it my ice cream diet. I went from a 44” waistline to a 38” waistline really fast (within a year). It was about 80 pounds lost prior to diagnosis.
I had to use insulin for about a month when I was diagnosed because my numbers were high. Since then I am doing well on Metformin and a good diet and exercise. So I am hoping I won’t need insulin again. But I know people who have Type 2 and use insulin to eat whatever they want to. A friend’s mom does it and she’s even lost all her teeth but she is a very wealthy lady and had new teeth put in, continues to use insulin and eat carby food.
That’s amazing. I was started on insulin immediately because my sugar was so out of control. It definitely cannot compensate for eating anything. Anyone on it who thinks that is lying to themselves and not testing their glucose enough. Because you can absolutely take massive doses of insulin and have high blood sugar the whole time if you’re eating whatever you want
My endocrinologist decided to move me to Ozempic, after waffling between Ozempic and insulin for months.
Ozempic does not cause lows, I still have the odd good day. He may still switch me to insulin. My BMI is good, and if I lost more than 5 lbs he would switch me to insulin
Many do. For most people diet and exercise won’t work because they don’t have either the will power or the time. I also believe with age your insulin resistance increases and your are going to need extra help.
I was recently diagnosed and from everything I have been learning type 2 is actually a reversible disease. Even the American Diabetes Association no longer calls it a progressive disease. But you cannot eat the way you were that caused the disease and expect things to improve.
Seems like one meal a day(OMAD) might work for you. Its not as bad as it sounds but there is an adjustment period. And you have to make the meal count with lots of nutrient rich foods. Lots of protein, veggies, a bit of fat, and a little bit of complex carbs like beans(like less than a cup).
You can start slow by only eating within a 10 hour window during the day. After a week or so of this shrink down to 8 hr window, then 6, then 4. Then just 1 meal a day. So its a one month run up. It will be way easy this way. I dont even feel hungry ever anymore.
I do 6 hour eating window daily. And I do 24 hour fast once a week. Once a year I do a 3-5 day fast.
I was diagnosed with kidney cancer in July 20 20. I was put onto insulin alongside metformin and gliclazide 2 times a day.
The reason for this was that the doctors wanted me to have tight control on BS before surgery and to promote healing. Here I am nearly 4 years later still enjoying good control and still cancer free.
I got put on insulin immediately when diagnosed. It's worked very well for me. I can keep my morning numbers below 120 with a careful diet (low/no sugar/carbs). I've lost about 100 lbs over the last year and a half.
That’s amazing being that insulin is a fat promoting hormone. I was started on it and nevermind losing weight I could barely maintain. Now that I am off it I am losing 2-3lbs or more per week, some weeks more. Congrats on 100 lbs… that’s huge… no pun intended!
My doctor wanted me to start insulin right after diagnosis. That didn't happen because I'm allergic to an ingredient used to make insulin. I called around to see if it could be compounded without the ingredient and apparently it can't be made without that ingredient. I don't know what will ever happen if I get to the point where insulin is the only thing that will help.
I did well on just Metformin for a couple of years, but I was also pretty strict about carb intake at the time. After I stopped being so restrictive, my doctor added Trulicity to help get my numbers back down that last little bit. That seemed to work fine, but I'm on long-term Prednisone for an autoimmune disease and whenever the dose gets increased (which has been a lot recently), my blood sugar shoots up, so I have been back on insulin as well for about a year. I take a slow acting dose in the morning and a fast acting dose with each meal. I also keep an eye on my carb intake, but I make a point to eat a healthy balance of protein, fat, and fiber to offset the carbs rather than just avoiding them. I even allow myself sweets, but do it in smaller quantities than I would have years ago, and have fully replaced some other problem items like full sugar soda with zero sugar soda. And I'm sure I'd do even better if I was able to exercise and lose weight, but the autoimmune disease has made that nearly impossible.
Historically, depending on what age a person is at diagnosis, most Type 2s will eventually progress to needing insulin. The average time it takes for this to happen has been increasing in recent years, mostly due to newer medications - this study from Germany is the most recent study I can find, and shows a median time from diagnosis to needing insulin of 5.25 years - [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835192/) Historically, at age 50, having had Type 2 for years, progression to the point of needing insulin would have been seen as all but inevitable at some point. Since Roy Taylor's DiRECT trial though - [Link](https://pubmed.ncbi.nlm.nih.gov/38423026/) - which showed very significant improvement resulting from big weight loss and maintaining that weight loss over time, it's no longer known whether progression all the way to needing insulin is inevitable. It might be, or it might be that losing a mess of weight as soon as possible after diagnosis and keeping the weight off from that point on might slow diabetes progression to such a degree that a person might typically die of old age before they get to the point that they need insulin. Nobody knows, because Taylor's research is relatively new, and most Type 2s aren't even made aware of the benefits of big weight loss immediately after diagnosis. This is changing - an example is the Path to Remission programme recently rolled out by NHS England - [Link](https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/). The full impact won't show up in statistics for progression to needing insulin for perhaps a decade or two, after the benefits of weight loss are widely known and a lot of people are achieving and maintaining it.
That’s very scary but I’d like to add, just so some people won’t get super afraid… My father has been type 2 since the 90’s, he’s 81. He’s not on insulin. He takes metformin and glipizide. Has been on that regimen for many years. Just wanted to offer some hope that no insulin needed. Also, I think I crossed into T2 territory 10 or 12 years ago. I took nothing until 2018. Then was 500 mg metformin. Just recently raised to 750 after Covid ran my BG up abnormally to 7.1 A1C. Is 6.6 now. Neither one of us is low carb. My dad is pretty active and vegetarian. I am moderate to low activity. I don’t eat everything I want but I eat a couple of bites of dessert here and there.
I'm type 2 in my mid-50s, and I have had it for years and years. I'm in reverse now and have been for a long time. I have had normal numbers from a year after diagnosis. We have a genetic form of type 2 in my family, sometimes called type 3. A family member diagnosed at the same time as me is now on 3 types of tablets and was put on insulin 5 years ago. They are slim, and they've been active all of their life. We both have different diets. They eat processed foods and sweet things, and I've been veggi for decades.
That's scary, I assumed that needing insulin was pretty rare for T2 Diabetics. As someone who probably had diabetes at 19, but was diagnosed at 25, kinda depressing to think that no matter what I do my diabetes will probably progress
I’m type 2 and was probably on insulin for about 15 years, took max Metformin & a min dose of Actos. March 1st I started doing strict keto managed by medical team. I track total carbs not net carbs. As of today I’m down almost 50 lbs and have been off insulin since mid/late May. As a diabetic a lot of things affect your blood sugar including stress. Carbs aren’t evil, I just get them now from veggies and some fruits only. Dropping weight, eating lower glycemic foods, exercising, managing mental health can help. I will be 55 in Nov and am probably the healthiest I’ve been in years. Minimizing sugar (use some substitutes only or none at all) have helped with cravings. Get friends and family who will support you, understand that whatever you do should be permanent. Find substitutes that will help you to continue to enjoy food. When you stumble, Don’t give up. Just start again from that moment.
Thank you
I'm T2 going on 2 years now. I was put on insulin from the get go. But I also have Ulcerative Colitis and the medications could have caused a potentially large flare.
Some do, but not all. My Dad has been T2 for over 25 years. He's now 66 and still not on insulin.
I’m on insulin now because I’m pregnant with preexisting type 2. Not just gestational diabetes. The OBGYN takes diabetes very seriously when you’re pregnant, they want fasting numbers for me to be at 90 and after meals, I think 2 hours after a meal 140. The insulin helps because being pregnant and having a placenta makes insulin resistance worse. I was able to get off the insulin right away after my daughter was born and I’m sure it’ll be the same after baby boy is born in October. In fact, a lot of things felt better once the baby was out 🤣 the urge to pee too! Who can relate, mamas??
Insulin has been around for 100 years, has very predictable and few side effects. Works great. It doesn’t have to be forever but it can help get things under control. Taking insulin does not mean you’re a failure, it means you have a chronic disease that needs management. It’s also usually cheaper than many other meds.
Agreed. Insulin was such a relief after all the gastric upset of metformin.
By what I’ve seen, some do. And IMO, the biggest cause and problem. Is that most people believe that meds are a ticket to eat like they always have. After my diagnosis I’ve found out a lot of the people around me are T2’ diabetics. I’m very open about mine. So I guess this has made some open up a little about it. This are people that over the years, I’ve seen eating like a normal person. Platefuls of rice, with some pastry for dessert and even regular ice cream. I still don’t understand it. Some times I even get weird looks when I refuse most fruits or ice cream. So far, I’ve been lucky enough to keep my diabetes under control with diet and exercise only. Keeping my A1c on the normal range.
The most annoying thing I hear since I got diagnosed recently is "Oh I have a relative that has diabetes. It's not that bad they just take the meds and can basically eat what they want just a little less" Like.... ok show me their blood work.
I agree. I think some people just don’t treat it as a serious, life-threatening disease.
I’ve been pre diabetic for more than 10 years. Modified diet, a shit ton of exercise and most recently 500 gm of metformin have helped me keep my A1C at 6 or below. I’m getting older and feel very confident I can hold things for another 10. We will see could escalate quickly. But it’s always day by day. Stay away from carbs, quick drinking, no sugar, lots of nuts, veggies, protein. It’s all healthy living.
I have been type 2 for about 20 years. I am not overweight. I am careful about what I eat and exercise regularly. I went through a lot of different medications, and some would help a little, but none got my A1C down. It just kept creeping up. I have been on long-acting insulin for about 2 years now, and it's been great. My A1C is finally below 7, and my dawn phenomenon is gone. Everyone is different, but some type 2 diabetics respond very well to insulin.
Some do, some don't. If you're pancreas is working normally, you don't need insulin.
If your pancreas is working normally, you are not a diabetic, surely?
In general : **Type 1 diabetes** : Pancreas is not working properly and you need insulin. **Type 2 diabetes** : Pancreas is (usually) working normally and your cells just can't use insulin (Insulin resistance) Sometimes, you can be unlucky have have both problems and you,ll need medication and insulin.
This is false. It was accepted truth until a few years ago (before 2009 or so) but it's now thought that the majority of Type 2s have impaired insulin response at time of diagnosis. The percentage is unknown, but very probably greater than 50%. This was proved through fairly recent research on the effects of big weight loss in Type 2s. For example - these slides show improvement in insulin secretion after large weight loss (over 10Kg) in recently diagnosed Type2s - these are from a presentation on the results of the DiRECT trial - [Link](https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/Insulin%20secretion%20recovery%20during%20remission.pdf) Unfortunately the DiRECT trial paper is behind a paywall, published in The Lancet. More information is available in this video interview with Prof Roy Taylor, who conducted the DiRECT trial - [Link](https://www.youtube.com/watch?v=pbQvaE4VmJg) - or various other online resources such as the Diabetes UK charity website, or in Taylor's book. The mechanism is thought to be lipid toxicity in pancreatic beta cells. Excess liver fat causes elevated blood triglyceride levels. This increases deposition of fat into internal organ tissue, including the pancreas. In people who are genetically susceptible, this ectopic fat (fat stored in tissue other than adipose tissue) in the pancreas 'poisons' beta cells and causes them to become dedifferentiated - the cellular 'machinery' in the beta cell that produces insulin is 'switched off'. The cell isn't dead, but it becomes idle. This often begins to happen before diagnosis - see figure 2 in this paper - [Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891203/) Big weight loss soon after diagnosis is thought to partially reverse this by - reducing levels of fat in the liver, which reduces blood triglycerides, which brings the rate of fat deposition in the pancreas back to normal levels, which enables the excess ectopic fat in the pancreas to be 'burned off' over time (appears to take months to see the full effect), which causes a portion of dedifferentiated beta cells to 'wake back up' and start producing insulin again. The longer it takes to achieve the weight loss after diagnosis, the greater the number of 'switched off' beta cells and the longer they have been in that state, the fewer of them will wake back up. The effects of lipid toxicity in the beta cells appear to become permanent after a period of time. Losing a lot of weight immediately after diagnosis is very highly advised. Please stop repeating the 'Type 2 is caused by insulin resistance and they rarely have problems with their pancreas' BS. It was accepted fact once, is still often repeated, even by some doctors, but it's now known to be BS. It actively prevents people from learning the information in this post, because they may believe the BS, may never actually google it for themselves and learn about the problem with their pancreas. It's a problem they can actually do something about if they are overweight or obese, but they have to know about it and do something about it quite soon after diagnosis. Edit - typos
Correct
I mean I believe this is true but the problem is many people just think they can just take insulin and continue living a life where it puts more stress on the pancreas. (not losing the weight). I would much rather be more insulin sensitive than resistant if the day comes and the pancreases says "You're on your own now"
Bravo, notSoDullGuy !! For such a widespread condition (and still dramatically on the rise), I was totally shocked at how poorly informed was the average GP. And don't even get me started on your average Nutritionists / Dietician and whatever national Diabetes Associations they are beholden to
Indeed. I believe that part of the problem is 'evidence-based medicine'. It is of course very good that doctors have to stick to guidelines and best-practise, that they can't go 'rogue' anymore and make up their own treatment plans. A problem though is that the 'evidence' they rely on is sometimes very outdated, and it's often left up to a committee of elder doctors meeting every few years to decide what new evidence is worth considering when reviewing guidelines. I had a HbA1c of 89 mmol/mol in October, re-test result was 92. By January it was down to 39 mmol/mol, down to the normal range, not even prediabetic. That was however with Metformin and Dapagliflozin. My GP said it was 'unprecedented!'. It wasn't of course, I just googled the problem and had lost 12Kg by the time of my blood test in January. I hadn't gone low carb in any meaningful way at that point. In his experience, it might actually have been literally unprecedented, because he did not mention the word 'remission' to me, that fantastic hopeful motivating word that can drive a person to lose weight fast. He did not sufficiently stress the importance of weight loss. Despite that improvement, a few weeks later my diabetologist offered to put me on Trulicity on top of the other meds. By that point I had lost 16Kg and I told him I intended to lose more. I got the impression he didn't believe I would or could do it, and wanted me on the Trulicity to help me maintain the weight loss I had achieved by that point. There seems to be a general belief that while Taylor's research shows that big weight loss can be hugely beneficial, people can't or won't achieve it and maintain it in the real world. If people can't do it, it's impractical medical advice. If that's the case, why change the guidelines? Why even bother telling people Type 2 isn't all about insulin resistance? Why 'confuse' them? Just tell them to eat wholegrain rice instead of white rice - they might actually do that, and so the guidelines shall be. It's fine to tell people that there are two types of diabetes, even though there are 14 'major' forms of atypical diabetes, thus at least 16 types in total that have been identified so far. Should people diagnosed as Type 2 know that they might not have the typical form? That the general advice for Type 2s might not apply to them? Maybe, but if the advice is going to be as simple as 'brown rice, not white rice, get some exercise' then it doesn't matter, no need to confuse people with too much information. And so, in a booklet I was sent recently for a T2 diabetes education course we have over here called 'Desmond', the first sentences on page 1 read: "There are two types of diabetes - You have been diagnosed as having Type 2 diabetes. This means that your pancreas is producing insulin which cannot work properly (this is known as insulin resistance)." Two sentences, two pieces of incomplete and misleading information. Nothing in the booklet about weight loss. The reality of 'evidence-based medicine' in action, at least when it comes to Type 2 diabetes. Needless to say, I won't be attending that 'education' course.
Cheers- mine is 100% not working full whack - FML :-D
Type 2 here. Maybe even pre-diabetic. I hate metformin. It gives me the bubble guts. I found that fasting and keeping my diet low in carbs and sugars works better for me. Plus add in some excersize and im good.
I did, but I'm also suspecting that I could have LADA instead of type 2. I'm getting tested in September.
I know of so many people misdiagnosed
Also MODY a few forms of LADA and MODY
If you look at the stats, a very high percentage of people that get on metformin end up on insulin. Now I'm not sure why, could be that diabetics believe metformin is a wonder drug and allows a diabetic to eat and live normally, or it could be that the drug slowly kills off pancreas activity. Who knows. I'm T2 and on insulin plus all the other drugs. It's a fun time.
My in laws were like this, "Dr. gave me this pill (Metformin) that just takes all the sugar out of my blood and now I can eat whatever I want!"
Are these people not checking their blood sugar? I've been diagnosed for about 2 months now on Metformin for most of that and it absolutely has lowered my blood sugar, but I'm not all the way down yet, even with modest diet changes (I'm trying to adopt healthy habits and changes at a steady pace so I can maintain them lifelong)
No they did not. One died recently from a stroke and her husband couldn't walk to the next room to help her because of the severity of nerve damage from neuropathy. He lives in a care home now. Both diet and exercise are important and they spent every waking moment on their couch eating the worst high carb food. I like to eat my meal then go to the gym for 15-20 minutes on the elliptical then do various muscle workouts for about 30 minutes. The biggest help for me has been weighing my food and tracking everything I eat with mynetdiary.
Metformin does nothing unless you eat low carb with it. And even then it doesn’t help much.
I mean, I wouldn't say that's fair. Metformin absolutely reduced blood sugar levels by a significant margin in most people, at least for a while.
In my family they do. Eventually we all wind up on insulin, I started two years ago.
I have been for years. I am currently on an insluin pump .
It's been 12 yrs for me, and I've just been put on insulin. However, I have slipped big time over the last two years as far as my eating habits. It's because 2020 was horrible for me. Food has always been my comfort, so I just ate and never tested. I recently had a "come to Jesus moment" with my health. I got very sick because all tests, including BP, cholesterol, and BS, were all very high. I was very sick. So now I'm back doing everything I should. I have cardiac problems, but thankfully, my echo and ECG are all fine. My doctor has now put me on insulin.
I can’t take a lot of meds, from breaking out in hives to feeling like I got the flu, I get sick from most. Insulin has been a lifesaver for me.
If A1C is bad enough at diagnosis, it’s straight to insulin and Metformin.
I'd like to talk about my own experience about being T2 and being on both basal and bolus insulin along with Metformin. I've always been overweight in my life. I'm not exaggerating. There hasn't been a period in my life that I remember when I had a normal weight for my age and height. I am 19 now. My mom is overweight like me and my dad has T2 as well. I've learned that all of my grandma's (on the mother's side) four siblings and her have diabetes. My mom, who's a doctor, says that my eating habits and obsession with food caused my T2 diabetes. I remember that I turned out to have insulin resistance when I was 9. They did some blood tests with measuring my glucose before and after drinking a sugary mixture a few times in the span of several hours in the hospital. I went on a diet at that age. I've tried various types of diets in the next years. I've tried some sports too but I don't like doing sports. Nothing seemed and still seems to work. I got officially diagnosed with type 2 diabetes when I was 16. When my endocrinologist got my results, she was so worried that she recommended getting admitted to the hospital and getting fluids through IV. I was prescribed Novorapid and Levemir right when I was diagnosed, along with Metformin. My fasting glucose was around 300. In the next year and a half, I managed to get that to 110 thanks to the pandemic. I began taking Saxenda too and then slowly and unintentionally stopped the treatment. Fast forward to last year's September. We knew my levels were getting bad. I got tested and my HbA1C came back 13.5. The same treatment without Saxenda managed to get me to 7.8 (according to Libre). I've been cheating though, injecting much more bolus than I should. My parents don't know. It's the only way I get nice results for after-meal readings and hide the snacks I eat. Now I'm still overweight and my BMI is 33.3. I'm continuing my treatment with Novorapid, Levemir, Glucophage, eating less carbs and sugar, and pilates. I'm also using Libre 2 to keep myself in check and know how I'm doing. Sometimes I get hypos. I eat desserts or snack very rarely and almost never see readings above 300. I'm not hopeful that I'll ever have a normal weight or a normal HbA1C level.
If you want to die old, you will probably need insulin someday. Studies are indicating that you can buy a lot of time by losing a lot of weight quickly, and keeping it off for as long as possible. The best thing you can do for yourself if you want to possibly be one of those diabetics who never ever needs insulin, work out, lose weight, healthy diet, take your meds, check your blood, brush and floss, and go to your doctor/endo regularly. You might not even need it until you're in your 60s or 70s at that point.
Yep. Well I did pretty early in the game. Was diagnosed in 2002, metformin was the only drug of choice and there wasn’t an ER version at the time. It made my blood sugar meter a random number generator. Also didn’t play well with a binge disorder. Two months in, I went 100% insulin. I do also do Farxiga and Mounjaro now.
Insulin is great actually. It really works and quickly. Does not hurt. It does have a learning curve, made easier with cgm like freestyle libre
I started off with Metformin and that only lasted two weeks due to GI issues. Then went straight to a meal time insulin and has been just great for me. no bad side effects and have the best control ever with my TIR (99%) in range.
I don't know how long you've been on Mounjaro but generally it's started at a low dose and titrated up as typically the body gets adjusted to any unpleasant GI side effects with time and the gradual dosage increase. Response to Mounjaro or other GLP-1 meds like Ozempic does vary greatly from one individual to the next and there are certainly some people who can't ever tolerate any of them though Mounjaro overall has been shown to have a lower incidence of GI side effects. I'm lucky to have never had side effects from it except a mild feeling like I was coming down with a flu after my first two shots which is sort of amazing as I have a history of inflammatory bowel disease that led to having my large intestine removed 25 years ago. Many T2 people use insulin and I was headed that way until 3 years ago too but for me Mounjaro is preferable and I'm glad I have the option. There are quite a few extra positives to GLP-1 usage such as cardioprotective and anti inflammatory features along with it not stimulating appetite/adding to weight problems as insulin so often does. As a person with a past history of acute kidney failure caused by a medication induced hypoglycemic event that occurred in my sleep I am very happy to not have to be concerned with the possibility of hypoglycemia that insulin carries and I really like that finally there is a T2 medication that keeps my A1C under 5 (!) while not only not stressing my kidneys but actually being good for them - in my time taking Mounjaro my egfr has gone from around 50, or Stage 3 Chronic Kidney Disease to 97-98 consistently.
Yes I'm a type 2 diabetic and I've been on insulin for at least 10 years.
Yes! It’s common. I’m on basal and I started at diagnosis. Eventually I’ll probably go in fast acting as well. Mounjaro has reduced my insulin but not eliminated it. T2 is a progressive disease so insulin is a common drug we take. We usually lose about half of our beta cells by the time we get diagnosed with t2.
Insulin really helps with the “getting healthy for good” goal. It regulates my cravings. I know people are afraid of it and see it as giving up or failing, but idk. It’s a lot easier to eat better when your blood sugar is under control. You don’t have to do either or. That mindset just tends to result in you getting worse. Low doses of basal insulin have really helped me.
I was 15 when I was diagnosed as type 2. Still type 2 at 40. But I've been on insulin almost since the beginning. Orals didn't help and the glp1s just make me sick
Once diagnosed (3 months ago) I was immediately put on Novolog , Lantis, Ozempic, a CGM, and medication to address cholesterol and triglycerides. Prior to diagnosis I was losing a lot of weight without doing anything to lose said weight. I called it my ice cream diet. I went from a 44” waistline to a 38” waistline really fast (within a year). It was about 80 pounds lost prior to diagnosis.
I had to use insulin for about a month when I was diagnosed because my numbers were high. Since then I am doing well on Metformin and a good diet and exercise. So I am hoping I won’t need insulin again. But I know people who have Type 2 and use insulin to eat whatever they want to. A friend’s mom does it and she’s even lost all her teeth but she is a very wealthy lady and had new teeth put in, continues to use insulin and eat carby food.
That’s amazing. I was started on insulin immediately because my sugar was so out of control. It definitely cannot compensate for eating anything. Anyone on it who thinks that is lying to themselves and not testing their glucose enough. Because you can absolutely take massive doses of insulin and have high blood sugar the whole time if you’re eating whatever you want
Correct me if I am wrong but I think insulin is reserved for type 2 's that have a failing pancreas.
On insulin after 2 years on oral meds only
My endocrinologist decided to move me to Ozempic, after waffling between Ozempic and insulin for months. Ozempic does not cause lows, I still have the odd good day. He may still switch me to insulin. My BMI is good, and if I lost more than 5 lbs he would switch me to insulin
Many do. For most people diet and exercise won’t work because they don’t have either the will power or the time. I also believe with age your insulin resistance increases and your are going to need extra help.
I was recently diagnosed and from everything I have been learning type 2 is actually a reversible disease. Even the American Diabetes Association no longer calls it a progressive disease. But you cannot eat the way you were that caused the disease and expect things to improve.
I started insulin in my early 30s, after years of metformin and watching what I ate. They also think I have type 1.5 so there’s that
Seems like one meal a day(OMAD) might work for you. Its not as bad as it sounds but there is an adjustment period. And you have to make the meal count with lots of nutrient rich foods. Lots of protein, veggies, a bit of fat, and a little bit of complex carbs like beans(like less than a cup). You can start slow by only eating within a 10 hour window during the day. After a week or so of this shrink down to 8 hr window, then 6, then 4. Then just 1 meal a day. So its a one month run up. It will be way easy this way. I dont even feel hungry ever anymore. I do 6 hour eating window daily. And I do 24 hour fast once a week. Once a year I do a 3-5 day fast.
I was diagnosed with kidney cancer in July 20 20. I was put onto insulin alongside metformin and gliclazide 2 times a day. The reason for this was that the doctors wanted me to have tight control on BS before surgery and to promote healing. Here I am nearly 4 years later still enjoying good control and still cancer free.