Question:

Hi Barbara, Can you think of a GOOOD reason for not converting someone to insulin, if they are max’d out on all possible orals, and have A1C 9.5%?

In the study, not all of these people WERE maxed out on orals , diet and exercise. If they were, I would agree with you. The only one I can conceivably come up with is that are 93 and not expected to live much longer anway. It is arguable that they are not going to gain either length or quality of life from the change, so why bother?

I actually started a fellow who was 100 on insulin. He was mentally intact, could handle the shots, and was really quite symptomatic with frequent urination and severe weight loss until we started insulin. I regret to say that he died a year later, from leukemia. OTOH if they are in their 60’s or younger, the only reason I can see for not trying to meet the targets is complacency…. maybe not being aware of what the targets are, or why they are set there.

Whose complacency ? One can understand that patients might not appreciate the importance of the targets unless it is explained to them, as most people with diabetes don’t frequent these news groups. But is it acceptable, do you think, that doctors treating people with A1C’s of 9.5% are not trying more aggressive therapy?

Once oral meds have been tried and failed, the only aggressive therapy is insulin. Getting a patient to convert to insulin is sometimes easier said than done. I have people flat out refuse, and go get another opinion.  I have had many people refuse, and then not get any other opinions, only to see me years later because of complications. Of course there are docs who are unaware of the targets for DM. But you might also be blown away by the fact that about 40% of people treated with DM don’t get a HbA1c even once a year !    How can you know if you are reaching a target of 7.0 ( or 6.5) , when you don’t even do a HbA1c ? I think we have done a good job locally with educating them about DM treatment goals and BP goals. I’m lucky enough to have a small enough audience here to keep them up to date. (About 500 docs in the region.)  Plus I have to hand it to the drug companies (who have a vested interest in this) for educating docs about what current treatment standards are. Apparently there are some areas of the country that isn’t getting the word out. Cheers, William C Biggs MD – Hide quoted text — Show quoted text – Barbara

Response:

Recall that many patients are not reaching appropriate targets of glucose levels. Acton et al in an abstract at the 59th ADA meetings reported a group of "typical" patients where 34% had A1Cs above 9.5 % .   That’s really bad, and I’ll bet most of these folks needed to be converted to insulin, but for whatever reason weren’t.

Can you think of a GOOOD reason for not converting someone to insulin, if they are max’d out on all possible orals, and have A1C 9.5%? The only one I can conceivably come up with is that are 93 and not expected to live much longer anway. It is arguable that they are not going to gain either length or quality of life from the change, so why bother? OTOH if they are in their 60’s or younger, the only reason I can see for not trying to meet the targets is complacency…. maybe not being aware of what the targets are, or why they are set there. One can understand that patients might not appreciate the importance of the targets unless it is explained to them, as most people with diabetes don’t frequent these news groups. But is it acceptable, do you think, that doctors treating people with A1C’s of 9.5% are not trying more aggressive therapy? Barbara

Response:

"Progressive" means what exactly?  That the cells will become more resistant to insulin and it will get more difficult to control over time?

AUIU, the main factor in the progression of T2 is that the pancreas’ peak capacity for producing insulin decreases over time. This happens in everyone as a normal feature of aging…. but it happens faster, and sooner, in people with T2. And in combination with insulin resistance, it means that BG can no longer be controlled without some sort of intervention. I’ve read that there is a huge variation in insulin sensitivity in the normal (i.e. non-diabetic) population, up to a factor of 10. And that the difference in insulin resistance between the highest and the lowest is roughly 50% genetic, with obesity and inactivity contributing the other 50%. This comes from an interview with Gerald Reaven, one of the main researchers in insulin resistance. Obesity has been over-emphasised at the expense of inactivity, he says… they are roughly equal in their potential effect on IR. The other statisic bandied around is that, at the time of diagnosis, the average T2 has 58% of the normal peak insulin-making capacity. And in the UKPDS, they calculated that it decreased by 4% per year *on average*, but obviously it is faster in some people and slower in others. Conclusion: it is not inevitable that your husband will end up on insulin. He should do the best he possibly can with diet and exercise (always), take whatever meds are needed to get tight control, and keep in mind the possibility that he may need more in time….. and maybe insulin. But if that happens, it’s not his fault. Barbara

Response:

Thanks all for the information.  He has now been on meds for 1.5 weeks.  Low reading is now 176, so it is getting better. I understand sometimes people inject just for a while until levels are where they should be.  He is dedicated to his diet, but hard to get him to exercise.  I help him alot by preparing the right meals whith the right balance and carb units.

Response:

Miranda, Exercise is a very important component for controlling diabetes.  Diet is of course in the same league. My initial diagnosis was in the upper 500 level!  3 months later I was off Glucotrol 10 mg.  For nearly 10 years, been fortunate controlling this beast with no complicattions, no medication, and healthier than ever being a proud AARP aged male. Exercise is the primary source to my success.  I bike alot,  last year almost 15,000….fifteen thousand miles.  This requires a high caloric intake and has allowed a large degree of choices in my eating regimen.  Nevertheless, I am a fishgetarian, no dairy product person by choice. You may not want to train or ride as much as me, however, do please consider exercise as an adjunct to his new lifestyle. Good luck, Ed Gin – Hide quoted text — Show quoted text – Thanks all for the information.  He has now been on meds for 1.5 weeks.  Low reading is now 176, so it is getting better. I understand sometimes people inject just for a while until levels are where they should be.  He is dedicated to his diet, but hard to get him to exercise.  I help him alot by preparing the right meals whith the right balance and carb units.

Response:

Hi, While I’m sure that your experience is by no means atypical… the YMMV aspect is highly relevant here.  In my short experience of this group you are likely to find many people to support your assertion and just as many to refute it. My personal experience leads me to believe that DM is progressive. But many others do not have that experience and can only deny it on that basis. There is this strong suggestion that coming back to this group as a diabetic who went on to a fairly successful pentathlon career would find a fit person with a much easier to control condition… How much of teh progressive factor is really the inability of many typical T2s who are severely overweight and have sedentary lifestyles and CANNOT lose weight or do exercise and so their conition declines.. Or is that the cynic within me. Martin (5′ 6" – 17st 8 lbs – 76units mixtard30 x 2) — Mart.            *OPINION OF* "Knowledge speaks, but wisdom listens." – Jimi Hendrix

: I started on oral meds in 1998.  They worked for awhile and control wa : difficult to maintain.  By May of 1999 I was on insulin.  Now am taking Lantus : (70 units at night) and Humalog on a sliding scale for meals. Diabetes is : progressive.  There is no cure only the ability to slow the progression of the : disease.  I am on two high blood pressure meds and Lipitor for cholesterol.  I : also have some gastric problems and use Reglan as needed.  But so far no : problems with my eyes or feet.  I get my eyes checked yearly and I watch my : feet.  I am a 54 year old male.

Response:

I started on oral meds in 1998.  They worked for awhile and control wa difficult to maintain.  By May of 1999 I was on insulin.  Now am taking Lantus (70 units at night) and Humalog on a sliding scale for meals.  Diabetes is progressive.  There is no cure only the ability to slow the progression of the disease.  I am on two high blood pressure meds and Lipitor for cholesterol.  I also have some gastric problems and use Reglan as needed.  But so far no problems with my eyes or feet.  I get my eyes checked yearly and I watch my feet.  I am a 54 year old male.  

Response:

Hi Miranda, I’m a T2 on Insulin.  I was started on Metformin and it was very successful.  I slipped in *my* control and so they increased the dose until my liver complained.  Then I tried several other drugs to some effect.  Over Xmas my pancreas decided to give up the ghost and so now I inject insulin. My biggest fear was realized…  Actually it is not the worst thing that can happen to you.  It sounds terrible but it is only a few seconds out of my life and is quite painless.  I also think that it is easier in some ways than the terribly restrictive diet I eat on oral meds… FWIW my Endocrinologist told me that he believes DM to be progressive and you need to work at it to maintain diet or diet + meds control. But it can be done. Good luck… Martin

: My husband was just diagnosed during a physical as T2.  His fasting BG was : 300.  He was without meds for a week and BG was ranging from 300 to 450.  He : has been on Avandia and Glucophage for one week and levels have come down to : 190 to 250.  Usually these meds take a while to work and his BG should : continue to come down.  It has already come down 100 points, and another 100 : he has arrived! : : Today he went for his Diabetes education.  The dietician really upset him : (and me). She wanted him on insulin immediately, but couldn’t reach his : doctor.  She said that the disease is progressive and will get worse over : time and that he will end up on insulin anyway sooner or later. : : I am diabetic also (T2 for 2 years) and keep mine under control with : glucophage alone. In all my research, I have never heard such a thing.  In : fact, I read somewhere that only 5% (I think that was the number) of T2’s : ever need insulin.  If we all end up on it at some time, then I would think : these numbers would be much higher. : : Anyone else out there with levels similar to his that have managed without : insulin?  Can anyone elaborate on the statement of this being a progressive : disease and that we all need insulin eventually? : :

Response:

– Hide quoted text — Show quoted text – <snip My husband’s high readings in the 250’s is after a meal.  The lowest so far was in the 190’s and that was fasting. I have never known him to exercise in our 12 years of marriage and he so far refuses.  I have gotten off of my exercise plan as well since I slipped a disc in my back a year ago.  I am better now (thanks to steroids) and think I will buy a treadmill.  We both need it! Diet and exercise are both vital for gaining good control.  If he is unwilling to exercise, then he is probably going to continue to have problems. Wow.  I didn’t realize that so many T2s use insulin. I don’t have any figures on that, but I do think there are more type 2s than there are type 1s.

By a *BIG* factor….

Response:

<snip My husband’s high readings in the 250’s is after a meal.  The lowest so far was in the 190’s and that was fasting. I have never known him to exercise in our 12 years of marriage and he so far refuses.  I have gotten off of my exercise plan as well since I slipped a disc in my back a year ago.  I am better now (thanks to steroids) and think I will buy a treadmill.  We both need it!

Diet and exercise are both vital for gaining good control.  If he is unwilling to exercise, then he is probably going to continue to have problems. Wow.  I didn’t realize that so many T2s use insulin.

I don’t have any figures on that, but I do think there are more type 2s than there are type 1s. — Type 2 http://www.redshift.com/~juliebove/

Response:

My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450. He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived!

His numbers upon diagnosis were very high.  They have come down, but are still too high.  I don’t know for sure about Avandia, but Glucophage takes about 2 weeks to kick in.  How is his diet?  Could well be that more changes need to be made there. Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later.

I dietician is not a Dr.  If she advised the insulin, take that with a grain of salt, but do call the Dr.  As for the rest of what she said, I have heard that same thing more times than I can remember.  But is it true?  I don’t know. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.  If we all end up on it at some time, then I would think these numbers would be much higher.

I heard it a lot.  Diabetes is an ever changing disease.  I was diagnosed about 2 1/2 years ago and have tried 4 different oral meds and also diet and exercise alone.  Something might work for me for a while, and then I will start having problems…either highs or hypos. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

I know a 75 year old man who used to use insulin and now uses Actos.  How is his control?  I don’t think it is very good.  He doesn’t exercise or watch what he eats.  And he only tests if I nag him to do it. I have heard the theory that the pancreas will eventually burn out, especially if you are taking certain meds.  But I don’t think this can be proven.  I think the meds are still new enough that nobody can say for sure. — Type 2 http://www.redshift.com/~juliebove/

Response:

James, I haven’t seen the 57% number before, but I’m sure there is a study somewhere that says this. The problem is whether 57% OUGHT TO BE treated with insulin, or 57% ACTUALLY ARE treated with insulin. I suspect it is the latter.   Probably more than 57% would be best treated with insulin at some stage of their life. Recall that many patients are not reaching appropriate targets of glucose levels. Acton et al in an abstract at the 59th ADA meetings reported a group of "typical" patients where 34% had A1Cs above 9.5 % .   That’s really bad, and I’ll bet most of these folks needed to be converted to insulin, but for whatever reason weren’t. Cheers, William C Biggs MD

– Hide quoted text — Show quoted text – Miranda, One of our hospital dietitians (i.e. not under our control) does that to us sometimes, too.  Gets our patients all angry and upset. We try to avoid that one. I have seen all sorts of statistics thrown around in this thread, and I can’t tell where they came from.  Could some of you cite a reference on these ? I got the 57% from a poster that hangs in my endocrinologist’s office.  I looked but could not find a cite for this, the best I could do was find one that says "more than half". http://www.emedicine.com/aaem/topic151.htm [...]

Response:

Miranda, One of our hospital dietitians (i.e. not under our control) does that to us sometimes, too.  Gets our patients all angry and upset. We try to avoid that one. I have seen all sorts of statistics thrown around in this thread, and I can’t tell where they came from.  Could some of you cite a reference on these ?

I got the 57% from a poster that hangs in my endocrinologist’s office.  I looked but could not find a cite for this, the best I could do was find one that says "more than half". http://www.emedicine.com/aaem/topic151.htm – Hide quoted text — Show quoted text -[...]

Response:

Miranda, One of our hospital dietitians (i.e. not under our control) does that to us sometimes, too.  Gets our patients all angry and upset. We try to avoid that one. I have seen all sorts of statistics thrown around in this thread, and I can’t tell where they came from.  Could some of you cite a reference on these ? As far as insulin vs. no insulin, I agree your husband should work this out with his doctor. He should get a firm understanding of what the doctor’s targets are for his glucose readings. Is insulin inevitable ?   No, and particularly not if your husband successfully loses weight, exercises, and watches his diet. If he does none of the above, then the odds are against him. In last months journal "Diabetes Care", the landmark UKPDS study showed that 53% of the newly diagnosed patients treated with sulfonylureas needed additional therapy with insulin. by 6 years from diagnosis.  Diabetes Care 2002 Feb;25(2):330-6 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&… ds=11815505&dopt=Abstract After 6 years that percentage continues to grow. I can give you the other side of the coin too. My grandfather took sulfonylurea meds, then metformin, for almost 30 years until he died, at age 94. But he watched his diet like a hawk. Good luck to you & your husband, William C Biggs MD

– Hide quoted text — Show quoted text – My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450. He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.  If we all end up on it at some time, then I would think these numbers would be much higher. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

Response:

My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450. He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later.

I can’t fathom why the "dietician" would take it upon herself to tell your husband something that is basically  rot. I also wouldn’t take what she says with ANY credence whatsoever. If you or your husband aren’t sure about his treatment (it’s VERY early days yet and oral meds need SOME time to "get going") then talk to your doctor. I personally wouldn’t even trust a dietician to tell me what FOOD is good for me, let alone what meds I shoould be taking, or what to expect down the line. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.

The number is substantially higher than that, but it’s still not to say you or your husband will ever be in the number that will need insulin. .   If we all end up on it at some time, then I would think these numbers would be much higher.

Good thinking. Sort of disporves what Miss Dietician of the Week has to say. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

Diabetes IS progrssive in SOME people, but how far it progresses and how seriously is a very "YMMV" thing. Beav

Response:

"Progressive" means what exactly?  That the cells will become more resistant to insulin and it will get more difficult to control over time? My husband’s high readings in the 250’s is after a meal.  The lowest so far was in the 190’s and that was fasting. I have never known him to exercise in our 12 years of marriage and he so far refuses.  I have gotten off of my exercise plan as well since I slipped a disc in my back a year ago.  I am better now (thanks to steroids) and think I will buy a treadmill.  We both need it! Wow.  I didn’t realize that so many T2s use insulin.

– Hide quoted text — Show quoted text – Well, there are a number of questions you raise here. First, 50 percent of T2s use insulin.  But that doesn’t mean your husband has to.  Also, starting insulin, or using insulin to quickly bring down BGs of a new diabetic, does not mean they have to stay on insulin. But that being said, IMHO your husband is showing great improvement, and it’s only been a week.  Glucophage usually takes at least 2-3 before it’s full effect is shown. You don’t say whether his 190 – 250 is fasting or post prandial (post meal)… there is a big difference. I would let the meds, and his new food and exercise plan work for at least a month… (he IS on a good food and exercise plan right?) UNLESS, he is seeing very very high post meal spikes (over 300)… then you may want to consider the nurses plan. Here’s the advice I give all newbies: You might want to try some  experiments. First:  Day one:  eat whatever you’ve been currently eating… but write it down. Test yourself at the following times: Upon waking (fasting) 1 hour after each meal 2 hours after each meal At bedtime That means 8 x for that day.  What you will discover by this is how long after a meal your highest reading comes… and how fast you return to "normal".  Also, you may see that a meal that included bread, fruit or other carbs gives you a higher reading. Then for the next few days, try to curb your carbs.  Eliminate breads, cereals, rices, beans, any wheat products, potato, corn, fruit… get all your carbs from veggies.  Test at the same schedule above. If you try this for a few days, you may find some pretty damn good readings.  It’s worth a few days to discover. That’s the thing about this disease… we share much in common… we need to follow certain guidelines… but in the end, our bodies dictate our treatment and our success. The closer we get to non-diabetic numbers, the greater chance we have of avoiding horrible complications.  The key here is AIM… I know that everyone is at a different point in their disease… and it is progressive. But, if we aim for the best numbers and do our best, that’s all we can do. Here’s my opinion on what numbers to aim for, they are non-diabetic numbers. FBG                         under 110 One hour after meals       under 140 Two hours after meals     under 120 Recent studies have indicated that the most important numbers are your "after meal" numbers. They may be the most indicative of future complications, especially heart problems. Listen to your doctor, but you are the leader of your diabetic care team.  While his /her advice is learned, it is not absolute.   You will end up knowing much more about your body and how it’s handling diabetes than your doctor will.   The meter is our best weapon. Just remember, we’re not in a race or a competition with anyone but ourselves… Play around with your food plan… TEST TEST TEST.  Learn what foods cause spikes, what foods cause cravings… Use your body as a science experiment. Best of luck! Jennifer My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450. He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing. In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.  If we all end up on it at some time, then I would think these numbers would be much higher. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

Response:

My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450. He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later.

I don’t know a lot about prals meds, but I do know some of them can take a couple weeks to work.  Only time will tell.  I’m not sure how she thinks she knows he will end up on insulin.  Lots of T2s control with diet and exercise, or diet, exercise and orals. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.

Actually it is 57%. If we all end up on it at some time, then I would think these numbers would be much higher. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

It is not an accurate statement.  Everyone does not end up on insulin.  Your dietician is high (kind of rude for her to not share).

Response:

Well, there are a number of questions you raise here. First, 50 percent of T2s use insulin.  But that doesn’t mean your husband has to.  Also, starting insulin, or using insulin to quickly bring down BGs of a new diabetic, does not mean they have to stay on insulin. But that being said, IMHO your husband is showing great improvement, and it’s only been a week.  Glucophage usually takes at least 2-3 before it’s full effect is shown. You don’t say whether his 190 – 250 is fasting or post prandial (post meal)… there is a big difference. I would let the meds, and his new food and exercise plan work for at least a month… (he IS on a good food and exercise plan right?) UNLESS, he is seeing very very high post meal spikes (over 300)… then you may want to consider the nurses plan. Here’s the advice I give all newbies: You might want to try some  experiments. First:  Day one:  eat whatever you’ve been currently eating… but write it down. Test yourself at the following times: Upon waking (fasting) 1 hour after each meal 2 hours after each meal At bedtime That means 8 x for that day.  What you will discover by this is how long after a meal your highest reading comes… and how fast you return to "normal".  Also, you may see that a meal that included bread, fruit or other carbs gives you a higher reading. Then for the next few days, try to curb your carbs.  Eliminate breads, cereals, rices, beans, any wheat products, potato, corn, fruit… get all your carbs from veggies.  Test at the same schedule above. If you try this for a few days, you may find some pretty damn good readings.  It’s worth a few days to discover. That’s the thing about this disease… we share much in common… we need to follow certain guidelines… but in the end, our bodies dictate our treatment and our success. The closer we get to non-diabetic numbers, the greater chance we have of avoiding horrible complications.  The key here is AIM… I know that everyone is at a different point in their disease… and it is progressive. But, if we aim for the best numbers and do our best, that’s all we can do. Here’s my opinion on what numbers to aim for, they are non-diabetic numbers. FBG                         under 110 One hour after meals       under 140 Two hours after meals     under 120 Recent studies have indicated that the most important numbers are your "after meal" numbers. They may be the most indicative of future complications, especially heart problems. Listen to your doctor, but you are the leader of your diabetic care team.  While his /her advice is learned, it is not absolute.   You will end up knowing much more about your body and how it’s handling diabetes than your doctor will.   The meter is our best weapon. Just remember, we’re not in a race or a competition with anyone but ourselves… Play around with your food plan… TEST TEST TEST.  Learn what foods cause spikes, what foods cause cravings… Use your body as a science experiment. Best of luck! Jennifer – Hide quoted text — Show quoted text – My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450.  He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.  If we all end up on it at some time, then I would think these numbers would be much higher. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

Response:

My husband was just diagnosed during a physical as T2.  His fasting BG was 300.  He was without meds for a week and BG was ranging from 300 to 450.  He has been on Avandia and Glucophage for one week and levels have come down to 190 to 250.  Usually these meds take a while to work and his BG should continue to come down.  It has already come down 100 points, and another 100 he has arrived! Today he went for his Diabetes education.  The dietician really upset him (and me). She wanted him on insulin immediately, but couldn’t reach his doctor.  She said that the disease is progressive and will get worse over time and that he will end up on insulin anyway sooner or later. I am diabetic also (T2 for 2 years) and keep mine under control with glucophage alone. In all my research, I have never heard such a thing.  In fact, I read somewhere that only 5% (I think that was the number) of T2’s ever need insulin.  If we all end up on it at some time, then I would think these numbers would be much higher. Anyone else out there with levels similar to his that have managed without insulin?  Can anyone elaborate on the statement of this being a progressive disease and that we all need insulin eventually?

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