Re: Article Type 2s: Insulin Early is Easy, Insulin Late is Not

[Guest guest]

Thanks for this. Definitely food for thought.

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of Jesso

Sent: Thursday, June 21, 2007 12:20 PM

To: blind-diabetics

Subject: Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

I found this online, thought some on the list might find it interesting.

Jen

Type 2s: Insulin Early is Easy, Insulin Late is Not

I keep reading postings here and there on the web from people with Type 2

diabetes that say something like, " My A1c was 11.5% even with Metformin, so

my doctor told me it was time to go on insulin. "

It is postings like this that bring home to me why so many Type 2s develop

terrible complications, and even more importantly, why even those who are

taking insulin often have dangerously high blood sugars.

The most conservative of medical groups--the ADA--tells doctors that an A1c

over 7% is going to cause serious diabetic complications like blindness and

kidney failure. Yet these people's doctors have encouraged them to dick

around with oral drugs when their A1cs were 10% or higher!

The years they've spent at those dangerously high blood sugar levels waiting

for oral drugs to do what all the research evidence shows oral drugs cannot

do have wreaked havoc on their organs that may not be completely reversible,

no matter what their blood sugars might be in the future.

In fact, a recent survey I read somewhere on the web found that most family

doctors don't put their patients on even an oral drug until the patient has

spent a year with an A1c of 8% or higher. That is a whole, long year where

dangerously high blood sugars are producing early retinopathy, advancing

neuropathy, and making small changes that lead to kidney failure.

Since none of the oral drugs is capable of lowering A1c much more than 1%,

this kind of treatment is criminal. A patient whose A1c is 11.5% on

metformin probably started out with an A1c of 12% or even higher. If you

don't believe me, go read the Prescribing Information for each of the common

diabetes drugs. They show exactly what the median change in A1c is that

their drugs can achieve, and you'll see it is rarely much more than a 1%

drop in A1c. For a patient with a 12% A1c, even a 3% drop would be pitifully

insufficient. But that is how these people's doctors are treating them.

All that unnecessary suffering. It makes me want to weep!

For patients with an A1c over 8.5% there are only two therapies that will

reliably bring blood sugars into the safe zone. Let's look at them now, very

carefully.

Carb Restriction

Many newly diagnosed Type 2s with surprisingly high A1cs have reported

online that they have been able to bring their A1cs down from 10% or higher

to the safe 5% range by cutting the carbohydrates out of their meals until

they were able to get a blood sugar under 140 mg/dl at one hour and 120

mg/dl a two hours after eating.

Though doctors pay lip service to the idea that their patients can control

diabetes with " diet " a depressingly high proportion of these doctors seem to

think that " diet " means " weight loss diet " rather than " Carb control diet "

so their patients end up starving on high carb/low fat meals that push up

their blood sugars to levels guaranteed to destroy eyes, nerves and kidneys.

Cutting out the carbs that raise blood sugar is the only " diabetes " diet

that will improve blood sugars for every person diagnosed with Type 2

diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

tried cutting way back on their starch and sugar intake, a stint of eating a

true diabetes diet, one that avoids all starchy foods, no matter how full of

" whole grains " they might be, a diet made up almost entirely of healthy

greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

all that is needed to perform blood sugar rescue.

But if cutting your carbs doesn't make a dramatic difference in your A1c

within a few months, there is only one sane therapy to consider, and the

faster you demand it, the less likely you are to end up as another tragic

diabetes disaster story.

That therapy involves insulin.

Insulin

Unlike every other diabetes drug you may read about, insulin, prescribed

properly (and those words are key) always works. Insulin is the only drug

that will lower blood sugar in every critter that has a blood stream with

glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

lower the blood sugar. And insulin can lower blood sugar however much you

need it lowered, if--and it is a big if--you learn how to use it correctly.

This is such a simple concept, you have to wonder why most doctors treat

insulin like it was devil's blood, trying every other possible

treatment--some of them quite dangerous--before putting their patients on

the one treatment that is capable of giving them normal blood sugars.

In the past, doctors seem to have assumed that needles were so terrifying to

patients that they would not use them unless faced with immanent death, and

as a result, insulin wasn't prescribed until Type 2s were on death's

doorstep. (Which, unfortunately, has made a new generation of diabetics

assume that if you get prescribed insulin, you are on your way out.)

But look what happened when Big Pharma came up with a new treatment, Byetta,

that was rumored to cause weight loss. Despite the fact that Byetta

treatment requires not one but two needles a day and can cause projectile

vomiting, patients lined up demanding it and thousands of Type 2s are

happily injecting themselves and whoopsing their way to happiness. So

clearly when patients perceive a benefit in a treatment, they'll put up with

needles.

The benefit of insulin can be much greater, since Byetta only works to lower

blood sugar significantly for a subset of those who take it. Insulin always

works.

Insulin Early is Easy, Insulin Late is Hard

My belief--and this is how I treat my own diabetes--is that if diet (defined

as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

don't give you normal blood sugars, it is time to move to insulin while the

beta cells still have enough life in them to make insulin safe and easy to

use.

This is a huge point many doctors miss. If your pancreas is a mess of scar

tissue, you probably have lost your alpha cells too, and this means that you

may have little or no ability to secrete glucagon to raise your blood sugar

if it goes too low.

If, on the other hand, you start using insulin when you still have 20-30% of

your beta cells living, you can use lower doses of insulin and if you take

too much your body will push your blood sugar out of the hypo range, because

it still has the other pancreas-produced hormone it needs to do so.

People with no beta cells have a much tougher time using insulin, especially

when they use it to control post-meal blood sugars. The stories you hear

from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some idea

of what it can be like to use insulin when you have a dead pancreas.

But most Type 2s don't have a dead pancreas, and though only a few of us

have pioneered the " insulin early, not insulin late " strategy, those of us

who have find that it makes living with diabetes far easier than we ever

thought possible. Insulin supplementation takes the burden off our

struggling beta cells. It can let us fine tune our blood sugars to where

they stay relatively flat and do not ever go near the zone where glucose

floods into nerves, eyes, and clogs up tiny kidney filtration units.

As Dr. Bernstein points out, small inputs make for small mistakes, and when

a Type 2 starts insulin early, the doses are much smaller than later, when

they have no beta cells, and the mistakes are much smaller too.

Here are some things your doctor might tell you if you want to start insulin

that you might want to question.

Insulin Myths

1. You'll gain weight.

This is what kept me from starting insulin for years, when I should have

been on it all along. It turned out NOT to be true as long as I use insulin

in a way that matches my carbohydrate input.

If you take more insulin than you need, you will get hungry. " Feeding the

insulin " will pack weight on you. But if you learn how to determine your

" insulin/carb " ratio, and inject an amount of insulin that matches your

food, you should not gain weight. If you are taking a basal insulin, Levemir

is also reputed to avoid weight gain.

And I also find that for me, the analog insulins seem to provoke hunger. But

R insulin (the cheap kind) does not, and I even managed to lose a couple

pounds last year while injecting R insulin 3 times a day.

2. You'll have hypos.

Using insulin requires using your brain. If you just want the doctor to tell

you how many units to inject, and blindly do whatever you are told, hypos

are a possibility.

But if you read up on how to use insulin--using the books and materials

intended for Type 1s who, unlike Type 2s, get training in how to use insulin

properly, you won't. I have not had a blood sugar reading under 60 mg/dl

fifteen months of using insulin with my meals.

3. Needles are Painful

The shots don't hurt. I was as needlephobic as anyone, but it took about a

day to figure out that my lancet for testing my blood sugar is a lot more

painful than the hair thin needles I use for injecting. The first time I

stuck myself with one, it was so painless I had to look down to make sure I

really had stuck myself!

Right now one company is marketing an inhalable insulin, one that isn't very

easy to use and which is very tough to match to carbs, by playing on

people's fears of needles. It is much more expensive than even the most

expensive injectibles, and it may harm the lungs. It is completely

unnecessary.

Give yourself a few days to get over your needle phobia, and you'll end up

laughing at how huge it used to loom in your mind. Injecting insulin really

is No Big Deal.

4. All you need is one shot of basal insulin

There are two kinds of insulin. One lowers your fasting blood sugar and runs

slowly in the background. Lantus, Levemir, and to a lesser extent NPH

insulin are in this category. This kind of insulin does NOT bring down high

post-meal blood sugars, it just lowers the point from which the post-meal

spike begins.

Most Type 2s get put on basal insulin, because it is easy to use. But if

your diabetes is mostly about very high post-meal blood sugars, a basal may

not solve your problems. So you may think that insulin doesn't work for you,

when in fact, the problem is you are using the wrong kind of insulin.

The meal-time insulin or " bolus " insulin is the insulin you match to your

carb intake. The key for a Type 2 to making meal-time insulin work well is

to keep your carb intake reasonable. Type 2s still have a small bit of

homemade stuff that kicks in after a few hours, unlike a Type 1. It is not

realistic to think you can eat 100 grams of carbs and match it with insulin,

because the variations in timing of all that carb hitting your system, mixed

up with your " sputtering pancreas " occasionally throwing a dollop of the

homemade stuff, are too complex to calculate. And if you dump huge amounts

of insulin into your system and it misses those huge amounts of

carbohydrate, well, yes, you do have a problem--one that can, worst case,

put you in the ER.

But most people with Type 2 can match 30 grams of carb or even 40 with

insulin without problems, especially after some practice, and possibly by

using the slower R insulin which is more gradual in its effect.

It may take you a lot of cautious experimentation to figure out exactly how

much carb and insulin you can use safely--starting out with a very low dose

and a small amount of carbs and carefully adjusting carbs and insulin until

you reach a level you can live with that gives you blood sugars that are

safe and normal.

When Is Insulin NOT Useful

The only people for whom insulin is not a good idea are those who are still

producing high levels of insulin, whose diabetes is caused entirely by

insulin resistance, not beta cell failure. Many of these people are very,

very large.

Typically, if your diabetes is caused by insulin resistance, your blood

sugar will drop to normal levels very quickly as soon as you cut out most

carbs. By " normal " I mean fasting blood sugars in the 80s or better. But if

your diabetes is caused by beta cell problems, though your blood sugar will

drop in response to a low carb diet, your fasting blood sugar may still be

over 100 or worse no matter how low your carbohydrate intake.

You may also be able to determine if you are highly insulin resistant by

having your insulin levels tested. If they are much higher than normal while

fasting, then you may be seriously insulin resistant and adding insulin may

not be the answer for you since your problem is that your body isn't using

insulin, not that you don't have enough.

Doctors often seem to believe that all Type 2s are seriously insulin

resistant, but in practice, this turns out not to be true. Mine told me I

" obviously " was insulin resistant, but when I finally started taking

insulin, my response was that of a Type 1 not a Type 2, showing I had very

little insulin resistance at all--and that I really needed insulin

supplementation.

That's enough for now. We'll come back to this topic again, though!

[Guest guest]

I am an experienced type2 diabetic, whose beta cells burned out four years ago.

When this happened, I became insulin dependent. I will also add that my insulin

dependence did not occur until I had three heart attacks, one stroke and two

heart bypass surgeries along with a smattering of some vision loss and a wopping

case of sexual impotence, all of these caused in my opinion by bad medical

advice in lieu of medical ignorance . The doctors just said just take these

pills and as long as you show good A1C's, then you are okay, and their A1C

standard was 7.5 or lower. How wrong could they have been? As long as medical

advice is controlled and largely influenced by the drug companies, I fear they

will continue to be wrong. Take this drug, Diabeta or glyburide, or take this

drug metformin, or this one Rezulin or Actos, or this new one here, name your

choice. No matter what you do avoid taking any natural substance and god forbid

you take something natural like insulin. When you take something natural, you

have to be instructed in the taking of it, and this is not necessary if you just

take this ppill. Never mind carb counting, because it is complex and requires

some thought and calculations, and god forbid you be required to add or

subtract. You are probably just another one of those dumb diabetic persons I

see every day, and I don't have the time nor inclination to teach you how to

deal with your illness, when a simple blood test and a simple prescription can

be delivered to you in less than ten minutes total, and be sure to come back in

a month or three months or as often as I say to do the same thing over and over

without all that necessary time spent in educating you. Unfortunately, this is

the thought process some doctors take just prior to dismissing you to their

front office, where you pay your bill and make another appointment to hear them

do the same thing again next time. I do not malign medical doctors out of

ignorance, because I am well acquainted with some sincere and well qualified

docdtors, who really do care and take the time to not only listen to you, but to

educate you regarding your illness and how to treat it.

,

I want to thank you for posting this message. From my experience I, not only

identify with it, but I also heartily endorse it. For those type2's out there.

Pay attention! If not, you may wind up like I did. Learn to count carbs and

also learn how to use a natural treatment like insulin to control and manage

your diabetes. It is not the only way, but it is without any doubt the best way

I know today.

Cheers,

Harry

Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

I found this online, thought some on the list might find it interesting.

Jen

Type 2s: Insulin Early is Easy, Insulin Late is Not

I keep reading postings here and there on the web from people with Type 2

diabetes that say something like, " My A1c was 11.5% even with Metformin, so

my doctor told me it was time to go on insulin. "

It is postings like this that bring home to me why so many Type 2s develop

terrible complications, and even more importantly, why even those who are

taking insulin often have dangerously high blood sugars.

The most conservative of medical groups--the ADA--tells doctors that an A1c

over 7% is going to cause serious diabetic complications like blindness and

kidney failure. Yet these people's doctors have encouraged them to dick

around with oral drugs when their A1cs were 10% or higher!

The years they've spent at those dangerously high blood sugar levels waiting

for oral drugs to do what all the research evidence shows oral drugs cannot

do have wreaked havoc on their organs that may not be completely reversible,

no matter what their blood sugars might be in the future.

In fact, a recent survey I read somewhere on the web found that most family

doctors don't put their patients on even an oral drug until the patient has

spent a year with an A1c of 8% or higher. That is a whole, long year where

dangerously high blood sugars are producing early retinopathy, advancing

neuropathy, and making small changes that lead to kidney failure.

Since none of the oral drugs is capable of lowering A1c much more than 1%,

this kind of treatment is criminal. A patient whose A1c is 11.5% on

metformin probably started out with an A1c of 12% or even higher. If you

don't believe me, go read the Prescribing Information for each of the common

diabetes drugs. They show exactly what the median change in A1c is that

their drugs can achieve, and you'll see it is rarely much more than a 1%

drop in A1c. For a patient with a 12% A1c, even a 3% drop would be pitifully

insufficient. But that is how these people's doctors are treating them.

All that unnecessary suffering. It makes me want to weep!

For patients with an A1c over 8.5% there are only two therapies that will

reliably bring blood sugars into the safe zone. Let's look at them now, very

carefully.

Carb Restriction

Many newly diagnosed Type 2s with surprisingly high A1cs have reported

online that they have been able to bring their A1cs down from 10% or higher

to the safe 5% range by cutting the carbohydrates out of their meals until

they were able to get a blood sugar under 140 mg/dl at one hour and 120

mg/dl a two hours after eating.

Though doctors pay lip service to the idea that their patients can control

diabetes with " diet " a depressingly high proportion of these doctors seem to

think that " diet " means " weight loss diet " rather than " Carb control diet "

so their patients end up starving on high carb/low fat meals that push up

their blood sugars to levels guaranteed to destroy eyes, nerves and kidneys.

Cutting out the carbs that raise blood sugar is the only " diabetes " diet

that will improve blood sugars for every person diagnosed with Type 2

diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

tried cutting way back on their starch and sugar intake, a stint of eating a

true diabetes diet, one that avoids all starchy foods, no matter how full of

" whole grains " they might be, a diet made up almost entirely of healthy

greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

all that is needed to perform blood sugar rescue.

But if cutting your carbs doesn't make a dramatic difference in your A1c

within a few months, there is only one sane therapy to consider, and the

faster you demand it, the less likely you are to end up as another tragic

diabetes disaster story.

That therapy involves insulin.

Insulin

Unlike every other diabetes drug you may read about, insulin, prescribed

properly (and those words are key) always works. Insulin is the only drug

that will lower blood sugar in every critter that has a blood stream with

glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

lower the blood sugar. And insulin can lower blood sugar however much you

need it lowered, if--and it is a big if--you learn how to use it correctly.

This is such a simple concept, you have to wonder why most doctors treat

insulin like it was devil's blood, trying every other possible

treatment--some of them quite dangerous--before putting their patients on

the one treatment that is capable of giving them normal blood sugars.

In the past, doctors seem to have assumed that needles were so terrifying to

patients that they would not use them unless faced with immanent death, and

as a result, insulin wasn't prescribed until Type 2s were on death's

doorstep. (Which, unfortunately, has made a new generation of diabetics

assume that if you get prescribed insulin, you are on your way out.)

But look what happened when Big Pharma came up with a new treatment, Byetta,

that was rumored to cause weight loss. Despite the fact that Byetta

treatment requires not one but two needles a day and can cause projectile

vomiting, patients lined up demanding it and thousands of Type 2s are

happily injecting themselves and whoopsing their way to happiness. So

clearly when patients perceive a benefit in a treatment, they'll put up with

needles.

The benefit of insulin can be much greater, since Byetta only works to lower

blood sugar significantly for a subset of those who take it. Insulin always

works.

Insulin Early is Easy, Insulin Late is Hard

My belief--and this is how I treat my own diabetes--is that if diet (defined

as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

don't give you normal blood sugars, it is time to move to insulin while the

beta cells still have enough life in them to make insulin safe and easy to

use.

This is a huge point many doctors miss. If your pancreas is a mess of scar

tissue, you probably have lost your alpha cells too, and this means that you

may have little or no ability to secrete glucagon to raise your blood sugar

if it goes too low.

If, on the other hand, you start using insulin when you still have 20-30% of

your beta cells living, you can use lower doses of insulin and if you take

too much your body will push your blood sugar out of the hypo range, because

it still has the other pancreas-produced hormone it needs to do so.

People with no beta cells have a much tougher time using insulin, especially

when they use it to control post-meal blood sugars. The stories you hear

from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some idea

of what it can be like to use insulin when you have a dead pancreas.

But most Type 2s don't have a dead pancreas, and though only a few of us

have pioneered the " insulin early, not insulin late " strategy, those of us

who have find that it makes living with diabetes far easier than we ever

thought possible. Insulin supplementation takes the burden off our

struggling beta cells. It can let us fine tune our blood sugars to where

they stay relatively flat and do not ever go near the zone where glucose

floods into nerves, eyes, and clogs up tiny kidney filtration units.

As Dr. Bernstein points out, small inputs make for small mistakes, and when

a Type 2 starts insulin early, the doses are much smaller than later, when

they have no beta cells, and the mistakes are much smaller too.

Here are some things your doctor might tell you if you want to start insulin

that you might want to question.

Insulin Myths

1. You'll gain weight.

This is what kept me from starting insulin for years, when I should have

been on it all along. It turned out NOT to be true as long as I use insulin

in a way that matches my carbohydrate input.

If you take more insulin than you need, you will get hungry. " Feeding the

insulin " will pack weight on you. But if you learn how to determine your

" insulin/carb " ratio, and inject an amount of insulin that matches your

food, you should not gain weight. If you are taking a basal insulin, Levemir

is also reputed to avoid weight gain.

And I also find that for me, the analog insulins seem to provoke hunger. But

R insulin (the cheap kind) does not, and I even managed to lose a couple

pounds last year while injecting R insulin 3 times a day.

2. You'll have hypos.

Using insulin requires using your brain. If you just want the doctor to tell

you how many units to inject, and blindly do whatever you are told, hypos

are a possibility.

But if you read up on how to use insulin--using the books and materials

intended for Type 1s who, unlike Type 2s, get training in how to use insulin

properly, you won't. I have not had a blood sugar reading under 60 mg/dl

fifteen months of using insulin with my meals.

3. Needles are Painful

The shots don't hurt. I was as needlephobic as anyone, but it took about a

day to figure out that my lancet for testing my blood sugar is a lot more

painful than the hair thin needles I use for injecting. The first time I

stuck myself with one, it was so painless I had to look down to make sure I

really had stuck myself!

Right now one company is marketing an inhalable insulin, one that isn't very

easy to use and which is very tough to match to carbs, by playing on

people's fears of needles. It is much more expensive than even the most

expensive injectibles, and it may harm the lungs. It is completely

unnecessary.

Give yourself a few days to get over your needle phobia, and you'll end up

laughing at how huge it used to loom in your mind. Injecting insulin really

is No Big Deal.

4. All you need is one shot of basal insulin

There are two kinds of insulin. One lowers your fasting blood sugar and runs

slowly in the background. Lantus, Levemir, and to a lesser extent NPH

insulin are in this category. This kind of insulin does NOT bring down high

post-meal blood sugars, it just lowers the point from which the post-meal

spike begins.

Most Type 2s get put on basal insulin, because it is easy to use. But if

your diabetes is mostly about very high post-meal blood sugars, a basal may

not solve your problems. So you may think that insulin doesn't work for you,

when in fact, the problem is you are using the wrong kind of insulin.

The meal-time insulin or " bolus " insulin is the insulin you match to your

carb intake. The key for a Type 2 to making meal-time insulin work well is

to keep your carb intake reasonable. Type 2s still have a small bit of

homemade stuff that kicks in after a few hours, unlike a Type 1. It is not

realistic to think you can eat 100 grams of carbs and match it with insulin,

because the variations in timing of all that carb hitting your system, mixed

up with your " sputtering pancreas " occasionally throwing a dollop of the

homemade stuff, are too complex to calculate. And if you dump huge amounts

of insulin into your system and it misses those huge amounts of

carbohydrate, well, yes, you do have a problem--one that can, worst case,

put you in the ER.

But most people with Type 2 can match 30 grams of carb or even 40 with

insulin without problems, especially after some practice, and possibly by

using the slower R insulin which is more gradual in its effect.

It may take you a lot of cautious experimentation to figure out exactly how

much carb and insulin you can use safely--starting out with a very low dose

and a small amount of carbs and carefully adjusting carbs and insulin until

you reach a level you can live with that gives you blood sugars that are

safe and normal.

When Is Insulin NOT Useful

The only people for whom insulin is not a good idea are those who are still

producing high levels of insulin, whose diabetes is caused entirely by

insulin resistance, not beta cell failure. Many of these people are very,

very large.

Typically, if your diabetes is caused by insulin resistance, your blood

sugar will drop to normal levels very quickly as soon as you cut out most

carbs. By " normal " I mean fasting blood sugars in the 80s or better. But if

your diabetes is caused by beta cell problems, though your blood sugar will

drop in response to a low carb diet, your fasting blood sugar may still be

over 100 or worse no matter how low your carbohydrate intake.

You may also be able to determine if you are highly insulin resistant by

having your insulin levels tested. If they are much higher than normal while

fasting, then you may be seriously insulin resistant and adding insulin may

not be the answer for you since your problem is that your body isn't using

insulin, not that you don't have enough.

Doctors often seem to believe that all Type 2s are seriously insulin

resistant, but in practice, this turns out not to be true. Mine told me I

" obviously " was insulin resistant, but when I finally started taking

insulin, my response was that of a Type 1 not a Type 2, showing I had very

little insulin resistance at all--and that I really needed insulin

supplementation.

That's enough for now. We'll come back to this topic again, though!

[Guest guest]

Hi Harry

One part of your rant really hit home with me. Doctors do often seem

ignorant or maybe just too busy to take the time to talk to patients. I was

diagnosed with type 2 diabetes at the end of 2001 when I finally went to an

E.R. due to a horrible infection in my foot that I had been trying to self

treat for months. One of the first things they did was prick my finger to

test my blood sugar. It was 380. A couple years before that, I had gone to

see a doctor recommended by a co-worker because I had a blister on my big

toe caused by a new pair of sandals, and the blister had turned purple. I

went to this doctor, and she put me in the hospital for a couple days so

that I could be put on IV antibiotics. She asked me if I was diabetic. I

said no (because as far as I knew, I wasn’t). In looking back on that,

shouldn’t she have tested me? Another doctor who came to see me while I was

in the hospital asked me the same question. Again I said no, and again he

took my word for it. If I had been diagnosed then, two and a half years

earlier than I was diagnosed, I might have been spared many of the problems

I’ve had over the past six years. Now granted I probably should have said

“I don’t think I am” instead of saying a definite no, but I still wish one

of these doctors had taken the initiative to stick my finger and find out.

Becky

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of Harry/ Bates

Sent: Thursday, June 21, 2007 3:27 PM

To: blind-diabetics

Subject: Re: Article Type 2s: Insulin Early is Easy,

Insulin Late is Not

I am an experienced type2 diabetic, whose beta cells burned out four years

ago. When this happened, I became insulin dependent. I will also add that my

insulin dependence did not occur until I had three heart attacks, one stroke

and two heart bypass surgeries along with a smattering of some vision loss

and a wopping case of sexual impotence, all of these caused in my opinion by

bad medical advice in lieu of medical ignorance . The doctors just said just

take these pills and as long as you show good A1C's, then you are okay, and

their A1C standard was 7.5 or lower. How wrong could they have been? As long

as medical advice is controlled and largely influenced by the drug

companies, I fear they will continue to be wrong. Take this drug, Diabeta or

glyburide, or take this drug metformin, or this one Rezulin or Actos, or

this new one here, name your choice. No matter what you do avoid taking any

natural substance and god forbid you take something natural lik! e insulin.

When you take something natural, you have to be instructed in the taking of

it, and this is not necessary if you just take this ppill. Never mind carb

counting, because it is complex and requires some thought and calculations,

and god forbid you be required to add or subtract. You are probably just

another one of those dumb diabetic persons I see every day, and I don't have

the time nor inclination to teach you how to deal with your illness, when a

simple blood test and a simple prescription can be delivered to you in less

than ten minutes total, and be sure to come back in a month or three months

or as often as I say to do the same thing over and over without all that

necessary time spent in educating you. Unfortunately, this is the thought

process some doctors take just prior to dismissing you to their front

office, where you pay your bill and make another appointment to hear them do

the same thing again next time. I do not malign medical doctors out of ig!

norance, because I am well acquainted with some sincere and well quali fied

docdtors, who really do care and take the time to not only listen to you,

but to educate you regarding your illness and how to treat it.

,

I want to thank you for posting this message. From my experience I, not only

identify with it, but I also heartily endorse it. For those type2's out

there. Pay attention! If not, you may wind up like I did. Learn to count

carbs and also learn how to use a natural treatment like insulin to control

and manage your diabetes. It is not the only way, but it is without any

doubt the best way I know today.

Cheers,

Harry

Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

I found this online, thought some on the list might find it interesting.

Jen

Type 2s: Insulin Early is Easy, Insulin Late is Not

I keep reading postings here and there on the web from people with Type 2

diabetes that say something like, " My A1c was 11.5% even with Metformin, so

my doctor told me it was time to go on insulin. "

It is postings like this that bring home to me why so many Type 2s develop

terrible complications, and even more importantly, why even those who are

taking insulin often have dangerously high blood sugars.

The most conservative of medical groups--the ADA--tells doctors that an A1c

over 7% is going to cause serious diabetic complications like blindness and

kidney failure. Yet these people's doctors have encouraged them to dick

around with oral drugs when their A1cs were 10% or higher!

The years they've spent at those dangerously high blood sugar levels waiting

for oral drugs to do what all the research evidence shows oral drugs cannot

do have wreaked havoc on their organs that may not be completely reversible,

no matter what their blood sugars might be in the future.

In fact, a recent survey I read somewhere on the web found that most family

doctors don't put their patients on even an oral drug until the patient has

spent a year with an A1c of 8% or higher. That is a whole, long year where

dangerously high blood sugars are producing early retinopathy, advancing

neuropathy, and making small changes that lead to kidney failure.

Since none of the oral drugs is capable of lowering A1c much more than 1%,

this kind of treatment is criminal. A patient whose A1c is 11.5% on

metformin probably started out with an A1c of 12% or even higher. If you

don't believe me, go read the Prescribing Information for each of the common

diabetes drugs. They show exactly what the median change in A1c is that

their drugs can achieve, and you'll see it is rarely much more than a 1%

drop in A1c. For a patient with a 12% A1c, even a 3% drop would be pitifully

insufficient. But that is how these people's doctors are treating them.

All that unnecessary suffering. It makes me want to weep!

For patients with an A1c over 8.5% there are only two therapies that will

reliably bring blood sugars into the safe zone. Let's look at them now, very

carefully.

Carb Restriction

Many newly diagnosed Type 2s with surprisingly high A1cs have reported

online that they have been able to bring their A1cs down from 10% or higher

to the safe 5% range by cutting the carbohydrates out of their meals until

they were able to get a blood sugar under 140 mg/dl at one hour and 120

mg/dl a two hours after eating.

Though doctors pay lip service to the idea that their patients can control

diabetes with " diet " a depressingly high proportion of these doctors seem to

think that " diet " means " weight loss diet " rather than " Carb control diet "

so their patients end up starving on high carb/low fat meals that push up

their blood sugars to levels guaranteed to destroy eyes, nerves and kidneys.

Cutting out the carbs that raise blood sugar is the only " diabetes " diet

that will improve blood sugars for every person diagnosed with Type 2

diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

tried cutting way back on their starch and sugar intake, a stint of eating a

true diabetes diet, one that avoids all starchy foods, no matter how full of

" whole grains " they might be, a diet made up almost entirely of healthy

greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

all that is needed to perform blood sugar rescue.

But if cutting your carbs doesn't make a dramatic difference in your A1c

within a few months, there is only one sane therapy to consider, and the

faster you demand it, the less likely you are to end up as another tragic

diabetes disaster story.

That therapy involves insulin.

Insulin

Unlike every other diabetes drug you may read about, insulin, prescribed

properly (and those words are key) always works. Insulin is the only drug

that will lower blood sugar in every critter that has a blood stream with

glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

lower the blood sugar. And insulin can lower blood sugar however much you

need it lowered, if--and it is a big if--you learn how to use it correctly.

This is such a simple concept, you have to wonder why most doctors treat

insulin like it was devil's blood, trying every other possible

treatment--some of them quite dangerous--before putting their patients on

the one treatment that is capable of giving them normal blood sugars.

In the past, doctors seem to have assumed that needles were so terrifying to

patients that they would not use them unless faced with immanent death, and

as a result, insulin wasn't prescribed until Type 2s were on death's

doorstep. (Which, unfortunately, has made a new generation of diabetics

assume that if you get prescribed insulin, you are on your way out.)

But look what happened when Big Pharma came up with a new treatment, Byetta,

that was rumored to cause weight loss. Despite the fact that Byetta

treatment requires not one but two needles a day and can cause projectile

vomiting, patients lined up demanding it and thousands of Type 2s are

happily injecting themselves and whoopsing their way to happiness. So

clearly when patients perceive a benefit in a treatment, they'll put up with

needles.

The benefit of insulin can be much greater, since Byetta only works to lower

blood sugar significantly for a subset of those who take it. Insulin always

works.

Insulin Early is Easy, Insulin Late is Hard

My belief--and this is how I treat my own diabetes--is that if diet (defined

as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

don't give you normal blood sugars, it is time to move to insulin while the

beta cells still have enough life in them to make insulin safe and easy to

use.

This is a huge point many doctors miss. If your pancreas is a mess of scar

tissue, you probably have lost your alpha cells too, and this means that you

may have little or no ability to secrete glucagon to raise your blood sugar

if it goes too low.

If, on the other hand, you start using insulin when you still have 20-30% of

your beta cells living, you can use lower doses of insulin and if you take

too much your body will push your blood sugar out of the hypo range, because

it still has the other pancreas-produced hormone it needs to do so.

People with no beta cells have a much tougher time using insulin, especially

when they use it to control post-meal blood sugars. The stories you hear

from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some idea

of what it can be like to use insulin when you have a dead pancreas.

But most Type 2s don't have a dead pancreas, and though only a few of us

have pioneered the " insulin early, not insulin late " strategy, those of us

who have find that it makes living with diabetes far easier than we ever

thought possible. Insulin supplementation takes the burden off our

struggling beta cells. It can let us fine tune our blood sugars to where

they stay relatively flat and do not ever go near the zone where glucose

floods into nerves, eyes, and clogs up tiny kidney filtration units.

As Dr. Bernstein points out, small inputs make for small mistakes, and when

a Type 2 starts insulin early, the doses are much smaller than later, when

they have no beta cells, and the mistakes are much smaller too.

Here are some things your doctor might tell you if you want to start insulin

that you might want to question.

Insulin Myths

1. You'll gain weight.

This is what kept me from starting insulin for years, when I should have

been on it all along. It turned out NOT to be true as long as I use insulin

in a way that matches my carbohydrate input.

If you take more insulin than you need, you will get hungry. " Feeding the

insulin " will pack weight on you. But if you learn how to determine your

" insulin/carb " ratio, and inject an amount of insulin that matches your

food, you should not gain weight. If you are taking a basal insulin, Levemir

is also reputed to avoid weight gain.

And I also find that for me, the analog insulins seem to provoke hunger. But

R insulin (the cheap kind) does not, and I even managed to lose a couple

pounds last year while injecting R insulin 3 times a day.

2. You'll have hypos.

Using insulin requires using your brain. If you just want the doctor to tell

you how many units to inject, and blindly do whatever you are told, hypos

are a possibility.

But if you read up on how to use insulin--using the books and materials

intended for Type 1s who, unlike Type 2s, get training in how to use insulin

properly, you won't. I have not had a blood sugar reading under 60 mg/dl

fifteen months of using insulin with my meals.

3. Needles are Painful

The shots don't hurt. I was as needlephobic as anyone, but it took about a

day to figure out that my lancet for testing my blood sugar is a lot more

painful than the hair thin needles I use for injecting. The first time I

stuck myself with one, it was so painless I had to look down to make sure I

really had stuck myself!

Right now one company is marketing an inhalable insulin, one that isn't very

easy to use and which is very tough to match to carbs, by playing on

people's fears of needles. It is much more expensive than even the most

expensive injectibles, and it may harm the lungs. It is completely

unnecessary.

Give yourself a few days to get over your needle phobia, and you'll end up

laughing at how huge it used to loom in your mind. Injecting insulin really

is No Big Deal.

4. All you need is one shot of basal insulin

There are two kinds of insulin. One lowers your fasting blood sugar and runs

slowly in the background. Lantus, Levemir, and to a lesser extent NPH

insulin are in this category. This kind of insulin does NOT bring down high

post-meal blood sugars, it just lowers the point from which the post-meal

spike begins.

Most Type 2s get put on basal insulin, because it is easy to use. But if

your diabetes is mostly about very high post-meal blood sugars, a basal may

not solve your problems. So you may think that insulin doesn't work for you,

when in fact, the problem is you are using the wrong kind of insulin.

The meal-time insulin or " bolus " insulin is the insulin you match to your

carb intake. The key for a Type 2 to making meal-time insulin work well is

to keep your carb intake reasonable. Type 2s still have a small bit of

homemade stuff that kicks in after a few hours, unlike a Type 1. It is not

realistic to think you can eat 100 grams of carbs and match it with insulin,

because the variations in timing of all that carb hitting your system, mixed

up with your " sputtering pancreas " occasionally throwing a dollop of the

homemade stuff, are too complex to calculate. And if you dump huge amounts

of insulin into your system and it misses those huge amounts of

carbohydrate, well, yes, you do have a problem--one that can, worst case,

put you in the ER.

But most people with Type 2 can match 30 grams of carb or even 40 with

insulin without problems, especially after some practice, and possibly by

using the slower R insulin which is more gradual in its effect.

It may take you a lot of cautious experimentation to figure out exactly how

much carb and insulin you can use safely--starting out with a very low dose

and a small amount of carbs and carefully adjusting carbs and insulin until

you reach a level you can live with that gives you blood sugars that are

safe and normal.

When Is Insulin NOT Useful

The only people for whom insulin is not a good idea are those who are still

producing high levels of insulin, whose diabetes is caused entirely by

insulin resistance, not beta cell failure. Many of these people are very,

very large.

Typically, if your diabetes is caused by insulin resistance, your blood

sugar will drop to normal levels very quickly as soon as you cut out most

carbs. By " normal " I mean fasting blood sugars in the 80s or better. But if

your diabetes is caused by beta cell problems, though your blood sugar will

drop in response to a low carb diet, your fasting blood sugar may still be

over 100 or worse no matter how low your carbohydrate intake.

You may also be able to determine if you are highly insulin resistant by

having your insulin levels tested. If they are much higher than normal while

fasting, then you may be seriously insulin resistant and adding insulin may

not be the answer for you since your problem is that your body isn't using

insulin, not that you don't have enough.

Doctors often seem to believe that all Type 2s are seriously insulin

resistant, but in practice, this turns out not to be true. Mine told me I

" obviously " was insulin resistant, but when I finally started taking

insulin, my response was that of a Type 1 not a Type 2, showing I had very

little insulin resistance at all--and that I really needed insulin

supplementation.

That's enough for now. We'll come back to this topic again, though!

[Guest guest]

Becky,

Unfortunately, it is not in the doctor's best financial interests to teach you

how to prevent diabetic complications. The doctor does not make any money

teaching you how to prevent diabetes type2 and its complications. In fact the

more complications you have from diabetes, the more money doctors can make

treating those complications.

The bottom line is the practice of medicine is not only an art, but it is

definitely a business. Today and even as late or early as 2000 if your blood

glucose level was above 200, an A1C should have been immediately ordered by the

doctor. The doctor's knew you were a diabetic, but they did not want to be the

one to tell you the bad news. You are a diabetic. My treating physician at the

time I had bad leg infections was completely ignorant about my infections and

its implications when you have diabetes. Fortunately, the folks on this list

did know, and they advised me to tell my doctor to place me on an antibiotic,

and to be sure to emphasize to him that my infection and diabetes requires me to

take the antibiotics, and I would probably have to take them a longer time than

a nondiabetic. When the doctor first saw a row of carbuncles on my leg, he

just said, " Oh, those are just boils that some diabetics get. " He did not offer

even an antibiotic at the time until after I reported to the folks here what

happened. Then my fellow listers insisted I go back and get that antibiotic and

kept on it. Today I thank fellow listers for saving my left leg from possible

amputation due to doctor ignorance. It was either doctor ignorance or doctor

negligence, take your pick.

Now what was the reading of your last A1C, which is the surest way to determine

if you are or are not a diabetic. If you are a diabetic under control, you

still should have an A1C done often. If any doctor wants to know whether or not

you are a diabetic, most times an A1C over 7.0 and definitely higher can tell

him right off the bat that you are definitely a diabetic. On oral medications

for diabetes I usually ran an A1C of 5.8 or 5.9, well under the 6.0, which I

personally feel is the mark of a diabetic. As often happens with a diabetic not

properly informed and properly treated, I ran high spikes and peaks in my bs for

years until I was informed that I was a diabetic. In fact I had a heart attack

and the next morning while I was in the intensive czare unit, the emergency room

doctor paid me a visit, and said, " By the way you have diabetes " Unfortunately,

too many diabetics learn they have diabetes the hard way by having it announced

to them following their first heart attack, which is a common occurrence.

Achieving blood glucose level control and mastery can prevent such drastic

events and complications as I have encountered. I hope you take preventive

measures and stay healthy, even if you do have diabetes. With today's knowledge

and technology you can have bs mastery and control.

Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

I found this online, thought some on the list might find it interesting.

Jen

Type 2s: Insulin Early is Easy, Insulin Late is Not

I keep reading postings here and there on the web from people with Type 2

diabetes that say something like, " My A1c was 11.5% even with Metformin, so

my doctor told me it was time to go on insulin. "

It is postings like this that bring home to me why so many Type 2s develop

terrible complications, and even more importantly, why even those who are

taking insulin often have dangerously high blood sugars.

The most conservative of medical groups--the ADA--tells doctors that an A1c

over 7% is going to cause serious diabetic complications like blindness and

kidney failure. Yet these people's doctors have encouraged them to dick

around with oral drugs when their A1cs were 10% or higher!

The years they've spent at those dangerously high blood sugar levels waiting

for oral drugs to do what all the research evidence shows oral drugs cannot

do have wreaked havoc on their organs that may not be completely reversible,

no matter what their blood sugars might be in the future.

In fact, a recent survey I read somewhere on the web found that most family

doctors don't put their patients on even an oral drug until the patient has

spent a year with an A1c of 8% or higher. That is a whole, long year where

dangerously high blood sugars are producing early retinopathy, advancing

neuropathy, and making small changes that lead to kidney failure.

Since none of the oral drugs is capable of lowering A1c much more than 1%,

this kind of treatment is criminal. A patient whose A1c is 11.5% on

metformin probably started out with an A1c of 12% or even higher. If you

don't believe me, go read the Prescribing Information for each of the common

diabetes drugs. They show exactly what the median change in A1c is that

their drugs can achieve, and you'll see it is rarely much more than a 1%

drop in A1c. For a patient with a 12% A1c, even a 3% drop would be pitifully

insufficient. But that is how these people's doctors are treating them.

All that unnecessary suffering. It makes me want to weep!

For patients with an A1c over 8.5% there are only two therapies that will

reliably bring blood sugars into the safe zone. Let's look at them now, very

carefully.

Carb Restriction

Many newly diagnosed Type 2s with surprisingly high A1cs have reported

online that they have been able to bring their A1cs down from 10% or higher

to the safe 5% range by cutting the carbohydrates out of their meals until

they were able to get a blood sugar under 140 mg/dl at one hour and 120

mg/dl a two hours after eating.

Though doctors pay lip service to the idea that their patients can control

diabetes with " diet " a depressingly high proportion of these doctors seem to

think that " diet " means " weight loss diet " rather than " Carb control diet "

so their patients end up starving on high carb/low fat meals that push up

their blood sugars to levels guaranteed to destroy eyes, nerves and kidneys.

Cutting out the carbs that raise blood sugar is the only " diabetes " diet

that will improve blood sugars for every person diagnosed with Type 2

diabetes. So for the newly diagnosed Type 2, or the Type 2 who has never

tried cutting way back on their starch and sugar intake, a stint of eating a

true diabetes diet, one that avoids all starchy foods, no matter how full of

" whole grains " they might be, a diet made up almost entirely of healthy

greens, cheese, lean meats, nuts, berries and nonstarchy vegetables may be

all that is needed to perform blood sugar rescue.

But if cutting your carbs doesn't make a dramatic difference in your A1c

within a few months, there is only one sane therapy to consider, and the

faster you demand it, the less likely you are to end up as another tragic

diabetes disaster story.

That therapy involves insulin.

Insulin

Unlike every other diabetes drug you may read about, insulin, prescribed

properly (and those words are key) always works. Insulin is the only drug

that will lower blood sugar in every critter that has a blood stream with

glucose floating around in it. Rodent, fish, monkey, or you, insulin WILL

lower the blood sugar. And insulin can lower blood sugar however much you

need it lowered, if--and it is a big if--you learn how to use it correctly.

This is such a simple concept, you have to wonder why most doctors treat

insulin like it was devil's blood, trying every other possible

treatment--some of them quite dangerous--before putting their patients on

the one treatment that is capable of giving them normal blood sugars.

In the past, doctors seem to have assumed that needles were so terrifying to

patients that they would not use them unless faced with immanent death, and

as a result, insulin wasn't prescribed until Type 2s were on death's

doorstep. (Which, unfortunately, has made a new generation of diabetics

assume that if you get prescribed insulin, you are on your way out.)

But look what happened when Big Pharma came up with a new treatment, Byetta,

that was rumored to cause weight loss. Despite the fact that Byetta

treatment requires not one but two needles a day and can cause projectile

vomiting, patients lined up demanding it and thousands of Type 2s are

happily injecting themselves and whoopsing their way to happiness. So

clearly when patients perceive a benefit in a treatment, they'll put up with

needles.

The benefit of insulin can be much greater, since Byetta only works to lower

blood sugar significantly for a subset of those who take it. Insulin always

works.

Insulin Early is Easy, Insulin Late is Hard

My belief--and this is how I treat my own diabetes--is that if diet (defined

as cutting carbs) plus the one safe med, metformin, and possibly Byetta,

don't give you normal blood sugars, it is time to move to insulin while the

beta cells still have enough life in them to make insulin safe and easy to

use.

This is a huge point many doctors miss. If your pancreas is a mess of scar

tissue, you probably have lost your alpha cells too, and this means that you

may have little or no ability to secrete glucagon to raise your blood sugar

if it goes too low.

If, on the other hand, you start using insulin when you still have 20-30% of

your beta cells living, you can use lower doses of insulin and if you take

too much your body will push your blood sugar out of the hypo range, because

it still has the other pancreas-produced hormone it needs to do so.

People with no beta cells have a much tougher time using insulin, especially

when they use it to control post-meal blood sugars. The stories you hear

from Type 1s who veer from 35 to 350 mg/dl in a few hours give you some idea

of what it can be like to use insulin when you have a dead pancreas.

But most Type 2s don't have a dead pancreas, and though only a few of us

have pioneered the " insulin early, not insulin late " strategy, those of us

who have find that it makes living with diabetes far easier than we ever

thought possible. Insulin supplementation takes the burden off our

struggling beta cells. It can let us fine tune our blood sugars to where

they stay relatively flat and do not ever go near the zone where glucose

floods into nerves, eyes, and clogs up tiny kidney filtration units.

As Dr. Bernstein points out, small inputs make for small mistakes, and when

a Type 2 starts insulin early, the doses are much smaller than later, when

they have no beta cells, and the mistakes are much smaller too.

Here are some things your doctor might tell you if you want to start insulin

that you might want to question.

Insulin Myths

1. You'll gain weight.

This is what kept me from starting insulin for years, when I should have

been on it all along. It turned out NOT to be true as long as I use insulin

in a way that matches my carbohydrate input.

If you take more insulin than you need, you will get hungry. " Feeding the

insulin " will pack weight on you. But if you learn how to determine your

" insulin/carb " ratio, and inject an amount of insulin that matches your

food, you should not gain weight. If you are taking a basal insulin, Levemir

is also reputed to avoid weight gain.

And I also find that for me, the analog insulins seem to provoke hunger. But

R insulin (the cheap kind) does not, and I even managed to lose a couple

pounds last year while injecting R insulin 3 times a day.

2. You'll have hypos.

Using insulin requires using your brain. If you just want the doctor to tell

you how many units to inject, and blindly do whatever you are told, hypos

are a possibility.

But if you read up on how to use insulin--using the books and materials

intended for Type 1s who, unlike Type 2s, get training in how to use insulin

properly, you won't. I have not had a blood sugar reading under 60 mg/dl

fifteen months of using insulin with my meals.

3. Needles are Painful

The shots don't hurt. I was as needlephobic as anyone, but it took about a

day to figure out that my lancet for testing my blood sugar is a lot more

painful than the hair thin needles I use for injecting. The first time I

stuck myself with one, it was so painless I had to look down to make sure I

really had stuck myself!

Right now one company is marketing an inhalable insulin, one that isn't very

easy to use and which is very tough to match to carbs, by playing on

people's fears of needles. It is much more expensive than even the most

expensive injectibles, and it may harm the lungs. It is completely

unnecessary.

Give yourself a few days to get over your needle phobia, and you'll end up

laughing at how huge it used to loom in your mind. Injecting insulin really

is No Big Deal.

4. All you need is one shot of basal insulin

There are two kinds of insulin. One lowers your fasting blood sugar and runs

slowly in the background. Lantus, Levemir, and to a lesser extent NPH

insulin are in this category. This kind of insulin does NOT bring down high

post-meal blood sugars, it just lowers the point from which the post-meal

spike begins.

Most Type 2s get put on basal insulin, because it is easy to use. But if

your diabetes is mostly about very high post-meal blood sugars, a basal may

not solve your problems. So you may think that insulin doesn't work for you,

when in fact, the problem is you are using the wrong kind of insulin.

The meal-time insulin or " bolus " insulin is the insulin you match to your

carb intake. The key for a Type 2 to making meal-time insulin work well is

to keep your carb intake reasonable. Type 2s still have a small bit of

homemade stuff that kicks in after a few hours, unlike a Type 1. It is not

realistic to think you can eat 100 grams of carbs and match it with insulin,

because the variations in timing of all that carb hitting your system, mixed

up with your " sputtering pancreas " occasionally throwing a dollop of the

homemade stuff, are too complex to calculate. And if you dump huge amounts

of insulin into your system and it misses those huge amounts of

carbohydrate, well, yes, you do have a problem--one that can, worst case,

put you in the ER.

But most people with Type 2 can match 30 grams of carb or even 40 with

insulin without problems, especially after some practice, and possibly by

using the slower R insulin which is more gradual in its effect.

It may take you a lot of cautious experimentation to figure out exactly how

much carb and insulin you can use safely--starting out with a very low dose

and a small amount of carbs and carefully adjusting carbs and insulin until

you reach a level you can live with that gives you blood sugars that are

safe and normal.

When Is Insulin NOT Useful

The only people for whom insulin is not a good idea are those who are still

producing high levels of insulin, whose diabetes is caused entirely by

insulin resistance, not beta cell failure. Many of these people are very,

very large.

Typically, if your diabetes is caused by insulin resistance, your blood

sugar will drop to normal levels very quickly as soon as you cut out most

carbs. By " normal " I mean fasting blood sugars in the 80s or better. But if

your diabetes is caused by beta cell problems, though your blood sugar will

drop in response to a low carb diet, your fasting blood sugar may still be

over 100 or worse no matter how low your carbohydrate intake.

You may also be able to determine if you are highly insulin resistant by

having your insulin levels tested. If they are much higher than normal while

fasting, then you may be seriously insulin resistant and adding insulin may

not be the answer for you since your problem is that your body isn't using

insulin, not that you don't have enough.

Doctors often seem to believe that all Type 2s are seriously insulin

resistant, but in practice, this turns out not to be true. Mine told me I

" obviously " was insulin resistant, but when I finally started taking

insulin, my response was that of a Type 1 not a Type 2, showing I had very

little insulin resistance at all--and that I really needed insulin

supplementation.

That's enough for now. We'll come back to this topic again, though!

[Guest guest]

Harry, come now.

We can accept there is doctor ignorance and there may be some neglectful

physicians. But to claim it is all just a plot to make more money off us is

stretching it to near paranoia.

Isn't the case really most closely that there is some ignormance that is

perpetuated by lack of time and overstretched resources to be knowledgeable

on every condition or complaint they have to see in a day, and they have to

see so many just to make an income they deserve for the time they put into

getting to that position and what they have to invest to maintain pace.

If you are finding doctor after doctor who is as uncaring and money grubbing

as you make out, you really need to find a new referral service. Or perhaps

it is your interpretation that needs to be attended to.

SS

[Guest guest]

Of course you are correct. Every body knows the doctors are knowledgeable and

caring. I am sure your doctor is. It just so happens that my present doctors

are, but my personal experience got me stuck with a couple of ignorant doctors.

Maybe they are the exceptionally ignorant ones. I use to work with doctors

daily for over twenty years, and I know for a fact that of the twenty or so

doctors I know personally, maybe only one or two of them read their medical

journals religeously every month. I am not even a medical doctor, and I red

their journals more than they did. I speak from practical, not theoretical

experience, on a day by day level working with them. How much time does your

physician spend with you? Does he explain in detail the diet, your medications,

the exercise program and options that are open to you? I doubt it. There is no

way he can do it in a ten minute session with you once a week or once a month.

Of course if you happen to be blessed with a photographic memory, it might be

possible. Unfortunately, most of us do not have such a memory, and I include

myself in this group.

Maybe this is paranoid thinking, but I think not.

RE: Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

Harry, come now.

We can accept there is doctor ignorance and there may be some neglectful

physicians. But to claim it is all just a plot to make more money off us is

stretching it to near paranoia.

Isn't the case really most closely that there is some ignormance that is

perpetuated by lack of time and overstretched resources to be knowledgeable

on every condition or complaint they have to see in a day, and they have to

see so many just to make an income they deserve for the time they put into

getting to that position and what they have to invest to maintain pace.

If you are finding doctor after doctor who is as uncaring and money grubbing

as you make out, you really need to find a new referral service. Or perhaps

it is your interpretation that needs to be attended to.

SS

[Guest guest]

I must be very lucky with my diabetic doctor, as he is a diabetic himself, and

he seems to understand more of the problems that us diabetics are going through.

Rowe

RE: Article Type 2s: Insulin Early is Easy, Insulin

Late is Not

Harry, come now.

We can accept there is doctor ignorance and there may be some neglectful

physicians. But to claim it is all just a plot to make more money off us is

stretching it to near paranoia.

Isn't the case really most closely that there is some ignormance that is

perpetuated by lack of time and overstretched resources to be knowledgeable

on every condition or complaint they have to see in a day, and they have to

see so many just to make an income they deserve for the time they put into

getting to that position and what they have to invest to maintain pace.

If you are finding doctor after doctor who is as uncaring and money grubbing

as you make out, you really need to find a new referral service. Or perhaps

it is your interpretation that needs to be attended to.

SS

[Guest guest]

My doctor spends approximately 30 minutes with

me. I bring my Digital Olympus DS-50 recorder

with me. I get her permission, and I record her

comments about everything. The recorder is in plain site.

It works for me, and it works for her.

Larry Gassman

At 11:04 AM 6-22-2007, you wrote:

>Of course you are correct. Every body knows the

>doctors are knowledgeable and caring. I am sure

>your doctor is. It just so happens that my

>present doctors are, but my personal experience

>got me stuck with a couple of ignorant doctors.

>Maybe they are the exceptionally ignorant ones.

>I use to work with doctors daily for over twenty

>years, and I know for a fact that of the twenty

>or so doctors I know personally, maybe only one

>or two of them read their medical journals

>religeously every month. I am not even a medical

>doctor, and I red their journals more than they

>did. I speak from practical, not theoretical

>experience, on a day by day level working with

>them. How much time does your physician spend

>with you? Does he explain in detail the diet,

>your medications, the exercise program and

>options that are open to you? I doubt it. There

>is no way he can do it in a ten minute session

>with you once a week or once a month. Of course

>if you happen to be blessed with a photographic

>memory, it might be possible. Unfortunately,

>most of us do not have such a memory, and I include myself in this group.

>Maybe this is paranoid thinking, but I think not.

> RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>

[Guest guest]

You have the right doctor. A doctor who will not allow you to record his or

your session with him is not a good doctor. At least this way you can listen to

his instructions over and over until you really understand what is being said.

Often the instructions are given rapidly, and it is difficult to remember what

they were. A recording can assist you in understanding what the doctor wants

you to know without a doubt.

RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>

[Guest guest]

larry, i tried that with my doctor and he almost threw me out. i just had my

questions for him on the recorder and he hit the roof. so that was the last time

i went to him. i had explained with being totally blind i could not take notes

and rite down my questions. no great loss. karen

RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>

[Guest guest]

Way to go . You made a wise decission.

RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>

[Guest guest]

Well folks, it not just Diabetics who face physicians who are too busy to be

bothered or do not want what they say to be documented.

I managed to come down with some really high blood pressures last fall and

had to deal with a number of doctors. One of the physicians would only spend

about 5 to 10 minutes with me and then would literally run out of the room

while I was asking questions.

You are also correct, most of us do *not* have a photographic memory or, if

we do, the film has expired. (LOL)

If the physician does not want to be recorded then it is time to seek a new

doctor....

Cy, the Ancient Okie....

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of Harry/ Bates

Sent: Monday, June 25, 2007 7:06 PM

To: blind-diabetics

Subject: Re: Article Type 2s: Insulin Early is Easy,

Insulin Late is Not

You have the right doctor. A doctor who will not allow you to record his or

your session with him is not a good doctor. At least this way you can listen

to his instructions over and over until you really understand what is being

said. Often the instructions are given rapidly, and it is difficult to

remember what they were. A recording can assist you in understanding what

the doctor wants you to know without a doubt.

RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money

grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>

[Guest guest]

my new doctor and i had a visit a couple of weeks ago. he had a student sitting

in and he asked me what is the difference between a good doctor and a bad

doctor. I thought he was going to tell me a joke. and I replied and what might

that be. he replied that a good doctor will answer questions to your

satisfaction. in disbelief I replied and that is why I come to you , because you

are a good doctor and will answer all my questions, smile. karen

RE: Article Type 2s:

>Insulin Early is Easy, Insulin Late is Not

>

>Harry, come now.

>

>We can accept there is doctor ignorance and there may be some neglectful

>physicians. But to claim it is all just a plot to make more money off us is

>stretching it to near paranoia.

>

>Isn't the case really most closely that there is some ignormance that is

>perpetuated by lack of time and overstretched resources to be knowledgeable

>on every condition or complaint they have to see in a day, and they have to

>see so many just to make an income they deserve for the time they put into

>getting to that position and what they have to invest to maintain pace.

>

>If you are finding doctor after doctor who is as uncaring and money

grubbing

>as you make out, you really need to find a new referral service. Or perhaps

>it is your interpretation that needs to be attended to.

>

> SS

>

>