.

I've been taking a low dose of basal insulin  for 2 1/2 months now. I'd
previously tried basal insulin and then stopped it. I was on much too
high a dose and was getting hypos that were undetected thanks to  having
a defective meter.

When I stopped the insulin I experienced a period where I was very
insulin resistant and I was seeing some pretty scary highs. However,
this may have been because I'd been on an overdose of insulin for 3
weeks and my body had adapted to it by increasing my insulin resistance.
Eventually, it calmed down.

I went back on the insulin at the right dose. When my insulin went bad
on me about two weeks ago and stopped working, my blood sugars went back
up to where they were before I started it, but it was no worse. So it
looks like using the insulin at the right dosage didn't worsen my blood
sugars.

That said, even if it is something I'll do for life,  I feel SO MUCH
BETTER while taking the insulin that I don't mind using it. For the
first time in years I have a lot more energy.

My family doctor suggested I start the insulin because I'd developed
what he thought might be early complications and because
I am not able to get truly normal blood sugars even with stringent low
carbing. My a1c had crept up to 6.0% and I was spending much of my time
between 120 and 140 mg/dl with the fasting blood sugar inching towards
120, too. With the basal insulin my "spikes" (if I keep carbs
controlled) are more like 120 and I can be in the 80s-90s range much of
the time.  My fasting is between 88 and 100.

The real challenge with small dose insulin for a Type 2 is getting the
dose right. Family doctors pretty much give you a generic dose without
considering of your weight and how insulin resistant you might be. And
not all of them follow up with you to make sure you have gotten the dose
right. I have a very good family doctor, but he relies on a nurse who
got her diabetes training 20 years ago to manage his patients' insulin
use. She turned out to be a font of misinformation--some of it downright
dangerous. If I'd listened to her I would have ended up in the ER in a coma!

So if you are going to use insulin you should definitely read up on your
own (Bernstein's chapters on insulin are a great place to start) and be
prepared to have to tinker a bit to find the correct dosage--something
not everyone is up to doing.

Ideally your doctor will work with you on the tinkering part, but my
experience was that I was pretty much on my own there. Even the
endocrinologist I saw after the initial mess with the Lantus overdose
told me that she only has experience prescribing insulin for people who
have terrible control (as in A1cs over 9%) so she had no idea how to
prescribe for T2s in what she thinks of as "good control" (under 7%).

She was supportive as far as writing me prescriptions, which is why I
still see her, and it was her suggestion I try the discontinued
Ultralente because of the problems I'd been having with Lantus which
turned out to be extremely helpful (though not, alas, a long term
solution). But to find the correct dosage, I pretty much had to start at
a 1/2 unit dose and work myself up slowly to where I got good control.

--Jenny

http://www.phlaunt.com/diabetes  Diabetes Info

http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood
Sugar Under Control

   The short answer:  No.

  The long answer:      Every T2 will need insulin if they live long
enough.    Perhaps they will need it at age 50,  or age 90,  or age 115.

However,   there is evidence that  low dose insulin will prolong the life of
weakened T2 beta cells and put off the day at which intensive insulin
therapy becomes necessary.    It's sort of a pay me now or pay me later
strategy.     One voluntary shot a day of basal for years starting now as a
trade for mandatory 5-8 shots a day in the future.    Another bonus is
easier control right now.

(Umm. . .take my word for it,   my mandatory 7-10 shots a day regime is a
Royal PITA)

An answer to a question you didn't ask:   Insulin gave me more energy and
endurance.   I felt better.   Some of our T2 posters have noticed the same
thing.

Regards
 Old Al

You're not locked into taking insulin if you're a type 2, but I doubt you'd
take less insulin than a type 1.  Most type 2s produce plenty of insulin.
If they need to use it, they need to use a lot MORE than a type 1!

Hi Erol:

I am a T2 using low dose insulin therapy.  I am not considered insulin
dependent.  I typically use 10 units of Ultralente just before bedtime.
I'm giving some information below, but I have not discontinued insulin.
I use some regular insulin for finer tweaking, i.e, 1 unit for each 10
mg/dl over 100 mg/dl. I limit regular to 4 units. Above a 40 mg/dl
adjustment, I increase Ultralente somewhat.  I do not believe that I
have very high insulin resistance for a T2 DM.

FBG in mg/dl
8/13/02 - 3/18/03  99.3   beginning database.
3/18/03 - 3/18/04  96.1   before low dose insulin, but good exercise
3/18/04 - 3/18/05  87.7   after low dose insulin, exercise reduced Nov.
when Vioxx was taken off the market.
Also increased metformin from 500 mg/d to 1000 mg/d in November 2004.
3/18/05 - 3/01/06  88.6   ruptured achilles 4/24, exercise nil since.

I figure that I am buying time until something better comes along.

Frank