When I first read "Diabetes Solution" by Dr. Richard K. Bernstein, M.D., he
wrote  about pleading with his newly diagnosed patients to begin insulin
early. His view, however, urges early insulin with a low carb diet and an
intensive regimen of multiple daily injections of small doses to achieve a
normal blood sugar profile.

There is research showing that beta cell function can be preserved with
early insulin therapy, particularly if you can halt overproduction of your
own insulin which is linked with weight gain and increasing insulin
resistance.

However, there is a concern that Type II's who are not adhering to a diet
and exercise regimen can gain weight with insulin injections and begin
injecting more and more insulin to counteract increasing insulin resistance
as they develop heart problems and an increased cancer risk because of
hyperinsulinemia.

If you're looking to insulin as a means of eating more carbs, you could wind
up like a very overweight Type II neighbor of mine who injects huge amounts
every day. His health is not good.

I elected to start early insulin tx with a 5.3 A1C on orals only. I'm glad
I'm on insulin, but I watch what I eat and exercise religiously to keep my
weight down. Insulin gives me dependable, predictable control.

Best wishes.

There's a downside to having too much insulin circulating in the
bloodstream. As I understand it (I once attended a lecture by a Howard
University professor of endocrinology, on this subject), high levels
of insulin have the effect of cancelling certain anti-coagulants in
the blood, thereby making heart attacks and strokes more likely.

Type 1 diabetics don't have this problem, because for them, the
insulin they take simply replaces the insulin that their bodies don't
make, and the serum insulin doesn't rise above "normal" levels. But
for many Type 2's, one of the features of their diabetes is insulin
resistance. Since their own insulin isn't being used effectively,
their bodies respond by making more of it. If you add outside insulin
to the mix, the problem is made even worse.

This is just one of the ways in which Type 2 diabetes is a more
difficult disease than Type 1. If indeed your problem is insulin
resistance, it would seem that the treatment of choice would be
medication to try to break down that resistance, rather than add even
more insulin.

  Since I'd prefer not to go

 Why not insulin for early

1. There is a good medicine for type 2 diabetes which is well worth
trying, Metformin. It has been in use for decades and the only major
side effect which we used to worry about (lactic acidosis) turns out not
to happen any more often than in people not on the drug. It lowers blood
sugar and prevents weight gain. It appears to be cardio-protective. The
extended release form doesn't cause anywhere near the stomach problems
earlier forms did. What's not to like?

2. Insulin for type 2s comes in two forms, basal (one or two shots a
day) which is what most Type 2s are taking when they say "I'm on
insulin" and fast acting insulin used before meals.

The basal insulins on the market today will not control your meals. They
only lower your fasting and pre-meal numbers.

The fast acting insulins have to be matched quite precisely to your carb
intake. For someone like you who still has a decent second phase insulin
release (which is why you don't stay over 200 for 4 hours) it is quite a
challenge to shoot enough to cover a high carb meal without ending up
having a serious hypo.  Even the "short acting" stuff lasts for 3 hours
or more so you can have pretty numbers at one hour and very little
circulating blood sugar left at 3.

Now try to figure out how much carbohydrate is in that order of fries
and that muffin on your plate, or in the cookie or piece of cake you are
planning to have for dessert. Let's say you need 1 unit for every 5
grams. Great, you've just guessed that you've got 55 grams on your
plate. Shoot 11 units. Whoops, turns out you really had 40 grams. Now
you've got 3 units too much insulin floating around in your system which
is going to suck away a lot of your blood sugar.  Time to start scarfing
more sugary stuff. Whoops, got too much sugary stuff, blood sugar is
back over 200 again.

Can you see why even those of us using insulin have to keep our carbs
much lower than so called "normal?"

Insulin for type 2s is strictly for after you can't achieve normal blood
sugars using carb restriction, and even then you will still have to be
very aware of your carb intake every time you eat.
--Jenny

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

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

barbara@the-kaplans.com wrote in message
<1142892899.226626.211930@t31g2000cwb.googlegroups.com>...

 That question as stated assumes that blood sugar control is the Type 2
diabetic's greatest problem.    In fact,  one can make a strong argument
that the increased heart attack risk of high Insulin Resistance is the Type
2 diabetic's greatest problem. **

That's a strong argument for starting T2 on anti-Insulin Resistance meds.
Metformin has the least side effects of the anti-I.R. meds,   Actos and
Avandia have more side effects but are also more powerful.    You can
'stack" metformin and (Actos or Avandia).

Metformin has a record of 40 years very successful and very safe use.   It
carries some risk but note that Type 2 diabetes is a deadly disease, almost
certain to cause premature death in its victims.    Diabetics don't really
have the option of avoiding all risk;  they must instead choose the risk
they wish to endure.

That said,   the combination of metformin for anti-Insulin Resistance and
insulin for any residual blood sugar control  works very well.   Of course,
that assumes that you are already using the Miracle Therapy for anti-Type 2
diabetes,  i.e.

   a.  Lose fat lb
   b.  Gain muscle lb
   c.  Exercise every day,  the more vigorously the better
   d.  Restrict your carbohydrate intake,  aim for slowly-digesting carbs;
spread your daily carb ration over several small meals.

Why don't more docs prescribe insulin?

Two big reasons:

     a.   Most folks hate the thought of taking insulin.   They will plead
for alternate therapies.   They will plead to be "taken off" insulin as soon
as possible.    They will actually refuse to take the insulin when
prescribed.

Note that insulin use will disqualify a diabetic for some occupations.    In
many areas,  it bars you from a pilot's license and a commercial drivers
license.

    b.  Docs are afraid to give folks insulin.    Insulin injections carry
the risk of low blood sugar episodes which can lead to accidents of one sort
or another.    Docs always have to balance the risk of a hypo against the
risk of complications from high blood sugars.

They tend to favor offering the risk of high blood sugar over the risk of
hypos.     That may not be an optimum choice,  but that's the way it is.

That said,  a strong argument can be made that if you,  Barbara,  combine a
strong effort at the "Miracle Therapy" with a single daily shot of slow
insulin taken before bedtime,  you will delay the onset of full-blown Type 2
diabetes for a very long time,  possibly for the rest of your life.   Lord
knows where you will find a doctor who will give you that advice and/or a
prescription but still,  the argument can be made.

(** Comments on heart attack risk and high Insulin Resistance apply to
80-90% of Type 2 diabetics.   There is a poorly understood minority,
estimated at 10-20% of Type 2 diabetics,   who do not suffer from high
Insulin Resistance and thus have a lesser risk of premature heart attack.

Umm. . .one of the better tests for identifying such folks is to give them
anti-Insulin Resistance meds and see if the meds help their blood sugar
control.    Surprise!  One of the common therapy strategies for newly
diagnosed diabetics is to give them anti-Insulin Resistance meds.   If they
work,  fine.   If they don't,   start them on insulin.)

Regards
 Old Al

Hi Barbara,

Old Al gave you excellent information, as he usually does when someone
asks a question here.  Diabetes is a very complicated disease and just
like snowflakes no two of us are the same.  Okay, bad analogy, but we
all do differ in terms of what foods we can eat, what medications will
work the best for us, and how our activity/exercise works into the
equation.  So, the main thing you should be doing is finding a good
doctor, preferably an endocrinologist, to ask these questions to.  He
or she will be able to zero in on what your specific needs are and help
you make the right choices.

Best,
Kurt

It's a mixed thing.  some people swer by it even fore early diabetics, If
you do go on insulin yu have to be very careful as it is very easy to gain
weight.  In addition, insulin does noting for the insulin resistance most
of us type 2's are running around with and it will give u even more
insulin inthe blood stream that is nt being absorbed.  

If used in conjunction with a insulin resistance reducigndrug like
metformin or Actos or Avandia that problem may be solved, but if yu are
using something liike these drugs yu may well not be need the insulin.

There are good points and drawback to any course of treatment and, in
general, meds are best worked out between yu and your doctor.  We, ostly,
can give our own ersonal experiences.  

Wendy