I have had Type 2 diabetes since late 1990's and have been on oral meds the entire time. My A1c's are excellent, but that may be due to the lows I have affecting it as I do get high numbers after eating and they last more than 2 hours after eating. My doctor, not an endocrinologist, of one year doesn't look at my readings. My previous doctor asked about my diabetes and glucose readings first thing in the office. My new doctor never even mentions my diabetes. She does know I have diabetes, but seems to ignore it and never ever asks about it. There is only one endocrinologist in my area and he is not accepting new diabetic patients.
I have noticed that the high numbers (150-190) after eating hang on longer than they used to, maybe 3 or 4 hours after eating, and/or they don't go down below 120 after 4 hours. This is new because they used to go down at 2 hours. I don't eat (or don't like to) when they are above 90. If I don't have a snack before bed I am up at 3 in the morning with a low and have to eat. Consequently, I have started taking an extra Prandin at 7 or 8 PM so I can lower my number and eat a snack by 10 PM. My doctor who retired said I could do that once in a while, but since I already take 6 a day (2 before meals), I am at the max. I only get 180 pills a month, so I won't have enough between refills if I do this every night. If that really isn't the max, I really don't want to control this by constantly taking more oral medication. I have enough medicines going into to my stomach due to herniated discs and a hiatal hernia.
I don't normally eat when my numbers are high because I don't want to add more to it. As a result, I often have late lunches because my breakfast numbers are also a bit higher longer after breakfast and I have the same thing every morning. I have cut back from 2 slices of toast to 1 1/2 slices and hoping that works, but it leaves me hungry. My late lunches force me to have dinner with numbers that are high because eating late really messes me up.
I would like to try a basal insulin injection in the morning to use along with my Prandin, or basal/bolus solo. Two years ago when I asked the doctor who retired about switching or adding insulin, he said that my A1c's of 5.5 - 5.7 don't warrant it and they don't make a dose low enough. Well, without the Prandin the A1c would be higher so basing it on the A1c's doesn't make sense. He said I have to wait until my A1c's are higher, then I pointed out the lows on the spreadsheets and graphs I used to give him and he changed my oral med from Glyburide to Prandin.
Tonight I had to have 3 at dinner time simply because I was having pasta. Mind you, I don't eat very much, seriously. I fear I will run out of the Prandin before it is time to refill.
I also read, a few years ago, in Diabetes Self-Management, an article by a doctor who stated that insulin should be first because insulin has protective benefits. He said doctors don't start Type 2 diabetics on insulin because they won't do it due to phobias, etc., so docs just don't fight patients with it and give orals. If insulin is better, I would rather learn how to use insulin now BEFORE my diabetes gets worse and affects other systems. I do have a little neuropathy in my feet. Most people have had diabetes a few years before being diagnosed and during that time, damage is being or has been done.
I am not overweight and there are only two things that concern me. I heard you gain weight on insulin. I assume that is because people tend to eat more, which I do not intend to do, just eat at times I am supposed to and eat at the very rare times I am at a party (within reason). Right now I do not enjoy parties, weddings, etc because I can't snack or eat when others are and if there is a meal served, I don't enjoy it and/or it is at a later time than I normally eat. We left one wedding and went to a restaurant for dinner because they hadn't served the food and it was 8:00 PM. I was told that there were crackers to snack on. I couldn't do that because I would have my full of carbs via junk food and not dinner. I figure with insulin I have the ability to adjust my body to have a little enjoyment. Again, this would not be a habit. We don't go to parties often, nor do we have many weddings to attend, but do have one coming up as our youngest daughter is soon to be married. The other thing I am concerned about is travelling on a plane with insulin and needles. The daughter who just got engaged lives in CA and we are east coast. We plan to visit her in April and then go out again for the wedding later this year. How do you do that? How do you carry insulin on a plane, carry it around while touring, attending weddings, eating out, etc?
Is there any reason I can't get on insulin and learn how to use it now rather than wait until it is a last resort and more damage has been done due to waiting for higher A1c's? My current doctor's PA even suggested I cut back on my Prandin because my A1c was so good. That is the reason it is that way. If I cut back, there goes the control and up goes the A1c. What is wrong with having A1c's that are equal to a non-diabetic?
When I did record my numbers, I did my own recording and graphing as opposed to the software that comes with my meter because all the preset programs get the time before eating and after wrong because the program assumes what time you eat. My own records and graphs accurately reflected the numbers in relation to eating, with notes. This was very time consuming but was a good source for me to keep tabs. Since my new doctor doesn't use any of it and so far has never asked, I stopped doing it. Nothing comes of the information I gather from it.
Sorry this is so long, but I have no one to get an answer to this question from. It doesn't make sense that my first doctor said they don't make doses low enough when my A1c's are that low due to the orals. It also makes no sense he said that given the report in Diabetes Self-Management I mentioned, and I have read the same thing in other reports. I know it will take adjusting but I would rather adjust when I am still feeling well and it is not a panic situation.
Also, what can I say to my current primary physician to get her to understand that I have diabetes and I want it acknowledged. I see her Jan 20 and am afraid I will say something sarcastic to her about it. I had to ask her about getting the urine test for keytones (I can't remember what it is called) this past summer and she asked why. I told her I have to have it every year because I have diabetes and it is due. I just don't get it. I asked if this doctor has diabetic patients, keeps up on the latest diabetes news, etc before I signed on with her. My other doctor was reading the same magazines I read. We didn't agree with the insulin, but many doctors feel as he did and he did keep up on diabetes news. I used to bring in my old Diabetes Self-Management mags for his coffee table for other patients and he greatly appreciated it. He always said I was the most organized diabetic he knew.
What can I do about all of this? Why can't I start insulin and is insulin better? Would it hurt to start insulin? How do you travel with it, tour, go out to dinner, etc? How do you travel on a plane with it? How can I wake up my doctor to the fact that I am a diabetic and I want to make sure it is being watched and treated in the best way without being the doctor myself?