I have a question regarding the stopping of insulin treatment. I was diagnosed a type 2 diabetic however due to the failure of my oral medications, I was put on insulin. I have been using insulin for several years now. I wish to move away from insulin use and move towards diet control and exercise as a method of managing my diabetes. I read somewhere that stopping insulin treatment can be extremely dangerous and fatal because of a condition called diabetic keto acidosis in which the cells of a diabetic under hyperglycemic conditions will begin to breakdown fat tissue as a form of energy source. This leads to the build up of ketones in the blood which can eventually acidify the blood and cause the diabetic to enter a coma or possibly die.
Is this true? I know it's different between type 1 and type 2 diabetics because type 1 diabetics are insulin dependent and whereas type 2 diabetics produce some insulin but experience insulin resistance. I am diagnosed a type 2 diabetic but since my oral medications failed to control by blood sugars, I have been using insulin for several years now. Is it safe for me to cease the use of insulin but manage my diabetes through diet and exercise?
Qiu - First of all, I am glad that you have some knowledge about diabetes. Diet control and exercising are great ways to reduce your blood sugar in addition to your medication treatment.
ReplyDeleteAs you said, ketoacidosis is a condition that occurs when you have an increased blood glucose level (usually above 300mg/dL) but your body can not use it as an energy source. Lipids are being used instead, which produces ketones. However ketoacidosis is more common in patients with type 1 diabetes because they often lack of insulin production. It is quite rare in patients with type 2 diabetes. However, if you stop taking your insulin, you are at risk of getting ketoacidosis because your blood glucose level may rise rapidly without adequate medications.
With that being said, I don't think it is a good idea to stop taking insulin. It is important for you to know that being put on insulin therapy doesn't mean you have failed oral medications. In fact, most people will need insulin therapy sooner or later as the disease progresses. Insulin therapy is very effective in managing your diabetes and its use should be encouraged. If you decide to stop taking insulin without consulting a doctor, you are putting yourself at huge risk.
To conclude, here is what I recommend. Take all your medications (including your insulin) as directed by your doctor. Meanwhile, you can start your diet and exercise program which is also very effective in reducing your blood sugar. Make sure you test your blood sugar up to four times daily and record the readings on a log book. The record will help your doctor decide whether to change your medications. Always have some glucose tablets or some carbohydrate snacks with you in case you experience hypoglycemic episodes. Keep a "sick day box" for yourself to better manage your diabetes when you are sick.
Felex Fff - Not at all. Type 2 diabetics vary in so many ways. Some only produce a little insulin, some are insulin resistant, some are a little of both. DKA can kill you. In type 2 it will happen slower than type 1. I won't consider that as an option for you because you are concerned about your well being and if you take insulin you have a glucometer and will see your sugar rise. Your best option is to minimize the complex carbohydrates and simple sugars (no rice, pasta, bread, high fiber cereal, raisins, and any drinks with sugar). Exercising will decrease your insulin resistance. There are very rare cases when someone can stop medication and maintain an acceptable A1C. They do this by what I mentioned above and some herbal products. There is a woman at a vitamin store in Pa who knows a sh** load of information about these products. I would tell your doctor your intentions and call the girl in Pa. You may have to hold because people call her all the time. You cannot just stop taking your insulin, you will end up in the ICU. You didn't give much information on your diet so I don't know what a typical day of eating is for you. Do not stop your medication. Try cutting the carbs, exercising (endurance, stretching and weights) and see how your sugars run. Tell your Doctor you want to test more frequently so they can give you a new Rx and you will get enough strips to test as needed. Call and ask to speak to the vitamin girl at 800-556-8396, they may ship them to you. I get my One Touch strips their for $40 (this includes shipping). I've seen the strips as high as $65 in some stores so you know they are ripping you off when someplace else sells the same product for $30 less. I think they are only open until 2 on Sat
ReplyDeleteTheOrange Evil - Diabetic ketoacidosis is extremely rare in Type 2 diabetics for one very simple reason: Type 2 diabetics, even when they become insulin deficient, usually produce SOME insulin. DKA just doesn't happen in the presence of insulin. For most Type 2 diabetics, the concern isn't DKA, but rather hyperosmolar hyperglycemia that can occur when blood sugar reaches 500-600 mg/dL. If you are producing insulin naturally, even if your blood sugar is high, you're not going to go into DKA.
ReplyDeleteBecause oral medications stopped working for you, necessitating that you go on insulin, I doubt that you're going to be able to control your blood sugar with diet and exercise alone. Oral medications require that your pancreas be producing a sufficient amount of insulin, even medications that stimulate insulin production. If the oral medications couldn't do the job, that suggests you are very insulin deficient at this point. Maybe not insulin deficient enough to go into DKA, but too deficient to rely on diet alone. You can certainly TRY, but consult your doctor first and keep insulin on hand in case you need to bring your blood sugar down in an emergency situation.
Also, as a warning: if you do try diet, you will probably be cutting back considerably on carbohydrates to control blood sugar. If so, you WILL produces ketones in your urine. This is normal. Do not panic. Ketones themselves are not dangerous. When you don't have insulin, the liver ramps up ketone production to a dangerous level. As long as you have insulin in the body, the process is kept in check. I have had ketones in my urine for 3 years because I eat <30 grams of carbohydrate per day. I have never gone into DKA. Even when my blood sugar was in the mid-300s, I had zero ketones in my urine. The ketones only appeared when I dropped the carbs.
Tabea - Unfortunately, diabetes is a progressive disease. This means that over time, a Type 2 diabetic often loses more and more of their insulin-producing beta cells. The fewer beta cells, the less insulin one produces. Once the cells are gone, nothing can bring them back. At this stage, the person then becomes insulin-deficient and needs to inject insulin to survive.
ReplyDeleteThe usual progression of the disease is as follows:
- management by diet/exercise only
- diet/exercise + pills
- diet/exercise + pills and/or insulin
So essentially what you are asking is, can I go back to a management method that would only have been effective in an earlier stage of the disease, when I am now in a more advanced stage of the disease?
Let me put this in a different context. Let's say you have a minor inflammation of your foot. You put it on ice, take some painkillers and keep off your feet for a while.
The pain progresses. You break your foot. You need to be on crutches for a while.
But tragedy strikes, your foot gets amputated. Then your other foot. You either need prosthetics, or a wheelchair or both.
Now, when you are at the stage when your feet have been amputated, do you think it's possible to go back to taking some painkillers?
Of course not.
A low carb diet and regular exercise are great for all diabetics. But depending on how much insulin you still produce, that might not be enough to manage your diabetes. Ultimately, you go by your blood sugars. If you are happy to live a lifestyle where you eat zero carbs and run a marathon a day, that *might* help improve your insulin sensitivity to the point where no further therapy is needed. But if your pancreas isn't producing insulin anymore, no amount of diet/exercise is going to help. And yes, some Type 2 really don't produce any insulin anymore.