When Starrt to take Insulin, and what tipe of it? April 17, 2019

 Many patients with type 2 diabetes eventually need insulin, as their ability to produce their own insulin from pancreatic beta cells declines progressively. The questions remain as to when insulin therapy should be started, and which regimen is the most appropriate.
Insulin treatment for type 2 diabetes: When to start, which to use
Cleveland Clinic Journal of Medicine. 2011 May;78(5):332-342
by Marwan Hamaty, MD, MBA
https://www.mdedge.com/ccjm/article/95511/drug-therapy/insulin-treatment-type-2-diabetes-when-start-which-use

        The real question is, why insulin is not first line treatment for diabetes any type of it?  As it is pointed out beta cells decline progressively. So, what are we weighting for? This is question. Insulin must be started as soon as diabetes was diagnosed. Why not? Insulin works for type 1 diabetes, and insulin therapy started right from the time diabetes was diagnosed. Diabetes type 2 eventually will progress and diabetic type 2 will need insulin. Of cause if diabetic type 2 still alive  after aggressive treatment with life style modifications, demand to live healthy with high blood sugar in blood, and treatment with SU, medicine which kills insulin secreting beta cells.
         The matter of fact, diabetics type 2 perish less then 10 years after being diagnosed with diabetes type 2 to all cause of mortality. As soon as diabetic type 2 start to take insulin in stead of any oral medicine the progress of diabetes slow down. With insulin injections diabetics can live over 60 years. Without insulin injections by the time of 60 most of them  would perish.
       So, why really the question stands, when to start insulin injections?
        Probably to find answer it is interesting to take look at the media. How to delay diabetes type 2 diagnose? Interesting question, is not it? There is no any question how to treat diabetes type 2. Just starve yourselves to Death, and then there is no diabetes. It is fake info. Diabetes stay in bones of skeleton. So, regardless if it is human being or corpse, diabetes still present. Logically speaking,  starvation is not cure for diabetes. ADA and professor R.Taylor are wrong. They mislead public and diabetic patients alike.
       Now back to the question, why it is so important to delay diabetes type 2 diagnose? Because of if treatment started early, and if treatment is effective, then  diabetes will be cured or progression of diabetes would be stopped. No amputations, no obesity, no diet needed. What all that industry suppose to do? Do they need to start to take those canned foods they pretend to be healthy by themselves? Do not be so naive. These food is for fool. They are smart. They eat in fine restaurants, and lead healthy life style. For us 'healthy' is all what is not healthy for them. Dual approaching.

Guidelines from professional societies differ on these points,^2,3 as do individual clinicians. Moreover, antidiabetic treatment is an evolving topic. Many new drugs—oral agents as well as injectable analogues of glucagon-like peptide-1 (GLP1) and insulin formulations—have become available in the last 15 years.

With so active professional guidance and new medicine avalable to treat diabetes type 2, diabetics type 2 moved from  7% to 10%  of American Population. Mortality of diabetics type 2 is 200,000 every year to all cause of mortality. And only diabetes, the untreated or wrongly treated diabetes stand on number 7 spot in line to grave. Great progress after 1980 when WHO developed a new diabetes classification and moved from one treatment for all diabetics, insulin, to dual therapy approach. They named it 'individualization'. One therapy to those who deserve to live. Another part of humanity, 95% of diabetic population, became guinea pigs for medical researchers and transplant organs.

The American Diabetes Association (ADA), in a consensus statement,² has called for using insulin early in the disease if lifestyle management and monotherapy with metformin (Glucophage) fail to control glucose or if lifestyle management is not adequate and metformin is contraindicated. The ADA’s goal hemoglobin A_1c level is less than 7% for most patients.

        A1c level is between 4% to 5.6% in non diabetics population. According to ADA A1c level , then 7% is considered to be good for diabetics. The question is, why? Why this gap between healthy level of sugar in blood and level to start the treatment?  Just why? Another question is, what that treatement would be?

The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE), in another consensus statement, use an algorithm stratified by hemoglobin A_1c level, in which insulin is mostly reserved for when combination therapy fails.³ Their goal hemoglobin A_1c level is 6.5% or less for most patients.

So simple. They all reserve their portion of income in expense of our lives and health.  But if it is clear to understand to every one who happened to have brain, then for public it is presented that diabetics type 2 done it for themselves. Why not? Who first shoot" Get The Tief!" That one who still. Every one do know it. Still, every one bark on victim that diabetics type 2 do not practice healthy life style. How can we do it? we are not healthy to begin with. 

Both consensus statements give priority to safety. The AACE/ACE statement gives more weight to the risk of hypoglycemia with insulin treatment, whereas the ADA gives more weight to the risk of edema and congestive heart failure with thiazolidinedione drugs (although both insulin and thiazolidinediones cause weight gain) and to adequate validation of treatments in clinical trials.

       Is not this ridiculous? More weight, less weight, more safety, less safety, and so so on.So, to Rx  to inject insulin MD must be sure in safety of medicine. But do not inject insulin is road to fatality. Is this safe? Yes, it is safe for MD, and it is profitable. Diabetics do not die fast as it happened when it is infection. It takes year, and in some cases more to develop fatal condition. This depend how much insulin diabetic body system able to produce. Diabetes is gap between insulin available in secretion and level of insulin needed to healthy body function. Then higher ability of body system to secret insulin then longer diabetic live.
     This is the point with all oral medicine. No one  modern medicine treat the cause of diabetes, limited insulin secretion. All medicine treat level of sugar, the consequence of limited insulin secretion. If insulin added in injections the gap between insulin in demand covered by insulin in injection, so the level of sugar dropping, and balance between insulin in demand and insulin available to be used  established. With time insulin secreting beta cells start to recovery, and secretion of insulin improves. This is why diabetics who take insulin decrease dose of insulin with time. If diabetes started to be treated in childhood, child will grow healthy and probably will not need insulin in injections for long period of time.

Factors that affect whether patients comply with a treatment include the number of pills or injections they must take per day, how often they must check their blood glucose, adverse effects, lifestyle limitations caused by the treatment (especially insulin), and cost. Most patients feel better when their glucose levels are under good control, which is a major motivation for initiating and adhering to insulin. The anticipated reduction of diabetic complications further enhances compliance.

        Number of pills or number of injections? Say me what does it mean for me? Nothing. I have to take not only medicine to diabetes treatment but for heart, lungs, depression, BP, DVT, Asthma, sleep with C POP, and so so so on.  What I can say, this is scam. No one can say, how many pills diabetic will take.
      Number of injections? What is the point in it? I take three injections daily. I take 480 units of insulin. I can take 200 units at once. Other diabetics will not be good even with 50 units of one injection. The dose of insulin and dose of each injection different with time. What is important, the body adaptation to insulin and patient experience bring all needs into balance. As I just said, it is easy to say, now many injections diabetic need. But what dose to inject? No clue. No one MD will answer to this question. So, what they are talking about? Pure charlatanism. They are dressing The King Naked.
       lifestyle limitations. What limitations? With SU there is no any way to predict or control when low sugar will strike. With Invokana diabetic must know all the time where restrooms are available to be used and how long one can hold. LOL! This question never in discuss of life style. But try to use Invokana, and stay out of restrooms? In contrary, with insulin I am good to take trip from my home to Adirondack and use restroom only once, at gas station. The same as my car. I can go to Met Opera nad stay on my seat in intermission. No need to stand in line from one end to another. There is only one restroom for Family circle and Balcony. Too many women in line. Yes, there is another restroom, but I cannot go there. It is on the top of the house. This is life style as it is.
      To low sugar I do have also good control. I never leave home without protein bar in my hand bag. Easy to use, easy to carry. One protein bar hold me for 4 or 5  hours. Try it with SU. Just try it. I suggest every MD before Rx any medicine try it on themselves. See, what happened. LOL! They would not take Glipizide. They will take safe Lantus Solo Star.

 Patient selection and insulin titration are key issues in ensuring the achievement of adequate control with the fewest side effects. Lifestyle management (diet and physical activity) enhances the efficacy of insulin therapy and reduces the chances of side effects, namely fluctuation of glucose levels, hypoglycemic episodes, and weight gain.

The question is, when insulin safely to take, when A1c>12.2% or when A1c> 5.9%?  When low blood sugar episodes will be more often, when sugar is higher, or when dose of insulin is small? Well, there is no clear answer to this question.  But the adaptation to insulin is faster with lover A1c then with higher A1c. The lower A1c the dose of insulin lower, and the right to low blood sugar never fatal. Diabetic can be hungry, but not skipping into coma. Then higher A1c then lower it dropping. So, when it is best to start Insulin Therapy?
      Lastly what I wish to say, I tried many types of insulin. I do not accept combination insulin such as fast acting and low acting insulin in one shot. Personally I prefer to take another shot of long acting insulin then take 50/50 insulin. I take only one type of insulin, long acting insulin Lantus Solo Star. Novolog is good to reduce high level of insulin and do it fast. But to control blood sugar long acting insulin is The Best. Still, it is only my practice, no studies.
      How to chose what type of insulin is best? well, it is very simple: it is MD and Health plan who pay for insulin do the choice. Usually Md Rx insulin which diabetic already takes. Another way, doctor prefer to Rx the type of insulin he uses in his practice. He knows how this type works. And finally, it is cost of insulin, choice of insurance company which serve diabetics. If diabetic pay our of pocket then the cost is most important. Once when I did not have insulin, I considered to start to take insulin for animals. I hoped it would be easy to get Rx. Happily for me, I did not need it. Now I do have Lantus Solo Star, and just recently got my follow up supply.

via Ravenvoron