When To Contact A Medical Professional
- Chest pain or pressure
- Shortness of breath
- Red, painful skin that is spreading quickly
These symptoms can quickly get worse and become emergency conditions .
Also call your provider if you have:
- Numbness, tingling, or pain in your feet or legs
- Problems with your eyesight
- Sores or infections on your feet
- Symptoms of high blood sugar
- Symptoms of low blood sugar
- Frequent feelings of depression or anxiety
The Younger The Sooner The Better
The key to when to start insulin is to identify the appropriate glycated haemoglobin target for an individual patient. Despite the promulgation of various ‘guidelines’, there is no single HbA1c concentration which suits everyone. For example, the younger patients already on maximal oral therapy and as much lifestyle modification as they can manage, would benefit greatly in the long term from early introduction of insulin, even if their HbA1c is only minimally elevated . The important point here is the early introduction of insulin, as the lifetime risk of complications for young patients is great. On the other hand, older patients who are not symptomatic and have no microvascular complications such as retinopathy, can be allowed to remain in ‘secondary failure’ at an HbA1c of 8-9%. In these patients, prognosis is governed mainly by macrovascular disease, which is not greatly influenced by glycaemic control.
How Is Type 2 Diabetes Diagnosed
Doctors can say for sure if a person has diabetes by testing blood samples for glucose. Even if someone doesn’t have any symptoms of type 2 diabetes, doctors may order blood tests to check for it if the person has certain risk factors .
Some kids and teens with diabetes may go to a pediatric endocrinologist â a doctor who specializes in diagnosing and treating children and teens living with diseases of the endocrine system, such as diabetes and growth problems.
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Prognosis In Intensive Therapy
In the UKPDS, more than 5000 patients with type 2 diabetes were followed up for up to 15 years. Those in the intensely treated group had a significantly lower rate of progression of microvascular complications than did patients receiving standard care. Rates of macrovascular disease were not altered except in the metformin-monotherapy arm in obese individuals, in which the risk of myocardial infarction was significantly decreased.
In the 10-year follow-up to the UKPDS, patients in the previously intensively treated group demonstrated a continued reduction in microvascular and all-cause mortality, as well as in cardiovascular events, despite early loss of differences in glycated hemoglobin levels between the intensive-therapy and conventional-therapy groups. The total follow-up was 20 years, half while in the study and half after the study ended.
Other, shorter studies, such as Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation and the Veterans Affairs Diabetes Trial , showed no improvement in cardiovascular disease and death with tight control .
A British study indicated that the HbA1c level achieved 3 months after the initial diagnosis of type 2 diabetes mellitus predicts subsequent mortality. In other words, according to the report, aggressive lowering of glucose after diagnosis bodes well for long-term survival.
How Is Type 2 Diabetes Treated
People with type 2 diabetes have to pay a little more attention to what they’re eating and doing than people who don’t have diabetes. They may need to:
- Eat a healthy diet, as determined by the care team.
- Get regular physical activity to achieve a healthy weight and allow insulin to work more effectively.
- Check their blood sugar levels on a regular basis.
- Get treatment for other health problems that can happen more often in people with type 2 diabetes, like high blood pressure or problems with the levels of fats in their blood.
- Have regular checkups with doctors and other people on their diabetes health care team so they can stay healthy and get treatment for any diabetes problems.
People with type 2 diabetes might have to eat smaller food portions and less salt or fat, too. Those who eat healthy foods, stay active, and get to a healthy weight may bring their blood sugar levels into a healthier range. Their doctors may even say they don’t need to take any medicines at all.
How Do I Take And Adjust My Insulin Doses
It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin syringe, pen, pump, or inhalation though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.
Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.
Avoiding Injection Bruises And Lumps
Bruising can happen when you catch a tiny blood vessel under the skin where you have injected. It is quite normal for this to happen occasionally when you are injecting regularly and youre not doing anything wrong.
If you are concerned, you could make an appointment with your diabetes specialist nurse who will be able to do a review of your injection technique. In some cases, bleeding and bruising can be reduced by something as simple as using a different sized needle or changing your needle after each injection.
Some people notice hard lumps that can form if you inject in the same place too often. This might be lipohypertrophy , or could be something called cutaneous amyloidosis. These lumps can stop the insulin from working properly, so make sure you rotate where you inject and choose a different spot each time. If you notice any lumps, especially if they’re not going away, speak to your healthcare professional for more advice.
Other side effects from injecting a lot can be itching, rashes and other skin irritations. Changing where you inject helps with this too. You can also get treatments from your local pharmacy that can will help with the irritation.
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What Is Type 2 Diabetes
There are two major types of diabetes: type 1 and type 2. Each type causes high blood sugar levels in a different way.
In type 1 diabetes, the pancreas can’t make insulin. The body can still get glucose from food, but the glucose can’t get into the cells, where it’s needed, and glucose stays in the blood. This makes the blood sugar level very high.
With type 2 diabetes, the body still makes insulin. But a person with type 2 diabetes doesn’t respond normally to the insulin the body makes. So glucose is less able to enter the cells and do its job of supplying energy.
When glucose can’t enter the cells in this way, doctors call it insulin resistance. Although there’s plenty of insulin in the person’s body, because it doesn’t work properly, the pancreas still detects high blood sugar levels. This makes the pancreas produce even more insulin.
The pancreas may eventually wear out from working overtime to produce extra insulin. When this happens, it may no longer be able to produce enough insulin to keep blood sugar levels where they should be. In general, when someone’s blood sugar levels are repeatedly high, it’s a sign that he or she has diabetes.
Concerns About Insulin Therapy
Pain, weight gain, and hypoglycemia may occur with insulin therapy. Pain is associated with injection therapy and glucose monitoring, although thinner and shorter needles are now available to help decrease pain. Weight gain associated with insulin therapy is due to the anabolic effects of insulin, increased appetite, defensive eating from hypoglycemia, and increased caloric retention related to decreased glycosuria. In the U.K. Prospective Diabetes Study, patients with type 2 diabetes who were taking insulin gained an average of 8 lb, 13 oz , which was associated with a 0.9 percent decrease in A1C level compared with patients on conventional therapy.5
Hypoglycemia may occur from a mismatch between insulin and carbohydrate intake, exercise, or alcohol consumption. Hypoglycemia has been associated with an increased risk of dementia and may have implications in cardiac arrhythmia. 6,7 All patients should be instructed on the symptoms and treatment of hypoglycemia. American Diabetes Association guidelines recommend that the blood glucose level be checked if hypoglycemia is suspected , then treated with a fast-acting carbohydrate, such as juice or glucose tablets. The blood glucose level should be rechecked after 15 minutes to make sure it has normalized.8
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Insulin For Type 2 Diabetes
If you have type 2 diabetes and your doctor thinks insulin can help you, it doesnt mean you now have type 1 diabetes. You still have type 2 diabetes, but you’ve changed treatment.
If you have type 2 diabetes, you may not need to use insulin straight away. But some people have very high blood sugar levels when they are first diagnosed. Insulin can be used as a short-term treatment to help quickly bring down your blood sugar levels.
Some people may need to take insulin for a particular reason, like during pregnancy or a severe illness, or after surgery. But you may also need to start it as a treatment if other medications havent helped managed your blood sugar levels or are not appropriate for you.
If you need insulin it isnt your fault and it doesnt mean you havent managed your diabetes well. It’s simply another medication that can help to keep you as healthy as possible. Managing blood sugars effectively is really important in reducing your risk of future diabetes complications and insulin may be the most appropriate treatment choice for you. Many people with type 2 diabetes need to use it as treatment at some point.
Its still important to keep going to your appointments and manage your condition with healthy lifestyle choices. Staying active and eating a healthy diet will reduce the risk of complications from your diabetes.
Choice Of Insulin Regimen: The Combined Oral Drug And Insulin Approach
Many patients and practitioners procrastinate as insulin treatment is erroneously considered to be risky and difficult. However, the regimen used routinely in our clinic is safe and easy to start.2 In our opinion this regimen can be started in general practice. The regimen consists of a combination of intermediate-acting insulin before bed, while continuing maximum oral drug therapy during the day.
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How To Know When You’ll Need Insulin
Injecting insulin above and to the side of the belly button can result in more consistent results.
There’s no simple way to tell when a patient with type 2 would do best on insulin, says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. But there are guidelines.
“In general if a patient has a hemoglobin A1C that is higher than the agreed upon goal and they are not on insulin, we recommend insulin therapy,” Dr. Hellman says. The American Diabetes Association recommends an A1C of 7% or below, and the American College of Endocrinology and the American Association of Clinical Endocrinologists recommend an A1C of 6.5% or below.
If you can’t lower your A1C with diet, exercise, or other medications, you may need insulin to do the job.
Exceptions to the insulin ruleThere are exceptions, of course. Someone who otherwise seems to be a good candidate for insulin may not be able to manage such a regimen if he or she has limited vision and dexterity and no family support. Good News About Today’s Improved Insulins
If you do need insulin in the short- or long-term, your doctor may prescribe one of four different types. These vary by how quickly or slowly they reach the bloodstream , the amount of time they work at maximum strength , and how long they continue to be effective .
According to the American Diabetes Association , your need for insulin is based on several factors.
When Do People With Type 2 Diabetes Start Insulin
After 10 to 20 years, many people with type 2 diabetes will begin insulin therapy, although every persons journey with type 2 diabetes is different. This happens when lifestyle changes and medications arent keeping your glucose levels in your target range. It is important that you start treatment as early as possible to avoid persistent hyperglycemia , which can lead to long-term health complications affecting your heart, kidneys, eyes, and other organs.
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Insulin And Type 2 Diabetes
Type 2 diabetes is characterised by the body not responding effectively to insulin. This is termed insulin resistance. As a result the body is less able to take up glucose from the blood. In the earlier stages of type 2 diabetes, the body responds by producing more insulin than it would normally need to.
If type 2 diabetes develops over a number of years, the extra demands on the pancreas to produce insulin can lead to a loss of insulin producing cells as they wear out.
Depending on their level of insulin resistance, people with type 2 diabetes may also need to take insulin injections to manage their blood sugar levels.
How Much Can You Receive From The Disability Tax Credit:
If approved for the DTC for diabetes, you can receive one or more tax refunds, depending on how long you have lived with the condition. To find out how much you can stand to receive from the DTC, use our highly accurate Disability Tax Credit Calculator. However, to give a rough estimation, here is how much you could earn from the DTC:
The Disability Tax Credit consists of a Federal portion and a Provincial portion. The Federal portion is the same across Canada, while the Provincial portion is different in each Province.
If found eligible for the Disability Tax Credit, you could receive:
- Annual refund If found eligible, you can claim a refund annually when you prepare your taxes. An adult can receive around $1,500-$2,000 per year, while a childs caregiver can receive up to $4,000 per year.
- Retroactive One-time Refund If youve been living with diabetes for years before your approval for the DTC, the CRA will evaluate your application to see when your symptoms started. If applicable for prior years, you could receive a one-time lump sum payment for up to the past ten years. If you or your supporter have been paying federal taxes during those years, you will receive up to $20,000, or up to $40,000 youre under 18.
FIND OUT IF YOU ARE ELIGIBLE TORECEIVE THE DISABILITY TAX CREDIT!
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What Is An Insulin Reaction
If youre going to use rapid-acting insulin, you need to be aware of insulin reactions and how to treat them. Rapid-acting insulin begins to work very quickly. So while you and your doctor are working to find the right dosage of this insulin, you may have some insulin reactions.
Hypoglycemia is the name for a condition in which the level of sugar in your blood is too low. If you use insulin, your blood sugar level can get too low if you exercise more than usual or if you dont eat enough. It also can get too low if you dont eat on time or if you take too much insulin. Most people who take insulin have insulin reactions at some time. Signs of an insulin reaction and hypoglycemia include the following:
- Feeling very tired.
- Being unable to speak or think clearly.
- Losing muscle coordination.
- Suddenly feeling like youre going to pass out.
- Becoming very pale.
- Candy: 5 Lifesavers.
- Glucose tablets: 3 tablets .
If you dont feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.
Situations When Type 2 Diabetics Must Go On Insulin
Few things are more worrisome for diabetics than when type 2diabetes needs insulin. Some doctors even use insulin as a scare tactic.
But the truth is, sometimes insulin therapy is really theonly way to go. Most of the time insulin is associated with worsened diabetesor the end of the road. But hopefully after you finish reading, youll feelmore confident that insulin is not the end and you can still regain yourhealth.
Insulin is indicated when blood sugar control cant beachieved with diet, exercise, and oral drugs for people with type 2 diabetes.
There are 3 main situations when insulin is usually used forpeople with type 2 diabetes. They are as follows:
Early Initiation ofInsulin in Type 2 Diabetes
For most newly diagnosed or people who havent had diabetesfor very long, their doctor will put them on oral medications and a diet andexercise regimen. The goal is to get these three to work in getting blood sugarlevels under control.
But when a type 2 diabetic presents with weight loss, moresevere symptoms and blood sugar levels greater than 250 mg/dL patients arestarted early on insulin therapy.
Late-Stage InsulinTherapy in Type 2 Diabetes
When MedicalSituations in Type 2 Diabetes Require Insulin
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