Editor’s Note: Type 2 diabetes management is highly individual. While some individuals thrive with diet and exercise adjustments, others benefit significantly from medications like insulin or advanced monitoring tools. It’s crucial to have open conversations with your healthcare provider to determine the best course of action for your unique needs. Never make changes to your diabetes management plan without consulting your doctor, especially if you have type 1 or type 2 diabetes.
Kate Cornell’s journey with type 2 diabetes began unexpectedly in 2005, at the age of 50. Like many, she was caught off guard by the diagnosis, revealing a common challenge in the early stages of diabetes management: navigating the healthcare system and advocating for personalized care.
“It was just a routine blood test at my gynecologist’s,” Kate remembers, recounting her diagnosis. “They weren’t even checking my A1c, just my blood sugar. And then they just told me, ‘I’m sorry, but you have diabetes.’”
The initial consultation with her primary care physician offered little more clarity. The advice was generic: “You probably have type 2. Just change your diet, get some exercise, and start checking your blood sugar with a meter.” This common yet often insufficient advice highlights a significant gap in initial diabetes care – the lack of comprehensive education and personalized strategies. Kate was sent home without resources, facing a life-altering diagnosis with minimal guidance.
“It was incredibly frustrating because I had no idea what I should be eating,” Kate explains, echoing a common sentiment among newly diagnosed individuals. “I tried everything, even WeightWatchers, but nothing seemed to work.” This trial-and-error phase underscores the complexity of type 2 diabetes and the limitations of a one-size-fits-all approach, especially when adequate support and tailored advice are missing.
The Metformin Path and Dietary Struggles
It took two years before Kate’s doctor finally prescribed metformin, a standard first-line medication for type 2 diabetes. Starting with a low dose and gradually increasing it to 2,000 mg daily over two years, Kate experienced the typical slow titration process.
Simultaneously, Kate was intensely focused on dietary changes, particularly reducing carbohydrates. This led her to confront another layer of complexity – food addiction. “I tried a really low-carb diet for a summer, and it did lower my blood sugar,” she admits. “But it wasn’t sustainable, and it made me miserable. Plus, I realized I can’t just have a little bit of carbs due to my food addiction.”
This highlights a crucial aspect of diabetes management: the interplay between medication, diet, and individual lifestyle factors. While carbohydrate reduction can be beneficial, it’s not always a complete or sustainable solution, and it certainly doesn’t address the needs of everyone, especially those with additional challenges like food addiction. Kate’s experience emphasizes that managing blood sugar is not just about willpower but also about finding a balanced and realistic approach.
Even with significant dietary restrictions, Kate found her blood sugar spiking dramatically after even small amounts of carbohydrates. “Even a sandwich would cause a super spike,” she recalls. This realization was pivotal, prompting her to recognize that diet alone, even with metformin, was insufficient for her needs. “If you can’t eat a sandwich without a spike, you need different medication,” she concluded, demonstrating a growing self-awareness and proactive approach to her health.
“Begging” for Insulin and Doctor Resistance
With consistently high fasting blood sugar levels in the 150-160 mg/dL range, Kate felt strongly that insulin was necessary. However, her doctor resisted. “I had been asking for insulin, but they kept saying, ‘Your A1c is fine, you don’t need it.’ It was so frustrating because a fasting blood sugar of 150 mg/dL is not fine!”
This scenario illustrates a common point of contention in diabetes care: the reliance on A1c as the primary marker of glycemic control, sometimes overlooking the significance of daily blood sugar fluctuations and fasting levels. While A1c provides a long-term average, it doesn’t capture the impact of frequent high blood sugar episodes on overall health and well-being. Kate’s persistence in questioning her doctor’s rationale and advocating for insulin showcases the importance of patient agency in healthcare decisions.
Frustrated and unheard, Kate sought a new healthcare provider. The contrast was stark; her new doctor immediately prescribed basal insulin. “I actually cried in his office when he agreed to write a prescription!” Kate remembers, highlighting the emotional toll of feeling dismissed and the relief of finally being heard and validated.
Despite the positive impact of basal insulin, Kate’s journey didn’t end there. She continued to encounter healthcare professionals who questioned her need for insulin, reflecting outdated perspectives on type 2 diabetes management. These encounters underscore a critical issue: misconceptions about when and why individuals with type 2 diabetes might require insulin. The outdated notion that type 2 diabetes is solely a result of lifestyle choices and can always be managed with diet and exercise alone persists, despite extensive research demonstrating the progressive nature of the disease and the eventual need for insulin in many individuals.
Alt text: Hands of a person with diabetes using a blood glucose meter to check blood sugar levels, emphasizing the daily self-management required for diabetes.
The Carb Conundrum and the Need for Mealtime Insulin
Even with basal insulin, Kate continued to experience post-meal blood sugar spikes, often reaching 250 mg/dL. This led to another layer of frustration – the resistance to prescribing mealtime insulin. “They still won’t consider putting me on mealtime insulin, but I can’t eat normally because everything spikes my blood sugar,” she explains. This ongoing struggle highlights the limitations of basal insulin alone in managing meal-related glucose excursions, especially for individuals with significant insulin resistance or reduced insulin production.
The restrictive dietary advice she received further complicated matters. “When I did go to a diabetes educator, she looked at what I was eating and all she did was encourage me to eat more carbs—like potatoes!” This well-intentioned but misguided advice, without addressing the need for mealtime insulin, only increased Kate’s frustration and sense of being misunderstood. It points to a potential disconnect between general dietary guidelines and the specific needs of individuals with poorly controlled diabetes.
Kate’s experience raises a critical question that many individuals with diabetes face: Why won’t my doctor put me on a CGM or mealtime insulin, or other advanced tools that could significantly improve my diabetes management? While Kate’s story focuses on insulin resistance, the question extends to other technologies and treatments, including Continuous Glucose Monitors (CGMs). CGMs, which provide real-time glucose readings and trends, can be invaluable tools for optimizing diabetes management, yet access can be limited due to various factors, including doctor hesitancy, insurance coverage, and perceived patient need.
The reasons behind doctor resistance can be multifaceted. They may include:
- Outdated Guidelines: Some healthcare providers may still adhere to older guidelines that emphasize lifestyle modifications and delay the initiation of more intensive therapies like insulin or CGM.
- Focus on A1c: Over-reliance on A1c as the sole indicator of glycemic control may lead to overlooking the importance of daily glucose variability and patient-reported symptoms.
- Concerns about Patient Compliance: Doctors might worry about patient adherence to complex regimens or the perceived burden of using technologies like CGMs.
- Insurance and Cost Considerations: Prescribing advanced technologies or newer medications can be influenced by insurance coverage and cost concerns.
- Lack of Specialization: Not all primary care physicians have extensive expertise in diabetes management, leading to a more conservative approach.
Alt text: A woman thoughtfully reviewing data on her smartphone, possibly related to her diabetes management or CGM readings, highlighting the role of technology in diabetes self-care.
Despite the ongoing challenges, Kate expresses gratitude for basal insulin and remains determined to advocate for her needs. “I never ever had an issue mentally with the idea of taking insulin because it’s obvious my body needs it,” she concludes, embodying a proactive and self-aware approach to managing her diabetes.
If you are facing similar frustrations and feel your doctor is resistant to discussing advanced diabetes management options, remember you are not alone. It’s crucial to:
- Educate Yourself: Learn as much as you can about type 2 diabetes, treatment options, and technologies like CGMs.
- Communicate Openly: Prepare specific questions and concerns to discuss with your doctor. Clearly articulate how your current management plan is impacting your quality of life.
- Seek a Second Opinion: If you feel unheard, consider consulting an endocrinologist or a diabetes specialist who may have more expertise and be more open to advanced therapies.
- Advocate for Yourself: Don’t hesitate to push for the care you believe you need. Your voice and experience are valuable in your diabetes management journey.
Resources for further support and information:
- [Link to Beyond Type 2 or similar resource about diabetes advocacy and treatment options] (Note: In the original article, there are no specific resources linked here, but in a real article, relevant links would be added).
Educational content related to Type 2 diabetes is made possible with support from Lilly Diabetes. Beyond Type 2 maintains full editorial control of all content published on our platforms.
