Sure it would, its what I do but I am not the average T2, I use insulin practically the same as a T1, I have studied and I employ proper techniques. I have defined basal and bolus ratios I have worked out just for me. as far as I’m concerned insulin is a full time occupation. You can’t be a part time insulin user, there is too much to learn and you can’t learn it through part time time use. The ever changing aspect of diabetes tells me that a part time user would never be able to fully adapt to insulin.
If you could find a doctor able to set bolus rates for an occasional user you probably should check his back room, he probably has a crystal ball hidden somewhere.
Would it work, sure its possible but its highly unlikely. Afrezza might make the chances for success more likely but still.
This wasn’t in the original question, which specifically asked about doubling metformin. Even if someone was below the max dose, my understanding is it works pretty slowly (like days) so it wouldn’t really help for a big meal.
However there are other oral meds a T2 can take for a specific meal. For example, starlix and glipizide are pills to take with meals that will stimulate the pancreas to produce more insulin, and could make you go low if insufficient carbs are consumed. It’s like a blunt instrument though, you don’t get the same amount of fine-tuning to perfectly balance carbs like you can with insulin.
I am assuming you are referring to the mental resistance, but of course Type 2’s have very real insulin resistance at the cellular level to contend with. All in all, a tougher nut to crack then just a “vanilla” type one.
To me that’s very understandable… insulin is a tough drug to manage and many patients, maybe even the majority suffer potentially dangerous hypoglycemic side effects with its use despite their best efforts—- if I was a doctor managing a patient who didn’t necessarily need it from day 1, I would also consider it a last resort to be used only if and when other levels of intervention weren’t effective
If you are only an episodic user of insulin, it would be very difficult to internalize what we learn over many months of daily use.
I would be worried of the “learn and forget syndrome:” I tend to buy large numbers of rifles, for instance. The ones I use often I am very comfortable cleaning quickly and efficiently. But the ones I only use once every couple of years, I have to relearn to take them apart and clean them every single time: very time-consuming. For insulin, also very dangerous.
So I think that @kenrick’s thought is pretty darn good: starlix, glipizide and similar substances, to me, seem to fit the bill better. You still have to check your BG, of course. But every T2 knows how to do that, so it is no concern. And the downside is not as extreme.
Though don’t those drugs have the risk of further burning out the pancreas and are increasingly avoided by some as a result? I would think boosting doses might work on occasion but could be a risky strategy if utilized more regularly (which might be tempting if it did in fact work).
I am not aware of that risk, although it may well be that I don’t know enough? Here is a recent (2015) discussion on Type 2 approaches (applies to HIV-infected patients), that does not discuss this facet:
I’m certainly not an expert on those meds, but I’d thought I’d heard concerns about that. I don’t know how supported by research it is though. Maybe @SLEE knows?
Glipizide is a second-generation sulfonylurea. This paper discusses the possibility of removing all sulfonylureas from a hospital formulary. The reason though, is hypoglycemia incidents:
I don’t know about type 2’s, but I often hear this in the LADA groups as being an issue for type 1s (most specifically those who are adult onset). Maybe that’s the context in which you heard that?
This is generally believed but is not proven. I read an article recently that was trying to dispel this thought. For me the jury is still out. I have taken a sulfonylurea such as glipizide but not the other drug that @kenrick has mentioned. I am in no hurry to take either of the two because I don’t want to take a chance with my remaining beta cells.
Sulfonylureas are risky, the first and one of the worse lows I have experienced happened while my only med was a sulfonylurea. I would not try exceeding the prescribed dose.
Have there been good longterm RCTs to test it? One thing that’s difficult with naturalistic observation is that probably the patients who are prescribed those meds tend as a group to have certain characteristics (that may be more or less likely to relate to reduced insulin function over time), so just measuring longterm outcomes of patients who use it vs those who don’t wouldn’t be particularly informative unless in the context of a randomized trial specifically structured to isolate potential impact of those drugs. If that has been done though, I would find that reasonably compelling.