Are we just completely ignorant about Type 2?

I was thinking about type 2 diabetes and conventional treatment. It really got me wondering: When did glucophage deficiency become a malady? The vast majority of people walk around totally deficient in glucophage, and yet they seem quite healthy.

Some T2s apparently are deficient in the hormone, GLP-1. This deficiency is causing their blood sugar to go too high. So, we have some supplements on the market -- Byetta, Victoza -- to bring up those levels of GLP-1.

And much more. Bragging rights to the first response that figures out where I'm going with this...

You obviously have a statin deficiency as well.

Answer to your title -- Probably...yes. Most likely yes.

Answer to figure out where you're going with this? The medical community needs to step back and re-evaluate what is actually causing type 2 diabetes is my guess besides the Glucophage deficiency (another/additional gene/switch). As Paul Harvey would say where is "the rest of the story"?

It looks like you feel that T2s are primarily insulin deficient and insulin is the answer. Might as well attack to problem head on.

I agree with you to some extent but not always because in some T2's the problem is insulin resistance with plenty of natural insulin production. In that instance the drugs you mention are very appropriate.

So true Gary. In my case, I showed signs of insulin resistance at diagnosis. Since diagnosis I've lost 60 lbs. without trying and continuing to do so, but my BGs are going up in the process. My weight loss is inverse to my blood glucose levels.

I would have thought based on my endo's recommendation that with diet and exercise, that my BGs would do better.

He immediately put me on Metformin and I thought I was going to die from the side effects and it didn't improve my BGs. Now we are in limbo mode. I've decreased my A1C from 6.7 to 6.0 but the decrease is due to the fluctuations between highs and lows.

I see the deficiencies you mention as effects, not causes, of T2 diabetes. It makes no sense to me to medicate that. The simplest, cheapest, and most effective treatment I know is to cut back on carbs. You'll know how much by what your blood sugar tells you.

Jan, I'm not sure if you are responding to Dave or me, but in my case, I'm already on a low-carb diet---no bread, potatoes, pasta, rice, oats, etc. Today I had to break the rules and order pasta due to logistical constraints, but I really work hard to stay on course. I paid the price, my BG jumped immediately.

Example - mornings I used to be in the mid 90s, now I'm in the mid 120s. Then breakfast -- 2 egg whites, bacon. And by 9:30 am I'm 140 - 150, whereas I used to be 95 - 118.

My endo says as long as I'm < 180 I'm o.k. but if I go over 140 I start having vision problems and fuzzy brain.

Dave, you're the first person who thinks the same way I do & has the same questions. I was diagnosed in 2009 but was probably diabetic long before. I'm 62. I passed out in school at 11 yrs. old after skipping breakfast & was unconscious for 20 minutes. The school wouldn't let me back in until I saw a doctor. The doctor didn't test my blood sugar; he just told my mom not to let me skip breakfast.

Over the years, before diagnosis, I noticed that when I'm hungry, I don't have much time before I get classic low symptoms & may pass out.

I had a "C-Peptide" test last year (it's supposed to measure insulin production). Doctor said my insulin production is normal. I asked him "so, why am I diabetic?" He said "Insulin Resistance. The solution is to lose weight." I lost 90 lbs. & my blood sugar & A1c went UP. The doctor said to start on insulin. Other questions I have: If a diabetic's insulin production is "normal," why is the solution more insulin? And, if Type 2 diabetes is caused by insulin resistance, wouldn't they also be resistant to injected insulin?

Sometimes I wonder why doctors won't say the words, "We don't know." Or, when they don't have an answer, they'll just blame the patient.

Dave's challenge is intriguing. Type 2 is a complex disorder. I've written before that Ralph Defronzo a respected researcher thinks that Eight separate physiological defects are involved. All the drugs that have been mentioned treat the resulting symptoms of these defects. Even insulin simply treats a symptom of the defect. And actually carb restriction is just another way of treating the symptom, it doesn't fix any defect.

The idea that T2 is all about insulin resistance and that insulin resistance is a defect cause by being overweight is really naive. There are just too many of us who were never really overweight and found no improvement with weight loss.

And this is why we all get upset when someone comes to tell us that there is a "cure" or that they can "reverse" diabetes. I've never seen any shred of evidence that the fundamental defects involved with T2 can be corrected with a drug or treatment.

Originally I was diagnosed hypoglycemic in my late 20s early 30s and then at 43 was diagnosed as Type 2. My endo says that's not unusual.

Did your doctor say why your A1C went up even though you lost weight? When I exercise, I'm constantly going hypo and when I drive home from work in the evenings I also have hypo events.

It's almost as if I have spurts of insulin overload and then insulin deficiency.

My mom's aunt (one of her dad's sister) had an endo who would keep her all day once a year to check her diabetes. I never knew what the tests were, but she would be an outpatient at the hospital. I always wondered.

Sorry but doctors are too arrogant to say the words "I don't know". There are a few who are humble enough, but they are few and far between. And yes, they do blame the patient for being 'unique', 'different', or not fitting in the 'proper category--A, B, or C'.

I don't know all the scientific knowledge behind it, but I do agree Brian.

There was a world of difference between my mom's parents' diabetes. I truly believe that my grandfather was LADA--he was on multiple shots (beef, pork, and finally human insulin) and had to check his blood and urine for ketones, sometimes in the middle of the night. He was on a strict low-carb diet (no breads/pasta/potatoes/rice), and he couldn't eat any sugar free foods--they always made him ill. Constant battle between hyper/hypo blood glucose levels.

My grandmother was the complete opposite as a Type 2--she was on pills for a very long time before she was prescribed shots and then she was on very low dosage and minimum shots. She could eat anything within moderation, and could have sugar free foods.

My mom is a hybrid between the two--she can't tolerate sugar free foods, but she can have some carbs, but she's on Lantus and Novolog. She couldn't take pills.

So far, I'm struggling with diet and exercise to control BG, but I think I'm heading in my grandfather's footsteps--absolutely no carbs or sugar free foods. And I'm constantly yo-yo-ing between hypos and hyper BGs.

Agree w/Brian on all counts. The T2 syndrome is much more complex than most people (doctors included) think, and we are much further from truly understanding it than most people (doctors included) believe. All we can really do at the present state of the art is manage the symptoms. The underlying cause(s) are essentially a mystery. There's no shortage of theories, but at this time that is all they are: theories.

There are quite a few T2s who have very little insulin resistance. I am one and there are many others here on TuD. The answer is not to be found in the back of the book -- not yet.

No, my doctor didn't have an answer for my A1C going up after losing weight. He actually said I was now "too thin." Interesting that he would say that since he was about 100 lbs. overweight. An overweight doctor things everyone is too thin. I told him, "I don't think 185 lbs. for 5'11" is too thin" (that was my weight at the time...160 lbs. now). I stopped seeing him after that visit.

In my opinion, a drug for diabetes is like a drug for hypertension - it just gives your meter a lower number without changing anything about your health. After all, where does the sugar actually go when you take a drug? I doubt it just magically disappears.

A T1 friend said he worked in a diabetes research lab back in the day, and apparently most T2s have pretty badly impaired insulin response. So it isn't just the insulin resistance. I think they are looking for the causes of insulin resistance, and metformin is used simply because it appears to work, is well tested, and for many the side effects aren't horrible. It also helps with the weight loss that is part of the problem for many T2s. I hated it though.

Metformin clearly made me more sensitive to insulin. I was on regular and doing MDI (prior to my T1 diagnosis) and as I approached very little insulin production on my own it would cause me to be insulin sensitive as it peaked and insulin resistant as it got out of my system. Also, when I got off it, I needed to take more insulin.

In addition to getting T2s on insulin, they really need to rule out T1 via testing.

As I recall Dr Bernstein used to claim that they lines between T1 and T2 are pretty gray, and we really don't understand T2 much.

True on all points. The best current understanding of metformin is that it does two things. It suppresses secretion of glucose from the liver, in effect lowering basal needs, and it increases insulin sensitivity so that what's present, works better. I've been using it for some years and for me, luckily, the side effects are relatively trivial. So it's a plus in my case.

And you are preaching to the choir here when you speak of putting T2s on insulin. From where I sit, early intervention with insulin is a no-brainer; the pros entirely outweigh the cons. I've pontificated on that many times here so I won't repeat myself other than to point out that Joslin now puts T2s on insulin right away.

As for Bernstein, his thesis as I understand him is that diagnostic explorations are interesting and useful, but at the end of the day it doesn't matter whether you're type 1, type 2, or type 89. What counts is taking the steps necessary to achieve control, whatever they are. Eyes on the prize -- a view to which I subscribe completely.

Spot on. But, the frustration is that doctors make Type 2s jump through hoops (which medication will work) that Type 1 never have to go through. I feel like Little Timmy "may I have some medical support please?" in a Cockney accent. You're doing good, fight the good fight, if your worse at your next appointment, we'll discuss insulin.

And why? Partially lack of knowledge of the disease, fear, coloring within the lines, the insurance game, all of the above?

I would rather choose to be in a researcher's study than subjected to feeling like something on the bottom of my shoe day in and day out.

A year or two ago I saw results from a study that were profoundly revealing. It surveyed both doctors and their patients in the same study. Two thirds of the doctors said they hesitated to prescribe insulin because people were afraid of injections. Note that: not because they had any doubts about the therapy, but just because they thought there was overwhelming patient resistance.

Now here's the kicker.

In the very same survey, only about a third of the patients said they were afraid of injections. In other words, patient attitudes about injections, and doctors' beliefs about patient attitudes, differed by 50% (or 100%, depending on which way you compare). And the figures were pretty consistent both here and abroad.

Think of all those thousands (millions?) of T2s who are not being offered a game-changing therapy simply because their doctors mistakenly believe they won't agree to it.

Absolutely mind blowing. When I first started with biologics for my RA, my rheumy didn't give me a choice about injections.

His question: Do you want to get better and feel better?

My answer: Yes.

His response: O.k. then the nurse will teach you how to give yourself two shots once a week starting today.

End of conversation.

As it is, no one recommended insulin to me. After a number of years of mediocre control, I made it my business to start learning everything I could about diabetes. Pretty quickly, I put two and two together, marched in to my doctor's office, and demanded it.