Back again

It’s been awhile since I’ve been on this forum. I thought we were through…guess not!

My husband (71) was formally advised he had D2 in the summer of 2019 through lab work required prior to meeting with a new doctor. He was shocked to learn that his A1C levels from lab work done in January 2017 indicated that he was already D2, but his doctor (who retired shortly afterwards) never advised him. At the time (2019) he had an insurance plan that did not give him good coverage and many of the diabetes informative sessions that were available to patients within the Baycare system (for example) were not available to him. Eventually he was able to find an endocrinologist who provided some basic information, scheduled checkups every 3 months and prescribed Metformin, but basically “we” were on our own (he does not meal plan or cook) and cobbled together an eating plan that reduced his carbohydrates. He dropped about 20 pounds, weight that he didn’t necessarily have (want) to lose, and although sometimes his numbers were erratic, they were basically good. For a period of time he used the FreStyle Libre, but because he was D2, it was an out-of-pocket expense. Months ago he stopped using the device because it had a short shelf life (hot tub?) and his numbers had been consistently good for a year or so. Despite carbs being increasingly added to his diet (he did not want to lose anymore weight) his BS levels were good…maybe for a year. In fact his numbers were so good/steady that he went off the Metformin (with his endocrinologist’s knowledge).

Without a change in lifestyle (same weight, same activity, same diet) through testing using finger sticks he has seen a gradual increase in BS these past couple of months …especially first morning readings which are often 140-160. He went back to taking Metformin at night as previously prescribed, but he is still getting high readings in the am (and sometimes in the pm). At the suggestion of his new primary, whom he likes and trusts, he dropped his endocrinologist. He has an appointment with his PCP in a month and is planning to get lab work done in a couple of weeks to be able to get an A1C reading. My husband is very aware (I believe) of how easy it is to go from D2 to D1, but as far as seeking medical attention goes, for him “less is more”. I’m glad he found a PPC whom he likes and trusts, but I think he should still see an endocrinologist; he has great medical insurance now and can choose one who is more integrated into the health system. Also, I want him to go back to using a GCM. His record keeping is a bit erratic. BTW…diabetes is apparently in his family, but they don’t talk about it much (hard to explain)

I don’t want my concerns to be a bone of contention…this has happened before…but I don’t like where this is headed. Thoughts?

Welcome back to the forum, @Lindam1. It certainly looks, from the situation that you report, that your husband’s type 2 diabetes (T2D) is entrenched in his overall health.

I have a few thoughts to offer you, but your husband is in the driver’s seat here. It will help you to understand his health predicament but you are relegated to the sidelines and can only offer support, not initiative.

While I have now lived with T1D for 38 years, I have learned a lot about T2D in the last ten years or so. T1D and T2D are two different diseases but there is much overlap. Be aware that people with T2D never migrate to T1D simply by using insulin.

T2D is marked by insulin resistance and the metabolic syndrome. T2Ds, at least for many years, produce an abundance of native insulin but their body resists its affect.

Whereas, T1D, a condition marked by an essential deficiency of natural insulin and must take external insulin or they will perish.

Type 2 diabetes is a tough condition to treat, especially using the traditional treatment methods of mainstream clinicians. If I were diagnosed with T2D, I would consider using the methods outlined by Virta Health.

They’ve only been around for the last five years or so but have racked up an impressive record of success in treating T2D.

But this brings things back to an essential reality. This is your husband’s disease and he needs to take ownership of it in order to make the changes necessary to turn his glucose metabolism around. Virta’s methods depend heavily on adopting a change in the patient’s way of eating. No one likes to change how they eat, so resistance to this method must be overcome before progress can be made.

You play a difficult role here and I sympathize. If your husband just wants to take a pill and go on with his usual eating habits, he won’t make much progress in defeating T2D. T2D can be placed into remission as long as eating remains disciplined. It takes hard work and perseverance but the rewards can be amazing.

People who are successful using Virta’s methods commonly report restored energy and clarity of thought that surprises them. They often remark that they didn’t realize how much their health had degraded until their glucose metabolism returns closer to normal.

You may want to seek some support with counseling. You can’t make the decisions and commitments for your husband’s health. Good luck!

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Sounds like he has a great support from you, which is awesome. Ultimately the ball is in his court in how he manages the disease. Be there to encourage and support, but it is his responsibility to take ownership.

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Interesting…will check out. Thanks.

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I basically agree with you and Terry that this is my husband’s choice. However, since he doesn’t engage in any meal planning much less cooking (I’ve tried), aside from caring about him, I have a role to play and have to be a part of the solution.

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Didn’t mean to discourage. You’re right about the important role that a loving spouse/partner can play. If you are willing to support his voluntary commitment to change his eating style by eating what he eats, your help can prove crucial to success. This way of eating is healthy and is good for everyone, with diabetes or not.

People who play the role of main supporter are often affectionately called T3Ds by this community.

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Here’s another resource that might help you and your husband.

Please excuse the commercial promotion of the exogenous ketones. This is not a path I would take but I’m thinking that many people would like that easier ramp to ketosis. There are many other products to consider if you need this help.

Type 2 DM here of 31 years, There are a couple of possibilities:

  1. Your husband is not type 2 DM, but latent autoimmune diabetes in adults - LADA. This is a slower acting type 1 DM that is often misdiagnosed as T2DM because of the age of the patient and the slow destruction of the Beta cells.

That doesn’t mean he is not T2DM even though many T2s are overweight at diagnosis. Some are not.

  1. He is Type 2 DM and it has progressed. I have been through all the stages (I think) of T2DM. I had good BG management with diet and exercise for a decade. Then with no changes in diet and exercise, BG began to rise again. At this point I was started on Metformin. Over time to dose was increased to the max. Then long (Lantus) insulin was added. One year ago I started MDI with rapid insulin before meals and for corrections.
    BTW I still exercise daily and am very careful about what I eat.

I have a close friend who was diagnosed as T2DM. Later when the T2DM treatment began to fail, he was diagnosed as LADA after his Endo did a C-Peptide and 4 or 5 antibody tests (I forget how many antibodies can cause T1DM.

He has been on MDI for several years now.

The important thing is that a proper diagnosis needs to be made so that his BG will be better controlled.

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What he may be thinking is going from just pills to insulin injections. Many T2 take both, as the pancreas is overworked due to insulin resistance.

I am T1, diagnosed age 5, but my mom is type 2, diagnosed in her 60s, and average/underweight most of that time. She’s 90 now!! She was on metformin only for many years, now on additional meds, but no injected insulin. At 90, no diabetes related complications.

There are some that just need help with meal time insulin. One option may be Afrezza, a fast acting insulin, that is inhaled. But hasn’t been too popular, as many insurance plans don’t cover.

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Thanks, everyone. I showed him what I sent to the forum and will share replies. Maybe he’ll join. In the meantime he has agreed to see a new endocrinologist and give FreStyle another chance. It’s a start!

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Terry, I looked up reviews of Virta Health and this study. There is a lot of controversy and criticism about this study. Only 267 people were involved in these studies over a period of 2 yrs. That is a very small study and 2 yrs is not enough time to tell whether the diet is hurting people like it hurt me.

I believe that eating 30 carbs a day to reduce weight or to get glucose levels lowered is fine for a short period of time, but for some people this type of carb restriction is harmful.

It was very easy to find strong criticisms of this group and these studies.

We are all individuals and must assess the value of any lifestyle choices we make. For some people, limiting eating carbohydrates to 30 grams per day is one of the healthiest things they have done for their health. I count myself in that group. I have sustained these dietary changes for ten years now.

Of course Virta Health and the many studies they have done are considered controversial in some quarters. The typical T2D treatment regimens of mainstream medicine have been abject failures. They consider T2D as relentless progression of the disease no matter what is done and they continue to layer on drug after drug.

Practitioners who continue to use failed treatment methods will naturally feel uncomfortable when a new method arrives that not only makes people better but also successfully take people off of drugs. Controversy sometimes indicates movement towards better treatment.

I know there is more than one path to the mountaintop. You have chosen your path and I have chosen mine.

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His numbers really might not be that bad for his age. You say he is waking up with a higher BG level and sometimes at night? So I am wondering if it’s mostly his high AM number causing issues?

First we can all vary during the day depending what we eat, so if it is only sometimes during the day maybe he just has to tweak some things he is eating. Learning to take a walk when he eats something that sends his numbers higher. Or maybe not eating as much of certain things.

But second, there is something called DP or dawn phenomenon. It’s a release of hormones before you wake that sends your BG numbers up to get ready for the day. In a “normal” person you make insulin to compensate and use it. It’s common in type 1’s and type 2’s. A type 1 lacks insulin to deal with it, a type 2 makes insulin but doesn’t use it well. The problem also becomes you are more insulin resistant for a few hours after you wake up. So if you wake up higher and then you eat, you go even higher and start the day with higher numbers.

A type 2 approach can vary, some try a small snack before bed, some try to not eat after 6 pm the night before. You have to figure out what works for you. I get DP and I avoid eating in the morning as I overreact to food in the am. I am a type 1 so I also take some insulin. It’s not always that easy to stop.

So it’s possible just a few tweaks can solve most of the issues. My hubby was/is a T2 and he didn’t want to give up foods he was used to, so he learned to take walks or swim when his numbers go up higher, he learned to control how much he eats of certain things and he learned sometimes he can’t eat certain things if his numbers are on the higher side.

I would not easily start insulin at 71 if he doesn’t have to. And a Type 2 never progresses to a Type 1. You can have both, but they are different diseases. A type 1 loses the ability to make insulin because the beta cells are attacked and destroyed. It’s an autoimmune disorder. They can also become insulin resistant. A type 2 makes insulin but doesn’t use it well, so they make more trying to compensate for it. And that’s a metabolic disorder. They can still develop type 1, but at the same risk of any person out there. You inherit a gene that puts you at risk for type 1, and then they believe exposure to certain viruses set it off. For some Type 2’s it helps to add an extra outside source of insulin to try to help.

There is also something to be aware of. There is something called type 1/LADA.When you are older and get type 1, it is a slower progressing, 8 years plus sometimes. 35% of type 1’s are misdiagnosed as a type 2 at first and 50% of type 1’s get type 1 after the age of 30. I was 46. It is a huge problem with being misdiagnosed. One of the reasons it is, is because it’s slow progressing, you make insulin and slowly lose the ability. So life style changes like diet and exercise, weight loss all help things look better for a while until you start to lack enough production of insulin that you start to get worse again. Unwanted weight loss is more common with type 1.

So if things don’t end up making sense he could be a type 1. To tell which, you would need an antibody test. If positive, it’s a sign of being a type 1, although some type 1’s test negative but still don’t make insulin and they don’t know why. Then a C-Peptide test which if low or low normal is a sign of being a type 1 as you lack the ability to make insulin, a high or high normal is a sign of type 2, because you make extra insulin and they just don’t utilize insulin well.

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Terry, I am not trying to discourage you from low carbing, I certainly low carbed for a very long time and I have great admiration for Dr. Bernstein. This way of eating works beautifully for him.

I looked up the study, because I was alarmed by you telling a member that this way of eating is good for everybody. It certainly wasn’t good for me. It was terrible for me and for others. No one way of eating is good for everybody.

I have never been a mainstream thinker, but I have become very circumspect when it comes to health books, websites, speakers, and studies. Especially these days when there is so much less than honest information out there.

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Welcome back. We’re all on this journey together. Unfortunately, there is no one way or right way. You just have to figure out what works for you (or rather him). The more information you have, the better informed your choices are. Hence why so many of us love CGMs. A lot of the medical community thinks they’re a waste on Type 2s, at least for those who don’t fluctuate a whole lot or require insulin… But I can’t imagine a better way to understand what foods affect him and in what way than by using that Libre, at least for a little while. That information is worth every penny! And that’s coming from someone who pays out of pocket for the much more expensive Dexcom system. Knowledge is power! The blood tests that confirm exactly what type he is, like the c-peptide test which measures how much insulin he’s making, is another one of those information factors that will really impact his treatment and hhealth in the long run

You’ll also find there’s a lot of misinformation out there. Which makes me ever so curious where this thought came from:

Did a medical professional say something that led you to believe Type 2s could progress to Type 1? Did you have this idea before his diagnosis? Do you know if other friends/family/associates believe this, too? There’s a common perception that when Type 2s “fail” at treating their diabetes, that they have to move on to insulin. (Not true, by the way! Different people need different treatments, it’s not a matter of failure or progression because of your behavior.) Is it just the misunderstanding that anyone who takes insulin is a Type 1? I wonder if this is a commonly held thought. If so, I didn’t know people were thinking that.

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