I think some of the misunderstanding that has occurred lately is because many people don’t know about the natural progression of Type 2. While not everyone with Type 2 experiences progression, a large number do, and that’s what I want to talk about.
In the beginning, people develop pre-diabetes, where their numbers are above normal, but below the cut-off for diagnosis. This is the time that diet and exercise really seem to work wonders in getting BGs back down to the normal range, and this is the time when intervention by health professionals would be most useful, although many insurance companies don’t see it that way.
Then there is diagnosis. By that time, the person has already lost 50% to 80% of their beta cells. While it is still wise (as always, and for everyone) to concentrate on improving diet and doing exercise, many people are started on Metformin at this time because diet and exercise are often not enough. At the time of diagnosis, many Type 2’s have unknowingly had diabetes for years, and a significant number present with complications already present.
As Type 2 progresses, and more and more beta cell function is lost, most doctors try adding other oral medications. These medications do various things, such as limiting liver gluconeogenesis, sensitizing muscle tissue to take up more glucose, slowing digestion, etc. The biggest problem with them is that most have side effects, such as gastrointestinal upset, and weight gain, which is disastrous for a
Type 2! In addition, there is some evidence that some of them cause an increased risk of heart disease, for which Type 2’s are already at great risk. Some drugs that were blockbusters have been pulled from the market, such as Rezulin and Avandia. Some of these drugs also cause hypoglycemia.
Finally, the oral meds stop working very well, and many Type 2’s go on insulin. Most of them are very scared of insulin, because they think it’s a punishment for not “succeeding” with the oral meds, but also because they have heard that insulin is a sure-fire way to weight gain. They sometimes have to take massive doses of insulin (in the 100’s of units), and the insulin-resistance does contribute to weight gain, so it’s often a no-win situation.
There is evidence that the insulin-resistance causes the weight gain rather than the other way around. But society places the blame on Type 2’s because they believe that obesity is caused by poor eating habits and lack of exercise, which may sometimes be true, but just as often is not. Type 2’s can be hungry all the time, and even if they eat “healthy” food, it still can result in weight gain.
There is so little known about obesity, metabolic syndrome and Type 2 diabetes, that what the media presents is often over-simplified, inaccurate and not relevant, especially to those with long-term
Type 2. Type 2 is an unforgiving disease, and while optimally, it should be prevented, those who have it are struggling against a lot of uncontrollable factors.
If it can be prevented… which I find very debatable. I don’t think many of us could’ve prevented anything… Otherwise, you are very right…
Thank you/ That has me a little more updaieded on Type 2.
That’s a nice article! I want to punch people who talk about T2 as if it were the people’s ‘fault’ (Drew Carey, Halle Berry, etc…) and the stuff I’ve seen makes me think that it is the medical industry scaring people away from insulin that would help a lot of them if they were afforded the opportunity to try it earlier in their timeline? Shots are no big deal but in my occasional perusals of T2 boards, I don’t get the impression that the litany of pills works all that well? Sure, insulin sucks but it comes in handy if your BG is not exactly where you want it to be?
I wonder too if pharmaceutical companies couldn’t perhaps manufacture stronger varieties of insulin to cope with insulin resistance? Dr. Bernstein’s book [ed. I am not a devotee but I respect him…] cites a study about how inconsistent large injections > 7U can be and I know that a lot of people take more than that?
I like your summary.
IF is a big if. I agree it is best prevented IF this is possible. I think insulin treatment should be started much earlier than at present. The Canadian treatment protocol required a dead pancreas before initiating insulin. This often makes the disease a nightmare instead of a manageable problem. I read on another web site than some type 2 can stabilize their disease with initial insulin and maintain a good range of BG with a minimal amount of external insulin hence low weight gain.
I think it can be preventable. We will see at the end of my son’s life if I was right or wrong. I wonder if he carries the gene. So far my mother and i have type 2. My other sieblings who never became overweight like myself dont have any signs of diabetes. So I think it can be preventable because they have lived lives with less stress and within normal weight. We are all one year apart so I think the age factor would have been in place by now.
I say if I really thought that type 2 was not preventable I would be feeding my kid ding dongs and cup cakes bathed in chocalate syryp with plenty of soda because if a person is damned if they do and damned if they dont then he might as well enjoy the best that junk food has to offer because to tell you the truth that stuff really tastes good and the kids loved it and I did too when I was obesse. I might as well say that his 70 to 80 bg is diabetes since I am a type 2 father and my mother had type 2.
We cant say that many of us would of prevented anything because I am the first to admin that I lived a very unhealthy lifestyle and became obesse. I have to compare myself to my family members with similar genetic mapping. Hind sight is 20/20 so we did not prevent it for ourselves and cant answer the question for ourselves either.
We will know if that was the case if a test can be done to verify if a person carries the genetic predesposition for type 2. Can we say that lung cancer is not preventable when people dont smoke? Can we say stroke or heart attacks can not be preventable with a good diet and excercise. What we can say is that the question cannot be answered at the time with data at hand.
I think the thought of prevent is not for us but for our children. As long as I have a kid and I make sure he eats right and excercises and does not become obesse. I think I am preventing the onset of diabetes for him if he has the gene. I am a glass is half full type of person who has hope that it is preventable with proper diet and excercise and the trigger never happens with these type of people.
I also wonder about insulin and weight gain. If I am a type 2 and become an excercise nut will I burn enough calories to drop weight. Mind you I am a bike freak and if I could stay on a bike for hours that is my love and passion I would, so I am not doing it because I am afraid of diabetes but because i love to ride.
Obessity got on my way of biking so I had to get it out of the way. Type 2 diabetes is on my way so I have to work to minimize the effects on biking.
The answers to why we got diabetes may not be answered in our life times with the information at hand but it should would be a great answer to hear. Not for us but for future generations.
it is the chicken and the egg question.
Nice summary, Natalie!
Some of the more interesting medication developments in type 2 diabetes treatment have concentrated on other hormones (beyond insulin) that are involved in the control of blood sugar. Some newer blood glucose-lowering injectables, including Byetta and Victoza, target the lack of gut hormone amylin (deficient in both type 1 and type 2). Because they increase sense of satiety (fullness) after eating, they may help with weight loss. It’s encouraging to see developments in medications that target blood glucose without making it more challenging to lose weight. Now, if we could only improve affordability and access!