One has to remember that metformin works on the liver. Let’s say that over production of glucose is not the “cause” of hyperglycemia and it is actually mediated at the pancreas. Then that approach wouldn’t be effective.
Like type 1, type 2 diabetes has many etiological factors at it roots. One think we know about both though is physical activity and watching one’s diets is an effective approach, along with pharmaceutical management, of successfully managing one’s blood glucose.
I don’t believe that if you have pre-diabetes you are doomed to progress. And you can do something to change (and minimize) that progression. But I feel it is harmful to suggest that pre-diabetes and diabetes can be reverse or prevented, the studies just don’t provide evidence of that. And telling everyone that their diabetes is “caused” by lifestyle is hugely harmful. Can you imagine the blame someone feels when they progress to diabetes after “failing” to change their lifestyle.
Yes, I can imagine it because I see it every day online when Type 2 is discussed and some jerk pops in with, “No excuse for Type 2 - it’s a lifestyle disease! Step away from the Doritos! Get off the couch!” I want to throat punch those people!! 3:)
Even when you have “full-blown” Type 2 diabetes, you’re not necessarily “doomed to progress.” Even though Type 2 diabetes is a progressive disease, I know many people who have “treated” their T2D with the “pop a pill and forget it” approach who have never seen any sign of progression - their numbers and other aspects of their health appear stables, except for pretty standard effects of aging. I think the same genetic components that cause T2D also control the progression or lack thereof over time.
My mother is one such example. She took metformin and at first, she tried monitoring BG and getting some exercise, though the quality of that was mostly in the “better than nothing at all” range. Then she tripped on a broken pavement and fractured her pelvis - permanently altering her routine. Since then much of her care and meal planning has fallen on my dad who has no understanding of nutrition, diet, or diabetes. I’ve taken her to the doctor several times and expected her diabetes to be completely out of control, yet her A1c has remained in the “mid-6’s” and, as a result of other issues, her doctor has taken her off all T2D medications. (Note: If I ate the diet she does, I would be both out of control and doubling my TDD!)
None of this means that we should NOT concentrate on good lifestyle choices. Regardless of T2D progression, lifestyle affects health on so many levels and good choices will likely help maintain a good, healthy, and productive life. Managing diabetes, like managing cardiovascular health and pulmonary health and so many other biological systems, is a lifelong requirement for a long, healthy life for everyone.
The blame is something that we can and should take steps as a society to address. It doesn’t help, and ironically it’s the same society that created a situation where a tremendous number of people are developing diabetes then turns around and blames the individual for it.
I will not accept though that the next generation is genetically doomed, and the next even more so, to have an ever increasing prevalence of diabetes. I believe there are steps we can take that would have positive effects in terms of how many people, whether genetically predisposed or not, will develop type 2 diabetes (and type 1 and many other diseases for that matter). Among those steps I think that eating healthier foods… Including a major reevaluation by society as a whole about what actually constitutes ‘healthy food’ and encouraging more physical activity would be high priorities.
Because someone is genetically predisposed to a condition does not mean that they can’t take steps to improve their odds. Alcoholism is a fantastic example. You can genetically be predisposed to alcoholism but you can take steps to absolutely ensure you are never stricken by the disease…
We are currently living in a world that evolution has not prepared our bodies for. There is nothing in our history that prepared human beings to sit at computers for 12 hours / day at work, to eat grains ground to a pulp then reconstituted, to eat the majority of our calories from highly refined carbohydrates, etc.
I believe that many diseases are preventable, including the majority of diabetes-- but it will take more than one person making good choices, it will take an entire cultural shift of direction to have a meaningful effect. Part of that cultural shift is to stop blaming, start understanding that we are all part of the culture that has gotten us here, and coming together to make changes.
Maybe the problem with the DPP and type 2, is that the blood sugar targets (hba1c 7, I assume), were set too high? If blood sugars are maintained at such a high level then there is ongoing beta cell damage (and other systemic damage) happening, which would necessarily make the diabetes progressive.
I wonder what would have happened (or if they could look at the outlier data specifically) to see if lower blood sugar targets (which are met / sustained) have implications for progression.
I say this because I was just studying an insulin drug information sheet, and all of their test subjects had hba1c around or slightly above 7. IF 7 is the objective… then it may just obscure all other possible outcomes and prevent real factor being found.
Thank you Judith!
I am happy to be part of this group! Although I do not have type 2 diabetes. I enjoy what I do professionally. I enjoy educating people about the importance of engaging in regular physical activity and healthy eating to prevent illness across the board. I believe that exercise is medicine.
http://www.exerciseismedicine.org
And more needs to be done to get communities moving. At the policy level, changes need to be made so that people a risk for a variety of illness can reduce their risk of developing all types of diseases–not only diabetes.
In fact, I was wondering the affect the situation with the lead contaminated water has on the prevalence of type 2 diabetes in Michigan. Drinking water and bathing are central to one’s lifestyle and in that situations there was nothing that the residents of Detroit/Flint could’ve done to change their lifestyle.
Diabetes, whether type1 or 2 is a multi-faceted complicated condition and much needs to be done from a all levels of society and on an individual basis to reduce the prevalence of this scourge.
Thank you so much for your kind words and I look forward to getting to know you as well.
Best!
Jo
So in my continued desire to EAT my RS as a food vs. simply chugging it in water, I have mixed up a new recipe that I wanted your feedback on. It’s in the freezer now and I plan to eat some for dessert at lunch and see if it affects my blood sugar in a delayed fashion like higher fat versions have in the past. I do plan to eat it with a bit of chocolate, so it’s still going to have some fat, but definitely less than using real peanut butter. This is a HUGE batch - made almost 3.5 pounds of ‘dough’, so keep that in mind when looking at the huge amounts in the ingredients:
1 16-oz container of pasteurized egg whites
3 cups PB powder
2.5 cups potato starch
1.5 cups erythritol
4 tsp vanilla
2 TB water
Nutritional content per 2-oz serving (makes 28 servings):
65 calories, 1.7g fat, 5.5g carbs, 6g protein, 11.4g RS
The taste is pretty good - not as delicious as the real peanut butter one I made before. I plan to eat it in a frozen chunk of ‘cookie dough’ along with some Lily’s chocolate (sugar free).
** in the nutrition I excluded the portion of the ‘calories’ from the potato starch that was the “RS” portion - so I excluded 80% of the calories and counted only 8 calories per TB, not 40)