Type 1 vs Type 2 Research

A very close friend recently had a high A1c after a few years of controlling his Type 2 with diet and exercise. At a recent follow up endo appt he was told he needed to go back onto Metformin in an attempt to decrease his A1c. He had gained some weight due to being sedentary over the winter due to illnesses and injury. Needless to say, he was devastated with this news. He felt like a failure after having been successful for many years with diet and exercise. He called me very distraught and devastated about his A1c. I tried to console him and gently told him that for the near future we would be on a fact finding exploration to determine what his BG was doing. Like I try to tell myself, I told him there was no emotional value in BG readings. We are scientists collecting information to make treatment tweaks to his meds and diet & exercise.

Why do we always, at first glance, condemn ourselves when we have an out of range BG reading. I'm working hard at it but it still takes my breath away when I get a wacky reading wondering what I did wrong for my BG to be so out of range. My friend was so dejected and disgusted with himself. He wanted to give up right then and there, telling me, "Why should I bother caring?? It won't get me any where!" I promised him I would brush up on my T2D knowledge and together we would navigate these new waters. I told him we were in this together & I would do all I could to help him learn to care for his T2D. So, I have been immersed in T2D research and have learned a great deal about the differences between T1D & T2D.

I admit I wasn't as well versed about T2D as I was T1D but I have done a great deal of reading & learning how to manage this type of D. First off, I asked him if he could commit to testing, for starters, twice a day-a fasting upon awakening and a BG check before bed. He has done an excellent job in taking on these new tasks. I was a little shocked to hear his endo tell him that testing wasn't that important & to test "whenever". I told him we needed to see what his baseline NG's were doing & if the metformin was working or did it need to be tweaked. He has taken these new tasks on , as well as, checking before lunch and postprandially to evaluate his baseline BG's. Doing so brought some interesting info to light that we wouldn't have been aware of without him testing as he had. He has a very reactive response to any carbs, so he's working on cutting portion sizes and making better carb choices. He is going to make an apt to see the Registered Dietician at his doctor's office soon to help with this.

My friend pointed out that I actually have it easier in dealing with my meals because I can bolus for any amount of carbs I ingest where he doesn't treat for carbs or correct for a high BG at this time. I agreed with him but I told him to hang in there. We are still in the beginning of his treatment of this beast and needed to continue to collect as much data to further evaluate his BG response to the Metformin and the new exercise plan he has embarked on. This weeks new task is to log the time and BG reading he gets so he can show his endo when he sees him next. This has been a little challenging as we all can relate to how much we hate to keep a log. We're looking at a few different iPhone apps to help with this, as well as, trying to get a meter that would automatically sinc his BG reading with his iPhone. We're looking at the Verio Sinc, specifically. It would be great if his insurance covers the strips for the Verio., then he could email his BG results to his doc for any appts he has. Any one have any suggestions as to a meter which would help in his quest to have his BG's automatically download, taking the hassle out of logging?? Also, are we correct in that the Verio sincs with the iPhone?? He has an iPhone so we've been searching and trying out new diabetes apps regularly.

It seems the Metformin is starting to kick in as his BG's have come down a bit, especially fasting. It's been very informative in researching T2D to help my friend. I also have another support person in him to help me with my day to day management of my T1D. I'll keep updating the blog with what I've learned through this new chapter in my and my friend's life as I try to support my good friend.

Remember, check! Don't guess!!

(Now, My friend understands why I say this phrase.)

I am really proud of you for reaching out. I think we those of us with T2 don't always appreciate how it is to have T1 and vice versa. It truly can be very frustrating to have T2, be told to eat a high carb diet, don't test and still have poor blood sugar control. And then if you do test after meals and find you are way high you feel powerless to do anything about it without insulin. You are to be commended for reaching out and helping.

If the metformin is working, that's great for him! Diabetes can be a disease of "problems" or "wrong numbers" but it also offers the opportunity for many victories if you know where to get them. It bothers me that people with T2 get the impression from doctors, or maybe it's just on their own, that medication or insulin are "failures". Diabetes is an evil opponent and, at least from what I've read, T2, seems to be sort of ongoing and degenerative. What worked once, say diet and exercise, may not always work. I'm dreading having challenges with exercise but I'm not getting any younger and, sooner or later, I'm probably not going to be able to do what I do now. As a T1, I agree it may be easier to change but it should not be looked at as hard for a T2 to start Metformin or Insulin or whatever other means might be necessary to get their BG back to normal or as close to it as they can get. To me, it seems totally reasonable that T2 should get insulin to use for parties or celebration or when Jupiter is in line with Mars and it makes their BG go up for a bit. That doesn't seem likely to happen any time soon.

Brian turned me on to Ralph DiFronzo and his article really helped enlighten me as to the insidious nature of T2: "From The Triumvirate to the Ominous Octet" It's sort of heavy and scientific but it lays out some great evidence that might suggest to your friend that he's right where he needs to be and may suggest a few other interesting options for him. Gila Monsters!

Every PWD needs a friend like you no matter what the D type.

One big difference between T1 and T2 is the way it progresses. T1 is pretty much full blown from the beginning but T2 progresses slowly over a lifetime. Because of the progressive nature of T2 you can do everything right but still it progresses. Your friend does not need to beat himself up over this. What is good is he sees the problem and is not denying it.

Bless you for helping him because I know from experience how easy it is to just give up. A friend to help him stay focused is just what he needs.

I hope your friend finds assurance that going on meds is not a failure. I'm Type 2 who is physically active, of regular weight and who was on moderate carb (now experimenting with low carb (50 grams daily)) and I still have to take metformin. Everyone's body is different, and some of us for various reasons (not always our fault) develop more resistance or other issues that make medication or insulin (or both) necessary to control our BGs. I hope your friend is no longer feeling guilty but is getting more positive, especially with your support. I also hope he gets a better control of his BGs.

Wow! You are a friend in deed, and a friend indeed!

Just to reiterate what you and others have said, I have the old cliche, "The only constant we have in our lives is change." So it is with diabetes of any type.

It sounds like he has made great strides, and your post is a lesson for us all to take charge of our care, test often and get our doctors to play on OUR team, not the other way around.

When our T(x)D starts acting wonky after a long period of relative stasis, it can be like learning to ride a bike again. You're wobbly when you start, you inexplicably lose control and crash (with varied levels of intensity), you can't imagine riding 10, 15, 20 minutes without losing your balance, or 10, 15, 20 miles (yeah, right!) You start saying, "What's the point?!? I will just crash again!" Then, all of a sudden, you get your balance, you learn how to correct when you get a bit wobbly and you can ride with no hands!! Joy is likely to follow ...

Blessings, Sandy. This is a recurring and very important thread in all discussions on all DOC websites. You are a wonderful friend.....

I'm T2, not on meds yet, but knowing I will have to be at some point. I have always believed we sink or swim together---the T1/T2 divisions are false barriers to me if we are serious about making changes......

Blessings, my sweet....you are doing good in the world!.....Judith in Portland..

You are a true friend. Everyone should have a true friend like you! Regarding testing, I actually have a mantra, "test, test, test!" Gotta test.