Type 2 Diabetes TOO is Serious

In light of the BIG news from Tom Hanks having type 2 diabetes, I wanted to expose this slide from a deck presented by an endocrinologist that presented in a corporate symposium during this year's AADE conference in Philadelphia.

I think this chart reveals something VERY important that we tend to ignore, which makes type 2 diabetes VERY serious too: beta cell function deteriorates progressively among people with type 2, STARTING at the point of diagnosis. This to me challenges a VERY important notion: having someone with type 2 diabetes start on insulin is NOT a sign of failure! Indeed, the doctor that introduced this slide mentioned he ALWAYS shows this chart to his newly diagnosed type 2 patients, because he knows over time they will become insulin-dependent, and he doesn't want them to feel like they have failed when they do.

Additionally, when someone starts taking insulin shots, the potential for hypoglycemic episodes increases, which makes the short term management of the disease very serious.

What has your experience been like managing type 2 diabetes?

It's been a rollercoaster ride this last year, Manny. Thanks for posting this, because I want to share this out on Facebook so my friends can see this as well. :) Great visual.

This certainly would have prepared me better for when I was told I would have to start insulin. I DID believe it was my fault for the not taking my diabetes more seriously the first several years after diagnosis. My Dr basically said exercise more, cut back on the sweets, eat more veggies and grains, and take these pills. I did what I thought he said and still ended up on insulin. So I must not have done it right.

I was late onset T1 and was treated like a T2 for a few years. While T1 is serious, it is also much more straightforward. Our body is lacking insulin, so we take insulin to manage our BG. Also, exercise and food are part of the equation. However, a bad case of T2 diabetes is pretty damn rough because the core issue is that the body's cells are not functioning properly in response to insulin. Once the damage is done simply losing weight and exercising isn't going to fix it, and then they're stuck taking 2-3 meds plus insulin.

I was already on basal/bolus insulin when I got my T1 diagnosis, and it was a huge relief.

Does this chart assume that patients are controlling their BG within certain guidelines? Does the slope increase/decrease with degree of BG control? Is there a point on the slope where most have to resort to insulin (I'm not really versed on the phases of T2)?

T1 isn't straight forward at all, we have dual issues with the liver, islet, alpha, beta cells destruction. We also produce ketones and go DKA. Every minute of the day our BG's are changing. T2's become resistant to their own insulin, typically make enough of it, high levels of Cpeptide, but they become resistant to it usually due to weight, especially in the mid-section. Tom Hanks HAS weight issues. A type 1 doesn't have the option of a simple diet and exercise routine to get off insulin, that's never gonna happen. If type 2's change their lifestyle they CAN go off meds and do this simply with diet and exercise. I don't believe T2's are insulin dependent as many haven't tried (or can't) to lose the weight and solve their lifestyle issues. Many T1's don't have weight issues. Most Type 2's have metabolic syndrome, which includes high blood pressure, cholesterol, etc...all which can be managed and controlled if their lifesytle changes, i.e., lose weight, exercise, eat better, etc...these are just facts, not judgments. If I had a choice, oh i wish I had a choice, to diet and exercise (although I have no weight to lose and already do exercise) and be able to manage if I did have type 2 diabetes with that...I'd be thrilled.

I don't have Type 2, and I agree with what you say - but I do have a question. If beta cells are destroyed in Type 2, then how is it that I have known several people who went on insulin years after their diagnosis, were "insulin dependent" for many years, and then for various circumstances (lost weight, tried new medication, etc.) they were able to get off insulin. What is causing the beta cell deterioration? Are they being destroyed, or just not working? If the beta cells have stopped working completely, how is it that some Type 2s are able to get off insulin after using it for years?

i don't believe beta cells are destroyed in type 2's. i also don't believe type 2's are insulin dependent. As you said, Jen....eventually, if they can change their lifestyle issues (easier said then done I'm well aware) they CAN get off meds, especially insulin, or cut way way back. We, as type 1's, typically end up increasing our insulin needs as the autoimmune attack progresses. They're two different things; one a metabolic syndrome the other an autoimmune disease and I get a bit burned out by people insisting they're the same or even close, they are not. Every endo I've seen has said to me, "You as a type 1 diabetic has nothing in common with a type 2 diabetic, there's no comparison what so ever." I'd take type 2 diabetes over type 1 in a heart beat...absolutely! That's not to say type 2 is easy or that it's not serious, of course it's serious, anything that can cause blindness, nerve damage, heart, kidney problems is serious but a type 1 without insulin....that's deadly and can happen very quickly, too.

So, inspite of being slim (6 ' and 165 lbs), eating about 70 carbs a day, exercise 1 hr/day 6 days a week, it's still my fault I'm type 2 and take meds/insulin? If so, I wish someone would point me in the right direction so I can heal myself and live a normal life.

i have no idea, who said it was your fault...maybe you're wrongly diagnosed. the majority of type 2's have weight issues, why do people always get so defensive about this, it's the truth. many type 1's become overweight, develop High BP, cholesterol too, however this can happen just with age and isn't part of their initial diagnosis.

"If type 2's change their lifestyle they CAN go off meds and do this simply with diet and exercise. I don't believe T2's are insulin dependent as many haven't tried (or can't) to lose the weight and solve their lifestyle issues."

Sarah, that is a really loaded comment and has no viable research to back it up. i am a type one but many people in my family are type 2. some are overweight, some arent. my aunt exercises like a demon, stays clear of carbs, eats clean. it doesnt matter what she does, shes got t2 and shell have it forever. same for her two brothers, my uncles. both take care of themselves and it DOESNT MATTER.

a choice between type 1 and type 2? is one really better than the other? i dont know. as a type 1, at least i found out immediately and the damage done to my internal organs pre-diagnosis maybe wasnt that bad. as a type 2, you might have years and years of damage before anything is noticed. i wouldnt want that. i also wouldnt want the doctor/insurance company/medicare to limit me to one or two test strips a day/week/whatever crazy limit they will put on t2s that arent on insulin. as a t2 taking care of myself, id want to make sure the food i was eating wasnt sending my bg to the moon, that the exercise i was doing was enough, etc. and to do that i would need test strips. finally, i wouldnt want the social stigma, the blame that everyone seems to throw at you as a t2.
who is saying its a t2s fault? it seems that you are:
"I don't believe T2's are insulin dependent as many haven't tried (or can't) to lose the weight and solve their lifestyle issues"

dont listen to that crap dg, you know the truth.

Thanks Pancreas!

I didn't mean to play a role in derailing this thread. Was just hoping to learn more.

Sarah Sarah Sarah....it's not about weight...nor lifestyle. It's beyond that for Type 2.
Type 2 is ALSO multifaceted, and affects your body as a whole.
Just because Tom Hanks has Type 2 and has weight issue does not mean that he wasn't wired for it in the first place, nor does it mean that all type 2 have weight issues/weight in the middle. You're lumping us all in one pot....and Type 2s also is FAR from straight forward. Some of us have no lifestyle to change...no weight to lose. THIS is facts. I too don't have a choice....and I too would be thrilled if I could "simply" manage it with "just" diet and exercise. You make it sound so easy.

Thanks for saying this. :) and this T2 here is limited to 1 test strip per day. That's all I'm allowed on BCBS. Thankfully, Roche's strip card is 15$ per 100, so I get them when I want too out of pocket and test more than the 1 allowed per day. It's also hereditary in my family. My super skinny and fit sisters have it (3 of them), I do and my brother is pre-diabetic. I'm not the skinniest guy, but it hast nothing to do with my weight. My sisters will tell you that.

Sarah, the first sentence of this scholarly article titled "Mechanisms of β-Cell Death in Type 2 Diabetes"

A decrease in the number of functional insulin-producing β-cells contributes to the pathophysiology of type 2 diabetes

contradicts your statement that

i don't believe beta cells are destroyed in type 2's

The article does say that β-Cell Death is not the only mechanism contributing to an insulin insufficiency. It also points out a myriad of factors are involved in the development of T2 and that not every T2 has all of them.

I have to agree with the folks suggesting T2 is very serious. Parts of your body are out of balance and have to be fixed. While I agree with Sarah and Halle Berry that some people with T2 are able to benefit greatly from lifestyle and exercise focus or improvement, I would say that all humans, and many animals also benefit from lifestyle and exercise improvements.

The DeFronzo Article "From The Triumvirate to the Ominous Octet" is a fascinating exploration of the different metabolic disorders all found in varying degrees in patients generally diagnosed with T2. Each case is different and, at least based on that particular source, likely more complicated from a "modeling" perspective than T1. T1 can be very linear.

I think the big problem with T1, which is shared with T2, is that doctors and the medical history are too tolerant of elevated BG which I suspect may make things more difficult to control than a smaller, more normalized target area. 140-180 isn't a target, it's the side of a barn, easy to hit but doesn't allow you to refine your technique. T2 you are trying to "adjust" 8 separate factors, many of which aren't tested for or measured, but all of which will elevate your BG. In addtion to the common human factors (stress, illness, trauma) that all of us share. I don't see any reason not to spread this stuff around even if I have to issue the disclaimer that I have "easy" diabetes.

My dear Sarah. Forgive me, but you have no idea how hard it is to maintain tight control as a T2. It requires a rigid routine and constant vigilance. You can't take a day off from your regimen anymore than you could take a day off from insulin.

Many of us T2s were far from obese at dx. I sometimes wish I was insulin-dependent so I could bolus for the occasional piece of cake or baked potato or brown rice or banana or pasta salad. But I can't cover the spikes those items and many others would give me. So I don't eat them. Ever.

I have learned to bake with nut flours and stevia, so I have a few treats available. And as to exercise, I was a professional dancer for many years who now suffers from fibromyalgia and arthritis. In spite of all that pain, I get moving for 90"/day 7 days a week.

I have very good control, but the cost is a great deal of physical and emotional pain....Blessings on ALL who struggle with this scourge.....

Thanks AR for mentioning DeFronzo. In his article you mention, he states:

By the time that the diagnosis of diabetes is made, the patient has lost over 80% of his/her β-cell function, and it is essential that the physician intervene aggressively with therapies known to correct known pathophysiological disturbances in β-cell function.

I really appreciate Manny posting this latest perspective on this. My last c-peptide was 0.4 ng/dl, I appear to be markedly insulin deficient. I wish I could just lose some weight and take some pill and make it all better, but that is just not going to happen. Type 2 diabetes is very complicated. In the end, I've accepted moving to insulin therapy. It's ok. I'll just do what I have to do to manage my diabetes.

My question wasn't in regards to ALL Type 2s, just some that I have known over the years. I certainly don't think that Type 2 is only lifestyle related or that any Type 2 who wanted to could get off medication. Type 2s MUST have some degree of beta cell deterioration, otherwise they wouldn't have diabetes. Sure, insulin resistance plays a role, but there are lots of overweight people who are insulin resistant who don't have diabetes. And there are lots of Type 2s who are not overweight, too. My question was more about whether the beta cells are actually destroyed or whether they are just in some sort of state where they're not producing insulin but are still present and (if all were going well) functional.

I used to think Type 1 and Type 2 were much more different than I do now. I still think they are different in some ways, but over the years of hanging out on TuD I've come to realize that there are also many similarities. Some Type 2s are truly insulin dependent (like a Type 1—would go into DKA if they stopped insulin) and some Type 1s are extremely insulin resistant (like a Type 2, and may even use Type 2 medications).