excellent thoughts and ideas. I agree!
God bless you Mikki. Keep up the good fight. I'm sure you'll win!!!
Glad to hear it, Kelvin. We use the tools that work best for the job. Good for you for reading about insulin to reduce concerns if it is needed at some point down the road!
I am a retired truck driver. Although I was a flatbed driver and got a lot more exercise than the van drivers, weight was still a problem. My brother is slim and has a job that is very physical, but is diagnosed as pre-diabetic. One of the reasons I retired is that oral meds, diet and exercise were not controling my diabetes and I went on insulin. As a CDL license holder, I cannot drive a comercial vehicle while on insulin without a waiver. after I get all the paperwork filled out and turned in, the Federal Motor Carrier Association (FMCSA) has, and takes, 180 days to approve the waver. Then I have to see my Endo and Eye doctor every three mounths to have paperwork filled with FMCSA. The Endo has to certify that while driving my BG has not been lower than 100 and not higher than 400. How many Doctors are going to go through three months of driver logs and compare them with BG logs? Now that I am on insulin, I have lost 30 pounds and feel better. Something is going on now that has increased my insulin resistance and stopped weight loss. Going on the pump has helped with my control. Before insulin, I was loosing feeling in my feet. That has now returned. FYI as of 2011 if you are type 2 and already on a pump BEFORE going on Medicare, Medicare covers the pump and supplies just like type 1.
I'm LADA and lived as a T2 for a while. As others have mentioned one of the big PIAs of being T2 is the crappy access to the tools we need to manage our D. There's a lot of blame by doctors directed at T2s (both with the disease and with management), and most doctors are happy with an A1C of around 6.5, so if you do everything right and work your tail off, they're generally not going to give you the meds you need because your A1C is low enough. Additionally, you aren't going to get the tools (higher number of strips, CGMS, insulin pump) because many are reserved for T1s.
The worst thing for me about D is being powerless, is being under the control of a doctor prescribing meds that we need, and T2s get a lot more of that. Heck, I recently tried seeing if I could buy a vial of saline to dilute my Apidra with (I called the company about what to use), and was told that I need a prescription for salt water.
I'd recommend watching: http://www.tedmed.com/talks/show?id=18029
Link to the youtube video – What if obesity has nothing to do with eating too much? Peter Attia, MD, President and co-Founder of the Nutrition Science Initiative, says we don’t know enough about the science of weight gain, and that clinicians – and society – should stop blaming the victims. It is 16 minutes but well worth viewing.
One also has to consider that insulin is not the only factor that impacts how energy gets into cells. Right now I am reading Dr. Dean's book, The Magnesium Miracle and she believes a magnesium deficiency is at the root of several disorders, including diabetes. A quote from her book: "Magnesium is required in the metabolic pathways that allow insulin to usher glucose into cells, where glucose particpates in making energy for the body. If magnesium is deficient, the doorway into the cells does not open to glucose, resulting in the following cascade of events: 1. Glucose levels become elevated. 2. Glucose is stored as fat and leads to obesity. 3. Elevated glucose leads to diabetes. 4. Obesity puts a strain on the heart. 5. Excess glucose becomes attached to certain proteins (glycated), leading to kidney damage, neuropathy, blindness and other diabetic complications. 6. Insulin-resistent cells don't allow magnesium into the cells. 7. Further magnesium deficiency leads to hypertension. 8. Magnesium deficiency leads to cholesterol buildup, and both these conditions are implicated in heart disease."
I found her book to be interesting and well worth the read even though I sense that the occurrence of T2 has got to be much more involved than a mineral or vitamin deficiency. I am open to learning all that I can about both T1 and T2, especially where these conditions overlap by way of complications, and differ by way of therapy.
This from a Mom of a 20 year old T1 (diagnosed in 2003) with a family history of no other T1's or T2's whatsoever.
"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."
Sorry, but that's misinformation and a bit offensive.
hmm... I was not really overweight when diagnosed. Thought I was healthy, drank lot's of juices, etc. 6 ft, less than 190 lbs. No, I didn't run 5 miles a day...but I was not a lifestyle disaster. I was misinformed about carbs.
In any case, I've been type 2 for 10+ years and have worked hard to keep in "range" with BGs. Watch what I eat, etc. Went through a range of oral meds, all of which progressively failed, including Byetta, Avandia (boo), etc. Insulin is all that works for me now...combined with a good, carb-aware diet, exercise and constant work.
And...all of these positive lifestyle choices have not "reversed" my need for insulin one bit or "healed" me. My pancreas has checked out and that's that. And as far as T2s not being insulin dependent...hmm...if I don't have insulin, my levels go up. High. And I get sick. Haven't found the magic herbal fix yet I'm afraid ;-)
I'm not a type...I have diabetes.
Well said, Barko...
Thanks for saying this! I am so tired of being type cast as a T2 diabetic. Sometimes people need to stop and think before they say things. There are a lot of things that really make it difficult to exercise and change lifestyles and to infer that is all that is needed to "fix" us is really demeaning.
I expected to see something like what's on that graph, but it was still disturbing to see the results.
Also, I agree with what's been said before. As a PWD on Metformin, I avoid carbs like the plague...when I can. I can't take insulin when I'm high after dinner and falling asleep while reading a textbook (only made worse by the high). Last night I went for a run after dark because I was trying to avoid the post-dinner high like I'd been having all week.
And the Metformin has...lovely...side effects. Which have disturbed my sleep and my LIFE so much lately that I had to cut back to 2 pills a day, which doesn't work as well as 3 (not that 3 is perfect, anyway).
The other pills also have side effects. And some of them (Avandia, Januvia) are really, really scary. And what about Beta cell burnout from Sulfonylureas? Is that a better solution?
Having lived for years with multiple lows per week (many of which I never felt--even below 60), I think it's safe for me to say that I prefer carb-counting and the risk of lows to dealing with feeling sick all the time. If I were able to get off meds with "diet and exercise", I would. I tried that BEFORE I was put on meds, actually.
(And FYI, I'm not obese or even close to it. I just barely qualify as overweight. And I didn't have bad eating habits before my dx and I certainly don't now.)
I agree with all the comments and frustration that diet and exercise can fix anything. That can be simply foolish wishful thinking. As the body ages, and starts to decline, there are multiple organs that may need medical boost/assistance to make the diet and exercise work. For me; I saw my liver overpower my 1200 calorie diet and exercise and kept pounding on weight. Once the issues like that were corrected, the weight dropped and the same 1200 calorie diet and 1.5 miles walking worked fine but that was a full package of meds, diet and exercise. The meds ended up with metformin, humalog lispro , leavothyroxin.
The concept that diet and exercise can do anything is simply whistling pass the graveyard looking for the simple one thing answers all on a multi-organ, multi hormone body that requires complex tuning to resolve the problem.
On my body , the partnership of medicines, diet control and exercise were all needed to stop the rot. I do not say cured incidentally so as not to inflame other passions and views here. Meds alone - no luck. two out of 3 - not a chance; all three - final back in control after 26 years a mess.
"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."
Everyone, including T1's, benefits from exercise and a healthier lifestyle. This is no different for T2's. Changes that make BG metabolism easier for the body work for everyone, including non-diabetics.
As was noted in this thread, research in the last decade has (somewhat surprisingly) found that some "normal" people have insulin resistance, indicated by hyperinsulinemia, while maintaining absolutely normal BG. And never develop diabetes.
Diabetes is not immune system destruction of beta cells. It is not insulin resistance. Diabetes mellitus is impairment of glucose metabolism.
Anyone with diabetes has the same disease as any other diabetic. The health risks, and treatment approach, is virtually the same for all diabetics. What differs between T1, T2 MODY, Gestational, and other "types" is the underlying cause; however, the disease itself -- impaired glucose metabolism -- is the same.
Diabetes mellitus is a disease of impaired glucose metabolism.
The fact that T2 diabetics can take pressure off their glucose metabolic system by lifestyle and exercise changes doesn't mean this is the cause. T1's benefit from this too, in terms of BG control, yet we don't attribute poor behavior with regard to these things as a cause in T1's, when, in fact, it very well may be too.
15 year T2 here.
Sorry to hear about your struggle to lose weight. 'Been there!
The one set of laws that can not be violated are laws from physics. The law of conservation of mass, and conservation of energy aren't suspended when it comes to human metabolism Everyone, period, will lose weight if they burn more calories than they consume. It really is that simple.
Where it's not simple is putting that in to practice. One has to really get on the program of carefully tracking everything they eat, totaling calories, and comparing to a daily budget. Must weigh oneself 1-2 times a week (more often introduces too much noise into the data), recording it, graphing so trends are obvious, and then adjust going forward.
Again, this works for everyone, diabetic or not. Most people struggle with weight loss because they treat the process as abstract, failing to record accurate data about input, output (exercise caloric burn for example), and state (weight). Rather, they go on a "diet", follow certain eating plans, etc., and weigh themselves.
Then get very frustrated when it's not working. Problem is, without detailed, accurate caloric input/output data, it's impossible to know why a diet's not working.
Get a good tool to help with the data acquisition and management. If you have a smartphone or tablet (apple or Android) get an app to help. There are many. I use MyFitnessPal, and in my opinion is among the best. However, there are many others.
Using a tool like this, plus discipline, the weight will come off. It's all about information, and control. You can't be in control if you're operating in an information vacuum.
It amazes me that the medical community will say stuff like your son was told. I am always told I need to exercise more. I realize I could start running marathons but isn't 15 or 20 miles a week of running enough exercise? I suppose I could never eat another "bad" food for the next 30 years but I find moderation more sustainable. I get very tired of being blamed for being diabetic by the doctors.
Hey Jim. Lots of good stuff above there. Thanks!
A few details to add that people might find illuminating:
- The widely held belief that insulin is necessary to transport glucose into the body's cells is wrong. Very wrong. Most tissue types in the body do not need insulin to absorb glucose. As such, there is no issue of "insulin resistance" with these tissues. This is the main reason hyperglycemia makes people sick, and causes all the damage it does -- glucotoxicity occurs in spite of insulin resistance. The most prominent player in this respect is the nervous system.
- The three tissues that require insulin to absorb glucose are hepatic, adipose, and skeletal muscle. They their reaction to insulin, and subsequent glucose storage, are in that order. Skeletal muscle, as you note, is fairly limited in it's glycogen storage, so it "fills up" pretty quickly and stops responding to insulin. The liver is the most sensitive, and can store a ton of glycogen. Enough to keep the body going for a day or two. Most glucose after eating is taken up by the liver, then released during fasting in between meals.
- If the liver gets full, it will signal adipose tissue to start taking up glucose and converting it to fatty acids.
- The rest of the body's tissues just absorb glucose at what ever levels are in the bloodstream. When it's chronically high in the blood, it's chronically high in much of the body's cells, nerves in particular. This results in toxicity that damages the nerves -- latest research seems to be pointing at mitochondria damage as the main culprit, not surprising given we're talking glucose, and mito's are the chief organelles that deal with the stuff -- and also explain "false hypo" when someone gets their BG under control after a long period of chronic hyper-G.
Due to a bad flu/cold I haven't been running. My normal week is about 15 or 20 miles. For a while I had access to a gym and also did heavy lifting. I was also consuming about 60 carbs per day, primarily in veggies and a couple fruits with 1 piece of bread thrown in. Lately I have upped it more around 100 because I didn't feel well. At 25 grams I am barely functional and could never adapt.
To sort of control my BG requires 2 different drugs. I have mild neuropathy. At one point I had some retinal bleeding but it seems to have improved.
So seriously, what kind of lifestyle changes do you recommend I make? O, I'm also in a normal weight range and have a 22% body fat which is lean/normal for a woman.
Thank you so much Jims!! I get sick everytime someone just insists all you need to do is diet and exercise and the diabetes will go away! Medications can make control difficult when they are for other issues....not to mention what other health issues a person has going on. My doc recently told me that I would be lucky to get things sort of steady and not to hope for too much. When you add in a great deal of other issues along with diabetes, control can be extremely difficult and sometimes may not be totally possible and being told that all you have to do is diet and exercise is foolish and hurtful.
Hi all. Been away from TuD and social media for almost an entire month, and this type 1 vs. type 2 discussion as to "what is easier to manage" has come up, again, for the zillionith time!! I agree strongly with this post by Donna H :We need to be vocal in tearing down the stigma associated with T2 - in addition to making people feel unjustly responsible for the onset of their Diabetes, it may very well keep people from seeking diagnosis and treatment because of unwarranted shame, 2. Insulin for treatment of T2 is not failure - in fact it is smart - helps those remaining beta cells do their work and gives the T2 patient a valuable addition to his or her diabetes management arsenal. Stay strong and stay together and do not blame anyone for getting diabetes, regardless of the type.
Brunetta.....I don't believe in comparative misery. If one is miserable, one is miserable. If one is struggling, one is struggling. It's not a damn competition......T1, T2, LADA, etc...blessings on us all.....