Type 2 Treatment

I just opened up to a new friend about having T1. She told me her husband has T2. He checks his BS every AM, takes a pill a day and goes on about his merry way. He goes to the Dr once a year! She read me his AM #'s…145, 165, 130, etc. Does that sound OK?
He “works so hard” and is always tired. Hmmmm…is this standard T2 treatment in America? Should I be maybe passing on a bit of info or at least hinting that better control is possible and should be a concern?

> Does that sound OK?

No

>He “works so hard” and is always tired.

Not surprising he is always tired

>Hmmmm…is this standard T2 treatment in America?

Shouldn’t be. Whether the problem is he is in denial or his doctor was educated in the last century isn’t discernible at this point. I would guess his HbA1c runs 8 to 9%, which I would be scared of. I’m a T2 and my HbA1c is 5.1%.

>Should I be maybe passing on a bit of info
>or at least hinting that better control is possible and should be a
>concern?

Hard to say, depends on the people involved.

Here is an excellent resource in case you are not aware of it:

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

I am type 2 and i check my sugar often but I am also on insulin and my doctor sees me every 3 months for standard diabetic labs.

This IS standard Type 2 treatment in America and it is why Type twos get amputations, heart attacks, kidney failure etc in huge numbers.

It is also why i dedicate so much of my time to web activities that notify people of the dangers of accepting that kind of horribly lax medical treatment.

Most Type 2s are treated by family doctors who were trained fifteen to thirty years ago who know almost nothing about diabetes and who believe their patients brought it on themselves through laziness and gluttony. The rotten treatment they give people with Type 2 verges on murder.

Type 2s have far more complications than Type 1s because they are allowed to keep their blood sugars very high all the time and never even given the information that carbs are what raise blood sugar. I still meet type 2s who have doctors who gave them the message that eating FAT raises blood sugars.

Thanks for the info, everyone. Now I have to devise a plan to gently tell my already stressed friend that her husband is on the path you all have described. I think he is in denial, as suggested, and she has her head in the sand. The thought of limiting carbs to her is torturous.

Elaine,

Sometimes we have to use a bit of tough love, the way Bernstein does when he opens his book. Until I read it, I didn’t really know what the euphemism “complications” meant. When he talks about “salami surgery” to remove pieces of your leg, well, suddenly giving up carbs didn’t seem like the worst thing that could happen to me.

I’d say that Bernstein is the best book for someone who you’d consider intelligent, Becker’s for someone not quite as good at handling facts and detail. But Bernstein is more likely to preserve health.

I second what you say - this IS standard Type II treatment, and it’s completely ridiculous. My father - a Type II diagnosed in the late 70s or early 80s - died of gangrene just a few short months after being put on dialysis. He’d had blood clots in his legs for years and had had a toe removed, so in retrospect, we all should probably have seen it coming. Even IF his doctors had a clue, no one was on his case about even so much as testing his glucose often at home. I can count on one hand the number of times I was aware of him testing himself.

One of his older sisters had diabetic- related complications (kidney failure/dialysis, stroke, heart issues), and also died in her 60s.

But his eldest sister, the one who had Type II diabetes the longest, stayed on insulin injections her whole life, clearly watched her diet (I remember some of the seemingly odd desserts she made - now I get what she was trying to do!), and outlived them all with few if any complications, to a month shy of 80. Either she was lucky, or had the BEST doctor, or was ahead of her time… In any case, my aunt, rest her soul, is my proof that Type II Diabetes doesn’t have to be the early death sentence it seems to be for so many others.

I got better treatment for gestational diabetes in 2003 than my husband has ever received for Type II - even after sending him to MY OWN ENDOCRINOLOGIST! I don’t understand why she was so lax with him and so much like what I call the “Glucose Police” with me! And, in all of his doctors’ defense, he himself is also not very proactive, but good God, if he’s getting labs every three months and they can therefore see what I see just living with him, why are his doctors not on his case, you know?

I had no idea he was letting himself go like that until I myself had to face gestational diabetes. (As you can see, I am now THE NAG… LOL.)

My brother was diagnosed with Type II last year, which spooked me into a low-carb, more active lifestyle, but was a useless endeavor (except for the 17 pounds I lost over almost a year, plus an additional 8 later) because 8 weeks into an unexpected pregnancy, I was diagnosed with Type II and had an A1C of 6.6 anyway…

I’m sending my husband to my new endocrinologist for diabetes and other reasons, but only if the doctor promises me he will get on HIS case as much as he’s on mine…

Thanks, Jenny, again for your help. I am thinking that this fellow hears “complications,” and pictures dying in his sleep of a heart attack 4 or 5 years before his time. He needs to hear a few things the good doctor has to say.

Yeah, the word “Complications” is such a euphemism!

For some reason it always makes me think of doing my income taxes.

Or maybe doing any sort of household renovation!

Elaine,

Dr Bernstein is probably not the best place to start your friend’s husband, in my opinion. Bernstein is the nuclear bomb of advice for diabetics, and very few people can actually follow his advice. Someone who is testing once a day and accepting lousy readings is probably going to be overwhelmed by Bernstein. Start somewhere more reasonable and achievable.

David, you may be right. We are talking dessert after a meat and potatoes dinner every night, followed by ice cream. No exercise. Lots of patterns to alter. Bernstein is convincing but his restrictions just might send a non-committed head back into the sand.

Gretchen Becker is gentler, but I think every person with diabetes has a RIGHT to be told the facts early on. And those facts are that high blood sugars at the level that family doctors ignore cause horrible things to happen, that oral drugs are hardly effective, but that you can lower your blood sugars by cutting way back on carbs and if you do that, you are likely to have a much more pleasant future.

That’s a pretty simple message. Most people with Type 2 don’t ever get told this. Certainly not by doctors.

It’s kind of ironic, because my impression reading here and in the blogs is that Type 1s get warned about complications all the time and it terrifies them but Type 2s only are given the message that the drugs do everything needed and not to worry. And of course, told to eat the HIGH carb diet, still.

My other strongly held belief is that most Type 2s are into denial and turn off when the word “Diet” is mentioned because they’ve been put on low FAT diets for decades that don’t work no matter how good they are, so they have developed a feeling of hopelessness.

I have seen so many Type 2s try a low carb diet out of desperation, drop 50 lbs, and become filled with hope and enthusiasm, that I figure it is always worth a try.

It is sane to give up when what you do doesn’t work, and for most Type 2 DIET falls into that category. Heck, I’m not even a Type 2, but as a menopausal lady I did an entire month of a 1200 calorie a day low fat diet and lost one pound which came right back when I gave up on the diet and filled my stomach. I know what that feels like (ravenously hungry the whole time) so I have more respect for people who turn off to the D (iet) word.

Give 'em some hope and see what happens. After that it is up to them!

I disagree with some of this.

“high blood sugars at the level that family doctors ignore cause horrible things to happen.” I’d amend to say "high blood sugars at the level some family doctors and some endos and CDEs ignore can cause horrible things to happen.

Life isn’t fair, and some people have superb control and get complications. Others are sloppy and don’t get complications.

“oral drugs are hardly effective.” Many people find metformin to make a big difference.

I agree that cutting back on carbs is a good idea. We still don’t know the relative importance of postprandial BGs and postprandial lipids. Some people say that postprandial lipid levels are one of the strongest markers of heart disease, and if you look at the graphs in the second edition of The First Year, you can see how high my triglyceride levels went after a low-carb, high-fat breakfast.

Bernstein claims it’s oxidized and glycated lipids that are dangerous, and he’s probably right. But we don’t have good evidence yet.

I think there are people who respond best to being scared. Other people respond best to being reassured. So we need different books with different approaches. My book does indeed point out that if you have high A1cs for 10 years or so, your probability of one type of complication goes up to 100%. But rather than trying to scare them, I urge them to take control so this doesn’t happen.

My book goes into more of the science behind diabetes than Bernstein’s does, and I sort of resent reading that it’s written for dummies.

Bernstein’s book is better for a type 1 and better for a type 2 who is willing to limit to 30 g of carbs a day and inject insulin multiple times a day to keep BG at 83 all day, even after meals, which most nondiabetics don’t do.

Many people aren’t willing to do this, and people with limited incomes probably can’t afford all the protein you need on a LC diet. So rather than saying, “You have to follow this strict regimen or your legs will fall off,” I think it’s better overall to offer different options and let each patient choose what works best for that patient.

Judith, thanks for your comments. I can’t seem to reply to you, so I’m replying to myself . I’d like to clarify that although I disagree with a few things that Jenny has said in this thread, in general her information is very useful, and her Web site and comments on these forums have helped a lot of people. Her research into MODY has even helped some doctors, including Bernstein, who wasn’t aware of how it worked.

I am honored that you are here, Gretchen. Thanks for the work you do on our behalf. I will recommend your book to my friend. As a T1, should I be ordering a copy for myself?

Gretchen,

I’m not seeing the correct reply links either.

Metformin works very well–when you cut the carbs. The data about what it does for people who don’t is unimpressive. A drop of less than 1% in the A1c when the A1c starts well over 8%. It doesnt’ get most people near 7% according to the studies included with the prescription information.

The “for dummies” books are in many cases the best written books available because they do an excellent job of explaining complicated things in a clear manner. Your book is like the For Dummies books on in that it is written so that even though you are discussing complex things, they don’t seem complex to a reader.

With Bernstein, it takes a bit more work to extract the meat out of what he is saying. And he does daunt people, with the detail he goes into, which you don’t.

I think he does a better job than you do of spelling out what “complications” are. In a way that would make a person think twice but I understand where you are coming from and that that isn’t the approach everyone needs.

All diabetes drugs seem to reduce A1c about 1% when people don’t modify their diets as well. An endo that I admire once said, “I think this is trying to tell us something, but I haven’t figured out what yet.”

Metformin helped me even right after Dx when I was trying to follow a modified ADA diet. When people aren’t willing to modify their diets, that’s when doctors start giving multiple drugs if they want to get A1c down from 10 or 11.

But simply cutting calories will also cut carbs. We all start out with different amounts of beta cells remaining, different amounts of weight to lose, different food preferences, different financial situations. Although I myself am following a low-carb diet and I agree with Bernstein that the less carbohydrate you eat the less insulin you’ll need if you’re type 1, and although I think there’s good evidence that peaks and valleys can cause problems even with good A1cs, I still don’t think everyone needs to follow the exact same diet.

Someone with a lot of insulin resistance because of being overweight with still a lot of insulin production remaining could lose some weight and then follow a low-GI diet and get good control. Someone whose primary defect was in insulin secretion would probably need a lower-carb diet.

Elaine, there’s information explaining some of the science in my book that could be useful for a type 1, but there’s also a lot about insulin resistance, which you probably don’t have. I’d recommend that you check your local library to see if they have it. Then skim it and see if you want to have it on hand as a reference.

Elaine,
I am a Type 2 and over the past year since my diagnosis the thing that has made the most difference for me is the thought of the complications. Whenever I feel like going astray (which is most every day) because like most Americans I was addicted to carbs (especially ice cream after a “bad day”), I ask myself, “would I be willing to give my right arm (or leg) for that”? That simple questions often (although not always) gives me the time and perspective I need to pass on the things “I used to love” because I love the idea of keeping the whole me more. Also getting into a regular pattern of aerobic exercise, which for me is walking for 40 mins. a day, has made a significant difference in controlling my type 2. I have been able to maintain my A1c at 5.5 for the past 6 months.

I do suggest that you hint to your friend that better control is possible. If you don’t and your friends husband gets a complication, how you will feel?

Friends don’t let friends (husbands) eat carbs…

T2Diabetic,

The wonderful thing nowadays is that Type 2s have so many tools with which to prevent complications, so making it clear to someone that complications are extremely likely if they do nothing isn’t saying, “You’re doomed.”

This wasn’t true 20 years ago when there was only one family of oral drugs which were horrible to take for many people thanks to the hypos they caused, limited access to meters, and a completely unjustified belief that low carb diets would kill you. So I can see back then why doctors might soft-pedal the bad news.

But today there is no reason for a Type 2 to risk their toes, eyes, kidneys etc, and yet many if not most doctors allow them to.

The most positive thing I see is the huge growth of this online diabetes community which is getting out to each other the message that doctors have not bothered to give their patients.

When I was diagnosed in 1998 and discovered Bernstein, I logged onto the diabetes newsgroup and posted about my experiences only to be met by furious messages from people who told me that by promoting a low carb diet I was “Murdering diabetics!”

How far we have come since then!