What about Impaired Diabetes?

I guess I have explored tudiabetes enough to get some feelings about it. I have been labeled a type 2 diabetic, but my tests mostly come out described as an “impaired diabetic”. Do any of you get the same “diagnosis”? This dangerous game is setting me on edge and I don’t like being deprived of foods that I love. What do some of you feel about this?

HI Barbie,
This is from Diabetes Mall.com and is about the only thing I can think. If your BG numbers fit…?

Sam

Pre-diabetes (previously called Impaired Glucose Tolerance IGT) was first named in 2003 and is designed to foster attention and action in people who receive this diagnosis. It is defined as having a blood glucose level that is higher than normal, but not high enough to be classified as diabetes. The cutoff for pre-diabetes is a fasting blood sugar of 100 mg/dl. Fasting levels between 100 and 126 mg/dl are diagnosed as pre-diabetes and a fasting level of 126 mg/dl and up is diabetes. The other determiner of pre-diabetes is a blood sugar level two hours after eating carbs of 140 to 199 mg/dl. A blood sugar under 140 mg/dl is considered normal and one 200mg/dl and over is considered diabetes.

It has also been referred to as borderline or chemical diabetes.

Early diagnosis is important. In the early years of pre-diabetes or diabetes, the beta cells are progressively damaged by high blood sugars.Usually by the time diabetes is diagnosed, half of the beta cells are nonfunctional. This can not be reversed so that the beta cells can go back to insulin production. When an early diagnosis of pre-diabetes is made, almost 100 percent of beta cells are functional. If lifestyle changes are made and some diabetes medications are used right away, many beta cells will stay healthy and make blood sugar control easier

Sam:

Good explanation. I was sitting here reading Barbie’s question and I said, “what is ‘impaired diabetes’”? Thank you for the explanation. I am T2, or at least WAS. Because I am on the pump now and my c-peptide met Medicate requirements, it looks like I might have converted to T1. I always thought that T1 was born with it or early onset.

Thanks again.

Lois La Rose
Milwaukee, WI

Dear Lois.

You wonder about the inappropriateness of our diabetes labels.

Lois,
I was diagnosed as Type 2 and then when I started exploring the pump my diagnosis was changed to type 1.5 based on my c-peptide results. It is possible you are Type 1.5

Samantha, Thank you so much for your information. You touched on the very issue I had been concerned with since I was diagnosed in 2005. Knowing more about impaired diabetic has ease my mind and makes me feel more courageous about keeping with the program I had designed for myself, by diet and exercise. I am still in control, but you provided the encouragement that I needed.

Yes. This is what I have been saying. People with pre-diabetes need to be put on metformin to deal with their insulin resistance and prevent, or at least put off, their becoming officially diabetic. Why do docs just wait till they go over that “magic line” before doing anything? I think insulin resistance should be aggressively managed as soon as it is noticed.

If metformin does not work, should insulin be tried?

Anthony, you might want to read the current issue of “Diabetes Sel-Management” (Jan./Feb., 2009). On the very last page (80), there is an excerpt titled “Early Insulin” given that might answer your question. In fact, the whole article might be of interest to you, "What Your Doctor is Reading"pp76-80, by Shauna S. Roberts, Ph.D.

My inclination would be to say I don’t think so, because for people with insulin resistance, especially if not yet diabetic, the problem is their bodies are already flooded with insulin–which cannot get into their cells to be properly used. Which is what metformin does, helps the insulin get into the cells.

Ellie, Obviously, you have done some study of your own on what works with the pre-diabetic. I am in that category right now and taking one-half pill (250mg) a day. When I was diagnosed (by the result of a Aic test) in 2005, I was put on 500 mg metformin and I worked with diet and exercise for about three years. Then my doctor determined that the metformin might have been responsible of driving my blood pressure down too far and she took me off of it. Three months ago, she put me on the half-pill and I will see this week whether my A1c is back where it should be (after I was tested out at 7.0.) I’m hoping the result will put me back in line this time. But thanks for your input. It gave me food for thought.

Dear Barbie.

I am unfortunately not subscribed to this magazine but really looks like a good one. Could you just paraphrase what they said. does giving insulin in the beggining help the pancreas?

But you wonder if the pancreas is working so hard is it not a good idea to relieve it with some exogenous insulin while you are reducing the insulin resistance by diet, exercise, metformin avadia or whatever else works. Once the pancreas dies the diabetes becomes a nightmare disease.

Anthony, I will try to give you the facts in this article:
1.Treatment usually starts with improved diet and increased exercise
2. If lifestyle changes do not control the the blood glucose level - drugs are added
(other drugs first, then insulin)
However, the usual approach may be backward
Evidence is gathering that startingi intensive insulin therapy early may put Type 2 diabetes into temporary remission by preserving insulin-producing beta cells.
A study revealed that adults newly diagnosed with Type 2 diabetes (with insulin treatments responded more quickly than the ones who took only the pills. (Study done iand reported in the May 24, 2008 issue of The Lancet.
The article rambleld on about how the study was done but the conclusion was one has to be early diagnosed and the study revealed that people who have had Type 2 diabetes for awhile might not get the same benefits because their cells may be beyond help. Anthony, you might be able to read this article on the website of Diabetes Self-Management. The address is: www.DiabetesSelfManagement.com I bid you success is getting what you want to know. Barbie

Dear Barbie.

The early use of insulin is of capital importance for our new diabetics or prediabetics.

For me it does not matter since by now my pancreas is dead or nearly so

There was a Canadian doctor Hertzel Gerstein preaching this 10 years ago but the Canadian Medical ■■■. did not allow insulin then until too late. Reading some blogs the opinion is changing since some patients on this site are allowed very low dosages of insulin.

This would have been precious knowledge 10 years ago when it was being destroyed. I did prodigious amounts of dieting and exercise in the beggining of my disease and then continued with the useless or harmful oral drugs and when pancreas kicked out only then insulin. Also the disease progressed from manageable to being your worst nightmare.

Just go to show that doctors don’t know everything. I’m sorry that this “new” information about insulin is too late to help your condition. The rest of us can only do the best we can and keep our connection open with each other on this site.

My understanding is that an A1C of 7 would mean that you are actually diabetic, not pre-diabetic, and at the top, in fact, of the “safe” range of control of diabetes. Might be worth discussing this with your doctor and others here.

Cool that your doc did some preventative stuff though when it first came to light. My husband was just told to go on a low-fat diet and exercise (though I have convinced him that for a pre-diabetic, low carbing makes more sense).

Dear Barbie.

My favorite medical student has learnt very little about diabetes which is a shame because he may go a practice for a few years in a native community which has 20% incidence or more.

The idea of this site is mainly to have the new diabetics take best care with a little help from the veterans. Also for the diehards there is new technologies like pumps and sensors that need explanation .

Anthony, I hope I don’t get that far into it. I don’t know anything about sensors, but I have to admit the idea of pumps make me nervous…

And high levels of insulin can cause high blood pressure (hypertension) and other problems. Hence the Metabolic Syndrome or Syndrome X.

For many years, my doctor did not put me on anything. I trusted him. After I had an operation and saw my glucose was up on the labs (no one made any mention to me there), I went gangbusters about it.