Why is pre-diabetes reversible but type 2 not?

my 30 years plus and last 4 years stopping mess would be:

a) pre diabetes is at point where while bg operating point is starting to drift up, body still regulating and skeletal muscle cells
have not saturated yet causing massive IR. Simple diet and exercise will contain and pull things back.

b) full on is where muscle cells and fat cells have large glucose load in local stores and one cannot haul the bg operating point back on diet/carbs control and hearty exercise. In fact meds intervention is needed to over come excees glucose generation/liver leak to keep BG down at 140 under. Sometimes carbs serious diet hall back plus meds needed to get saturation hauled back off of muscle/fat cells to enable body to regulate and then gradually increase diet back up but maintaining energy balance. Some suggest setting carbs load to be 20 per cent under daily need to be safe.

My read is that liver, pancreas and skeletal muscle cells form the servo system that sets BG operating point when gut has no glucose out. The liver provides a low level constant stream of glucose larger than what is basic use of brain, breathing, heart and pancrease sits there issuing stream of small insulin pulses to have skeletal muscles and fat cells pick up the excess and pancrease ups or slows the pulses to maintain BG at 80 to 90. This accounts for the tight regulation.

As liver ages its low level stream gets larger and pancreas probably drops its pulses slightly causing the set point to slip upwards. In early stages, change is small so that carbs diet/exercise changes are sufficient to regulate back.
As one gets even older, liver starts leaking worse and more causing muscle cells and fat cells to store more excess glucose and saturate causing insulin resistance.

My cgms and the prior 30 tests a day clearly expose liver as stinker over releasing the glucose when it shouldn't
in larger amounts when one ages even more to extent where carbs/diet control and more heraty exercise are not sufficient to overcome the excess glucose by liver release.

Hence the reason to load metformin to cut liver back.

Type 2 diabetes is about 2 things, the first is the inability of our bodies to use insulin efficiently (called insulin resistance). The second is slow death of beta cells, they are the cells in our pancreas that make insulin.
We all start out with a pancreas that can make more insulin than we need. Usually, diabetes is only diagnosed when we have reached the point where we cannot make as much as we need, so our glucose goes up. You may have symptoms (thirst being the most common), but at any rate a rise of glucose leads to the diagnosis.
Our needs have gone up, due to insulin resistance. It is also true that the capacity of our pancreas to produce insulin has gone down. On the average, the pancreas of a type 2 loses about 4% of it's ability to produce insulin each year.
So, what can you do? Reducing the amount of carbohydrates you eat will reduce your need for insulin. Sometimes, but not always, weight loss for those that need it, will reduce your insulin resistance. For most people, exercise will burn glucose in your blood and reduce insulin resistance. Oral medications will reduce the amount of glucose your liver makes, help lower insulin resistance, slow digestion, or induce your pancreas to make more insulin. There are also injectable medications that can help.
I went through most of these for 12 years, when my pancreas could finally not keep up, even with the help of oral medications. I went on insulin.
Over a 2 year span, I dropped my A1c down from 8.5 to the 4.9 to 5.4 range, where I have kept it for 4 1/2 years, with the help of limiting my carbohydrate to 80 grams a day.
I am not cured. My diabetes is very well controlled, my glucose is in the middle of the non-diabetic range after 18 years of T2 and no complications. What many people think is a cure is in fact simply effective treatment.

-Lloyd

I totally disagree. This is the glorious mistake.

Skeletal muscle cells have finite ability to store so much glucose.

Once full, insulin resistance sets in. Cell physiology studies prove this.

This is not about insulin efficiency and just shove more glucose and more insulin and body is to absorb get rid off.

The american manufacturing model of just dam the torpedos and shove more glucose and insulin totally ignores the finite glucose storage oif the skeletal muscle cells and fat cells.

That attitude dams all type 2 diabetics to rotting out to the grave yard.,

\The real story is about glucose saturation, energy balance in body and managing total energy burn against the liver leakage plus gut digestion glucose generation against the energy burn of the body and ensuring balance not out of whack so cells do not top off and block insulin and room always to store more glucose on command of insulin providing BG regulation.

Any other story is a con jiob, fraud and ■■■■■■■■.

I accept that there may be a point on the progression to diabetes where, if action is taken to change lifestyle, it may be possible to return to a state of "latent diabetes". What I don't agree with is the blood glucose levels used to determine that point. It is way below 100mg/dl(5.5mmol/L) or an A1c of 6%.

By the time we reach that point we are well down the path to frank diabetes and the best we can do is control it; hopefully to the point where we delay the arrival of complications as long as possible or until we depart the planet.

I don't have a problem with an elevated A1c being used for diagnosis as long as doctors remember that a normal A1c is not proof of non-diabetes. If ANY one of FBG, peak post-prandial or A1c is above non-diabetic levels then the patient has diabetes as far as I am concerned.

But I'm just a diabetic, not a doctor.

Cheers, Alan, T2, Australia
Everything in Moderation - Except Laughter
http://loraldiabetes.blogspot.com/

Alan, I love the term latent diabetes as opposed to pre-diabetes. Much more realistic, and truthful.

At no time has the word "cure" graced or escaped my lips.

I am not Doctor but an electronics engineer tracing/chasing complex electronic behavior in multi IC digital processing systems using behavior analysis and black box behavior coupled with complex data and test information logging systems to track down bizarre behavior and poor designs.

I spent 30 years on the diabetes bull crap answer rotting out my body and in last 4 years getting serious and started getting detailed data and work on all the aspects of meds, carb control and hearty exercise after stroke to identify what was behavior going on from a black box behavior and help my Doctor resolve this mess.

Imagine my shock when checking into all the research behavior on the subject and finding out that:
Human skeletal muscle cells and fat cells have local stores of glucose that when get overloaded, the cells can turn off their response to the body's own generated insulin to prevent more glucose transfer to cells already loaded full of glucose.

Human muscle cells glucose transfer is one way into those cells only and if local skeletal muscle cell stores of glucose are low, skeletal muscle cells can tunnel through their cell walls to import glucose directly even if insulin is totally impaired. Answer: Exercise can always flush out glucose and best way to get rid of excess glucose is hearty exercise in sufficient quantities.

Metformin really is a miracle drug stopping excess liver glucose release when metformin is up to sufficient strength in blood. See Salk and John Hopkins latest research. Ask the current cure peddlers why this data is sitting in a warehouse like the Holy Grail in a Indiana Jones movie.

My conclusions that track last 4 years of 30 pricks a day and now a CGMS are extremely suggestive that:

1. Insulin does not burn off glucose nor help that process. Only body process - heart , lungs, brain and organs/digestion system plus hearty exercise burn off glucose.
2. If body skeletal muscle cells get topped off, the same cells turn on Insulin resistance to block any further glucose transfer causing BG glucose content to rise and reach levels to rot out body.

3. Blood stream glucose regulation depends upon always having room in skeletal muscle cells, fat cells, liver to store more glucose on body insulin command. Energy balance of body is required; ensuring that liver glucose release/leakage, gut/intestine glucose generation are in balance so cells do not saturate.
Insulin efficiency theories are exactly that and not really on the focus of the problem. That theory suggests one can keep shoving more glucose against a storage location that only has a finite storage capacity. It is simply the infinite motion theory in drag.

4. Today's 24/7 miracle availability of super rich grains, rice, corn and science manufactured tons of sugars - high fructose corn sugar of huge successful farming gains and operations coupled with massive energy saving couch potato tools and games - lap tops, video games, wide screen TV , cars and other labor saving tools move the external food/calorie operating point from a meager starvation operating point banging along the bottom of food supplies to one of constant excess. The hunter gatherer body was optimized against starvation and not excess constant high energy foods.

That means today, the human needs to do the energy balance control as natures super efficient optimization process never had to deal with excess glucose/calories. If it had, it would simply pass the excess straight thru when body fully loaded with glucose preventing this issue.

For me, metformin stops the medical issues of liver releasing too much glucose and my diet of 1200 calories a day coupled with one to 2 miles walking every day keeps mess in balance.

Portion control and carbs control are also most critical.

For those working on the pharaoh’s tombs and edifices moving 2 ton stone blocks by hand better eat up
on the best and richest of the carbs so you do not starve.

Thanks. Should I copyright it? :)

But it's true. Those of us who have it in our genes were latent type 2 diabetics from the moment of conception.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter.

Copyright it if you wish Alan, as long as you let me steal it ;)

Hey, Alan, that's a great term! Since there ARE now some genetic tests that can determine genetic susceptibility to T2, wouldn't it be great if children whose families have high rates of T2 could be tested, and diagnosed as Latent T2 Diabetes if they carried the genes, and started on preventive treatment BEFORE the disease manifested itself?

It's a difficult concept, especially with children.

Look at it in a different light. I wish I had been diagnosed when I was pre-diabetic in my 40s, because I could have done something about it. But I'm glad my incompetent doctor of the time also failed to diagnose me with leukemia, because all I could have done about that was worry and get depressed. Which I did, just before I turned 55 :)

For kids with the relevant gene, who may or may not get type 2 later in life, I can see how much of a blight that may be on a kids childhood especially if the parents are overprotective and become the food police.

Maybe a test at adolescence, but not prior to that in my opinion. If the genetic test became specific enough to be absolutely certain, that may cause me to review that opinion.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter.

Hi James
Absolutely not. It is true that your FBS should be the lowest as you stated. Ideally less than 100. You should also check your sugar 2 hours post prandial (after eating a meal), until you are confident that your blood sugar is well controlled. Your 2h post prandial should be less than 140.

Actually; that is not quite correct.

Pre-diabetes is a very specific term covering impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). The diagnostic criteria are spelled out here: Diagnosis and Classification of Diabetes Mellitus

Scroll down to the section headed "Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)". Pre-diabetes is defined after listing the various blood glucose levels involved for those two conditions:

Patients with IFG and/or IGT are now referred to as having “pre-diabetes” indicating the relatively high risk for development of diabetes in these patients.

An A1c of 5.7% - 6.4% (39 - 46 mmol/mol) has now been added to the diagnostic criteria since that document was published.

Metabolic syndrome is a separate set of conditions which may, or may not, be a precursor to diabetes. The NIH defines it as follows:

Metabolic (met-ah-BOL-ik) syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.

The term "metabolic" refers to the biochemical processes involved in the body's normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

In this article, "heart disease" refers to coronary heart disease(CHD). CHD is a condition in which a waxy substance called plaque (plak) builds up inside the coronary (heart) arteries.

Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.

Metabolic Risk Factors

The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

  • A large waistline. This also is called abdominal obesity or "having an apple shape." Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
  • A high triglyceride level (or you're on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.
  • A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL sometimes is called "good" cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
  • High blood pressure (or you're on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
  • High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter.

joke time again.

well keep up the crap.

onlly about 30 per cent of population seem able to survive glucose super load. the rest are doomed to rot out.

other than genetic issues that result in the set point control wandering higher and greater levels of liver glucose release; the rest is a battle of science upgrades on food supply versus the old hunter gatherer gene/digestion track optimizations thousands of years ago to improve survival against staravation. Today energy balance control now a critical factor.

keep laughing folks. real joke time.

@ jims just between us engineers

Close but no cigar

Like most people you have been misdirected by the drug pushers into concentrating on the fuel delivery system.

The answer was found by Johanna Budwig 60 years ago but has been covered up so the drug pushers can continue selling their drugs to Type 2 diabetics.

To make an analogy like an automobile:

The original problem was a plugged air filter (lack of Omega-3 FA), but now the carburetor has been varnished over by excessive fuel so not only do we need to clean the air filter, but we also need to "degunk" the carburetor.

Budwig was smart enough to supply sulfated amino acids in the form of low fat cottage cheese to transport the Omega-3 FA to the cells, there has been no one else that smart since then.

Then one needs a surfactant to remove the "varnish". Lauryl sulfate is a strong surfactant that is used in shampoo, a point to ponder!

ColaJim

Thanks for writing.

After being misdirected by the pill pushers for 26 years, I a today off the actos, off the excess insulin and meds reduced to metformin mostly and small boost shots of insulin.

My health is vastly improved and have lab tests from kidney doctor, my main doctor and lung /allergy doctor showing the gains.

Yes in past mislead. today on right track as a1c, average bg and lab tests all show.

No confusion here what so ever.

I believe your comments misplaced.

my response is far simpler:

1. You can have and keep cigar.

2. My only interest is that I was t2 for 30 years + and getting worse .

3. 4 years ago I got on it with my doctor and thru detailed data gathereing and Doctor's help stopped tthe rot.

4. At the 2 year point after meds tuning and same diet and exercise for 2 years prior to change point,; my a1c dropped to 6.9 initially and body finally started to heal.

5. Prior to this change point a1c was 13.3, I was 330 pounds and rotting out with body swelled and full of excess water. I was on the glorious more and more insulin approach of 75/25 insulin - 26 doses, actos and starlix and untimed metformin doses and getting serious liver dumps all the time.

6. After med point changes, remove 75/25 - 26 units of Humalog , remove actos, starlix removed
and still maintaining 1200 calorie diet and one to 2 miles walking, a1c further dropped to 6.4, body has shown continuous improvement, weight dropped from 330 to sub 260 and still dropping and kidney lab reports over this 2 year period have shown stabalization of kidneys and efficiency improvement and all numbers stable and improving. Lungs have improved as well as shown by continuous testing at Allergy Doctor and eye hemorages cleaned up clear for last 2 years.

For me, you are welcome to believe what you wish, but I was rotting out and dying and now I have much of my health back and far better. Your remark about pill jockies and pill pushing use applied in the period prior to meds change point. On top of all this my pancreas that was mostly shut down is now after 30 years kicking but.

I am not selling a cure, or anything else other than what has worked for me and the research out there that supports this.

Its your call, this problem starts soft and misleading and over years gets very bad. You want to rot out to graveyard - be my guest. I do not intend to.

Folks, I see where the disconnect here is:

1. Stopping the rot out of body really requires getting average BG under 155 and better.

2. Pill pushers simply push pills supposedly to do this.

3. Unforunately ignoring insulin resistance, its reasons for and just shoving more insulin - shots, pills -glyburide/starlix and avandia/actos are a total
disaster. One needs to solve insulin resistance first and quit the crap.. in my books insulin resistance is body push back that IT DOES NOT WANT ANY MORE GLUCOSE SHOVED into body skeletal/fat cells.

4. Solve the saturation issues and get body cells backed off so they have room to store more glucose on body insulin command enables pancreas to work and really get Blood BG back down.

5. Insulin does not burn off excess and or daily loads of glucose - Only Hearty exercise can. Contrary to the ■■■■■■■■ press.

Shoving more and more insulin and actos against insulin resistance is a abject failure, stupid and ridiculous. Guaranteed early rot out to graveyard.

De-saturate body cells of glucose will enable body to go back to work.

Bariatric durgery, staravation diets etc are all showing unexplained curious results while the onointed ones hang on to their orthodoxy like certain religious orders do. The religious orders have that right to some extent; diabetes cure promoters do not and should be providing information that really helps type 2's and not just raking in billions of dollars.

Why wouldn't one "aim" at an average bg in the normal range? I'm way late and on the "wrong" team here but am always interested in the relationships between food and chemistry and I always think that it's a disservice to T2 to aim for a target of 155 which is so much higher than "normal" or even "close to normal" BG? I'm pretty sure I've seen people hit lower targets using a variety of strategies.

Jims, I'm not laughing. Nor am I understanding.

Nothing personal, write whatever you wish. But I must admit I have difficulty reading most of your posts past the first paragraph and usually give up after that. I have lost track of the message you are trying to send us; I'm not actually sure that I want to find it again.

Possibly you could make them shorter and clearer in simple english?

Cheers, Alan, T2, Australia
Everything in Moderation - Except Laughter

Alan, I thought it was just me.