Replies to This Discussion

Permalink Reply by acidrock23 on September 20, 2011 at 7:05pm

I **still** remember how ghastly I felt before I was put on insulin in 1984. I was 5' 10" or so and had gone from 150 to 120 lbs along with all the other symptoms but it took a while to figure it out. I gained weight on insulin and lost weight on insulin but I am very certain that I am glad to have had it available. I suspect that the best "weigh" to avoid gaining weight is to avoid dieticians. Unfortunately, in my experience, any mention of food to doctors usually results in an attempt to rx a dietician.

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Permalink Reply by Natalie ._c- on September 20, 2011 at 9:45pm

I sure hope you didn't have to ASK for it, AR! It's one thing for the diagnosis to be obvious, which I hope yours was, and another thing to have to beg for insulin because current treatment is not working. Remember how bsc had to beg and was turned down and had to put HIMSELF on insulin? No one should have to do that, even if they are a Type 2. People shouldn't be victims of doctors' poor diagnostic and treatment skills!

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Permalink Reply by jims on September 20, 2011 at 11:55pm

It is not all Doctors fault. Current diagnosis technique should be done with a loner portable CGMS pack plus chenical analysis that can track body for 2 to 3 days through all cycles of sleep, digestion, meals, liver action, kidneys, thyroid., pancreas, gut/intestine and signalling hormones. Then data can be analyzed by computer and Doctor gets full picture of issues, marginal operation and intermittent ops as well as suggested diet and exercise needed to resolve.

My take is that the present one shot lab tests and failure to fully check all organs is the key problem in solving this nasty type 2 insulin resistant diabetes that results on orchestral playing off key of the multi organs complex system mentioned.

The failure to look at only pancreas and ignore other factors suggests that educated guess's, order of Merlin and divening rod are not up to task as cases explode and double.

Type 2 is not a monolithic single organ failure but a web of issues from medicine , diet and exercise.

No we are not in 23rd century with Dr. McCoy of star treck and his magic wand and the computers on the bridge of the Starship Enterprise backing up Doctor. But we sure as hell could do better.

Most Doctors and patients are simply working with insufficient data and analysisand trying to solve serially in time at 15 minutes at each visit to doctor and one shot lab tests when what this needs is a full picture complex adjusting of multi-factors in parallel to get patient back rolling fast and cost effectively.

I have worked on complex digital systems and debugged and at first time of trouble - out come the detailed test gear of logic analyzers, scopes and meters all being pressed to collect fast detailed data pictures, analyze the issue and solve the problem.

Show me a diabetes case for type 2 - a multi-organ - multi hormone complex human system where the human gets as detailed a check as the digital computer gear with a problem gets. Then we wonder why type 2 diabetes cases are exploding.

Put me down as fed up with the nonsense with dark ages thinking and approach in this day of modern computers and testing capability.

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Permalink Reply by Natalie ._c- on September 21, 2011 at 5:58am

There are a lot of hormone and gut enzyme abnormalities for which there is as yet no practical test. However, even the now abandoned OGTT gives a clearer picture than a simple fasting glucose, or worse yet, an A1c. Add in a C-peptide and antibody tests, and you get a pretty good picture of where to start. The reason for abandoning the OGTT was that it was a hassle for the people getting tested, and for the doc. But when it comes to early diagnosis of Type 2, isn't that better than waiting for complications to happen before diagnosis? One day of hassle is better than years, or a lifetime of misery!

Personally, I'm in favor of eliminating the "prediabetes" label, and aggressively treating those people who are at risk BEFORE they develop full-fledged Type 2 with complications. Support for effective diet (which is a distant dream at the moment) and a supervised exercise program would be a start. Preventing complications and keeping people in the workforce (as long as there are jobs!) is surely better than supporting them on disability!

We, as a country, are rich enough to start wars, but not rich enough to take care of our own people?

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Permalink Reply by BadMoonT2 on September 21, 2011 at 6:17am

Agree the pre diabetes label should be dropped. This is the best time to get aggressive in treating although, I'm skeptical about how many would take it seriously, even with a new label. Unfortunately restricting carbs is the approach that works best, but most are very resistant to the idea.

Re gut enzyme abnormalities: I recently started Victoza which is an artificial gut enzyme (GLP-1) It has made a huge difference in my control, which had been deteriorating. So apparently part of my diabetes has something to do with GLP-1. I went into my last appointment having decided to ask to be put on insulin but my Dr. wanted to try Victoza first. For me I think it was the right choice, because I have lost some weight, which is another effect of Victoza, in some people. In the end this should help with insulin resistance.

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Permalink Reply by jims on September 21, 2011 at 9:17am

Natalie:

Excellent informed and detailed response.

Agressive treating early is key and usually carbs control and hearty exercise can usually pull one back into line.
Leave it like me 28 years later, agressive meds help, super carbs control and yes rot stopped.
All cannnot be fixed though even though body does herculean effort to cure when given chance.

Carbs control is extremely important but unfortuantely food police have beat the crap out of the fork knife and plate bad habits with no useful effect.

I believe big issue is that many of us are stuck with the 10,000 year old hunter gatherer gene digestive system optimized to pull out every possible calorie when food quality was low, scarce and scrawny and the body was optimized to prevent starvation under such circumstances.

Today with the incredible farming operations generating such huge volume of the grains/carbs, our old bodies cannot handle calorie overload each and every day. Thus carbs control is absolutely key.

Yes , one can eat the fun foods but it is key to manage energy input today. Only about 33 % of population has systems appropriate to preventing type 2 insulin resistant diabetes. The rest of us have to be careful and get sufficient exercise.

Blaming type 2 insulin resistant diabetes on excess weight and fat while of interest is too far down the body glucose chain while lap band, bariatric surgery, starvation tight diets suggest something else as those folks get results well before any obvious fat loss.

I did not do any of those BUT after getting leaky liver shut off and diet to 1200 calories and 1 to 2 miles walking each day, my body also threw off the excess insulin -75/25 humalog-26 units, starluix/glyburide and that other fun party actos all after about 6 months. Foks doing the tick stuff usually get results in 8 weeks.

This is for me after 30 years of wrong crap and handling. Yes I use some humalog lispro - 2 to 4 units each meal and one shot of 8 units of lantus to beef up basil insulin. AT age 64 , it is logical that I might need boost of insulin due to aging.

That I found my own pancreas kicking ass after all this and watch on my cgms after eating each meal is even more curious when it should be withered and out of puzzle after 30 years as type 2.

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Permalink Reply by Cathy Jacobson on September 21, 2011 at 6:15pm

Please know that I stood up and shouted "HURRAH" about us being a country.....etc.

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Permalink Reply by smileandnod on December 13, 2011 at 11:13am

Very well said, Natalie, and I completely agree with you.

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Permalink Reply by AngelaC on September 21, 2011 at 12:11pm

With numbers such as yours, it's not likely you're going to be approved for insulin. Your bgs are considered to be 'adequately" controlled with the medications you're currently using, even if you're not entirely happy with your numbers. In 2007, my A1c was up to 8% and I was placed on Metformin ER (extended release). My fasting numbers went from 180 down to 90 fairly quickly, but it did nothing for my post meal (docs call them "post-prandial") numbers, which would still be over 200 even 3 hours after eating. I even tried eating meals composed mainly of low-carb vegetables and meat and I'd still have bgs over 180 three hours later. When I pointed this out to my doctor, he dismissed it and upped the metformin from 500 mg/day to 1000 mg/day. The change still didn't do anything and worse, it wrecked havoc with my appetite. I started losing weight I could ill-afford to lose. Still, my post-prandial numbers were through the roof and I was an unhappy camper. I didn't just ask to go on insulin; I BEGGED. I was continually denied and essentially told that my poor performance on metformin must be my fault. It took changing doctors and finally getting a c-peptide test (an indirect measure of your insulin production) before I was able to convince anyone that insulin was necessary. If my experiences are to be taken as a guideline, then I would think it would be unlikely, given your success at managing your diabetes with oral medications, that you would be prescribed insulin. The risks outweigh the benefits.

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Permalink Reply by jims on September 21, 2011 at 12:39pm

I would offer a different response. Being adequetly controlled and stopping the body rot are not same thing.

Marginally controlling BG can lead to being condemmed to body rot, eye and kidney complications. It leads to same dumb excuse - we do not fix liver leaks - tough shit.

My read is that calorie load needs to be on average lower than the actual body need long enouigh with sufficient exercise to prevent body muscle cells being topped off with glucose each and every day/.

Get average glucose low enough so that any excess laying around body is burned off enables body to get back in control.
and bg pulls into spec on type 2 diabetes insulin resistant.

It is high time for a change and to stop the doubling of this disease.

Inadequete diagnostic tools lead to failure by Doctor and patient alike and then ends up Doctor thinks patient isn't doing his job or following instructions.

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Permalink Reply by Natalie ._c- on September 21, 2011 at 12:42pm

I'm not sure the risks of insulin outweigh the benefits for Cathy. As a Type 2, her risk of hypoglycemia is much lower than for a Type 1 (although not nonexistent), and with a low-carb diet and consistent exercise, weight gain shouldn't be a problem, either. On the other hand, since Januvia (part of Janumet) is pretty new, no one knows the cancer or heart-disease risks associated with it nor what other side effects it might cause down the line. Plus I've never heard of any definitive answer as to whether a sulfonylurea, like Amaryl, actually causes faster decline of beta cell function.

I do agree, as I said earlier, that the doc may be unwilling to put her on insulin, since her numbers are relatively good. The problem for her is wanting tighter control than the doctor thinks is necessary. Studies like ACCORD didn't help the tight control viewpoint, especially in older people, even though there has been a lot of criticism of its flaws.

In the end, I think the Type 2 patient should have the choice, because only they can decide what risks they are or are not willing to take. Studies only deal with populations and statistics, not individuals, and any given individual may NOT fall under the bell curve of the study. And insulin DOES allow for more precise fine-tuning than any oral med.

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Permalink Reply by MossDog on September 21, 2011 at 12:52pm

The manufactuers af the newer generations of sulfonylurea's including Glimeperide contend that the beta cell destruction is NOT affected by the medication. Take that with a grain of salt because I am not sure there is a whole lot of data out on that and of course they have a vested interest in saying that it doesn't.

If I were a Type 2 I would avoid sulfonylurea's like the plauge but I truly believe that they make the Doc's job of maintaining glycemic control in the early to mid stages of Type 2 a bunch easier. The positive's and negatives for the patient are a little more uncertain.

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