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Definition of what is type 2

HSSS

HSSS

Expert
Messages
7,675
Location
South of England
Type of diabetes
Type 2
Treatment type
Diet only
What is the most thorough and evidenced description of type 2 you’ve come across (with links if possible) to explain the whole process not just a one line summary.

To include things beyond just high blood glucose and to include the mechanisms involved that are compromised eg first stage and second stage insulin response, beta cells, insulin resistance etc
 
HSSS said:
What is the most thorough and evidenced description of type 2 you’ve come across (with links if possible) to explain the whole process not just a one line summary.

To include things beyond just high blood glucose and to include the mechanisms involved that are compromised eg first stage and second stage insulin response, beta cells, insulin resistance etc
Click to expand...
Here is an interesting article:
https://diabetes.diabetesjournals.org/content/51/suppl_1/S117
 
HSSS said:
What is the most thorough and evidenced description of type 2 you’ve come across (with links if possible) to explain the whole process not just a one line summary.

To include things beyond just high blood glucose and to include the mechanisms involved that are compromised eg first stage and second stage insulin response, beta cells, insulin resistance etc
Click to expand...

Which type of type two you enquiring about?
There are many causes/reasons for type two!
 
This is all taken from Bilous (Handbook of Diabetes 4th ed) which is (as I understand) still the current NHS textbook on the subject. I have only a hard copy of the book and I don't think it's available anywhere free online. The textbook costs about £50 unless you find one, as I did, in a charity shop.

Bilous says (chapter 1):
"Diabetes mellitus is a condition of chronically elevated blood glucose concentrations which give rise to its main symptom of passing large quantities of sweet-tasting urine.....The fundamental underlying abnormality is a net (relative or absent) deficiency of the hormone insulin. Insulin is essentially the only hormone that can lower blood glucose. "

"There are two categories of diabetes: type 1 is caused by an autoimmune destruction of the insulin-producing beta cells of the islets of Langerhans in the pancreas (absolute deficiency) and type 2 is a result of both impaired insulin secretion and resistance to its action - often secondary to obesity (relative deficiency)."


Chapter three then gives the practical impact of those definitions - ie the "rules for diagnosis" as:

  • HbA1c = or >6.5% (48mmol/mol)
  • A casual (random) plasma glucose level = or > 11.1 mmol/L (200mg/dl) in someone with typical symptoms of diabetes
  • A fasting plasma glucose level = or > 7.0 mmol/L (126 mg/dl)
  • A plasma glucose level = or > 11.1 mmol/L (200mg/dL) 2 hours after a 75g load of glucose given by mouth (the oral glucose tolerance test - OGTT)

There's also a box giving the classifications of T1 and T2 - autoimmune, insulin resistant, gestational etc which I won't type out at this stage. And of course there's a description of symptoms, but with a single exception (second bullet point above) symptoms don't seem to be all that relevant to the medical view of the definition.
 
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Tannith said:
Diabetes is the result of having inadequate supply of functional insulin-producing β cells. https://www.sciencedirect.com/science/article/pii/S1550413117304928
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From your linked article (my bolding):

"Diabetes, both type 1 and type 2, is a disease characterized by an absolute or relative deficiency of β cells (Weir et al., 1990)."

A relative deficiency means a person may need a massive amount of insulin because of insulin resistance.
So yes, there is a deficiency as proven by high BG, but you can have this relative deficiency while producing much more insulin than average.
 
Tannith said:
β-Cell function decline: the major cause of disease progression
A hallmark of type 2 diabetes is a decline in β-cell function, which begins as early as 12 years before diagnosis and continues throughout the disease process. https://care.diabetesjournals.org/content/32/suppl_2/S151
Click to expand...


Quoting an article in which the very first sentence is incorrect isn't a great start though?

"Type 2 diabetes is a progressive disease"
 
Tannith said:
· The Twin Cycle Hypothesis suggested that excess fat gradually accumulated in liver then pancreas eventually causing loss of glucose control. All studies since have shown that this explains both the cause of type 2 diabetes and its remission https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.2297
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The Twin Cycle is just a theory, and it has not been proven. The work done by Newcastle a/c has demonstrated that there is a possible association between ectopic hepatic fat and glucose intolerance in T2D, but it does NOT prove that the fat causes T2D, and does not consider that the effect may in fact be due to Insulin resistance Since the diet used by Taylor et al removed hepatic fat, it also removes mitochondrial fat, and this would possibly indicate a different form of IR in the muscle tissue. As I have said in another thread here, it may be a signalling issue and not a physical change to the beta cells. The Newcastle Study has not separated any of these potential confounders.

The Diet has a limited success rate. If it had had 100% success, and the effect was more permanent, then maybe the Twin Cycle may hold some water, but at the moment what you have written here is incomplete and incorrect. So far there has been no corroborating evidence providing any measure of proof. Prof Taylor is a single source for this theory. It is his viewpoint, that's all. Another piece in the jigsaw.
 
What strikes me is how many of these "definitions" are either entirely circular (the variants of "diabetes means high blood glucose, and having high blood glucose means you have diabetes") or refer the 'cause' one step further back without explaining it.

As an example of the latter, the Bilous definition says diabetes is caused by "a net (relative or absent) deficiency of the hormone insulin" - which begs the question of what causes that deficiency. It's not the only one.
 
KennyA said:
What strikes me is how many of these "definitions" are either entirely circular (the variants of "diabetes means high blood glucose, and having high blood glucose means you have diabetes") or refer the 'cause' one step further back without explaining it.

As an example of the latter, the Bilous definition says diabetes is caused by "a net (relative or absent) deficiency of the hormone insulin" - which begs the question of what causes that deficiency. It's not the only one.
Click to expand...
And that definition would include T1 and T2 but would not include me as I have drug induced diabetes I don't think it's possible to define diabetes as a single entity..
 
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