Diabetes type 2 a progressive illness??

[sdgray22]

Well, what is your opinion is it progressive. NHS employees of all kind appear to think it is just a matter of time before we type 2s have to progress to insulin taking and that the disease just progresses whatever you do. Is that so? or just another NHS myth!! I am hoping not if sugar levels are controlled does it get worse as time goes on?

 

[borofergie]

Well, what is your opinion is it progressive. NHS employees of all kind appear to think it is just a matter of time before we type 2s have to progress to insulin taking and that the disease just progresses whatever you do. Is that so? or just another NHS myth!! I am hoping not if sugar levels are controlled does it get worse as time goes on?

Well, it's a self fulfilling prophecy isn't it? If you control your T2 diabetes the way that the NHS want you to, then it will be a progressive illness, and you probably will end up on insulin (not that that's necessarily a very bad thing).

I think that there is enough anecdotal evidence (on this forum and other places) that well controlled diabetics don't always (or indeed often) progress onto insulin or worse.

 

[Daibell]

Hi. I agree with Borofergie. I've not come across any statistics to demonstrate that it is always progressive and in what way. I suspect some of the progressive T2s are in fact undiagnosed T1 LADA etc where the pancreas islet cells do gradually get destroyed. For many insulin resistant, overweight T2s I suspect many will have an extended period without insulin if they follow the exercise and diet guidelines on this forum as their islet cells appear to be funtioning OK?

 

[xyzzy]

I fully 100% intend to die of something else.

I think you have to recognise it may be progressive and that you will at some point end up on insulin but you should use the time prior to that to prepare for that eventually. I would not be particularly concerned about going on insulin as a slim and relatively fit person who mostly manages their blood sugars within non diabetic ranges.

It terrifies me when I read the stats on life expectancy of diabetics on insulin who are overweight, have poor control or both. The rates of heart attacks and strokes and other outright killers is really dramatically high.

I said in another thread the other night I see a possible progression for myself as overweight low carb + met directly to low to normal weight + low / medium carb + insulin because that misses out the progressive bit of killing off what remains of your pancreas with the insulin stimulating drugs. In my mind the choice maybe to get to a good healthy weight and fitness then swap to insulin as the insulin dose needed would be lower than if you killed your pancreas first with drugs. You're also at a point where mentally you know what a good healthy diet is as you've been on one so theoretically you should be in a stronger mental position to resist the temptations of being able to eating "anything" on insulin and therefore getting overweight.

 

[IanD]

On diagnosis 11+ years ago, I was told diabetes was progressive & given a long list of complications. Diab would progress & I should not consider myself to have failed as the problems developed. I was given plenty of info on how to manage diab & had a session with the local dietitian. She, of course, recommended the usual high carb diet. Progression would be delayed if we followed their advice carefully. I did.

After 7+ years the complications were setting in chronic tiredness, crippling muscle pains, beginning of retinopathy ... my active life was over. That I found this forum & the low carb diet. The complications were substantially gone in 3 months. My HbA1c is around 6, down from 6.7.

4 years on (at 73) I am fit & well & physically active.

I agree with previous posts. Diabetes T2 is progressive - if you follow the NHS/DUK diet advice; your best chance is a low carb diet. For me, that reversed the progression.

 

[Pneu]

I suspect some of the progressive T2s are in fact undiagnosed T1 LADA etc where the pancreas islet cells do gradually get destroyed.

Not true.. damage to beta cells has been show to start at blood glucose levels as low as 5.6 mmol/l and prolonged exposure to blood glucose levels over 7.8 mmol/l destroys 'kills' beta cells. Poorly controlled blood glucose in any type of diabetic will kill beta cells.. the only difference being that in type 1 and type 1.5 our bodies very helpfully provide an auto-immune response to help them on their way! Thus a poorly controlled type 2 diabetic can effectively kill off their pancreas by poor blood glucose control only... If you look at the standard NHS treatment path then this is typically what happens... i.e. more and more drugs are used to stimulate or help an ever decreasing amount of pancreas function until eventually insulin is required.

 

[womble]

As a professional working in the NHS & also a recently diagnosed type 2 i have rarely witnessed type 2 diabetics progressing to insulin. If you look after yourself properly then unless its a genetic condition there is current research to suggest weight loss & exercise can help reverse the problem with the pancreas in type 2 diabetes. How Metformin works has nothing to do with the pancreas but instead how the liver breaks down glucose. Loads of research being done into diabetes with talk of new tablet expected out hopefully next year that assists in reversing some of the damage to the pancreas & making it work more efficiently in type 2. May not suit all though. UK & American governments putting lot of money into research to try & control this condition & stem cell research continues for type 1....

 

[Pneu]

Womble.. I can only say then that your experience must differ vastly the the treatment path offered to the 100/1000's of type II diabetics on this forum... the majority of which are offered dietary advice from the 1980's and pushed down a treatment path of ever increasing amounts of various drugs... I have no real issue if a person makes this decision for themselves the primary problem that the majority of us have is the lack of information (or cynically mis-information) that is given to patients... no one is given the information they need to make an informed decision.

Although Metformin dose not stimulate the pancreas a number of the follow up drug's that are prescribed do.. and there is plenty of evidence to suggest that these drugs have an adverse effect on the pancreas... eventually leading to an individual who requires insulin due to decreased pancreas function.. again plenty of people on this forum in this boat...

Clearly weightloss, exercise and a controlled level of carbohydrate are all important in the battle against type II diabetes... such as shame that the NHS's standard line is not the above... I am all for new drugs and treatments although perhaps a bit cynical in my view that it wouldn't be necessary to prescribe expensive new drugs.. if the NHS offered blood glucose testing strips and correct dietary advice to newly diagnosed type II's... who could then effectively (and I suspect more cost effectively) manage their own conditions.

 

[xyzzy]

If you look after yourself properly

Womble you've hit the nail on the head; we need to look after ourselves properly. Trouble is very few of us think that how the NHS tells us to "look after yourself properly" actually works that well. I am not saying you are one of them but I really do believe that at present only a small minority of NHS HCP's actually "get it" when I and others say we want to look after ourselves properly.

What I mean by that is to many of us looking after yourself means things like:

Aiming for an HbA1c in the 5% range and not accepting that the NHS 6.5% to 7.5% target range is anything like acceptable. At 6.5% you are still running blood glucose levels averaging 7.8 which means you are doing damage to yourself (I'll provide you with links to the relevant studies if you ask). Not acceptable to many of us.

Aiming to have blood sugars in the range or as close to that of a non diabetic. I was actually told by my diabetic nurse that as a Type 2 this was impossible. Not acceptable to me or many of us. My results 3 months from diagnosis where my blood glucose readings began with readings in the 20's are that I now achieve a range between 4 & 6.5 probably 98% of the time. Today is March 6th. In the last month I have only had 3 readings in excess of 6.5. I test before and at 2 hours after most meals (yet another contentious issue). If you do your research (again I'll give you the links if you want) then I am back within 3 months to having blood glucose readings equal to 19 out of 20 of the non diabetic population. Many other Type 2's, Type 1's and Type 1.5's achieve exactly the same kind of results.

So how do we achieve this level of control. It certainly isn't by going on the drugs escalator the NHS would put us on. Yes I take 2 x 500mg of Metformin a day but it by no means allows me to get my glucose levels in that 4 to 6.5 range. At most Metformin makes a 1 or 2 mmol/l difference. I'll agree it helps with spikes (somewhat) but that's about it.

What does account for 95% of the improvement to levels is our diets and this is the real issue of contention because currently you as an NHS HCP will tell me to eat a ridiculously large amount of carbohydrates and then throw insulin stimulating and pancreas destroying drugs at me in a vain attempt to lower my blood sugar levels enough to get me within your 6.5% to 7.5% HbA1c range which isn't safe anyway.

When I fail which I suspect the majority do you'll up my doses more and more until you kill off all the pancreatic function I have left and then put me on insulin. Even then you don't stop. You still tell me to eat the same stupid amount of carbohydrates more in fact in case I hypo. I'll then most likely put weight on and if a heart attack or stroke doesn't kill me (on average 10 years before my time) I'll just gently stew in my own sugars gradually having my internal organs rot away.

As you can tell this all makes me very angry because as you can see by some of the HbA1c's of people on this forum we do "know how to look after ourselves." We do it by simply eating a level of carbohydrate that allows us to control our condition whatever that level turns out to be - yes shocking it turns out that each person has a different tolerance.

What a radical thought this low to moderate carbohydrate approach is but no it's not even that because that's what many other countries health care systems say to do that aren't clinging on to 40 years of starchy carbohydrate dogma. Go research the 2011 updated diabetic guidelines and practices found in Sweden you'll find they are exactly what I've just outlined. They seem to have based their findings on data collected in the 21st century.

I agree it may be difficult, at least to start with, to cut down on carbohydrates but I've done it as have many 000's of people you have found this forum over the years. The advantages seem obvious; for a start I am not stressing my pancreas with insulin stimulating drugs, I'll lose weight on a low to moderate carbohydrate diet and finally if I want to play the "can't be doing this any more" card and elect, in my own time to go on insulin I'll still have pancreatic function left meaning I will need to inject less insulin anyway.

Now I wonder are you one of those HCP's who actually listens to your patients or are you one of the we know best brigade? I would point out that a growing number of your enlightened colleagues do actually post on this forum perhaps you would like to learn some more and become one of them.

 

[bonnynemia]

Sdgray22,

May I invite your attention to my two posts titled, This 'Week Marks the 21st Year' and 'My T2D Seems To Be Not Progressive.'
In both of them, you will clearly see that I have been getting very very lucky in discovering 'my way' of managing my diabetes.

I have to emphasize that 'my way' should never be copied by any other type 2 diabetic. What works for me will not necessarily work for others. My suggestion to you and to others who are convinced that T2D can be reversed is to find for yourselves your individual special, unique, effective, easy, and safe way to have a long, healthy, happy, and productive life free of diabetes complications.

Enjoy life always!!!

Bonny Damocles