How certain is progression?

[markd]

Most GPs/Diabetic Nurses tell their patients that T2 diabetes is always a progressive illness that will inevitably lead to insulin injections - but there are schools of thought (especially more recently) saying that strict early control may put off the fateful day for a long time, if not indefinitely.

I can't seem to find much info on the proportion of patients that retain good control for an extended period without using insulin (or pancreatic-stimulating drugs) - anyone?

It is a year since I started using a OneTouch Ultra meter and recently started using the free software and adapter that goes with it. Here's the results of the last year, 370 readings in total:

The results of the last 12 months:
Glucose average: 4.8
in target :98%
standard deviation : 0.5

The results of the first 3 months:
Glucose average: 4.8
in target :96%
standard deviation : 0.5

The results of the most recent 3 months:
Glucose average: 4.8
in target :100%
standard deviation : 0.4

And finally, the results of the last month:
Glucose average: 4.8
in target :100%
standard deviation : 0.4

The default targets that the software sets were rather high, I felt, so the parameters it is using now are:

before meal : 3.5 - 5.5
after meal : 3.5 - 6.5
Hypo : 3.4

No signs of deterioration there; slightly the reverse - but I've lost over 7 stone in weight since diagnosis; however have cut my Met down to 2 x 250mg a few months ago. Those two factors may have skewed the results a bit, but my weight is now pretty stable (maybe anther half-stone to lose)and I have no plans to change the meds, so from now on, I should be able to see any signs of progression.

While I don't want to mentally/emotionally store up future trouble, neither do I want to view the future through unwarranted rose-tinted glasses, hence my interest in what proportion of well-controlled people can stay that way with no more than modest doses of met, coupled with sensible low-carb diet and reasonable exercise. What are we looking at; 3 years, 5, 15??

Mark

 

[Dobbs]

Personally I think I'd prefer not to know, but I did find reading the discussion of this subject on Jenny Ruhl's site very inspiring. Here's the link in case you haven't seen it.
http://www.phlaunt.com/diabetes/14046702.php

 

[Sid Bonkers]

Not sure what the medical or scientific answer is but your numbers look pretty good to me so as long as you keep good control I wouldn't worry too much.

I believe a positive mental attitude (PMA) is of paramount importance in keeping yourself healthy so best not to dwell on the negatives that may or may not happen.

 

[hanadr]

My GP says progression is inevitable, but my DSN says that with my numbers, It's most unlikely.
If you keep to non-diabetic numbers, progression, logically, shouldn't happen
Hana

 

[Soundgen]

What do you eat to get such low Bgs ?

 

[Bluenosesol]

I have started attending my local support group and the average age appears to be mid seventies and all appear amazingly healthy on the surface. (Dont know anyone well enough to become more informed). My friends father was diagnosed in his early fifties and died in his late eighties and there wasnt much support or knowledge in his day, so ample anecdotal evidence to say that once diagnosed, if you take heed you will stay the distance and with all your faculties!!.

I consider myself very lucky to have been diagnosed T2 diabetic...!!

I was sedentary, very overweight and eating a disastrous diet.
Imagine then that I was leading a lifestyle with underlying conditions that may well have resulted in an early demise.

Now as a DX T2, I have good blood glucose control, am active, eat a healthy diet and am more alert, fitter and happier than I have been since the kids were babbies!!

Steve.

 

[markd]

What do you eat to get such low Bgs ?

Well, they are not quite as low as I'd like - the non-diabetic average being a few points lower, I think. As of this morning, the last 7day average is 4.6, so still in the right direction.

Although the 250x2 Met, diet and exercise have all helped, I'm sure that the real deciding factor was losing over one third of my body weight - all fat - since diagnosis. My BMI is now 24.5, I plan to very slowly (over the next 6 months) edge it down to 23.5 or so, to keep a small margin in hand for the occasional blow-out/holiday/pigroast/birthday etc..

I eat around 2200 cal per day, not that I count obsessively, lots of chicken, turkey, beef and occasional crispy smoked bacon (amounts in that order), lots of veggies (including peppers, onions, radishes, fresh ginger, mushrooms) and fresh fruit. No bread, pasta or potatoes, no chocs or sweets generally. Salmon and/or tuna once or twice per week.

I drink a few pints of real ale per week - spread out over the week - and a glass or three of wine and/or port with some Stilton (on low GI oatmeal biscuits) before bed most evemnings.

I do some minimal weightlifting - just hand-weights so as not to lose upperbody muscle. A reasonable amount of fast (5mph) walking, anywhere between 25 and 50 miles per week, plus maybe 20 miles per week easy cycling commute.

With this reasonably low-carb lifestyle, I no longer feel hunger pangs (though it took several months for *that* to happen) - if I'm not careful, I can easily skip meals when I'm busy since I just don't feel hungry. I also don't get the, not exactly mood swings, that I used to get when eating in more uncontrolled fashion - I just feel more stable, I suppose - difficult to describe.

Anyway, seems to be working for me, so far!

Best of luck with whatever approach you settle upon.

Mark.

 

[hanadr]

Soundgen
I think your question was addressed to me.
I eat, meat( quite a bit of cold meat with salads)
fish, eggs, cheese, salads, green vegetables,SMALL amounts of crispbread, a bit of fruit( mainly berries)
I put cream into my coffee,
I avoid starch and sugar. Generally if anything is labelled as being more than 5% carb,And I use my Collins Little Gem I don't eat it, although I do eat 1 square of 74% cocoa, chocolate(33% carb) every now and again. The key to this is to have 1 square. 33% of not much isn't a lot. I even had a tiny bit of my friend's doughnut last week. About enough to fill a dessert spoon. Again, not a lot of carb. I went to lunch at a friend's house and carefully had the smallest baked potato. It was really small. The size of a medium egg.
I'm alert for carbs all the time. I've just asked the manager of the cafe at my gym to provide nuts as snacks, because there's absolutely NOTHING else served there that I am prepared to eat. I'm not obsessed, but always alert. It's become a way of life.The philosophy is: "If I don't eat it, It won't appear in my blood sugar.
it works.!

 

[Angela09]

Hi, I have always been told at the doctors that it is a progressive disease and that all type 2's end up on insulin. Cheerful isn't it? I was getting progressively worse until I started eating red grapes every lunchtime. I ate them because I just like them but at my next test my blood sugar was down by .7, it has never gone down before. I think I have improved since then as I no longer have some of the symptoms which I had before. My doctors have changed the frequency with which we are tested from twice yearly to yearly and we will be tested in the month of our birthday. This means I will have gone for quite a few months without being tested (and lots of other patients will have too). As my birthday is not until February I have quite a while to wait! There is a chemical in the skin of red grapes which is known to lower blood sugar and Type 2's should be ok to eat them. They also count as one of the 5 a day so it's a win-win situation unless you dislike grapes! I also make sure to walk for 30 mins every day as that also helps.

 

[Bluenosesol]

Just shows you.... I have a portion of 10 red grapes and my blood sugars go up. If I had 5 fruit portions a day I would lose control. PS I have a HBA1C test every 3 months. Apparently you are entitled to ask for this if your GP doesnt offer.

Steve.

 

[inwales]

My doc told me that a lot of T2s progress to insulin, talking to the DN last week she said many of her patients never take control of their condition. She was so pleased to meet a patient that actually was going in the right direction.

 

[Bluenosesol]

It is my view that a new "breed" of informed diabetics is emerging and that medical opinions on likely outcomes and standard prognosis are beginning to be seriously challenged.

Steve.

 

[salsasue]

[quoteMy doc told me that a lot of T2s progress to insulin][/quote]

Flippin' 'eck! That's pretty depressing! So really, whatever one does to try and improve one's 'lot' so to speak, we're still headed down the same route?! Hope to God these people never get to tell that to a load of newly diagnosed/registered type 2's, it can be a shock/stunning result as it is, provoking various responses including deep depression/denial WITHOUT such nurses telling 'em that, poor people! :shock: :shock:

 

[hanadr]

My GP also told me that I'd inevitably end up on insulin, because everybody does, but that I wouldn't be able to get on at him about it, because he'd have retired by then. (He's the same age as me,62) However the DSN thinks it's not likely with my numbers.I think it's down to control. If you settle for NICE guidelines control, it's iffy. If you don't achieve even that, it's a racing certainty If you get to non-diabetic number, it shouldn't happen.

 

[dragongirl]

I was told exactly that when I was diagnosed only recently - not only that as I was not overweight and already eating a balanced diet and so it would be tablets for me (in September - but no explanation as to why the wait!), but that metformin wouldn't be appropriate so it would be the next lot (sylphoni something or others) and then insulin. No one said you could try cutting carbs. And yes it was a shock and maybe that's why I am distressed at the moment about losing more weight every day. It feels like trying to avoid being shot. I just want to delay or prevent the assumed progression for a least a while.

 

[Bluenosesol]

I was dx in April and put on Metformin and told to expect to be on insulin at my first 3 month review. Just had my 3 month review, HBA1C down from 10.3 to 5.8 and advised to reduce metformin from 2 x 500 to 1 x 500, with a view to coming off them at my next review!!.

I am aware of T2's who have been on drugs only for over a decade.
Also a progression to insulin is not the end of the world.

Excuse me I dont join in the pessimism.

I intend to remain complication free and die of a non related illness or accident!!.

Steve (My glass is half full )

 

[markd]

Excuse me I dont join in the pessimism.

I intend to remain complication free and die of a non related illness or accident!!.

Steve (My glass is half full )

Well said, that man!

I am of like mind.

Having just looked at my latest numbers, this week's average is down to 4.6 so lowcarb and a bit of Met is still doing its magic, interstingly, it is the postprandial numbers that have come down most.

mark

 

[ShyGirl]

I'd rather be back on insulin in a way as oral meds just don't agree with me but I remember what my nurse said in Jan when I changed meds yet again" there's nothing left after ".

 

[saz1]

In my experience most people advancing to insulin especially in early stages are the ones who have blood sugars of dangerous levels with no consideration of diet/lifestyle changes for a period of months or years. I was told I was going onto insulin on my 3 month review because of fasting bs of 15 and hba1c of 11.2 at diagnosis. Nice. Went home and did a whole bunch of research and went strictly low carb initially. Blood sugars came crashing down, blurry vision and all and after a week of low carbing I didn't measure one sugar of over 6.5. My gp still doesnt quite believe it and even though I eat more carbs now, the trends are still coming down. Very soon I'm due to have another review and blood test so we'll see.