Diabetes: Have We Got It All Wrong? (T2D)

[KK123]

One of my T2 friends get insulin to inject

Hi there, can you tell us more? What are her/his circumstances, maybe they need it and maybe they don't, that's the gist of this thread I reckon.

 

[Daibell]

Who is treating Diabetes T2 by injecting insulin?

Many GPs, if you believe the posts on these forums over the years, do prescribe insulin for T2s. I have often thought that where the patient has a high BMI and therefore probably insulin resistance that treatment with insulin may not be the best approach? It may be adding insulin to an already insulin-overloaded system. That's why I believe the c-peptide test is under-used. So I wonder whether some GPs understand T2's connection with insulin resistance and hence high insulin levels? Note that some slim T2s are not T2 but mis-diagnosed LADA (like myself) and hence insulin will be needed.

 

[Fenn]

Well this is cheery lol

 

[ziggy_w]

Personally, I found this graph very interesting. It is from a presentation by Ken Sikaris in 2018.

It seems that even with a very high HbA1c, many T2s are still making a lot of insulin. With an HbA1c level of 12%, (108 mmol) the median C-Peptide level is still a bit higher than with an HbA1c below 5% (31 mmol).

 

[Norfolkmell]

All three of my late mother's sisters were t2 and put on insulin as they were unable to control their BG, which since they were following the must have carbohydrate at every meal, and a sandwich in their handbags for emergencies diet it isn't really surprising. My Mum followed the same diet but with a mars bar for emergencies never got to the insulin stage, despite having chocolate when she felt she needed it and hardly ever tested her BG but she got to be 89 before having a fatal stroke.
This was only in 2005 and still some GP's (luckily not mine) insist on carbohydrates all the time.

 

[JohnEGreen]

My GP flat out refused to do either C-pep or Gad tests though my consultant did do the Gad test .

 

[LittleGreyCat]

From some posts on this forum, there are T2s who are diagnosed (as are many T1s) due to emergency admission due to Diabetic Ketoacidosis and go immediately onto insulin.

I suspect that in these cases they may still be producing a lot of insulin, but can no longer overcome the insulin resistance.

I think some have started insulin on diagnosis, but been able to come off insulin after lifestyle changes.

I agree that a c-peptide on diagnosis (or even a full IR test) would give a much clearer picture of how the body is behaving and probably the best route to improve the situation.

I do recall my GP at the time (who was very diabetes aware) saying that they didn't test to see if it was IR or low insulin production because the treatment was the same in both case.

 

[HSSS]

that they didn't test to see if it was IR or low insulin production because the treatment was the same in both case.

Ahh but it isn’t though is it! And therein lies the problem, too many gps unaware of non medication alternatives to be given as a patient choice. If they were then they’d understand the value of understanding insulin production status.

 

[presidentholmes]

Who is treating Diabetes T2 by injecting insulin?

When I was initially diagnosed, the doctor was going to put me on insulin but I asked if I could try tablets and dietary changes first.

 

[kokhongw]

I do recall my GP at the time (who was very diabetes aware) saying that they didn't test to see if it was IR or low insulin production because the treatment was the same in both case.

A change in approach here would have been helpful to many newly diagnosed. I think that is the crux of the the article.

For too long, there has been little effort to make the differentiation, believing that the treatment should be the same for both...

 

[Tophat1900]

A change in approach here would have been helpful to many newly diagnosed. I think that is the crux of the the article.

For too long, there has been little effort to make the differentiation, believing that the treatment should be the same for both...

Yes, it's a failure of the system to educate doctors in the first place. And a failure of the system to even know what they are talking about to begin with or maybe it's willful ignorance. C-peptide and IR testing. C-peptide and GAD are a simple test at such a pivotal point for many. The fact it isn't done and continues to be ignored has huge ramifications in terms of cost to the persons health and the health care systems. Look at the miss diagnosis of type because it isn't done, sure it's not infallible, but just assuming or guessing a type is hardly good practice imo.

 

[ianf0ster]

Slightly off subject, this video (towards the end) talks about why Medical Students are taught inappropriate ways of treating Metabolic Diseases.

It also covers Dieting, Fasting, Bariatric Surgery, Obesity, Type 2 Diabetes, Coronary Vascular Disease, building better bones and muscles etc.

 

[ickihun]

https://www.bariatric-surgery-source.com/laparoscopic-gastric-bypass-surgery.html

This procedure involved reducing the stomach size and the upper sections of the small intestines. The patient will lose quite a bit of bodyweight because the shortened digestive system will absorb much less nutrients and calories. Patient will also be advised to eat a lesser and taking certain supplements. With lesser carb from such a diet and greatly reduced body weight, it is not surprising that body will secrete lesser insulin and insulin resistance will be reduced.

I have not have time to examine the biochemistry in the paper yet.

This described me.
If you mean I need less insulin per kg of body weight, then yes. Less IR. Not sure yet. I'm nearly 4mth post op. Less weight on my back and joints but didn't hv any problems until I took canagliflozin tablet.
I'm finding metformin has reduced my painkiller need amounts. Slow loss now but due to see dieticians. Hoping they say something to advise on periods of no loss. Insulin reduced too much gives higher bg levels not weight losing friendly, for me.
Ps. Only difference is less food eaten so less muscle density. Fat loss is very little especially in my core. As GP puts it. I hv loads to still lose.
My greatest fear is plateauing for too long. In hormonal peaks I add weight. Not menopausal yet. Hormones are currently irregular as of periods.

 

[ickihun]

Yes, it's a failure of the system to educate doctors in the first place. And a failure of the system to even know what they are talking about to begin with or maybe it's willful ignorance. C-peptide and IR testing. C-peptide and GAD are a simple test at such a pivotal point for many. The fact it isn't done and continues to be ignored has huge ramifications in terms of cost to the persons health and the health care systems. Look at the miss diagnosis of type because it isn't done, sure it's not infallible, but just assuming or guessing a type is hardly good practice imo.

Tests are not done due to lack of knowledge with results too.

 

[millenium]

This described me.
If you mean I need less insulin per kg of body weight, then yes. Less IR. Not sure yet. I'm nearly 4mth post op. Less weight on my back and joints but didn't hv any problems until I took canagliflozin tablet.
I'm finding metformin has reduced my painkiller need amounts. Slow loss now but due to see dieticians. Hoping they say something to advise on periods of no loss. Insulin reduced too much gives higher bg levels not weight losing friendly, for me.
Ps. Only difference is less food eaten so less muscle density. Fat loss is very little especially in my core. As GP puts it. I hv loads to still lose.
My greatest fear is plateauing for too long. In hormonal peaks I add weight. Not menopausal yet. Hormones are currently irregular as of periods.

Did the health professional prescribe some exercise programme to u? If u are able to do that and take enough protein, healthy fat and adequate vitamins and minerals while keeping an eye on your carb intake, you should be able to increase more lean mass while losing more body fat at undesirable areas.

 

[Stephen Lewis]

See below for the progression of my T2 from Metformin, to insulin and Metformin in 13 years, and my regression to just Metformin in less than a year. I am now at a point where my bg drops below 4.0 4 or 5 times a week, often at nighttime and rarely goes above 8.5 even after meals and only when I know I am doing something 'special' such as fish and chips. My current average is running at 5.8, 24/7/30 so I am watching what happens if I increase my carbs above my target of 50 gms per day. Right now my body has no issues dealing with the increase and the average is still decreasing with few spikes over 8.5. When I have something with higher carbs because my bg is low, there is usually a very rapid drop often to below the previous low within an hour.
So yes it is possible for a T2 to get off insulin but as we all say 'we are all different' and we can only give information about what works for ourselves. For me - LC (not trying for HF), exercise (at gym weightlifting and lots of walking), FS Libre (to get continuous and diet specific information), lots of info from T2s on this forum (that kept me motivated) and prayer at Church (whatever it takes).
My doctor said I was doing so well I could delay my quarterly A1C test. The diabetic clinic cancelled my appointment because I did not need them anymore. I have now made a doctor's appointment, have to wait another 5 weeks, to see if there is any test that will say if my pancreas is now working properly (cured) or if I still need to control my diet but perhaps at an increased carb level (remission). Any information about my current status and how to deal with it is greatly appreciated.

 

[slip]

For too long, there has been little effort to make the differentiation, believing that the treatment should be the same for both...

Could this be because both conditions have the same name?...................

 

[JohnEGreen]

Just to make things clear well for me any way

IR = Insulin Resistance = insensitivity to insulin.
Low insulin production = pancreas not making enough insulin.

These to me don't seem to be the same thing and I was not aware that they had the same label of course I could be wrong.

I mean I could die from asphyxia but that could be due to my condition stopping me breathing or it could be because of a lack of breathable air.

 

[Tophat1900]

Just to make things clear well for me any way

IR = Insulin Resistance = insensitivity to insulin.
Low insulin production = pancreas not making enough insulin.

These to me don't seem to be the same thing and I was not aware that they had the same label of course I could be wrong.

I mean I could die from asphyxia but that could be due to my condition stopping me breathing or it could be because of a lack of breathable air.

I believe we are in the same boat on both counts.

 

[Member496333]

IR = Insulin Resistance = insensitivity to insulin.
Low insulin production = pancreas not making enough insulin.

You are of course correct, but if I may build a little on that - I actually prefer to differentiate between insulin resistance and insulin sensitivity. Everyone has varying levels of sensitivity throughout the day and from day-to-day. It changes constantly based on many variables. True insulin resistance is actually hyperinsulinemia brought about by the liver beginning to reject glucose because it is running out of places to store fat. For example, apple cider vinegar or a cinnamon supplement may improve insulin sensitivity, but they'll do absolutely nothing to reduce real hyperinsulinemic resistance.

Sensitivity and resistance may appear semantic, but actually I think conflating the two is erroneous. At least this is the way I like to frame things. Others may have a different point of view.