Is T2 Diabetes always progressive?

[spendercat]

The Dietician addressing the newbie group I was referred to quite clearly said that it is progressive. That we will get worse. That testing is pointless, and expensive. That medication is inevitable. Diet and exercise will help but the prognosis is inevitable deterioration.

Other information I have read says that statistically, people who maintain good BG control almost never (less than 1%) suffer complications. That Syndrome X can be controlled if not cured by lifestyle changes.

So which is right? Has anyone here been going down the low carb, low GI route long enough to have some solid experience on this?

In the absence of anything else, I am going down the more hopeful path of diet and exercise. I suspect that I may have been diabetic for many years, even as many as 25, since I had gestational diabetes the first time I was pregnant. Soon after that I became gluten and milk intolerant and thus I have been unconsciously following the low GI diet all along. I only recently tripped the alarm signals when I started to drink daily non diet colas and snack on commercially produce gluten free goodies (high starch).

Angela

 

[smeatons]

Testing is pointless? I don't think so. It has proved invaluable for me in understanding the impacts different foods have on my levels. When I went on my course to learn how to be a good T2 diabetic this line was trotted out and they weren't too impressed with me doing the testing I did. Their attitude was that if you test and your numbers are high you can't do anything to put it right. They failed to take account of the fact that it gives you knowledge to steer clear from a particular food product, or limit the amount of a food product next time.

As for the two statements you make:

1. prognosis is inevitable deterioration
2. good BG control means complications are unlikely

I don't see why both can't be right.

With 1. what they are saying that if you want to maintain good BG control you will ultimately need medication and maybe insulin at some point, but diet and excercise can put those dates off...
...and if you do maintain good BG control (2.) you significantly reduce the risk of complications such as eye damage, foot issues etc.

regards,
David

 

[Unbeliever]

testing probably has been pointless for many people who, like myself were just insructed to test in order o hkeep a record for the docor/nurse. Being shell shocked by the diagnosis and sick rom the metformin hen shocked by the retinopathy and various family problems iit was over 3 years after diagnosis before i could really look into the raionale of tesing.


What you say abut your course makes me want to despair. if HCp's have this atitude - and i know they do- then what message are hey giving o patients?

I like many others have the same symtoms when i am hyper as when I am hyp. I think it is quite important o know which it is.

if you know your bg is oo high then you can maybe exercise - if it is not too high and can certainly avoid making it even higher .

I suspect hat certain medications given o T2s can be more flexible than we are old. I have had some recent experience of his. it often appears o me that T2s are not rusted to manage their condition whereas T1s have to be trusted. I wonder if this is because unti quite recently most T2 s diagnosed were older?

I understand that much of this is because it has been decided that this "epidemic2 of T2 diabetes is ackled more easily by treating everyone in the same way and seering them ono "inevitable" and cheaper. insulin asap . Its a pity they cannot see hat keeping people off medicaion and giving them the tools and the education to control the condition themselves might be more effecive - and ultimately cheaper.

 

[IanD]

The Dietician addressing the newbie group I was referred to quite clearly said that it is progressive. That we will get worse. That testing is pointless, and expensive. That medication is inevitable. Diet and exercise will help but the prognosis is inevitable deterioration.

I was told the same thing (11 years ago,) though testing was mentioned but not discouraged. We were told also that following the diet (high carb, medium GI) was the way to delay onset of complications. I was too frightened NOT to follow the diet, & I bought a test meter & have alsways had test strips prescribed (100 per month.) I get plenty of exercise as I play tennis & go to the gym twice a week. I started metformin after about 3 years. My HbA1c was around 6.5.

3 years ago the predicted complications set in, with background retinopathy & debilitating muscle pain. Physical activity was ended. HbA1c was 6.7, & my overnight readings averaged 7. Then I found this forum & the advice to reduce carbs. Immediately my overnight readings dropped below 6, & in 3 months my mobility was fully restored, & I had lost 6 Kg (14 lb.)

3 years on I am still free of complications & play tennis again. My HbA1c is 6.1.

 

[markd]

I believe the dietician is wrong on several counts;T2 manifests itself in so many different ways that there is no one answer that fits every case.

Sure, if a patient turns up grossly obese at diagnosis and does the bare minimum of self-care with no exercise, the chances are high that they'll get worse and need meds.

I was grossly obese at DX, started an exercise and diet program (lost 40% of my weight) and, having an early-interventionist Dr, immediately went on Met and Acarbose for a while. Over three years on, and my A1c is between 4,7 and 5.1 and my average for the last 90,60,30,14 and 7 days is 4.7, 4.7, 4.5, 4.3 and 4.3. Fasting never exceeds 4.7 I'd slacked off on the exercise quite a bit over winter and now eat a little closer to 'normal' but still heavily influenced by lo-carb / lo-gi.

Quite a few grossly obese people who tackle this head on seem to have the same success.

It seems as if losing weight (if obese) very promptly at diagnosis gets your body back to a point where the pancreas can manage again. For how long? Who knows. All I know is that my averages still show a slow steady improvement over three+ years.

By the time many patients are diagnosed, often they've been diabetic for a very long time - it seems that reversing the damage is less successful then. I was lucky; been grossly obese for years, put a bit more weight on and tipped over the edge and was promptly diagnosed.

But what about those patients who are lean and healthy when diagnosed? That's why I think there is no one answer, I can't believe that the disease starts and progresses in quite the same way for them. If already lean, fit and healthy with a good diet, all they can do is look to medication to control BG if they are already doing the 'right things'. Those are the people I really feel for since they really have little control over the outcome.

But then there's one guy I know with a BMI of well over 60 - and has been like that for several decades - who still has normal BGs. I gather he has hugely high circulating insulin levels and has done so for 20+ years, but his pancreas shows no signs of giving out (so far anyway).

There seem to be several pathways to T2 diabetes; I think it's a very brave (or foolish) person who tries to label them all the same with one treatment regime and one outcome.

But then, a Dr that I know socially has had to upbraid his diabetic nurse several times about doing things by rote too much - his practice is in an area where he seems to get a stream of obese, inactive and junk-food-consuming patients coming in the door complaining that they've started to wee all night. She's apparently close to some sort of empathy-burnout having so many patients who ignore the advice, get complications then come back and complain all the time. I suppose it must be pretty dispiriting if that is your entire working day.

Maybe your dietician has hit the same point and is just reiterating what happens to the majority of patients - those who don't achieve any sort of lifestyle changes. Maybe reading this forum might open your dietician's eyes a bit.

Mark

 

[spendercat]

Thanks for these replies. You are, I think, confirming something I suspected: that the process of losing weight and changing lifestyle really helps improve BG levels, but it might not be enough.
I am, BTW, one of the plump T2s, with a BMI of 28, it was 31 at diagosis, and I am losing weight quite easily. (No drugs yet) Amazed to find that the GI diet is the answer to my lifelong search for a diet that works!
I can keep my BG levels between 5 and 8 all day but I cant get these overnight fasting levels down nohow. I go to bed 6.2, and get up in the morning 8.7
I suppose I hoped that the whole thing could be permanently controlled by keeping my insulin levels down to normal levels by natural methods. I must still be in the denial phase.
I have known people who would literally rather live in a wheelchair than try to change their eating habits, so I can sympathise with medical staff who are exasperated by this. But why assume that everyone is the same? Diabetes is spread right across society, all types get it.
Or are they falling into the cultural groupthink that fat people are lazy and stupid - diabetics are mostly fat - therefore diabetics are lazy and stupid people?
Angela

 

[viviennem]

Spendercat, your high morning levels are probably 'Dawn Phenomenon', and are quite usual for some diabetics, me included. My first-thing bg levels are always the highest of the day. But - over the last 6 months even they have come slowly down, so that they are rarely over 6 and never, now, over 7.

Basically, your liver pumps some glucose into your system as you wake up, to get you energised for the day. That's a bit simplistic, but it's what happens. There's info on here about it, and you can also Google for info. Don't worry about it too much. Your diet seems to be working well, and if your other readings are okay, I'd just simply keep on with what you're doing.

A small carby snack at bedtime, eg a couple of oatcakes or a plain biscuit, might help reduce your morning levels.

Never mind 'plump', I'm an obese Type 2, with nearly-white hair, and being treated as a stupid fat old woman really does my head in! When I get fed-up with HCPs doing it, I ask them their IQ and then tell them mine. That usually shuts them up!

Keep cheerful - I think we all go through denial to some extent, but it is liveable with. In fact, it may be the best thing that's ever happened to me in terms of weight loss, diet and exercise!

Viv 8)

 

[spendercat]

Thanks for the advice Viv, I had tried a bedtime snack - but I went for a protein (soya milk cocoa with cinnamon). I will try the carby option and see if it helps.

Angela

 

[markd]

Thanks for these replies. You are, I think, confirming something I suspected: that the process of losing weight and changing lifestyle really helps improve BG levels, but it might not be enough.
I am, BTW, one of the plump T2s, with a BMI of 28, it was 31 at diagosis, and I am losing weight quite easily. (No drugs yet) Amazed to find that the GI diet is the answer to my lifelong search for a diet that works!

At diagnosis, my BMI was over 40, now its under 25 so technically, I was morbidly obese - not a very pleasant term and one that helped galvanise me into action once I passed the barrier from being 'ordinarily' obese to morbidly obese and got a diabetes diagnosis to boot.

So I suppose I was the poster boy for the 'fat diabetic slob who is responsible for his own condition' archetype much beloved of the rightwing newspapers.

Mark

 

[spendercat]

It seems pretty clear to me that insulin resistance (or syndrome X) is a metabolic disorder of genetic origin, and its earliest complication is often the disruption of the fat storage mechanism. This in turn leads onto other complications, including commonly, obesity, high BP, high cholesterol, high triglycerides, and neuropathy.
Being fat is not the cause of T2 diabetes - it is the earliest symptom in most people, and as such such should be seen by the medical profession as a warning sign of a metabolic disorder, not an indication of a personality weakness.

 

[sparkles]

Well said spender cat!

I wish I could have seen my own growing obesity as more of a ‘warning of metabolic chaos’ than of what I thought (and was conditioned to think) of as the vice of a personal uncontrolled greed. It might have saved me from beating myself up quite as much as I have over the years and perhaps even rescued my dwindling self-esteem. It might have made me explore my relationship with food from other perspectives and not just as someone who lusts after it, lives for it and lacks control. Had I been able to see my obesity not as a result of my own personal weakness but as the warning of a metabolic problem that was NOT self induced but as a medical illness, without guilt, ….like measles.. Hmmm…

..I might have been motivated to face the prospect of living with diabetes differently earlier.
(and time counts!)

But as it was I saw it like this:

Diabetes is my punishment. I deserve Diabetes -It is a predictable (unhealthy) manifestation, a result of my gluttony,

And I developed a ‘devil may care’ attitude.

The self-fulfilling prophesy of the glutton:
-in which people began when I was young saying ‘she loves her food’ and progressed in time to ‘she’s greedy’ and I know from my experience with food they’re right!! I over eat, love food and lack self conrol around it, I internalise, rationalise and accept . OK ;I’m greedy, ‘ ,,,,there are worse sins in life, I’ll live.

BUT Because of ‘MY vice ‘ which is ‘greed’ And ‘MY weakness’ which is ‘lack of self control’ now they’re telling me I am ill and I’ve developed Diabetes.
I understand:
….It was inevitable right? You warned me…

I made myself ill. I over-ate, didn’t diet when I was warned, …didn’t change my ways…
And since I never managed to find control with food I KNOW I’ll probably never be able to ’manage’ this ‘illness’ called Diabetes because its management is food related.
It’s a vicious circle.

So may be this is why every time someone lectures me as to how I need to diet or aught to lose weight
or should watch what I eat
….I fail and I feel uncomfortable rejected, out of control. and so frustrated and angry at them, …or is it with me?

The HCPs give me loads of literature about my condition: diabetes.. . But sometimes its easier to stay ignorant and accept defeat:

‘diabetic‘
.
Its just another label like ‘greedy. ‘ ‘obese’ ‘fat’ ‘weak’ ‘ill’ ….Its not so bad.

But hey, What‘s this?! Metabolic disorder? Genetic origin?… both my parents were thin?
And if fat doesn’t cause T2 diabetes… what about overeating? ….Overeating did make me fat. …
…How and why the metabolic disorder? Why do some people have amazing self control around food and others like me… zilch?
SPARKLES

 

[Unbeliever]

Well sad indeed Spendercat. i found your post very moving Sparkles. reminded me of a friend who died a few years ago. Taking the oestrogen only pill in the 60's caused her weight to balloon almost immediately from a size 6-8 to a size 18. she was only about 4ft 10 too.
in spite of spending thousands on weight loss clinics etc ec she never managed o lose any weight .
So much of what you say rings a bell with me.
Her father had died in a diabetic coma and although she never tested "positive" it was believed that the gene played a part in her problem/
It is very sad to hink that sommant=y are blaming themselves for somehing which is very probably a medical condition which requires treatment.
is it any wonder that many just give up and decide there is nothing they can do as nothing seems to work.
I hope spendercats post helped a litttle. The fact that your parents were thin does not mean ,i am sure that they could not have passed the genes in question to you.

It makes me very sad to think that people are blaming themselves for somehing which they have no control over. a medical condition requiring treatment not blame.

 

[viviennem]

I am the only (diagnosed) diabetic in 3 generations of my family - but I am definitely not the only obese family member there's ever been!

I am also the only one who's ever been diagnosed with osteoarthritis;

and the only one to have teenage asthma, which I think was triggered by severe whooping cough when I was 13.

It is possible that there was diabetes and OA in my parents' generation, whci may have gone undiagnosed because that generation 'didn't bother the doctor'.

Or could it be that all these conditions are some sort of auto-immune response, and the whooping cough triggered the lot?

My neice is the only one anywhere in either of her families who has MS. Where did that come from?

As for obesity, Sparkles - by the sound of your posts on here you've never eaten a 'bad', junk-food diet - you are too good a cook! Me too - I've always eaten good food, just far too much of it! and every time someone got heavy with me ( :lol: no pun intended) I would reach for the food - my main prop and comforter. I would have done better if someone (including me) had tried to find out why I was over-eating, instead of just going on at me.

Some obesity is certainly caused by the burgers, crisps, sweets and fizzy drinks, and sheer gluttony. In my opinion, some of it is just as serious an illness as anorexia and bulimia. If I was as much underweight as I am overweight they'd all be falling over themselves to help me!

Except I'd be dead, of course . . . it just takes longer with obesity!

Viv 8)

 

[ebony321]

Surely most illnesses are progressive, as the body changes and gets older it can no longer maintain the ability to sustain the illness at a certain point?

Still progressive or not the whole point is to prevent progression where possible by testing to see how your body is maintaining the ability to process glucose by itself or with medication.

It's like saying to me, 'well your going to die eventually through progression that all bodies go through diabetes or not, so just don't take insulin, don't test and die a bit quicker?'

Ridiculous.

 

[sparkles]

Sorry to hear about your friend unbeliever, I guess the thing is to hold on and never give up. Most of us do have some control and we can take responsibility even though we often choose not to. I chose not to take responsibility because I was probably scared of failing as well as of giving up the stuff I like most… food.
But I’m here now and that’s what matters. I don’t know ’syndrome X’ or how it relates to or differs from full blown diabetes types 1 and 2. But I am still not convinced that diabetes is ’only’ a metabolic disorder in most people. I think that individuals probably do, through their unhealthy eating habits, and through eating unhealthy food play a role in their own body’s susceptibility and development of diabetes. (Correct me if I'm wrong.) What is wrong is not only the individual’s unhealthy eating styles but the guilt trip. The guilt trip is counter productive really and needs tackling on all levels.

Unbeliever you are right ‘Diabetes IS a medical condition requiring treatment‘. Insulin resistance is probably going to lead to diabetes and so it too should be taken seriously by everyone. ( guilt free) But where does insulin resistance start? And why? And is it self induced with food abuse? And if it is and if there are hundreds of thousands of people out there who are like me… not very good at controlling their input of food, …a bit on the greedy side ….what can be done? Like Viv says… if she were anorexic or bulemic they’d be falling over themselves to help.
But instead for people who overeat or who eat junk…Food is just out there, everywhere and so much of it is sweet, carb rich, and addictive. And if you are the type who just can’t help yourself Well….
I was very skinny as a kid and very active. I liked my food but probably wasn’t allowed to overeat as I did when I got older. I look at children today and many of them are much plumper than I was as a child. Will this matter to them in the long run? Also my grandfather died of diabetes as a young man in the 1940s, yet in our large extended family there was only one person who was diabetic when I was a child and now there are many in my family (-who like me have developed type 2 in older age. ) We say ‘its in the genes’ now, but we never used to say that before. So is it the genes triggering? or is it food abuse? Or even abuse by the food industry? Or a combination? And if food and diet can trigger a metabolic syndrome which leads to diabetes and if its becoming an epidemic then it IS serious!…just as serious as anorexia and bulimia. And probably more widespread! So the prejudices around ‘fat’ ‘greedy’ ‘weak’ etc need to be challenged. I have only had brilliant care from my GP but It would be good for HCP’s generally to acknowledge weight loss is harder for people like me. Many of the ‘obese’ population might benefit from acceptance, education, understanding and healing psychologically as well as nutritionally .

Yes Viv, your right, my diet wasn’t all fast food but I have had more than my share of cheap white bread, cakes and biscuits, ready meals. sweets and chocolate, and chips. Never much went for fizzy drinks though. And those days are gone now. Ebony, you are right of cause!! Testing is a tool an individual can use ultimately to help prevent or slow down the progression of diabetes and maintain a higher standard of health. The nurse was wrong.
SPARKLES

 

[imalittlefishy]

I agree with all that's been said here, just as a side note though, I don't think it's true to say that medical professionals are "falling over themselves" to help those with anorexia or bulimia...a close friend of mine has as yet unlabelled eating disorder...but because she is not obviously underweight and is fit and 'healthy', no professionals seem to be interested in helping her, even when she has gone to doctors for help. I would agree though, that problems with overeating, whether contributing to or caused by (or some combination!) to metabolic problems such as diabetes are serious and do need to be treated accordingly.
xx

 

[Unbeliever]

Once again I just hope and pray hatHCP's are reading this forum and taking note.

 

[raymond123]

my glucose readings now average 15. my gp told me to exercise to burn up sugar, unforunatly he had forgotten about my sciatica. which is worse? HELP!

 

[sparkles]

I cant answer your question Raymond but hope someone will. Though It sounds like dietry control would be a more appropriate approach than excercise at the moment for you. Hope things get better.
Sparkles.

 

[anniep]

I have read that if your BGis over 12 you shouldn't exercise as it can send it higher - but I am not an expert