Not understanding why some use Insulin with T2D IR

not pathetic. Have a socially distanced hug.

 

And then accused of being lazy and sitting around eating chips and chocolate all day.

 

when I spoke to the liver consultant last week, it was encouraging to me that he listened, and agreed with my insulin resistance, and that the lack of weight loss was not my fault, which is backed up by years of blood test results. Some specialists out there are listening.

 

My utter layman's understanding: T2 is, fundamentally, insulin resistance. Your body no longer responds to it correctly, and it takes a lot more of the hormone to bring your blood sugar levels down. Your elevated sugar levels still trigger your pancreas to work flat out producing insulin to bring them down, and it's this constant stress that ultimately wears your pancreas out. It's like revving an engine to death to try to compensate for a badly slipping clutch on a hill start. As the damage to your pancreas worsens, its ability to produce insulin decreases. You're now dealing with a double whammy of both producing inadequate amounts of insulin, and not responding adequately to the amounts that you do.

There's a good explanation of how a number of diabetes medications work here:
https://www.ahrq.gov/prevention/curriculum/chroniccaremodel/chronic2a12c.html

Most stimulate your pancreas to produce more insulin, stimulate your body to respond better to insulin, or inhibit your liver from dumping sugar into your blood. But once you don't have enough capacity to produce insulin for these to be sufficient, you're going to need to start to inject.

The low carb diet approach, tries to limit the amount of sugar that gets into your blood in the first place, thus reducing your dependence on these processes. There are also drugs that can partially inhibit digestion of carbs, allowing a lower carb uptake from a higher carb diet.

 

Talking about testing t2 I tried last summer to get an insulin resistance test by post but the company stopped doing postal tests (due to heat affecting results).

Anyone know of anything outside of London and not £100’s to get tested for insulin/glucose or c peptide? Would like to rule low insulin/potential LADA out for piece of mind at least even though I think it unlikely.

 

You are correct in the general sense of course, but lately scientists have been hypothesizing that all diabetes, (Type 1, LADA and subtypes of Type 2), have an autoimmune component. Obesity causes insulin resistance but not all obese people progress to hyperglycaemia. Some maturity onset diabetics are not obese. The key flaw is a defect in beta cells. It has been suggested that low grade inflammation causes the beta cells to malfunction and that this has an autoimmune basis. Whether it will make a difference to treatment options in humans is academic at the moment. If you would like to read the review here is a link:
www.ncbi.nim.nih.gov>PMC6620611

 

My understanding of insulin resistance is that it causes weight gain. Sometimes years before blood sugar is high.

 

One possible cause yes. Not the only one and as stated above insulin resistance also causes obesity. I’ll look at the paper later when I have a minute

 

The link doesn’t work.

 

Sorry the link does not work, but if you google Type 2 Diabetes and Autoimmunity you will find it and other references. I am not disputing all the things we currently know regarding insulin resistance, high insulin levels and obesity. I was just putting forward an academic argument to explain why some diabetics, currently diagnosed as Type 2, may require insulin. Until recently Type 2 diabetes has been regarded exclusively as a metabolic disease but it may not be.

 

I’ll look. But I think the key word is “currently”. Many LADA are misdiagnosed type 2 initially. Who knows how many more are out there still labelled as type 2 but now on insulin under the traditional view that it’s progressive and unsurprising (rather than theirs is, and always has been, autoimmune not type 2). There are still doctors that have never heard of LADA or believe type 1 only occurs in youth/suddenly

 

Not all the time... my symptoms were the rapid loss of a stone and a half that went un-noticed because I simply assumed it was the stress of my mother passing away suddenly - I had lost a stone when my dad died, so I did not even bother much about it until all the other symptoms started to present.
Turns out ... my body was ignoring all this lovely glucose washing around in my cells for energy... and decided instead to munch on my muscles instead which ironically should have been another clue as for the first time in ages I hadn't had to fight with a pair of knee high boots to get them to zip up over my ex-athlete calf muscles.

Whenever my pancreas decides to have another little wobble, one of the first indications that my bloods are soaring is that my weight drops like a stone.

 

As sonia2016 said, we are all a bit different.
I'm type 2, was previously underweight and now just about on the right side of that threshold. Don't think my carb intake would ever have been more than 200 per day and is now usually below 100 per day - yet I still need insulin.
When I was diagnosed, one of my endo's mentioned that he and his colleagues has discussed the possibility that I was LADA, but they decided against that.

 

Any idea why?

 

I'm afraid not. At the time I didn't really query it. My sister was diagnosed Type 1 as a teenager and I knew a bit about type 1 and type 2, but not LADA and I knew before going to my doctor what was wrong with me, but as my symptoms were nothing like hers I was expecting to be told I was type 2, so just accepted it when it came.

A few years later I did query with another endo if they were sure that I was type 2, but he said it was impossible to be sure and as far as he was concerned, if I needed insulin, I needed it whether I was type 1 or 2 or Lada. (Only quoting my endo, and I have to be careful saying that, because I mentioned this (not on this forum) and almost got my head bitten off for 'saying Type 1's and 2's should be treated the same' which wasn't what I said or meant)

 

Possibly a very stupid question, but does it really make any significant difference if one is LADA or T2 and insulin dependent, as the treatments seem to be very much the same.

 

Not a stupid question, but one I'm not sure about. One thing I have learned is everyone is different in some way and the comments my endo made were about me and may not apply more generally.

The reason some people get upset, (at least this is my impression) is that they believe they have been denied some treatment/equipment because of their classification and if they don't agree with their classification that can be frustrating.

For example in the US, insurance companies may refuse to pay for insulin pumps, etc and the patient, rightly or wrongly, believe that decision was based solely on their 'type'.

Here, in the UK, I wasn't sure whether I would get the FreeStyle libre on the NHS, but thankfully I did.

 

Three issues that I can see. First is if the person indeed “needs” insulin. Obviously a type 1 or LADA certainly does. A type 2 might not depending on their own insulin production levels, diet and preferences. I suspect a lot of actual type 2 on insulin have, or had at the time of starting it at least, options related to diet unrecognised at the time. Second would be funding for pumps libres and maybe insurances differentiating by type. Third would be autoimmune diseases tend to be common in clusters. Awareness of one might raise awareness of others.