Pancreas..... can it die

[ken355555]

I have been typed to diabetic for 23 years and my pancreas does not seem to work anymore no matter what I do my numbers are always high what can I do to check if it's still produces insulin

 

[HSSS]

There are tests that can show what the pancreas’ output is.

There are insulin tests (but if you are on certain medications this includes their effect not just your own ability to produce unaided).

There are c peptide tests which show what insulin you produce yourself by measuring a by product of that production. This separates out injected insulin but includes having your own production ”boosted” by certain medication.

There are also tests to check the other digestive enzymes etc the pancreas also makes.

However, within the nhs at least they rarely test insulin production in assumed type 2 and only really use it to help diagnose suspected type 1 in the field of diabetes. Shame as early insulin testing would pick up those heading for type 2 with raised levels long before the problem showed up in blood glucose and avoid many type 1 being misdiagnosed as type 2 that simply get worse quickly.

 

[HSSS]

Your profile says you don’t take any diabetes medication. Is that right?

If your levels are always high it does suggest any medication isn’t fully doing its job as desired. Or that your diet has room for changes that could help.

The biggest single adjustable factor to blood glucose levels in type 2 is carbs eaten. Many find having fewer helps a lot but depending on any diabetic medication you may be taking you may need to go slowly and make sure your dr is aware of your plan and monitoring the effects of changes. Cutting too many carbs too quickly with some medications like insulin and gliclazide can cause hypos. Medication like these and diet need to be matched together.

What sort of levels are you seeing and what does a typical days food look like? Perhaps we can make some suggestions to help.

You could take a look at these links too. Many of us have useful information automatically posted at the end of our posts as ”signatures”.

Intro to T2 and low carb. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html
All the things I wish I’d been told earlier https://www.diabetes.co.uk/forum/th...ish-i’d-been-told-at-type-2-diagnosis.173817/

 

[ken355555]

There are tests that can show what the pancreas’ output is.

There are insulin tests (but if you are on certain medications this includes their effect not just your own ability to produce unaided).

There are c peptide tests which show what insulin you produce yourself by measuring a by product of that production. This separates out injected insulin but includes having your own production ”boosted” by certain medication.

There are also tests to check the other digestive enzymes etc the pancreas also makes.

However, within the nhs at least they rarely test insulin production in assumed type 2 and only really use it to help diagnose suspected type 1 in the field of diabetes. Shame as early insulin testing would pick up those heading for type 2 with raised levels long before the problem showed up in blood glucose and avoid many type 1 being misdiagnosed as type 2 that simply get worse quickly.

I'm going to Thailand in a few weeks I'm going to have that c peptide test done there because it's very cheap trying to get anything done in England is impossible

 

[In Response]

As I understand it, with type 2, there are two things to consider
- is your pancreas producing insulin?
- is your body able to use that insulin?
Both mean your pancreas cannot produce the insulin you need but neither mean your pancreas is dead - it does more than just product insulin.
Your BG may be rising because you have more insulin resistance or because your pancreas is producing less insulin.

 

[Melgar]

Hi there @ken355555 , I have attached a research paper entitled Islet B cell failure in type 2 diabetes. Briefly, Type 2 often occurs when you have insulin resistance plus some degree of Beta cell failure. Beta cells produce insulin , both background insulin that’s pulsed out constantly (Basal) or in the presence of raised blood sugars (Bolus) usually after a meal.

B cell failure maybe down to pure genetics, meaning you may have had a decreased B cell mass to begin with or it occurred later in life due to an insult to your islets /B cell mass, and then with the development of insulin resistance your pancreas’ beta cells could not cope and your blood sugars rises.

This paper covers both initiation of Beta cell failure and progressive Beta cell failure. They use obese individuals as a study because obesity is one of the main causes of insulin resistance. I’ve made it sound simple but its not.

Beta cell death can occur in the presence of high blood sugars and high lipids over a period of time - glucolipotoxicity. I’m sure that you want to know if your beta cell mass will recover , in the main resting your beta cells, ie with a very low carb diet may give them some respite, and also reducing insulin resistance may allow beta cell mass to recover, but I think that depends on the length of time one has been in a glucolipotoxic state and what has caused your islet damage.
The paper is a bit dense, but reading the introduction and then the concluding remarks may make this paper easier to decipher.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483155/

 

[Outlier]

Does obesity cause insulin resistance or does insulin resistance cause obesity? I thought it was the latter, but am ready to be put right.

 

[ianf0ster]

As a slim Type 2 (in remission now for over 4yrs) I feel that at least in my case it's the insulin resistance which caused the weight gain, since I was gaining weight over the long time (around 10yrs) when eating the NHS advised Low Fat (high Carb) so-called heart healthy way. The increase started slowly but increased until I was actually 2lbs into the overweight BMI category upon T2D diagnosis.

It is also my feeling that most T2's when diagnosed have a good set of Beta cells which are working harder than meant to pumping out lots of insulin, so for many/most I think that in the early years T2D is a state of high insulin but insulin resistance rather than low insulin without insulin resistance. This would make sense as a good reason why Prof Taylor only accepted relatively newly diagnosed T2D patients onto his DIRECT Trial since the trial was meant to show reversal of insulin resistance is possible rather than that Beta Cell function may be regained!

 

[Melgar]

Not wishing to derail the thread here, I am going to stick my neck out and say that you cannot have type 2 diabetes with just insulin resistance alone. You have to have some degree of beta cell failure. Beta cell failure can be down to some genetic predisposition or some insult on the pancreas‘ islets or beta cells.

Also excess weight does not cause diabetes. You can be obese, be hyper insulinemic and still have normal blood sugars. It is the demise of the beta cells, whether they perish, or are not efficient that causes diabetes. Hence the reason why the vast majority of overweight/obese individuals do not have diabetes. Their beta cells and islets are working perfectly, producing enough insulin to compensate for the insulin resistance. No diabetes.

I have no insulin resistance, it is my beta cells/ islets that are failing that is causing my elevated blood sugars, not insulin insensitivity.

 

[HSSS]

Not wishing to derail the thread here, I am going to stick my neck out and say that you cannot have type 2 diabetes with just insulin resistance alone. You have to have some degree of beta cell failure. Beta cell failure can be down to some genetic predisposition or some insult on the pancreas‘ islets or beta cells.

Also excess weight does not cause diabetes. You can be obese, be hyper insulinemic and still have normal blood sugars. It is the demise of the beta cells, whether they perish, or are not efficient that causes diabetes. Hence the reason why the vast majority of overweight/obese individuals do not have diabetes. Their beta cells and islets are working perfectly, producing enough insulin to compensate for the insulin resistance. No diabetes.

I have no insulin resistance, it is my beta cells/ islets that are failing that is causing my elevated blood sugars, not insulin insensitivity

not agreeing or disagreeing but do you have any links to back this position that IR alone isn’t enough and beta cells must be compromised?

Excess weight may not automatically cause type 2, as you rightly say there are examples of obese persons without it. But there is a lot to suggest it can, along with other factors that also can

Those that are hyperinsulimic may be on the path towards type 2 just not quite there yet as we pretty much all start out that way. We manage with higher and higher insulin (and presumably functional beta cells to produce it) and normal glucose, until we can’t any longer and it shows up in bgl too. Is that because beta cells fail or IR becomes so great it’s insurmountable even with functional beta cells though?

You say you have no IR (curious how you know this) and for you it’s beta cells (more akin to type 1 or 3 perhaps). You also identify as ”other” type of diabetes rather than type 2 so I’d expect your pattern to be different in that case.

 

[Jaylee]

not agreeing or disagreeing but do you have any links to back this position that IR alone isn’t enough and beta cells must be compromised?

Excess weight may not automatically cause type 2, as you rightly say there are examples of obese persons without it. But there is a lot to suggest it can, along with other factors that also can

Those that are hyperinsulimic may be on the path towards type 2 just not quite there yet as we pretty much all start out that way. We manage with higher and higher insulin (and presumably functional beta cells to produce it) and normal glucose, until we can’t any longer and it shows up in bgl too. Is that because beta cells fail or IR becomes so great it’s insurmountable even with functional beta cells though?

You say you have no IR (curious how you know this) and for you it’s beta cells (more akin to type 1 or 3 perhaps). You also identify as ”other” type of diabetes rather than type 2 so I’d expect your pattern to be different in that case.

I know my beta cells dont produce insulin as a T1.
But of my pancreas was totally dead, it would need some sort of removal..?

I'd push it even further...

The day my T2 father was dying. A slim chap on diagnosis lossing even more weight with vascular dementia.

He was also blood testing hypos...(by a nurse, sub 3.5mmol.) He'd eaten an hour or so earlier..

From what I've come to understand vascular dementia also affects the part of the brain like the ECU on a car "mapping" the precission of the engine & the assotiated components?

Edit to add; he also had "skin tags?"
Asosiated with an over productive pancreas???

 

[Melgar]

not agreeing or disagreeing but do you have any links to back this position that IR alone isn’t enough and beta cells must be compromised?

Excess weight may not automatically cause type 2, as you rightly say there are examples of obese persons without it. But there is a lot to suggest it can, along with other factors that also can

Those that are hyperinsulimic may be on the path towards type 2 just not quite there yet as we pretty much all start out that way. We manage with higher and higher insulin (and presumably functional beta cells to produce it) and normal glucose, until we can’t any longer and it shows up in bgl too. Is that because beta cells fail or IR becomes so great it’s insurmountable even with functional beta cells though?

You say you have no IR (curious how you know this) and for you it’s beta cells (more akin to type 1 or 3 perhaps). You also identify as ”other” type of diabetes rather than type 2 so I’d expect your pattern to be different in that case.

No problem @HSSS, just had a quick look for evidence that insulin resistance alone does not cause diabetes. See quote from attached research paper.

“In nonobese individuals who have become insulin resistant for reasons other than obesity, whether they become diabetic would depend on the balance between the severity of the insulin resistance and the ability of the β-cell to compensate for the insulin resistance, just as is the case for obese individuals. Theoretically, a spectrum could exist: at one extreme, insulin resistance initially might be absent, and the immediate cause would be impaired insulin secretion; at the other extreme, impaired insulin secretion might be absent, and insulin resistance would be the immediate cause. I am unaware of any well documented cases of the latter situation.”

Insulin Resistance Is Not Necessarily an Essential Component of Type 2 Diabetes1

Insulin resistance and impaired insulin secretion are usually present in patients with classic type 2 diabetes as well as in most people with impaired gluc

academic.oup.com

As for my statement that I don’t have insulin resistance, my C-peptides are low, but within still in normal lab parameters. If I have insulin resistance then I would be producing much higher levels C-Peptides, given the correlation of C-Peptides to insulin. As for ‘other’ I have nothing in common with type 2 diabetes other than my age. Even going on a very low carb diet , like under 35 grams per day for 9 months did next to nothing to lower my blood sugars. I was very active rebuilding a small cottage. All that happened was I lost weight I could not afford to lose plus I was in ketosis so given all I read the very low carb and all the activity I was doing should have lowered my blood sugars but didn‘t. My blood sugars are very unstable and I still go hypo. To me that points to a failing pancreas.
My Dr thinks it’s early LADA, hence I have put ‘other’ as reading Type 2 discussions holds very little relevance for me.

 

[HSSS]

Theoretically, a spectrum could exist: at one extreme, insulin resistance initially might be absent, and the immediate cause would be impaired insulin secretion; at the other extreme, impaired insulin secretion might be absent, and insulin resistance would be the immediate cause. I am unaware of any well documented cases of the latter situation.”

Theoretically sure. But aren’t almost all type 2 insulin resistant and producing a fair or large amount of insulin at least I initially, giving credence to the assumption their beta cells are pretty operational? I’d assume the reverse to this and think it unlikely that many type 2 have impaired insulin secretion initially.

Your situation seems to confirm my thoughts that your body and test results have little in common with type 2. Hence my confusion how your situation was relevant to type 2 as the op is.

 

[Melgar]

Theoretically sure. But aren’t almost all type 2 insulin resistant and producing a fair or large amount of insulin at least I initially, giving credence to the assumption their beta cells are pretty operational? I’d assume the reverse to this and think it unlikely that many type 2 have impaired insulin secretion initially.

Your situation seems to confirm my thoughts that your body and test results have little in common with type 2. Hence my confusion how your situation was relevant to type 2 as the op is.

Yes, they are producing a lot of insulin, like over 1000 pmol/ls fasting. If your pancreas is healthy then it will keep on compensating for insulin resistance - 1700 pmol/ls and upwards. That‘s why you can have two identical people, both over weight, eating exactly the same diet, everything being equal, but only one of them is diabetic. Both are completely hyper insulinemic , but the person with diabetes, their pancreas cannot compensate for the insulin resistance. We often cite IR as the driver, me included, but really it’s an inability of the pancreas to compensate for IR.
If you find a research paper than says otherwise I would be very interested to read it.

 

[Melgar]

Sorry @ken355555 I have somewhat derailed your discussion.

 

[LittleGreyCat]

The test that you need is HOMA-IR.
I had one done privately many years back (GP surgery did the blood draw).
This showed that I was producing insulin at a low level of normal but had slightly elevated blood glucose.
Conclusion: I had mild insulin resistance.

The one thing this did do was to confirm that I was not over-producing insulin, unlike the average T2.

 

[Melgar]

The test that you need is HOMA-IR.
I had one done privately many years back (GP surgery did the blood draw).
This showed that I was producing insulin at a low level of normal but had slightly elevated blood glucose.
Conclusion: I had mild insulin resistance.

The one thing this did do was to confirm that I was not over-producing insulin, unlike the average T2.

Interesting. So your issue was your beta cells not able to compensate for your mild insulin resistance. So, removing the insulin resistance, through exercise for instance would give your beta cells a chance to replicate and replenish , if depending on what is causing your diminished beta cells mass / weak islets to fail. And @LittleGreyCat you are on meds as well.

Getting a HOMA-IR test here in Canada would take some doing.

@ken355555 , For what ever my opinion is worth, giving your beta cells a rest by reducing your carb intake so they don't have to keep compensating for the insulin resistance or high carb intake, may allow your beta cells to recover. Also reducing your insulin resistance, depending on how high that resistance is may also help. It might be worth asking how other long term Type 2 diabetics have been able to control their blood sugars.

 

[LittleGreyCat]

Interesting. So your issue was your beta cells not able to compensate for your mild insulin resistance. So, removing the insulin resistance, through exercise for instance would give your beta cells a chance to replicate and replenish , if depending on what is causing your diminished beta cells mass / weak islets to fail. And @LittleGreyCat you are on meds as well.

If only it were that simple.

There are mechanisms which regulate when insulin is called for, when it is throttled, when the liver releases extra glucose.
My BG control seems inconsistent, for example being more able to handle carbs after mid-day for some reason.
Also, my BG over night seems (on some days) to be at the same level when I go to sleep and when I wake up (flat line on my Libre graph) but if I start low it stays low and if I start high it stays high.
All this down for further investigation when I have time and energy.

Fairly strenuous exercise does seem to have a benefit for the next day or so, but this tires me out a lot so there is a limit on how much I can do.

However in danger of derailing the thread.

 

[Antje77]

I have been typed to diabetic for 23 years and my pancreas does not seem to work anymore no matter what I do my numbers are always high what can I do to check if it's still produces insulin

The pancreas does a lot more than produce insulin, so whatever is going on for you, your pancreas is very unlikely to be dead.

According to your profile, you're treating your diabetes with diet only, which can be enough for some but may not be enogh for others, especially after such a long time in.
What type of diet do you follow, and what kind of blood glucose numbers do you see?

 

[AloeSvea]

@ken355555 , the cheapest easiest way to check out your own-insulin production is the c-peptide as mentioned above. You will need to have the results interpreted for you, ideally from your medical professinals.

But, I have never had this interpreted for me by medical professionals, but by my own internet research. And of course, as with everything? diabetes, there are two ways (at least!) to measure it, and different countries measure with different units, so you have to be careful that you are comparing in the right units of measure, also referred to above I believe.

So, you could get your C-peptide measured, and then come back in here with the number (and the all important unit of measure! ie pmol/L or
ng/mL,or nmol/L).

Or order the actual insulin resistance and auto-immune response tests, of course.

Just to reassure, it seems that beta cells, if you have T2D without pancreatic damage (which is the majority situation), do self-repair. (There have been bona fide scientific studies answerng this particular question in this way and easily accessible online.) Which is how many folks with the 'milder' versions of T2D (not my word, but the Swedish endocrinologists who came up with this and published on it) can go into remission, and even pretty quickly. According to my maths on the Swedish research - that's about 66% of those with Type two diabetes.

About 25% of all people with diabetes, including type 1s, are insulin-dependent, according to those Swedes, so their pancreases and or/beta cells are damaged and the person with diabetes needs to have insulin in order to survive.

So yes, the trick is to find out which type of diabetes you personally have, and be treated accordingly.

Your healthcare professionals should be able to answer this because they did the tests at diagnosis time. (Or, your symptoms made it very obvious which type of diabetes you have, therefore, the state of your pancreas.) No self-respecting diabetes specialist would be phased by you asking such a baseline important question! Nor of course, to answer it.