Proberly a silly question (s)

It's not a silly question.

Many T2s do use insulin, and I'm sure that there are some on pumps - although I'm sure that it would be much easier to calibrate a pump for a non-insulin producing T1 than a T2 who is still producing some of their own.

Some T2s who start off on diet and metformin end up on insulin as there pancreas function declines. Some, like Sid, start off on insulin and manage to come off it when their control improves. Although in general, I think it's only used as a last resort for T2s, as the downsides of using insulin include hypos and possible weight gain.

Angela(NZ) said:

Hi

This proberly a silly question, but why cant a type 2 on insulin have a pump like some type 1's do?

another question, how come a type 1 can inject insulin to cover carbs but a type 2 cant? is it because a type 2 can become resistant to insulin?

Click to expand...

Firstly you need to understand that insulin doesn't just control blood glucose, it has a number of other roles in the body the primary one being the control of the fat metabolism. Secondly you need to understand that there although the outcome of the condition is similar (raised blood glucose) the mechanisms that cause the outcome are quite different.

Type I diabetics produce very limited or no insulin. This means that they must inject insulin in order to live... the insulin that is injected doesn't just cover carbohydrates it also helps regulate liver glucose, the fat metabolism, etc...

Type II diabetics initially have a resistance to insulin... so they still produce insulin, in a lot of cases a lot of insulin but this isn't utilised properly. Insulin resistance tends to be caused by excess body fat.. so in a type II diabetic where insulin is causing a build up of body fat, which is making them more resistant to insulin the last thing you want to do is add more insulin to the cycle! Thus a number of other drugs are used to try and decrease insulin resistance or decrease glucose uptake.

Now add to the mix that high blood sugars cause damage to the beta cells in the pancreas that produce insulin.. what this means is that some type II's due to poor control (or having the condition for a long time before diagnoses) have damaged their pancreas to a point where it can't produce enough insulin.. in these cases additional insulin tends to be prescribed.

Incidentally Type I diabetics can also have insulin resistance like type II diabetics this is known as 'double diabetes'. There could also be I guess a case where a type II diabetic has damaged their pancreas so much it ceases to function effectively making them type I but I should imagine this is pretty uncommon.

The primary difference in blood glucose between a type I and type II is that in a type I the range and speed of change is much greater.. this means that it much more difficult to control.. pumps tend to be supplied to those people who struggle or who are just pre-disposed to have difficulty controlling blood glucose.. there would be no real medical need for a 'normal' type II to have a pump as the purpose of the pump is to try and decease the erractic nature of type I diabetes, not just to be an easy delivery method for insulin.

Pneu said:

The primary difference in blood glucose between a type I and type II is that in a type I the range and speed of change is much greater.. this means that it much more difficult to control..

Click to expand...

Angela having a Type 1 son and being Type 2 myself I get to see the difference in action.

If we assume both he and I are aiming to maintain our BG's in the same safe range at all times then I would sum it up like this.

It is far harder for my son to physically control his BG's on say a minute by minute or hour by hour basis. He not only has to factor in what he's eaten and calculate how much insulin he has to inject but also factor in things like how much exercise he does or even if he has taken the bus or walked to walk and of course he has the constant worry and anxiety of over injecting and hypoing etc. which I don't.

For a Type 2 who aims for an equivalent BG control then I would say the hard part is the psychological control and mental strength you need to develop to keep your BG's in a safe range through diet for what amounts to the rest of your life. The aim as far as I'm concerned is to keep my BG's in a safe range through carbohydrate intake control as that will give me the least chance of diabetic complications. Other Type 2's elect knowingly or unknowingly to control their BG's via drugs but drugs will only do so much which is why as a Type 2 developing carbohydrate intake control is so important (it is for Type 1's as well)

Of course the big issue is what is a safe range. I define it as trying to keep in the range that 19 out of 20 non diabetics achieve that is under 6.5 two hours after every meal some people are willing to take more (and some a lot more) risk and some less.

Still not entirely happy with that explanation but the best I can convey.

Angela(NZ) said:

Hi

This proberly a silly question, but why cant a type 2 on insulin have a pump like some type 1's do?

another question, how come a type 1 can inject insulin to cover carbs but a type 2 cant? is it because a type 2 can become resistant to insulin?

Click to expand...

Hi Angela,

If you read Sir Steve Redgrave's article here,(he has Type 2 diabetes) he is on a pump but he is very much the exception to the rule. I would surmise that his training and performance makes him prone to hypos. I have read of Type 2's in America having pumps too but am not privy to the reasons why.
http://www.nhs.uk/Conditions/Diabetes-t ... grave.aspx

There are many T2s who use insulin pumps, it all depends on who is doing the funding.
http://docnews.diabetesjournals.org/content/2/8/5.full
One problem that can be associated with it. is that most T2s have far bigger insulin needs than many T1s. The maximum capacity of a pump reservoir is 300u, some T2s may need to change the reservoir daily . This was the case of the one T2 I've met it France with a pump. Having said that I have also read of people with very strong insulin resistance and thus taking huge amounts of insulin who have used U500 (an extra strong insulin) in a pump.

In the diabetes 'community' the author of this book is well known for being a 'pumper'.
http://www.amazon.com/Successful-Diabet ... 1461143551

Hi.
No its NOT a silly question at all ...
Thanks for raising this up as it is something I too have wondered about.
Have read these replies with interest .
However we are a bit dependant on type 1's to help out with answers here !
My own DSN has subletly hinted that I may have to eventually hook up to a pump.
On the financial thing we could afford to buy one .
As I will 'struggle' with MDI regime. [am on basal only they're reluctant to let me go bolus as]
My maths is terrible will probably underdose or even overdose myself !!!
Memory is dreadful also, plus am very weight gain concious and phobic.
Had open heart surgery and am at risk . [hole in heart]
On the famous person thing, halle berry is type2 I think?
Looks fabulous and has a successful life .
Anna.x

You need to keep in mind a pump is not going to manage your diabetes for you.. pumps still need an awful lot of user input.

I would love a pump more than anything for the extra flexibility it would give me in relation to exercise and basal control (I am injecting my basal 4 times a day at the moment).. But given my MDI control the NHS is unlikely to fund one any-time soon!

Here in Canada we have many type 2 pumpers. I have three personal friends who pump. T2 is progressive, and eventually insulin is required <- assuming you follow standard disease management. Many of my online friends work backwards. ->

Heavy insulin using type 2's are in my opinion the hardest people to manage, They make some of their own insulin, have insulin resistance, take many meds some, struggle with diet and exercise, blah, blah, blah. Worst case patients, not all. Doesn't it make sense to give the most difficult patients the best tools?

The decisions here are made between endocrinologists and private health insurers

xMenace said:

..........T2 is progressive, and eventually insulin is required <- assuming you follow standard disease management.

Click to expand...

.......Simply not true.

xMenace said:

T2 is progressive, and eventually insulin is required <- assuming you follow standard disease management.

Click to expand...

If Canadian standard disease management is the same as the UK's "always eat starchy carbs and not tell the patients the real dangers of high blood sugars" then maybe that could be true but it is still a very self defeatist attitude.

If you control your BG levels by diet so that they remain in a normal non diabetic range and even help by including passive drugs like Metformin then you can slow the progression down massively so that with luck something else kills you first and you will not need to progress to insulin. That's a far more positive message and not unrealistic.