Type 2 Risk of complications?

I'm certainly no expert, even if I have had T2 since Nov. 2005, no actually, quite a bit longer, because I remember my toes having that 'cottonwolly' feeling long before that. Anyway, I lost weight, came in remission, joined the Danish diabetes association, and received their monthly mag. For me the motivation was and still is to avoid all those complications, so my heart sank when one article was all about how even those with good control still risked losing a variety of limbs etc. etc. What I did decide to lose was my membership of the Danish diabetes association, and the monthly mag with all the adverts with healthy, happy looking 60 odd year olds buying all sorts of diabetes paraphernalia and disheartening articles + recipes. I just didn't need being discouraged.

Anyway, that's why I took notice when recently in a thread in here (can't for the life of me remember which), someone mentioned that it might not be high blood glucose that causes complications and further havoc, but an excessive amount of insulin (IR) floating around in one's bloodstream. Somehow it makes sense, but is there a way of bringing it down? I'm quite sure I'm insulin resistant, but after 8-9 months of eating very low carb could it have improved? What's your take on that? My BGs are well controlled, and have been since April 18. I'm just wondering if my WOE is not enough to prevent complications later in life. In other words - are we doing enough, or can we do more?

I started this question as a reply to this thread https://www.diabetes.co.uk/forum/th...ly-to-have-an-amputation.159532/#post-1944889, but didn't want to derail.

helensaramay said:

That's an interesting theory.
However people with type 1 are at risk of complications but we have no insulin floating around our blood stream

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Thanks, Helen. It's such a puzzle, isn't it? I still can't seem to really understand what's actually going on, but a T1 who accidentally gets her insulin dosis wrong and injects a dose larger than needed, well, that would result in a hypo, right? Hence no surplus insulin.
I suppose I'm not over that article yet, because if a T2's BG is always within range, what's causing the complications?

Resurgam said:

After eating low carb for two years since diagnosis I am pretty sure that my response to insulin has quickened - my BG level reduces as the carbs are stashed away as fat, no problem.
Insulin is released as a response to glucose in the blood going up - so having reduced that it does seem to restore normality, as much as it ever was for me.

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I've been doing it for 8-9 months now. I don't normally experiment with carb intake, but keep it as low as possible. It would seem that I'm in mild ketosis (1.3 last time I checked), but then one morning I tried eating 12g of carbs in an attempt to stop what I assumed was a liver dump. My FBG was an annoying 6.2, and one hour and 12g.s of carbs later it was 10mmol/l That's why I assume I'm still badly IR. I should be working on my patience instead. Thanks, Resurgam.

Resurgam said:

Perhaps it depends how you define good control.

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Of course, and a HBA1 won't really give you the right impression if your graphs look more like a Himalayan landscape than a wheatfield. The 10 mmol/l I mention in my previous post is by far the highest they've been since spring. My daily estimated A1C is somewhere between 4.7 and 5.5. Very rarely any highs or lows.

Jim Lahey said:

but there is apparently research which shows that good glucose control by itself is not associated with better long term health outcomes in those using hypoglycaemics and exogenous insulin.

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Thanks, Jim. That's pretty much on par with that pesky article from years ago. I still use crutches (metformin and victoza), and as my weight loss seems to have stagnated for the last couple of months, even when eating very few carbs, I'm just feeling a little hopeless today. As if I'm not really going anywhere. At least I know that my feet haven't deteriorated in a year - and I have both of them Yay!

Jim Lahey said:

I have no knowledge of Victoza though.

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My gut feeling, and that of bloodsugar 101, tells me that its not nearly as harmless, but at least my dose has been reduced by 1/3rd, and I've come of the SGLT2 inhibitor called 'jardiance' a couple of months ago. I hope it doesn't linger about in my body for too long. If I do manage to get off all meds eventually, I'll consider it a major miracle. The advantage of injecting myself with victoza is that I get all test strips for free. Always look on the bright side, and all that

Hmmm, just looked it up. "Liraglutide [victoza]works by stimulating the secretion of insulin as well as suppressing the secretion of glucagon in a glucose-dependent manner.". Not really what an IR T2 would be looking for. Better take that up with my DN.

Bluetit1802 said:

T1s inject insulin, so there is insulin floating about,

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Ok, here I go again asking silly questions ... So a T1 injects insulin, but without IR surely that person's various cells would use all that insulin, perhaps causing a hypo? An IR T2's body would go 'right, more insulin. Who cares. My cells can't use it anyway"?

Jim Lahey said:

This is true. In fact many T1 become insulin resistant and develop T2 on top.

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You live and you learn. I didn't know that (either )

Jim Lahey said:

this topic of ‘complications irrespective of blood glucose levels’ was one of my driving factors in getting off all drugs.

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You and me both, and I hope to be able to keep off it if I manage once again. Hate that wagon.

Jim Lahey said:

T2s can batter their pancreas so hard that it goes on strike

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I did know that. That the pancreas might stop producing its own insulin altogether. I really do consider myself fortunate that after 13 years I'm still ok, to the best of my knowledge. Other people shout at their tellys when watching soccer matches, I do it when watching programmes on nutrition.