• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Type 2 progression to insulin

HSSS

Expert
Messages
7,675
Location
South of England
Type of diabetes
Type 2
Treatment type
Diet only
A comment was made on another thread that many type 2 progress to insulin within 10 years due to beta cell damage. (In order not to derail that conversation I though it would be interesting to continue this here.)

Is that an assumption based on continued consumption of high carb levels and a medication only approach, and is it often more than 10 yrs?

To my view it is an “assumption” is that beta cells have worn out due to type 2. It’s likely many of these are caused by the wringing out every possible drop of insulin of the already massively overproducing pancreas by medications such gliclazide. It’s also highly likely that many still overproduce, not under, but have become hugely insulin resistant which mimics underproduction.

Few type 2 are actually tested for insulin or c peptide production at diagnosis nor before being moved onto insulin. Even fewer have beta cell checks made (can that even be done?).

So how do we know why so many progress to insulin - if in fact they even do so - and at what point in time after disease onset/diagnosis.
 
As far as I can remember the cycle to insulin is
1. Too many carbs and polyunsaturated fats.
2. Inflammation of the endocrine organs
3. Prediabetes, with 4.
4. Insulin resistance.
5. Hormonal response.
6. Circulating insulin.
7. Fatty liver (NAFL) and liver and kidney function
8. Hypertension, hyperinsulinaemia, insulin resistance, insulin response.
9. Burn out or insulin not having effect on glucose.
10. Insulin.

There are many things that could change if dietary advice is known. Insisting on eating what you can't tolerate is what progress the condition.

We are all different (again!!) This list does not happen to all T2s, it all depends on the cause of the condition and how your hormonal response copes with your dietary response.

Medication should be tailored to what type of T2 the patient has, and what stage has the condition deprecated. So if like me, your initial insulin response is poor, you will need a drug designed to increase insulin, so that my body can cope with too much glucose. And helps stopping the secondary insulin response.

Apologies if this is not quite right.
 
Time was people believed that we could not get T2 diabetes into remission and that many/most would progress to needing insulin and too many lose eyesight, develop such bad neuropathy it affected walking and maybe lose toes/feet. My mother was one of these and went almost blind and could barely shuffle a few steps - but could not give up cakes and sweets. I would take lower carb treats when I visited but her carers used to supply the sugary stuff and the 'very sheltered' accommodation she was in had two or three parties a week with cake, biscuits. squash to drink and a few white bread sandwiches with ham or cheese. Not even the so-called Eatwell plate was as bad!
My GP agreed I could try low carb first before accepting the statins and metformin, but in spite of this success I haven't heard of anyone else being offered low carb there and the other doctors at the practice always tell me I am on a low carb/HIGH FAT diet and tell me it isn't good for me.
In spite of thousands of us demonstrating that low carb works - whether we get into remission or stabilise/reduce the drugs while keeping BS under control - the medical profession as a whole hasn't caught up.
 
I've always eaten a heavy protein diet but also ate simple carbohydrates more with occasional sugary treat. However once I went off the rails and then into burnout did I need insulin. Because of my body weight I was hugely insulin resistant. Muscle needed insulin to function and supply energy. Hence my protein intake also needs insulin. I'm very careful what I eat with protein my priority in a meal or snack depending which one I prefer. Yogart has plenty of protein for me at times. However fruit needs insulin... for me. So I've managed a low calorie, low carb and high protein diet but it still needs insulin. Untolerated high amounts of Metformin needs support. The safest med I feel for me is low amounts of insulin as a result. This can be reduced minimally to encourage small weight loss. I would still be 14st even on no injected insulin so circulating insulin doesn't seem to be very positive on my body. I'd need to swim athletically or jog/run to turn that production into positive energy. Throughout I have an inability to sleep unaided. No matter how strict my routine. I'm guessing adrenaline plays a huge part on which I've lived off since my babies were born.
I'll never be 9st or even 10st woman. My own insulin or liver excretion works overtime..... for now. No matter my diet, exercise or medication routine.
 
I was diagnosed 10 years ago. Not needed insulin yet, but since Covid (March 2020) I am finding it more difficult to control BGs with diet.
 
I paid for an IR test a few years back.
Insulin production low side of normal, fasting BG slightly elevated so some IR.
13 years in I am still managing on Metformin, diet and exercise.
Normal weight so not much scope for improvement there.
I can manage on very strict low carbohydrate but it is BORING!
One day I will have to got to the next level of medication.
Further on no doubt I will have to go to insulin.
Just not yet.
 
As a #T2D that did progress over 10 tears to the point of being referred for insulin therapy. and as I have said on other threads, my bgl was way out of control even when maxed out on gliclazide and Metformin, then I would have been just another statistic indeed.

However, I found this website here and changed my lifestyle, and have been in good control for some 7 years now. I have minimised my medication and can eat toast and tatties again without feeling guilty.

I am a single (n=1)_ example of why the NICE guidelines are wrong for many T2D, and that often it can be a recoverable condition. There are many testaments on this site claiming similar reversals, so I know I am not unique.

Recently I had to go into hospital where I was placed back on the NHS idea of a 'healthy diet' known as Eatwell that is the low-fat high-carb diet like wot I used to follow. When I came out my bgl control had dissolved into mush, and I had to start again. Had I continued with the NHS diet, then I would indeed progress back to requiring insulin therapy, but as it is I have regained my lifestyle and control within a week of discharge. My beta cells are still functional and responding to the demands of my diet.
 
Whilst personal experiences are always interesting to read about I guess what I’m looking for is expert or evidence based opinions and studies that explain what is actually happening and why this occurs.
 
Again this is personal experience, sorry. It might help to explain the expectations of the medical profession though.

I recently collapsed whilst out walking, pushing myself to get back to my fitness level of 18 months ago. Two experienced nurses stopped to help me. They asked if I was diabetic and if I was having a hypo. I said I was a diet controlled T2 and had never had a hypo in 10 years. They asked if I deliberately ran my BGs high so that I didn't hypo. I said No, I am well controlled and exercise doesn't lower my Bgs. I don't hypo as I am not on insulin and don't have reactive hypoglycaemia. If my Bgs start to take a nose dive my liver always helps out.
They said I needed to be on insulin as I must be running my BGs too high. The idea that BGs could be controlled by diet was alien to them. I gave up and let my hubby assure them he would make sure I saw my GP.
 
HSSS said:
Whilst personal experiences are always interesting to read about I guess what I’m looking for is expert or evidence based opinions and studies that explain what is actually happening and why this occurs.
Click to expand...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811457/
https://care.diabetesjournals.org/content/37/6/1751
https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-015-0140-6
https://www.everydayhealth.com/hs/better-type-2-diabetes-control/how-diabetes-changes/
http://archives.diabetesforecast.org/2015/sep-oct/type-2-diabetes-progression.html

Dr Google is quite informative on this - there are more
 
Did hubby drag you screaming and kicking to the GP?
 
Oldvatr said:
Did hubby drag you screaming and kicking to the GP?
Click to expand...
Lol no. He wouldn't dare . He just wanted to get the nurses to leave me alone so I could recover from my fainting episode in peace.
 
OMG! Its scary. I worry when I'm unable to manage myself. I will have to get a solicitor involved otherwise I'll be dead or blind or similar.
In hospital a few weeks ago I was allowed to manage my own insulin it was liberating. I'm hoping you can feel the smile on my face right now. I'm happy to do that going forward. Unless I become soooo forgetful I cannot manage but I'll write a flow chart for Carers. Even for my partner and sons who help me with my health needs already.
What it all depends on is long standing over 8s but with urgency if over 10s and I'm a huge believer in if everything has been tried insulin is needed when running 18s+.
Everyone is different but the meter and the hba1c is still the answer to detecting a huge problem for type2s. With numbers just mentioned action is needed and if all has failed insulin is needed regardless of years diagnosed.
I hope this helps @HSSS ?
 
I think NICE recommendations can influence hugely on how we Type2s are treated by GPs.
I'm soooo close to perfecting the best I will ever get with or without insulin. So my GP can manage my care going forward. My thyroid is managed by same Endocrinologist so maybe they will both be cared for by GP? Maybe.
In my experience different health authorities prioritise differently too.
 
Frightening the level of ignorance about how hypos occur in medical staff, regardless of the role diet takes.
 
I’m not suggesting insulin is never required. It very definitely has an important place in the arsenal of potential treatments.

I’m just very concerned that it is being used before “all has failed”, when lack of insulin isn’t the main issue and when it might just add to the problems rather than address them.
 
 
I think if health authorities set out a better plan of action to prevent insulin need then this can help thousands. Like I've witnessed. Even I don't know how to safely reduce or get rid of medications for diabetes (other than metformin and insulin - I personally can). I'm unsure how to get rid of high blood pressure, thyroxine and asthma medications safely.
GPs are great at prevention and treatments but not keen on reduction or resolution.
Myself I'm happy to stay as I am with these meds rather than risk death or heart attack/strokes. Everytime.
I wish though there was a clear pathway/alternative management. To chose from rather than suffer medications and their side effects. I'm happy not to ever have a stroke or heart attack so prevention has been fantastic for me and especially my kidneys.
 
Especially if a c-peptide shows not enough insulin.
 
HSSS said:
Whilst personal experiences are always interesting to read about I guess what I’m looking for is expert or evidence based opinions and studies that explain what is actually happening and why this occurs.
Click to expand...

I'm sure it says expert under my avatars!
Ok, I give in. I am a layman, who for the past twenty years or so has had to put up with poor dietary advice. Until I got a true diagnosis, my reasons for research was crucial.
Because it was so rare. I have learned so much on this site, that when my wife was diagnosed with T2, I wanted to learn how to control T2.
 
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…