Type of Type 2

[markd]

A friend of mine has just been diagnosed with T2 (great timing just before Christmas, huh?).

His fasting is consistently just high enough to be diagnosed, but his post meal figures seem to be OK - at least in the week or so of testing he's been doing, always around 4.5 at two hours.

He's not had an OGTT (yet) that may happen on a future visit, for now, he's been diagnosed just on the fasting levels.

So, the question he asked me, to which I didn't have a ready answer, is what is the prime cause of his T2 - is it insufficient insulin being produced, or insulin resistance that prevents him using it properly (I copped out and said maybe a bit of both...) He's 45 and a bit overweight, maybe 3 stone at 6ft-ish tall.
With some people, it is the fasting that goes out of control first, with others, it is the post meal - so I'm simplistically thinking one is related to a knackered pancreas and the other to IR - but which is which - or is it not as simple as that?

And Merry Christmas - or what is left of it. Well, Happy New Year anyway...

MarkD

 

[Daibell]

It's not easy to distinguish between Type 2s with IR and those with a lack of insulin. Your friend's GP needs to do tests such as C-Peptide which they may not choose to do. 20% of Type2s aren't overweight and probably not IR. To me the important thing is BS level 2 hours after a meal as this will measure the influence of a meal on BS levels. Fasting tests can be influenced by overnight liver glucose dumps so may not indicate much about your average BS. The HbA1c test remains a good measure. Diabetes is much more complicated than just one category or the other. For example I'm not IR although my GP has never tested for this. The med that has the most effect for me, for example, is sitagliptin which affects an enzyme that influences the pancreas' output so I may or may not have knackered pancreas. Gliclazide has little effect although it should do and so on. We're all different with no simple answers! Your friend should start first by looking at diet and keeping carbs under control (see relevant parts of this forum). The surgery should do an Hba1c test in the coming months and that should give a good indication of the next steps if any to take.