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What makes someone T2?

D

Dippy999

Member
Messages
9
Type of diabetes
Type 2
Treatment type
Diet only
Hi, new member here! I have asthma and have an annual medical review and blood test. In September 2022 I had an A1c of 6.1%. In the following year I reduced my sugar intake but didn’t do much about reducing carbs (ignorance!) and upped my exercise. In September 2023 my A1c was 6.2%. This year I was quite ill with some massive inflammatory reaction - cause unknown but I have my suspicions. My blood test showed I had an A1c of 6.6% and two weeks later it was 6.8%. The latter high number being attributed to a 5 day course of Prednisolone. I was diagnosed with T2.

I was shocked into action. I started reading and slapped on a CGM. I immediately overhauled my diet and reduced my carb intake, learnt about the T plate and combining carbs with other food groups, etc, etc. the CGM. Within a few days my average blood sugar was showing at 5.4 and 96% of my time was spent in a range between 4 and 7.9. I wake up every morning with my blood sugar in the high 4/low 5 range. I’ve been monitoring for about 8 weeks now and have another round of blood tests scheduled for mid October. I’m not taking any drugs to lower my blood sugar. I should add that I understand that CGM readings are not the same as an A1c and also that they contain a margin of error.

So my question is as follows. It seems that no matter how well I control my diet going forward I am forever labelled as diabetic or at best a diabetic in remission, even if I never stray into the high zone again. There must be something else that validates/confirms diabetes. I have read about glucose tolerance tests and fasting blood sugar tests but none of these have been offered to me. So other than a brief foray into the twilight zone, what is it that makes me diabetic?
 
Hazarding a guess here, as professionals might not agree: You're a T2 diabetic when you have insulin resistance / impaired insulin sensitivity. Plenty of insulin floating around, but your body can't use it like it should. So you may be able to keep your numbers in range, (as I have these past 8 years), but still be diabetic, because something doesn't quite work like it should, anymore. You could request an oral glucose tolerance test, but it would just show you're a T2, as you've been in that range already. It'd not really add anything, so might be hard to wrangle one.

That said, if you are on strong steroids daily, for the asthma, your diabetes could be steroid induced. Doesn't really change anything, as you're not about to magically be cured and not need the steroids anymore, but something to take into account, maybe. (Some people take come comfort in knowing it's not something they could've avoided, as certain meds are just plain necessary.)

Hope this helps,
Jo
 
It's a bit of a circular argument usually: you're diagnosed as diabetic because you have high blood glucose, and you have high blood glucose because you're diabetic. I don't find that at all helpful.

Despite what I'm about to say, if needed I will normally just tell people I'm "T2 diabetic, but my blood glucose is currently normal" and leave it at that.

I actually think of it as having a metabolic condition. For me, that means that something in my insulin response system isn't working properly, which means that if I continually overload it with carbohydrate and glucose, it will start to fail. I don't know what bit isn't working properly and like you I've never had an OGTT or any other test. Damage to nerves and capillaries is caused by elevated blood glucose levels over time, so to me it's important to keep my BG levels low, particularly as I start to take damage with a BG of around 43 or 44.

Overloading my system is exactly what I used to do when I followed the healthy eating guidelines and ate lots of starchy carbs, vegetable and seed oils, and very little fat. That took me out of normal BG range around 2010, and steadily but slowly HbA1c climbed to 50 by 2019. Along the way I picked up an increasing number of symptoms caused by my elevated blood glucose. I don't know, and i don't want to find out, what would happen if I again ate as I did in 2009 - would I again take ten years to get to "officially diabetic" levels? Five years? One?

My other analogy is that it might be like having a broken leg. It can heal, and it might seem to be as strong as it ever was, but the only way to really find out is to risk breaking it all over again,

As diabetes has always been viewed by most medics as a progressive, incurable, condition, manageable only by medication etc etc it follows that if you stick to this line then, once diagnosed, the patient must therefore always have it. This of course ignored quite a huge chunk of history, science and knowledge but that's how it happens. Remission was (a few years back) defined by my practice as a full 12 months of normal (ie sub-42) HbA1c results in the absence of glucose lowering medication. That to me indicates seeing remission - the absence of disease symptoms - as a complete absence over time of the defining feature of T2 - elevated BG.

These days the official line on remission is to have two sub-48 A1c readings three months apart, no glucose-lowering medication. So officially as T2 you can be in "remission" but still have substantially elevated BG levels. I suspect this is more about setting a means to pay GPs for doing something about diabetes than it is about people's health.

It's not that long ago that what we now call Type 1 and Type 2 diabetes were often thought to be different aspects of the same problem - being described eg as "insulin-dependent diabetes mellitus and non-insulin dependent diabetes mellitus". Gary Taubes' book "Rethinking Diabetes" is very good on the history of the conditions and their definitions, which often had less to do with science and more about who's got the power. Testing blood glucose and even the classification of Type One and Type Two is a much more recent development than I'd thought.
 
Thank you for the reply. From what I’ve read not all diabetes have insulin resistance, especially those who are not overweight to start with. The steroids are a whole other bag of worms, I agree. I’ve had different responses from different doctors, some saying that inhaled steroids make no difference whilst others saying the complete opposite. Oral steroids are a different matter and my exposure to them has been pretty limited of late.
 
What makes someone T2 ? T2 is a complex metabolic disorder. In the vast majority of cases, T 2 has two elements - Insulin Resistance and a pancreas that cannot produce and secrete enough insulin to overcome this resistance to insulin.

T2 is a long time coming. Many people become insulin resistant over time. What this means is the insulin your pancreas is producing becomes less effective. Insulin allows blood glucose to enter your cells. It acts like a kind of key. If you become insulin resistant this key no longer works so the blood glucose cannot enter your cells and convert to energy. So this glucose hangs around in your blood giving rise to higher blood sugars.

Insulin resistance appears in none diabetics too, but the difference in insulin resistant none diabetics and insulin resistant diabetics is the pancreas’ ability to produce and secrete enough insulin to overcome this resistance. With none diabetic , but insulin resistant the pancreas can produce enough insulin to overcome the resistance. That is why you often hear T2 is a disease of pancreas insulin insufficiency. T2 occurs when the pancreas cannot produce enough insulin to overcome the body’s insulin resistance.

That’s it in a nutshell. Obviously there are many more elements to it, but in classic Type 2 diabetes (T2 covers a number of blood sugar issues but IR and pancreatic insufficiency are the main ones).

@Dippy999 I see you are taking Prednisolone. Prednisolone is a corticosteroid. corticosteroid increases insulin resistance significantly. Likely the Prednisolone is raising your insulin resistance beyond your pancreas’ capability to overcome this resistance. It may settle down when you stop the Prednisolone. Still, many members here reduce their blood sugars by giving their pancreas a helping hand, either by significantly reducing their carb intake or and exercising.

Your pancreas’s inability to produce enough insulin fir whatever reason, genetics or some insult, likely means as soon as you try and resume a ‘normal’ diet your pancreas cannot respond, hence the diabetes label.
 
I don’t have insulin resistance @Dippy999 and I’m thin and athletic. My pancreas does not produce enough insulin.
 
Thank you for this very thorough response and yes, I agree that it seems to be a very circular argument.

But what you wrote has given me food for thought. My diabetes diagnosis came at a time when I was suffering from really high inflammation and the results are further muddied by the steroids. My weight has never been an issue though I do fluctuate up and down but in a relatively narrow range. My blood glucose levels have returned to normal in a few short weeks and I’m hopeful that the next blood test will confirm this. I think my questions have been triggered by the speed at which my readings have stabilised but we will see. Maybe I need to get my head around your approach of I'm "T2 diabetic, but my blood glucose is currently normal" and leave it at that. Thank you again.
 
As someone has already stated you become T2 when your hba1c is above a certain level from two blood panel tests at a specified time between.
However, T2 is a label.
There are many causes to get you to that hba1c level, it might be the steroids, it might be something completely different.
There are many types of diabetes or conditions of a metabolic disorder, syndrome or conditions that effect your organs.
There are many different hormonal imbalance issues within endocrinology.
This effects your first phase response or second phase.
Intolerance to such as carbs is a factor.
Inflammation is a precursor in your gut.
Gut bacteria is another factor.
BTW, there is quite a bit I have probably not posted.

It's so complicated and individual.
What works for me, possibly won't work for you.

It's a chance for you to do something about what needs to be done it you want to lower your hba1c levels into or around normal levels.
How you do it is up to you.
We on here have found the low carb approach beneficial.
How you do it is up to you.
 
Some excellent answers here, I hesitate to even try to add anything, but it is horrendously confusing and difficult to make sense of ... but I think after a lifetime of ... doing what you're told and then taking the medicine when things go wrong, it's just too easy to hold on to that paradigm, when we are all so complex.

Part of the "circularity" is just a question of statistics. You; many on this forum, will be motivated to control the underlying drivers of this metabolic condition better than others who will never be diagnosed, but the statistics population-wide are against us. The system must be wary, because it sees the condition as fundamentally a chronic, degenerative disease. The good news is you can choose not to see it that way; but in the meantime, you get free eye tests for life, so it's not all bad...

Then, yes, insulin resistance. It's a slippery ****** to pin down exactly what it is, because there are many causes, and one of the effects is that it requires more insulin, and you go round in circles.. so for example, the stress hormone Cortisol will trigger insulin (you can see where that's going, Cortisol is a Cortico-steroid, so all such drugs will trigger insulin) - and the effect of that over time is insulin resistance.. even if you never touched carbs. It's really because insulin is a hugely important hormone, but meant to be used sparingly, so it's easy to get into a spiral. Some of the time this is normal, we all go through a period of significant insulin resistance, for example, but we call it puberty... so you can take from that that we can reverse it, if we find a way to stop the thing which is creating that insulin response, and that will be different for different people.

It is complicated, but you already have all the important things you need. For what it's worth, I haven't yet officially reached remission, but after about a year, I'm of a mind that I'm grateful for having to learn just how important all of this is ... forgetting whether you are labelled as one thing or not.
 
Thank you, that’s a really clear explanation and one of the best I’ve read. It certainly beats the common explanation that you’re diabetic because your blood sugar is too high. I guess that I would summarise it as ‘high blood glucose is a symptom and pancreas malfunction is the cause’. I’m already on a low carb diet and my glucose levels are in the normal range so I need to continue to manage that. I’m also off Prednisone though I continue with inhaled steroids. The jury seems to be out on whether inhaled steroids affect blood sugar or not.
 
Thank you. I’m starting to understand just how complicated and variable it can be.
 
I had a great-aunt who lost a leg to diabetes when she was well into her 60s. i can picture her in her wheelchair every time I’m tempted by carbs or sugar. That’s highly motivational. And just to say that I’m of an age where I already get free eye tests
 
I take Prednisone for eye inflammation and oedemas. I have an eye disease. I’m on a wait list for corneal transplants. The reason I mention this @Dippy999 is the Prednisone. My surgeon assured me that the steroid eye drops do not cross into the blood stream. I certainly haven’t noticed any significant rise in my blood sugars when I do take them . So I’m guessing with your inhaled steroids it may well be the same. The steroids do not cross into the blood stream.
 
If you're already getting free eye tests, then I'm right out of peppy benefits for you... <grin>

The role of the Pancreas is critical, and obviously if it is damaged - that will be the determining factor.

Others suggest that insulin resistance and rising blood glucose can happen even with a totally undamaged pancreas.

This is one way of visualising the situation-


I'm in no position to say "this is correct" - but my reading of the chart is;

At the start, as glucose rises, insulin rises to cope (the one thing common to all types of Diabetes, is that too much blood glucose is toxic)
The crossover could be after decades, with; if you will; classic T2DM, or much quicker with damage to the pancreas, but for a bunch of possible reasons, insulin drops off (but remains higher than at the start) and so blood sugar shoots up, leading to diagnosis.

The point of this chart, is that the period where insulin is high, but you have a "good" level of blood glucose, is still potentially very bad, because insulin is incredibly powerful and affects hundreds of processes. To stretch the metaphor, it's like taking heroin for a headache; it will resolve the headache, but there may be trouble ahead...

I'm slightly asthmatic, and use inhaled steroids (though I've reduced my dosage through this year) - all the research I've done (which adds up to nothing you should base anything on) is that injected cortico-steroids will affect insulin in exactly the same way as Cortisol created in your body, but that inhaled steroids are too low of a dose to have an effect (you would have to inhale massive amounts to have enough absorbed into bloodstream; they are really designed to act locally in your lung).
 
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there’s some recent research that suggests there’s a link but there’s no definitive answer and doctors tell me there’s no crossover.
 
No problem. I have never had a shortage of insulin (attested to by my ability to gain weight very quickly) and no pancreas problems that I'm aware of. It's my belief - without much evidence to support it other than many accounts on this forum - that what we call "Type Two diabetes" has a number of causes that produce symptoms that are often similar, but which can also be very different.

After all, if your car suddenly started to do 5 miles to the litre rather than its normal 20, there is a number of things that might cause the same effect - the mechanic calling it "fueletes" doesn't really tell you much about which bit has gone wrong and needs fixing.
 
So what I get from this chart is that after all the years when I’ve been having my blood glucose tested I (everyone) would be better off if the medical profession was testing our insulin levels. Is that correct?
 
Yes, I’ve learnt a lot just from this thread and I can see how different everyone is.
 
Hi everyone. I'm a newbie to posting although I have followed the site for nearly a year. I've found everything I've read so interesting and helpful, particularly this thread, and learnt so much. I'm a woman in my 70s and have never been overweight. I had an HbA1c in May 2022 of 50 - my first one ever despite my family history being on my medical records. I thought I was only getting a cholesterol check. Two weeks later it was retested at 45. Since then I have gone low carb and finger prick tested, but my levels have remained firmly pre-diabetic at 46, 47 and 45 (July 2024). At least I now know the score.

I have a long family history of diabetes - my mother, my grandmother, my great-grandmother (who had a leg amputated), and my daugnter who is also now pre-diabetic and had gestational diabetes in 2015 with her second pregnancy. Has anyone here come across MIDD or Maternally Induced Diabetes and Deafness? I have worn hearing aids for some years. Is this it? My GP has never heard of it. My sister in Australia has a HbA1c of 41 and has already been prescribed metformin as a 'preventative measure' because of our family history - not a route I'm keen to follow.

I had a private Kraft Test (not cheap but worth it to me) in April 2023 which tests for glucose tolerance and insulin response side by side, and which showed I have a very poor insulin response, as though my pancreas is slowly wearing out, so maybe that is the weak link in my family history. I don't understand why more insulin testing doesn't take place as a general rule as surely it is a key piece of information in the jigsaw that is diabetes.

I identify completely with the phrase 'high blood sugar is a sympton, pancreas malfunction is the cause'! I shall keep on with my low carb diet and finger prick testing and just hope I can stay below that 48 figure. My GP has given me a prescription for the testing strips, sort of in return for my agreement to go back on statins. I stopped taking them for six months but it had made no difference to my BG levels.

Good luck on your journeys, everyone, and thank you for all your posts. I shall keep reading and learning.
 
Hi @Makewell , welcome to posting ion the forum.
With your strong family history of diabetes on the female side, being thin, and having hearing issues, looking into MIDD makes perfect sense to me.
MODY is another type of diabetes with a strong inherited component.

It might be worth seeing if you can get a referral to an endocrinologist, not only for your own sake but because of your family members as well.

Good luck!
 
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