Type 2 and Insulin

[Phranky]

Is it inevitable that all type 2's will eventually need to go onto insulin?

I'm still new to this, I know it's a progressive condition, but I was just reading in another thread that there are Type 2's who are on the pump!?!

As mentioned, I'm just on metformin, seems to be working great, but in a couple of years will I be virtually a Type 1 then?

I thought the difference between the two was that with Type 1, your cells are actually attacked and destroyed, thus preventing and destroying insulin producing cells. Type 2 on the other hand, is insulin resistance, the pancreas is still producing, in many cases large amounts, but it is not being utilized fully; hence, drugs like metformin.

So, will my pancreas eventually "burn out" and then I'll be fully insulin dependant.

Sheesh - there's my happy diabetes thought for the day....

[sydneya]

"that all type 2's will eventually need to go onto insulin?" I don't believe that anything having to do with diabetes is a positive thing. Yes, Type II is a progressive disease and some Type II's are on the pump. In a few years you may be a insulin dependent type II, but maybe not. I read somewhere that a recent study shows that most type II's start with a 60% use of insulin and it progresses down until some have 0%. This study also showed that exercise and keeping things under control slows that down. So every bit of effort you put in helps.
When I was questiioning a doctor about the C-Peptide test to see how much insulin I produce, I was told it doesn't matter. My treatment would be the same. That made no sense to me. Oh, well.....life with diabetes is confusing.

[DesertDiabetic]

It is said over and over again that early detection and with aggressive treatment type 2's can reverse their disease. Not cure. You don't hear cure being talked about, except in the "I can cure everything ads, just send them some money and......"

Type 2 is just about the only disease that the patient can do more than the medical profession. Let me put that more correctly - it is the only disease where most of the treatemnt is in the hands of the patient. Meds alone do very little for the treatment of type 2. The medical profession does not select what you eat,nor do they control how you exercise. As far as that goes they do not give you your medication when you should take it. It is up to you to plan and do what has to be done.

No, it is not automatic that you will be on insulin. Don't look at the type of meds you will need as the guage of your condition. Look at the blood tests, your weight.

[JediSkipdogg]

Type 1 and type 2 are totally different, but with the same idea. Type 2 is the body's inability to use the insulin produced or the pancreas is in a weakened production state. Type 1 is an immune disorder where insulin producing cells are killed off.

Most type 2s will never need insulin if they can control with diet and exercise. The need for insulin only occurs if they overwork the pancreas too much to the point of where it wears itself out.

[Phranky]

Thanks for all the input - since I had already been on a diet for a year when I was dx'd, it's not a problem for my eating, I'd lost 75lbs, went from 305 and am now around 230-235, would like to get down another 20 pounds, but I weigh now what I did when I got married at 26.

I've got to up the excercise thing, I should do more, got to hit the treadmill as well as karate, I certainly am extremely concious of the food I eat and carbs.

I like the post that said this can be controlled mainly by me - I intend to do that.

Thing that sucks though, is that I'd got the weight down, my blood pressure was better as a result, I thought keep up with the program, and maybe in awhile I may even be able to reduce my BP medication, and things will start to look up!

Then this ferkin' diabetes thing came along and it just ferkin' sucks.

That ain't goin' away....

[DesertDiabetic]

Let me bore you some more - Ok, it sucks, I do agree.

But, and it is a very important point - If a type 2 follows the program that is needed to maintain weight and blood glucose levels by diet, meds and exercise they will be healthier than they have been for years. Their lifestyle will change so much to the positive. The foods you won't be able to eat is such a minor thing. We over vaule the freedom to eat anything we want a whole lot. It is so self-service to do that(no pun intended)

In some cases being diagnosed saved a life....

[Ritehsedad]

Let me bore you some more - Ok, it sucks, I do agree.

But, and it is a very important point - If a type 2 follows the program that is needed to maintain weight and blood glucose levels by diet, meds and exercise they will be healthier than they have been for years. Their lifestyle will change so much to the positive. The foods you won't be able to eat is such a minor thing. We over vaule the freedom to eat anything we want a whole lot. It is so self-service to do that(no pun intended)

In some cases being diagnosed saved a life....

Wow, talk about a bullseye shot!!

I feel as though I'm in the best shape of my adult life! I truly believe that being diagnosed save my life.

As far as the inevitability of insulin...I wouldn't worry about it. I' control by diet and exercise...for now. Someday I may be put on meds. Someday I may be put on insulin. Whatever it takes to control this works for me.

Those T2's out there on insulin, how do you feel about having to take insulin?

[Phranky]

Yea - losing the weight just struck me one night sitting on the side of my bed...bigga belly hanging out!

Sheesh - and here I had been for years, 235lbs, Dr. used to laugh that my weight never changed except by a few grams, that was four nights at the karate dojo, andx-training with runnning.

Then first child is born, career building began, then it was chicken wings, bbq ribs, pizza, and finally this habit I got into of every Friday buying my wings, ribs, pizza, wine, and just feasting, because I thought I'd earned it....then suddenly you turn 40, look in the mirror wondering why all your old clothes don't fit, and your 305lbs!

So now, no food out of a box (reduce salt), portion control is a huge thing, I started my diet, and still do, by eating 5 small meals a day to keep the metabolism going, just fresh good food etc...

What read here that's interesting, is that both my GP and my endo have said that the parodoxical thing about diabetes (type 2 i guess) is that if you control, use proper diet and excercise, chances are you will be healthier than the general public, because the rules for a diabetic *should* be what everyone else should be doing to stay fit and healthy.

The only thing that reverses my bummed out feeling about type 2 is the alternative, that they say up to 30% of the population is undiagnosed. Dr's said I was very lucky, they caught it in months, not years, and that NOT being diagnosed for many years is what can lead to the EOD (end organ damage) and all the other nasties.

So, on the other hand I'm glad I know, and in many ways it is the impetous to continue my healthy eating habit...

Cheers!

[Lynne1]

I think everyone's progression is different. Type II's generally manage their diabetes using diet and exercise first. When that no longer works, pills are added. When that no longer works, insulin is needed. I don't think there is a standard timeframe for the progression. Some people may not even progress at all.

I was manageing on diet and exercise before I decided to get pregnant. After two kids I was looking forward to ditching the shots...however, that never happened. Now I need more insulin than ever. Go figure. Realistically, I could stand to loose 20-30 lbs and I don't exercise nearly as much as I used to. However, my endo said that loosing weight and exercising would decrease my insulin needs, not eliminate them. So, I acclimated myself to the fact that I can't go off insulin and decided to get a pump. My endo pushed it because it provides better control than MDI and control is the name of the game!

I hope this makes sense. Good work on your weight loss, BTW.

[labob]

I was put on insulin the day I was diagnosed as a Type 2, and even though I stopped taking insulin three weeks later, in a perverse way I guess I'm glad I had that early experience because it demystified the whole process for me (and, by the way, really caught my attention when it came to managing my disease). Right now I'm on a fairly low dose of pills -- 1.25 mg of glyburide and 15 mg of Actos once a day -- and am working toward stopping the glyburide entirely once the Actos "kicks in," which my CDE says can take over a month. In the meantime, I've altered my diet since being diagnosed last December -- never thought I'd see the day where I would avoid hamburgers, not because of the fat and salt, but because of the darn bun! -- and am hoping to delay the progression of my disease as long as possible. But if and when I get to the point where I need to take insulin again, I'll do it. I feel so much better since my glucose levels have gotten under control that I will do whatever it takes to keep them there. If insulin is the answer, well, so be it.

[vvti-le]

I'm one of those with the progression. I first started out with diet and excerise. Next was oral medication with Glyburide then adding Metformin. The Glyburide over time became less effective as the dosage went up until the maximum dosage. Then I was put on Humalog for the meal time and Lantus for the long acting coverage.

[Floss]

It's that old truth - everyone's different. I know of some type 2s who have managed for years and years on just diet and exercise alone; others start on very low dose meds and then gradually these are increased as required; others start on insulin... there really is no way of knowing... just your pancreas knows I guess.....:help:

As everyone has said, if you can do your best with diet, exercise, and regular monitoring, you are doing everything possible to help the situation and are giving yourself the best chance possible.

My hub was diagnosed 2.5 years ago (they caught it within months fortunately) but had to go straight onto a hefty dose of metformin. He is very diligient with diet, exercise and meds - the docs said his sugar control was 'exemplary'; unfortunately despite this, he is now on gliclazide, statins and beta blockers and it seems that insulin may not be too far down the line - why? who knows? Sadly, it's just that kind of disease.

Try not to get too depressed though - keep fighting, keep trying and don't let it win - everyone is here is support each other, which is an enormous help and comfort. ;)

[mg_2204]

Is it inevitable that all type 2's will eventually need to go onto insulin?

I was told (and not only once) that inevitably I will need insulin. Well not that I will need insulin but that I would end up on insulin. But that's a whole different debate...

Yes it is a progressive disease, I can rationalize that. I have spent 10 years diet controlled only. I have been on Metformin for 18 months now and doing very well. My philosophy is to continue to do my best, always aim for a better A1C, and... be happy in the mean time. Perhaps I will or will not need insulin later on, who knows? I shall cross that bridge when I get there. And personally reading from other members who are on insulin has demystified the use of insulin. And let's not forget, we have this wonderful forum too.

[Brenda A]

I am type 2. I take insulin R and Symlin. Yes, this diabetes sucks!! It doesn't matter what you take, pills or injections.There is one thing for sure you are alive because these are available to you. My grandmother had 12 kids, 11 ended up diabetics type 2. Their children are diabetic. The control of diabetes was very poor and grandmother died with too much insulin given to her. My mom was on insulin but she spent years not taking care, she let it get her kidneys, and eye sight before taking it serious, she died 2 years ago. I have progressed from control with diet, herbs,then pills, now insulin. They are all the same bottom line. I am allergic to most insulins and pills, they give me tremors, prickly feelings and make me very sick. It took my endo 2 years to find an insulin that I could live with. I take 1 injection of Insulin R and 1 of the new drug symlin before each meal. If needed at bedtime I take another R. That is 7 injections a day and 8 test pricks. It is all a matter of not dwelling on the stinking diabetes and how it upsets your life. It does and it will always, no matter what method you use to control. Our minds rebel because we did not ask for this, we don't want it! We just have to live for the rest of our lives with it. The operative word here is LIVE. You have to find what you can feel the most comfortable with and tame the diabetes snake that crawled into your otherwise normal life. Even with the best of control it can suddenly change without warning and bite you. What ever the method, it is not as bad as the alternative.

[GlucoFreak]

"that all type 2's will eventually need to go onto insulin?"
When I was questiioning a doctor about the C-Peptide test to see how much insulin I produce, I was told it doesn't matter. My treatment would be the same. That made no sense to me. Oh, well.....life with diabetes is confusing.

That makes no sense to me at all either. My understanding is that there may be some future potential "cure" that would require some insullin producing capacity. If you have no beta cells working, it wouldn't work for you. I know this potential "cure" could be years and years away, but why wouldn't the doctors want to help preserve what you have? I am very concerned about this for myself as well...as i am not the typical type 2. I've even heard of some doctors recommending insulin for type 2's to ease the strain on the pancreas. I am definitely going to ask for the C-Peptide test at my next visit. In fact..I'll demand it! :-)

[Carpe Diem]

Thanks for all the input - since I had already been on a diet for a year when I was dx'd, it's not a problem for my eating, I'd lost 75lbs, went from 305 and am now around 230-235, would like to get down another 20 pounds, but I weigh now what I did when I got married at 26.

I've got to up the excercise thing, I should do more, got to hit the treadmill as well as karate, I certainly am extremely concious of the food I eat and carbs.

I like the post that said this can be controlled mainly by me - I intend to do that.

Thing that sucks though, is that I'd got the weight down, my blood pressure was better as a result, I thought keep up with the program, and maybe in awhile I may even be able to reduce my BP medication, and things will start to look up!

Then this ferkin' diabetes thing came along and it just ferkin' sucks.

That ain't goin' away....

My problems started AFTER I adopted a low-carb lifestyle. In fact, I had lost 45 pounds the previous year through low-carbing, getting down to current weight of 194 (I'm also 6'4" tall, but 47 years old). Then, after being on low-carb maintenance, and admittedly having a couple of surgeries as well (one for a herniated disc in my neck and one for a meniscus tear in my knee), my problem arose. I was eating a little more carby, however, when it popped up. It may have just been waiting to catch up with me all along...

Bummer... hope it gets better for you!

[lottadata]

I researched this question in depth back when I was diagnosed as a Type 2. (Almost 8 years later, I discovered I am not insulin resistant and, in fact, have a MODY genetic diabetes.)

http://www.phlaunt.com/diabetes/14046702.php discusses what I learned when examining the research on which this idea is based.

That said, the kind of diabetes I have turns out to respond like magic to insulin, while low carb dieting and pills could not normalize my blood sugar. (This is because my insuiln itself is defective, not the receptors as is the case with insulin resistance.)

Like most Type 2s, I thought of insulin as something dreadful to be avoided. Now I wish I'd started it years ago. Insulin has one, enormous advantage over every other diabetes drug. It works.

The problem is that most doctors don't prescribe it correctly for type 2s. They don't titrate it to the individual but prescribe generic doses which are usually not enough to get anywhere near normal.

I'd advise all people with Type 2 diabetes to read Dr. Bernstein's Diabetes Solution by Richard K. Bernstein and learn how to accurately use insulin, even if you don't need it now. It demystifies the whole experience and his techniques (including the painless injection technique) work as described.

With his advice, I have been able to get very close to normal blood sugars, thanks to insulin. If I'd used the doses (and needles!) my doctor first prescribed I'd have been in BIG trouble.