[Ronin]

Fellow Pre-D's and other Diabetics:

Most of my reading says that Pre-D and Type-2 are usually the result of "Insulin Resistance" (IR). The treatment for "IR" is said to be exercise, areobic and lots of it. Well, I ride a tandem or single bicycle almost daily for at least 90 minutes and usually over two hours. I've lost over 75 pounds and kept it off for some time but my FBG levels peg me as a Pre-D although my HbA1c's are consistently between 5.2-5.4% range.

So, I have to wonder if I'm actually IR, or if my pancreas is just putting out less-and-less insulin. Or maybe, due to my aggressive exercise schedule there might be something else going on. Perhaps my body just gears up for the exercise load every day?

I do have a close friend who is now fully diagnosed Type-2 who is a fellow cyclist/tandemist and his condition was pretty much where I am now, 13 years ago. Now he is using insulin injections and is pretty much back to "normal" although he finds that he needs to be closer to 100 mg/dl before starting a ride or he just runs out of fuel before he hits an hour of riding. Perhaps I'll be following his wheel along the path to insulin injections myself.

Any thoughts, or shared experience will be apprecaiated. Days like this I feel doomed.

[MJB]

You have great A1c numbers and that is a better indicator of how you are doing.

Don't forget that your FBG is often raised by your own body, dawn phenomenon.

Try checking your BG right before you eat lunch or dinner and see where you're at, I bet your lower than your FBG.

Lastly, don't fret over what might be in your future. After all, we all are going to die someday but we can't (shouldn't) live our lives worrying about it.

You're doing the right things. Don't stop and don't despair.

[barko]

Yep... what MJB said.
Your A1c is great, no need to worry.

[BlueSky]

Originally Posted by Ronin

.... I have to wonder if I'm actually IR, or if my pancreas is just putting out less-and-less insulin. .....

This is very unlikely, and here is why. A healthy pancreas has lots of excess insulin production capacity. So much so that, with T1s, 80% of the beta cells have been destroyed by the time blood glucose starts rising. Bear in mind that T1s are typically NOT insulin resistant. Which suggests that, if you are not insulin resistant, 80%+ of your beta cells must be defunct as your blood glucose is rising.

There would have to be a major cause of such a major loss of beta cell function, like a pancreatic tumor or T1 diabetes. But if this was the case, you would probably be in quite a bad way by now. So it is probably mild insulin resistance. You can tell for sure by getting your doctor to do an insulin level or C-peptide test. High/normal insulin levels would confirm insulin resistance. But if they are low/normal, maybe something else is going on.

[Ronin]

BlueSky, et al.,

Pardon my relative newbie confusion. Insulin resistance (IR) is purported to be related to excess weight and/or lack of exercise. Well, I've lost over 75 pounds and I exercise a lot. So, I should have overcome IR, but the FBG numbers still say I'm a Pre-D (although my HbA1c's in the low 5's say I'm not, and they have been consistent regardless of my dietary control or lack thereof).

All of this begs a question that I really don't understand. Most Type-2's eventually wind up injecting insulin. If they are IR how does more insulin help?

Perhaps it is all genetics and the fact that medical science doesn't fully understand diabetes in the first place.

[lilituc]

My progression was quite similar, and I turned out to have LADA and not insulin resistance. You could always have your doctor order a C-peptide and GAD65 antibody test and see what you get.

[Ronin]

Everyone:

I'm still in a muddle over my previous question: Most Type-2's eventually wind up injecting insulin. If they are IR how does more insulin help? I've also been reading that there is a study showing that prescribing small amounts of insulin injections for Pre-D's as they begin to slip towards Type-2 slows the progression.

Perhaps I just don't understand how insulin works?!?!

[JediSkipdogg]

Firstly, insulin production can be measured with a Peptide C lab test. A Peptide C measures the C Peptide output which is a peptide that is produced at a ratio of 1:1 with insulin. This can help to tell how well your pancreas is doing. A high level generally means you are highly insulin resistant and a low level can either mean you are type 1 (A GAD Antibody would then be done) or your pancreas is dying off (simply like a heart attack.)

I'll get back to you on how more insulin helps IR.

[BlueSky]

Originally Posted by Ronin

... Most Type-2's eventually wind up injecting insulin. If they are IR how does more insulin help? ...

I agree, giving insulin to someone with IR is treating the symptom rather than the cause. And injecting more insulin adds fuel to the IR fire. You hear stories about T2s who are injecting huge amounts of insulin and still not getting adequate control. This is why doctor's don't put T2s on insulin until they have lost so much beta cell function that their endogenous insulin has to be supplemented. And normally they would try to combine with this treatment that reduces the insulin resistance - diet, exercise, weight loss and insulin sensitizers.

I haven't heard of pre-Ds being given insulin. And I can't see the sense in it. But I have heard of newly diagnosed T1s being given tiny amounts of insulin in the hope that this will prolong their honeymoon period. Mixed results have been achieved with this and the studies on it have been inconclusive.

[Ronin]

BlueSky, et al.,

The response contained the following quote: "I haven't heard of pre-Ds being given insulin. And I can't see the sense in it. But I have heard of newly diagnosed T1s being given tiny amounts of insulin in the hope that this will prolong their honeymoon period."

I read about this in an article about Richard Jackson, MD who is doing research (and is the author of Know Your Numbers, Outlive Your Diabetes [Marlowe Diabetes Library]) Unfortunatley I can't find the cite again.

It seems that there are two primary causes of Adult Onset Diabetes. One is IR where the body just doesn't react to insulin any longer. In general these people are obese and do not excersise, hence diet and exercise can reverse the condition or delay the onset of Type-2. The other is that the pancreas is either slowing down or being attacked by the immune system. If it is the second case, the use of insulin to supplement the suppy of insulin would, at least in theory, get the individual back to "normal."

My concern is that, while my HbA1c's are all in the low 5's I can see a slow-but-steady drift upwards which could indicate that I'm either becoming IR, or that my Pancreas is reducing in function. The key seems to be that my Post Prandial BG levels rarely drop into the 90's and are generally in the 105 - 135 range two hours Post Prandial. On the other side I do get a LOT of exercise with a daily tandem ride and a fairly active life off the tandem. So, I doubt that my condition is IR induced.

At my next regularly scheduled blood test (September) I'm going to request a baseline assessment of my C-Peptide and then check it six months to a year later to see what direction it is headed.

[HelenM]

The other is that the pancreas is either slowing down or being attacked by the immune system

I think you're talking about 1.5 here

The Tokyo study seemed to show that beta cells in spiddim (slowly progressing insulin dependent diabetes) and LADA (latent auto immune disease of adults) might be preserved (for a time) with the early use of insulinbut (as ever) there have been other studies contradiciting this idea.http://http://www.postgradmed.com/is..._05/nabhan.htm

I have LADA and have noticed that on average I need to take less basal insulin than I needed during the first 2 months after diagnosis ( 2 years ago, but its 5 years since onset of symptoms).At the moment whether I have a BG of 140 or one of 80 at bedtime I have fbg of between 70 and 80 each morning. It seems to me that I may well have some residual insulin and perhaps have gained a little more beta celll function since starting insulin. (At least 'd like to think so).

[JediSkipdogg]

Originally Posted by HelenM

I think you're talking about 1.5 here

Type 1 and 1.5 would be the dying off. The slowing down would not be type 1 at all but more type 2.

[Harold]

The normal slowing down of insulin has historically been considered a Geriatric issue. Typically we are talking 70+, but we all age differently at different rates in different areas. So the possibility of seeing it in the late sixties is possible. My guess or MHO if your genetically predisposed to IR you might see it even earlier many years earlier.