Sunday, June 27, 2010

The Type Two Word

Do you like word games? Here's one: I'm thinking of a word, a word that may be the most important word about Type 2 diabetes, and yet I suspect that it's a word that most people, including too many T2 diabetics themselves, don't really understand.

Give up?

The word is "progressive". And I'm not trying to sell you car insurance.

See, type 2 diabetes changes, or at least always has the potential to change. It doesn't suddenly appear: most T2s, whether they've known it or not, go though a condition now being called "prediabetes", in which insulin resistance has begun but has not yet seriously outpaced the pancreas's ability to regulate blood glucose. Eventually, for those diagnosed with type 2, the pancreas can no longer keep up - the insulin needs are too great, and at the same type the pancreas has become damaged. (The traditional view has been that the pancreas has been "worn out" trying to overcome the body's increasing insulin resistance. As I understand it, there's now doubt about that.)

The diabetes has progressed, has moved from a normal metabolic state through prediabetes to diabetes.

And, for many people, the disease continues to progress from there, requiring more aggressive treatments and posing greater danger to the body. The danger lies in pretty much the same set up complications as exist for Type 1 PWDs, because the feet, kidneys, eyes, and arteries don't care about the clinical reason for the blood glucose being too high.

For some people, good control and a healthy lifestyle slow, stop, or even (for a time, anyway) reverse the progression of the disease. My own father has had T2 for around 25 years and is still (I believe) being adequately controlled by the same medication I take. To the best of my knowledge, he has experienced almost none of the commonly-known complications. (He does have another rather nasty condition that MAY be a complication.)

Will I be so blessed as to be like my dad and prosper so long without major progression in the disease? I don't know, and I can't know. Even if the genes are the same, some of the other factors are different. It may be that I will go down a road requiring additional oral medications, then injected medications, then basal insulin, then full insulin therapy. If I'm to travel that road, I have no way of knowing how long it may take.

If anyone ever wonders why I hold so tightly to the online community when diabetes as I currently experience it is so much less of a problem than it is for many others, the answer is simple:

Type two diabetes is a progressive disease.

(And also, of course, that I love y'all dearly.)

The things I learn from my friends on insulin about insulin and insulin dependency are things I may need someday.

For all of the people who teach me, I thank you.


  1. Dr. Richard K. Bernstein recommends type 2's avoiding drugs that stimulate the pancreas to produce more insulin. E.g., sulfonlyureas, meglitinides.

    They lead to premature pancreas "burn-out," he says. High carbohydrate consumption also leads to burn-out, according to Dr. B.

    I have no strong opinion on it one way or the other, yet. Haven't seen the scientific studies.

  2. "The things I learn from my friends on insulin about insulin and insulin dependency are things I may need someday."

    In total and complete agreement here. I often hear "why don't you just go on insulin?", but it's not that easy. Not when you haven't progressed to quite that point.


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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.