Re: Insulin for T2 and prevention of complications.

[Guest guest]

In a message dated 11/25/2005 10:43:47 AM Eastern Standard Time,

one-stop@... writes:

> Since DM is a progressive disorder as well as a highly . . .

I'm not clear what progressive means as regards well controlled diabetes.

Does it mean that if BG control is maintained in the normal range, say 4.8%, by

diet and exercise, that factors other than aging are expected to cause

deterioration in the diabetic condition? It seems like a difficult thing to

prove.

If you have fewer beta cells, but manage to keep excellent control by diet,

your insulin levels could be lower than in a nondiabetic person. As I recall,

insulin is said to be deleterious. In that case a diabetic controlling by diet

could age more slowly than a nondiabetic.

My take on all of this is to strive for excellent control with diet and

minimum medication. Time will tell whether this is a good strategy.

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

In a message dated 11/25/2005 10:43:47 AM Eastern Standard Time,

one-stop@... writes:

> You are not the only medical professional with this sort of tunnel vision

> as to the treatment of type IIs

Hello Noble.

There are less aggressive, less judgmental ways to argue one's point than

this. If you are offended by the style I hope it won't dissuade you from

offering

the benefits of your 25 years experience. We'll continue to offer our

patient's perspectives and learn from each other.

<< this is more of the same old barrier that medical professionals put up in

front of type IIs that makes them feel like failures >>

The same remarks apply here.

Cheers,

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

Hi Vicki,

I am controlling my bgs with D & E and will have my post diagnosis

A1c done in February. My NP wants me to go on medication now even

though I am controlling with D & E. She said it is preventative. I

personally want to hold off on medications for as long as possible,

but want to make sure I am basing this decision on factual

information and learn all I can. I wanted to be sure I understand

what you are saying. You said:

....As for the first part of that -- yes, reversal of complications

can occur. At the beginning of your diabetes, you might be able to

control with diet and exercise; many on this list have. ( --

you there?) However -- diabetes IS a progressive disease and

ultimately there may come a time when diet and exercise don't work

as well as it once did. That's the time to go on pills. Or straight

to insulin. There are many studies showing that starting insulin

earlier rather than later is more beneficial to type 2s. I have

saved some in my archives...

>>>So, reversal can happen...by D & E or with D& E and medication?

You mentioned studies that show starting insulin earlier rather than

later is more beneficial...but earlier than what? Does this mean to

start on the insulin as soon as D & E don't work - or does this mean

to start on insulin/medications even if D & E is working. Also,

since it is a progressive disease do you know of any studies that

compare D & E to D & E and oral medicaitons. Will it progress more

rapidly with D & E or will the medicaitons slow the progression

down?

I feel I am in a position to make a decision without having all of

the information - it feels a little bit to me like playing Russian

Roulette (with more than one bullet). I want to make a decision I

can feel at peace with.

Thanks

Dawn

[Guest guest]

Noble Zachariah wrote:

> The statement that most will eventually end up on insulin is referring to

> those unable to maintain their A1c below 7 with diet, life style, exercise,

> Metformin + Glyburide. 25 years of experience in this field makes me

> confident in stating that less than 10%T2s with dedication to maintain their

> A1c below 7 and BMI below 23, need to go on to Insulin.

For myself, insulin is a wonderment. I'm a T2, tried for 2 years to

control with d&e and it worked to some extent, but by the time my A1c

got back up to 7 I started having eye probs again and promptly went on

insulin. Now I can maintain a 6.0 and still enjoy a holiday meal

sometimes. There's more to life than avoiding insulin. If the stress

of trying to maintain a " normal " A1c without it is such that life

becomes a chore and a bore, then I say get insulin - now! Mental health

counts, too.

CarolR

[Guest guest]

In a message dated 11/25/2005 4:58:42 PM Eastern Standard Time,

croberts@... writes:

> I've yet to see anything that would make me think that taking metformin as

> a preventative measure would be a worthwhile activity. It's like taking

> aspirin today to prevent a headache tomorrow.

I can't speak for the Metformin, Carol, but some meds do help. For example,

baby aspirin is used to help keep blood flowing in the arteries and reduce the

risk of a stroke. Currently, I take three baby aspirins a day for two

reasons:

1. I'm temporarily off Coumadin in preparation for a catheterization

procedure.

2. I'm a big baby

Cheers,

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

Dawn, each individual case is a little different. There is no " rule "

for controlling diabetes enough to avoid complications. Your answer is

in your meter - and your meter, only - no one else's meter will work for

you. If you have set a " range " goal and you are staying within that

range you should ultimately be complication free. When d&e no longer

work to keep you within the desired bg range, then you will have to make

some decisions - try oral meds or go straight to insulin. Neither

choice is a moral judgement or an indication of failure. It's a

treatment choice, period.

CarolR

dawn_qabbalah wrote:

> Hi Vicki,

> I am controlling my bgs with D & E and will have my post diagnosis

> A1c done in February. My NP wants me to go on medication now even

> though I am controlling with D & E. She said it is preventative.

[Guest guest]

Hi Carol,

I do not see medication as a moral judgement, nor am I trying to use

other peoples meters to gauge what I need to do. The bottom line is

that I am being told to go on medication even though I am controlling

my numbers with D & E and I am trying to gather information to make an

informed choice. I am being told that controlled bgs are not enough.

That I should take the medication for preventative reasons. So - this

is what I am trying to research. I further understand that I make a

plan and go with it and adjust as needed. I am in the making a plan

part of the process :-) I also realize that there is not going to be a

clear cut answer for me but that too is part of the proces I suppose.

Dawn

[Guest guest]

> My take on all of this is to strive for excellent control with diet

and minimum medication. Time will tell whether this is a good

strategy.

Hey ,

When I read this I started laughing (at myself) - it clicked for

me...you are right - time will tell - but in my quest for information

to make a decision I didn't realize I was looking for a guarantee

(from my body :-) and we know thats not going to work. So - yours was

the right sentence at the right time for me. Thanks!

Dawn - NC - T2

D & E and confusion.

[Guest guest]

And some of us WERE seeing doctors regularly, but were not given the

right tests for diagnosis. My only symptom when I was diagnosed was

tingling toes, a sign of neuropathy. After several years of normal

BG's, this has been reversed. I'm just glad more damage was not done

before I was finally diagnosed. Sue

>

> IMHO, if people saw their doctors more regularly, like for yearly

> checkups when they're feeling okay, more diabetics would be diagnosed

> BEFORE the problems occur.

[Guest guest]

What I learned, during the time I was actually trying to follow doctor's

orders, is that the doctors generally are following a script written by

the ADA, and it's a one-size-fits-all script. We know, from just

general living, that one size does not fit all. From my own research

and from the people on this list I've learned that keeping bgs within a

" normal " range is what will prevent complications, regardless of how

that is achieved. If you're able to do it without meds, for a year or

five years, do it. I've yet to see anything that would make me think

that taking metformin as a preventative measure would be a worthwhile

activity. It's like taking aspirin today to prevent a headache tomorrow.

CarolR

dawn_qabbalah wrote:

> Hi Carol,

> I do not see medication as a moral judgement,

[Guest guest]

At 2:19 PM -0500 11/25/05, DEKEP@... wrote:

>In a message dated 11/25/2005 10:43:47 AM Eastern Standard Time,

>one-stop@... writes:

>

>> Since DM is a progressive disorder as well as a highly . . .

>

>I'm not clear what progressive means as regards well controlled diabetes.

Progressive seems to mean that the diabetes can get worse even when

you have good control--the pancrease can slow down, the insulin

resistance can increase no matter how good the control is. Since I

have shifted from D&meds to D&E and back several times I am not too

sure I completely agree with this.

>My take on all of this is to strive for excellent control with diet and

>minimum medication. Time will tell whether this is a good strategy.

I like this strategy for me. Especially the minimum medication. I

have to take too many drugs anyway to take a diabetes one if I can

avoid it. I do feel that if my BGs creep up with little or no change

in diet or exercise it is appropriate to shift to meds.

--

Ray B.

rbowler@...

Type 2 diet, Fortarmet

Live near Des Moines, IA

[Guest guest]

--- whimsy2 whimsy2@...> wrote:

> As to Noble's statement that type 1 and type 2 are entirely different

> diseases, from what I've learned, it's actually the CAUSE that's the

> main difference; type 1 is autoimmune induced. Due to an immune attack,

> the pancreas stops producing beta cells, which carry insulin throughout

> the body.

Er, well..... Beta cells stay in the pancreas producing insulin, which carries

throughout the

body. Beta cells stay in the pancreas, which is why Dr. Langerhans found them

there and they were

accordingly named the " Isles of Langerhans " .

Ted Quick

[Guest guest]

At 7:34 PM +0000 11/25/05, dawn_qabbalah wrote:

>that I am being told to go on medication even though I am controlling

>my numbers with D & E and I am trying to gather information to make an

>informed choice. I am being told that controlled bgs are not enough.

>That I should take the medication for preventative reasons.

Like I think the less medication the better. I have never seen

anything to indicate that preventive medicines are good. On the other

hand when my numbers are only slightly high and I take meds I

sometimes go hypo--even when I was taking Actos which shouldn't cause

hypos. I think you are wise to be skeptical of this advice.

--

Ray B.

rbowler@...

Type 2 diet, Fortarmet

Live near Des Moines, IA

[Guest guest]

But does it mean that everyone progresses to keep getting worse? or can

people really just be controlled the rest of their life?

>However -- diabetes IS a progressive disease and ultimately there may

>come a time when diet and exercise don't work as well as it once did.

>

[Guest guest]

Hi, Dawn...I understand your confusion. I will insert my answers right

by your questions, below.

Re: Insulin for T2 and prevention of

complications.

> Hi Vicki,

> I am controlling my bgs with D & E and will have my post diagnosis

> A1c done in February. My NP wants me to go on medication now even

> though I am controlling with D & E. She said it is preventative. I

> personally want to hold off on medications for as long as possible,

> but want to make sure I am basing this decision on factual

> information and learn all I can. I wanted to be sure I understand

> what you are saying. You said:

>

> ...As for the first part of that -- yes, reversal of complications

> can occur. At the beginning of your diabetes, you might be able to

> control with diet and exercise; many on this list have. ( --

> you there?) However -- diabetes IS a progressive disease and

> ultimately there may come a time when diet and exercise don't work

> as well as it once did. That's the time to go on pills. Or straight

> to insulin. There are many studies showing that starting insulin

> earlier rather than later is more beneficial to type 2s. I have

> saved some in my archives...

>

>>>>So, reversal can happen...by D & E or with D& E and medication?

Reversal can happen when you obtain non-diabetic A1Cs and maintain them

for an extended period of time. However you obtain them. So if your

lab normal is 6.0, that's what you want to aim for.

If you can do it with diet and exercise alone, great. If you can't --

well, that's the time to think about pills and/or insulin.

> You mentioned studies that show starting insulin earlier rather than

> later is more beneficial...but earlier than what?

Most diabetics are reluctant to start insulin for various reasons. Many

doctors assume all patients are reluctant to start insulin so when diet

and exercise aren't doing the job, they start prescribing pills. There

are many different glucose-lowering pills and they work in a variety of

different ways so if one doesn't work, the doctor will try another. Or a

combination of pills. Meanwhile, your BGs continue to be high.

Doctors usually don't prescribe insulin until all else has failed. But

by this time the complications have already made themselves felt. I've

typed many reports of type 2 diabetics in for poor wound healing, an

obvious sign of poorly controlled BGs, who should be on insulin but

aren't. So that's what I mean by " starting insulin earlier rather than

later " .

Does this mean to

> start on the insulin as soon as D & E don't work - or does this mean

> to start on insulin/medications even if D & E is working.

When diet and exercise don't work, IMHO, going straight to insulin is

probably a better choice rather than suffer through months of trial and

error trying to find the right pill or pill combination. I have

scholarly articles pointing out the advantage of this approach and I'll

be glad to give you a copy of them. However, at this point I think it's

premature.

As I mentioned earlier, since you should be having an A1C test every 3

months, it's pretty easy to see when diet and exercise aren't doing the

job. That's the time to think of insulin. Or pills, if you choose, but

do be aware that there's a period of trial and error with pills, and

meanwhile you're having high BGs. Unless you hit the right combination

at the beginning.

Also,

> since it is a progressive disease do you know of any studies that

> compare D & E to D & E and oral medicaitons. Will it progress more

> rapidly with D & E or will the medicaitons slow the progression

> down?

>

The only criteria is keeping your A1C at non-diabetic levels. However

you reach that.

> I feel I am in a position to make a decision without having all of

> the information - it feels a little bit to me like playing Russian

> Roulette (with more than one bullet). I want to make a decision I

> can feel at peace with.

I understand. Good luck!

Vicki

PS: I think you're naturopathic physician is not correct in prescribing

metformin - or any pill - as a preventative. If you can control with

diet and exercise, that's perfectly adequate.

>

> Thanks

> Dawn

>

[Guest guest]

Thanks Vicki. I am scheduled for my next HbA1c test in February - this

will be my first one after diagnosis so time will tell if D & E is

working for me. It made sense for me to wait until then to make a

determination about medication since I have been able to control my

numbers with D & E. I will re-evaluate once I receive those results.

Dawn

[Guest guest]

> OTOH, in type 2s, there's plenty of insulin

> being produced; it's just not getting to the

> cells appropriately (insulin resistance).

I don't believe that it has been established that

" there's plenty of insulin being produced " , Vicki!

There are explanations around that say that Type 2

is also a result of having insufficient insulin

to overcome that particular person's insulin

resistance. There are people with insulin resistance

who do not have diabetes Type 2 because they are

still producing sufficient insulin to overcome the

resistance.

I understand that it is only when age and obesity

and the genetic factor all eventually combine to

reduce the amount of insulin produced by the beta

cells to be below the requirement that the condition

called diabetes Type 2 appears.

In other words, everybody has some insulin resistance.

It is only when either it increases to the point

where the insulin produced is not sufficient to

overcome it or when the amount of insulin produced

has fallen to that same point or a combination of

both, that there is trouble.

I believe this explains why only 80% or so of

diabetics Type 2 are overweight. In the 20% who are

normal or underweight, age and the genetic factor are

sufficient to take them to the point where they are

not producing enough insulin for their particular

degree of insulin resistance. In the case of young

Type 2s, obesity and the genetic factor are sufficient

to get them to that stage.

This seems to me to be logical; not everybody will be

producing the same amount of insulin, some will be

nearer to the point at which they do not produce

enough than others are.

There is a thorough (but highly technical) explanation

of the role played by genetics, age and obesity in

beta cell dysfunction in type 2 diabetes at:

http://www.medscape.com/viewarticle/514155_3

It seems to me that in Type 1 you suddenly do not

produce enough insulin while in Type 2 it happens very

slowly - that is the real difference between the two.

Regards

Thornton

[Guest guest]

For Dawn: If you can keep your bgs below 6 without hypos and without

high numbers, with diet and exercise, then go for it. Exercise will

decrease insulin resistance more than metformin. Several studies have

shown D&E is more effective for controlling metabolic syndrome and early

diabetes. How do you know you are early? Because you can control with

D&E, if you did not have enough beta cell function left, you wouldn't be

able to.

The longer you can stave off medication, the healthier you will be later.

Natural is the best way to go and D&E are natural.

They used to call Type 2 diabetes " old age diabetes " because the pancreas

ages along with the rest of us. Perhaps, tight control, including low

carb choices, will put less stress on the pancreas and slow down its

aging. We don't know at this point in time, but it is surely worth the try.

As to the ace inhibitor - that's a toss-up. Diabetic kidneys need all

the help they can get, but which is better - good numbers or medication?

The answer may well be different for different people; however, you

need to go with your personal preference. I don't think there are any

studies using well controlled diabetics showing this kind of information.

And by well controlled, I mean an A1c as close to 5 as possible.

The outcome of what you do today will determine what you need tomorrow.

In Feb, you may have to make different choices, or you may be able to

push any choices off for years.

For the list: My c-peptide was a 1.0, quite below the normal range. I

also have lots of IR; I know because actos makes a BIG difference in my

numbers. So 2s can have both conditions. At the beginning I too

controlled quite well with diet and exercise; now I am on insulin,

metformin and actos, plus low carb. And I have neuropathy. Our advice

is just that: Advice. Perhaps something that gives someone else a idea

for their own regimen, but always, YMMV.

Helen

[Guest guest]

> If you can control with diet and exercise,

> that's perfectly adequate.

That was my downfall, Vicki! I started off with

diet and exercise and I realize now that the

" if you can " criterion really means: If you take

it seriously enough!

In other words, " if you can't " then that could

well mean (as it did in my case) that you are

not dieting severely and/or that you are not

exercising strenuously or for long enough.

(By " you " , I mean " me " , of course).

It is really an argument in a circle because if

you ask: " What is severely enough and what is

strenuously and long enough? " then the answer

has to be: " Enough so that you can control your

T2 diabetes. "

I now believe that the dieting has to be taken

REALLY seriously and that the exercise has to be

enough to result in a significant sustained

weight loss (i.e. it goes down and stays down

for ever). Both have to become just about the

most important things you do!

If you can control your diabetes with less than

that then good, if you can't then you are just

going to have to do more or eventually find that

dieting and exercise do not hack it or no longer

hack it!

There may be reasons why you can't do " enough "

even if it is only that you just do not have the

stamina or the will-power in which case oral

medication is the logical next step.

Regards

[Guest guest]

Anything that helps our insulin resistance is worthwhile, in my

opinion. If I went on insulin, I would still take metformin. Sue

On Friday, November 25, 2005, at 04:53 PM, Carol wrote:

> I've yet to see anything that would make me think

> that taking metformin as a preventative measure would be a worthwhile

> activity. It's like taking aspirin today to prevent a headache

> tomorrow.

[Guest guest]

That's a hard one to answer, , since none of us have lived " the

rest of our life, smile.

However, I'm fighting the good fight -- doing everything I can to keep

my A1C under 6. And I've been diabetic for 7 years, almost 8 now, and

have no complications.

Vicki

Re: Re: Insulin for T2 and prevention of

complications.

>

> But does it mean that everyone progresses to keep getting worse? or

> can

> people really just be controlled the rest of their life?

>

>>However -- diabetes IS a progressive disease and ultimately there may

>>come a time when diet and exercise don't work as well as it once did.

>>

[Guest guest]

I'm hoping so, LOL. So far, so good. Sue

>

> But does it mean that everyone progresses to keep getting worse? or can

> people really just be controlled the rest of their life?

[Guest guest]

Thanks, , for that clarification. It sounds right to me.

However...I'm going to quibble about your last sentence

" It seems to me that in Type 1 you suddenly do not

> produce enough insulin while in Type 2 it happens very slowly - that

> is the real difference between the two. "

The quibble is this: With type 1 the reason we " suddenly " do not

produce enough insulin is because of an autoimmune attack. In LADA,

it's not sudden at all, as it is with type 1 in children - it can take

months (like for me) or years (like for ).

Vicki

Re: Insulin for T2 and prevention of

complications.

>

>

>> OTOH, in type 2s, there's plenty of insulin

>> being produced; it's just not getting to the

>> cells appropriately (insulin resistance).

>

> I don't believe that it has been established that

> " there's plenty of insulin being produced " , Vicki!

>

> There are explanations around that say that Type 2

> is also a result of having insufficient insulin

> to overcome that particular person's insulin

> resistance. There are people with insulin resistance

> who do not have diabetes Type 2 because they are

> still producing sufficient insulin to overcome the

> resistance.

>

> I understand that it is only when age and obesity

> and the genetic factor all eventually combine to

> reduce the amount of insulin produced by the beta

> cells to be below the requirement that the condition

> called diabetes Type 2 appears.

>

> In other words, everybody has some insulin resistance.

> It is only when either it increases to the point

> where the insulin produced is not sufficient to

> overcome it or when the amount of insulin produced

> has fallen to that same point or a combination of

> both, that there is trouble.

>

> I believe this explains why only 80% or so of

> diabetics Type 2 are overweight. In the 20% who are

> normal or underweight, age and the genetic factor are

> sufficient to take them to the point where they are

> not producing enough insulin for their particular

> degree of insulin resistance. In the case of young

> Type 2s, obesity and the genetic factor are sufficient

> to get them to that stage.

>

> This seems to me to be logical; not everybody will be

> producing the same amount of insulin, some will be

> nearer to the point at which they do not produce

> enough than others are.

>

> There is a thorough (but highly technical) explanation

> of the role played by genetics, age and obesity in

> beta cell dysfunction in type 2 diabetes at:

>

> http://www.medscape.com/viewarticle/514155_3

>

> It seems to me that in Type 1 you suddenly do not

> produce enough insulin while in Type 2 it happens very

> slowly - that is the real difference between the two.

>

> Regards

>

> Thornton

>

>

>

>

>

>

>>

[Guest guest]

Oops, thanks, Ted, I only had it a little bit backwards .

Vicki

Re: Insulin for T2 and prevention of

complications.

> --- whimsy2 whimsy2@...> wrote:

>> As to Noble's statement that type 1 and type 2 are entirely different

>> diseases, from what I've learned, it's actually the CAUSE that's the

>> main difference; type 1 is autoimmune induced. Due to an immune

>> attack,

>> the pancreas stops producing beta cells, which carry insulin

>> throughout

>> the body.

>

> Er, well..... Beta cells stay in the pancreas producing insulin, which

> carries throughout the

> body. Beta cells stay in the pancreas, which is why Dr. Langerhans

> found them there and they were

> accordingly named the " Isles of Langerhans " .

>

>

> Ted Quick

[Guest guest]

I'm on insulin and I also take metformin. But I take it because my body

has proven to me that I need it. If I could achieve a 6.0 level of

control without it I wouldn't take it, especially based on something

that might happen in the future. In my case, the future is here.

CarolR

Sue wrote:

> Anything that helps our insulin resistance is worthwhile, in my

> opinion. If I went on insulin, I would still take metformin. Sue