So, Type II folks, what’s the exit strategy?

[MoseySusan]

My mom was Type II diabetic, and she took a pill to manage, but this was more than 30 years ago, and I was too young and focused on myself to understand the details. I don’t remember her talking about a future with restored insulin function. 

Recently, my BiL was diagnosed pre-diabetic, so he shifted his diet and activity level and  avoided diabetes. 

Suffice to say, I don’t understand how Type II diabetes works. Is there an exit? Or, is this insulin functioning as the new normal? 

As for kidney disease, I’m in it. After all the tests, my nephrologist thinks some trauma in my 20’s has finally caught up. When I was 22, I was thrown from a motorcycle traveling 70+ mph, and he didn’t give a definitive, but said it’s likely. The exit strategy is to putter along with whatever function I have, minimizing phosphates, sodium, potassium, and avoiding NSAIDs. 

[BuffJim]

There are many different type 2 trajectories. Some people are going to have high blood sugar, no matter what they do, and will need insulin. Others can manage to control through diet exercise and meds. Some overweight type 2s can lose weight and effectively reverse their condition. Some thin type 2s have no weight to lose.

My end game is to avoid insulin as long as I can. So far so good, and it’s been 15 years since diagnosis. 

[Mr. Silly]

My endocrinologist said that my pancreas may increase its function so I could reduce my insulin usage.  Measuring my glucose level and injecting insulin is my normal though and I my expectation is that it will be for the rest of my life.

I am looking forward to warmer weather so I can get on my bike regularly.  That should reduce the amount of insulin I need.

Increase activity and reducing carbs could probably save your BIL the aggravation of having to test and inject.

Don't let your BIL cut carbs too much.  You need carbs to eliminate a substance called ketones.  If the build up you end up with ketoacidosis.  That is how I ended up in the ICU.  My dietitian suggested I have at least 45 grams of cards per meal.  ChrisL's told him 30.  Suggest he discuss it with his doctor.  My organs were shutting down, feel free to use me as a cautionary example of being too aggressive when cutting carbs.

Type I diabetes is when the pancreas in not functioning at all.  Someone with Type I is 100% dependent on insulin for the rest of his life.

Type II diabetes means the pancreas is still functioning but not optimally. Insulin will can make up for what the pancreas is unable to do.  Diet and activity can reduce the need for insulin.  My endocrinologist said that diet and exercise can eliminate the need for it.

There is a Type III and IV diabetes as well.  One is when the pancreas is removed surgically (perhaps to treat cancer) and the other pregnant women can get and is usually temporary.  I forget which is which.

[sheep_herder ★]

At this point in my life at 81 years old, I will be taking some regime of long and short acting insulin and another chemical like victoza to even out the highs and lows until I leave this earth. During the tenure of my disease from autumn 1999 to now, I have gone from shooting insulin 4 times a day to oral medication and eventually to no medication at all with changes in diet and increased exercise both in the gym and via cycling. As I have gotten older, the advent of arthritis in my shoulder and increased problems with my foot have reduced my movement and most definitely my exercise, except that associated with feeding and caring for the livestock. I don't keep a diary or flow chart, so I cannot tell you when I have passed from one phase to another. In addition to type II, I take medication for afib and my many allergies. As I have shared with you before, my kidney function is not A1, but based on creatine level, etc. measured every 6 months it is stable for now. This was something that was noted way before I was diagnosed with type II. I also have edema in my legs which they think is due to a leaky valve in my heart, and during one of the scans to check the valve was when they discovered the afib. Yes, I have gained weight and should work to lose some, but we shall see what the future holds. Who knows maybe I'll buy a step through bike from Rivendell and start cycling again, but the traffic situation once I leave gravel is not conducive to having fun and feeling safe. Life goes on!

[sheep_herder ★]

I might also add this as Mr. Silly has described the disease.

In type 2 diabetes, the pancreas makes insulin, but the cells don't respond to it as they should. This is called insulin resistance. When glucose can't get into cells, the blood sugar level rises. Then the pancreas works harder to make even more insulin.

[MoseySusan]

20 minutes ago, Mr. Silly said:

Increase activity and reducing carbs could probably save your BIL the aggravation of having to test and inject

He’s in the clear with no risk of diabetes anymore. 
 

21 minutes ago, Mr. Silly said:

My dietitian suggested I have at least 45 grams of cards per meal.

How do you count? I ask because tracking food macros is a task. I’ve been estimating my levels based on some “high/moderate/low” and “ok/avoid” charts the dr gave me instead of tracking mg per meal. 

[MoseySusan]

14 minutes ago, sheep_herder said:

. I don't keep a diary or flow chart, so I cannot tell you when I have passed from one phase to another

Life does go on. You make 81 look good. 

[Mr. Silly]

38 minutes ago, MoseySusan said:

How do you count?

Carbs are listed on food packaging.  Fiber, which is a carb, can be subtracted from the total since it cannot be digested.  The result is call, net carbs.

For fruits and vegetables, I've looked up their net carbs.  There isn't that much variation from week to week with the produce we get so it isn't too big of a burden to memorize them.  Some veggies, like lettuce, I treat as free-bees.

The challenge is with soups, stews and other foods that are a combination of other foods.  With those foods, I just guess.

[MoseySusan]

4 minutes ago, Mr. Silly said:

The challenge is with soups, stews and other foods that are a combination of other foods.  With those foods, I just guess.

For sure. Eating out, too. 
I’ve loaded the recipes form all of my homemade soups, stews, and pasta dishes into MyFitnessPal for the macros and the sodium and potassium levels. A task, but it’s done. 

[ChrisL]

Many good responses already. My $.02 is one, there are people predisposed to diabetes like me.  There are those who become pre or diabetic due to lifestyle.  

I think there is a clear path or exit strategy for those with lifestyle induced diabetes. Eat better & lose weight. As others mentioned sugar/carbs & processed foods are driving the diabetes epidemic. It can be reversed or even cured with diet & exercise.  For those who are predisposed, I think the strategy shifts to delaying insulin as long as possible.  

My diabetes has had its ups & downs but like the stock market is pretty much trending up, towards insulin.  I became pre diabetic in my 30’s while still fit from running. Definitely predisposed.  I became diabetic in my early 40’s.  Just like my mom and several siblings.  When my Dr recently switched me to Mounjaro as Ozempic wasn’t working, I said to myself I can do better and started making lifestyle changes.   At this time I also got a notice from my medical provider of a program to get off diabetics  meds called Virta.  You can look it up, this post is already getting long but it’s working well for me.

My current plan is to see how many diabetes meds I can reduce while on Virta.  I dropped Jardience and halved my metformin.  My glucose has stabilized around 100 (fasting) so I think I hit a plateau but that’s the best it’s been in decades and pretty close to “normal”.  I also lost weight and so had to adjust my BP meds from 40 mg, to 20 mg and now 10 mg.

So we’ll see, maybe I can lower my meds over time but I’m happy where I’m at now.  I plan to stick with Virta long term as the benefits of the program far outweigh the foods I’m missing.  

[jsharr ★]

I know that with diet and exercise I can greatly reduce my need for meds.  I do regular blood work and they check for kidney function.  I do to my eye doc to have my eyes checked for damage from diabetes.    Would love to get off the drugs but not sure that will happen.  Dad was never able to do it either and he walked and played tennis until the parkinsons and dementia kicked in.

I do not want to spend my final years in a bed unable to control my bodily functions, so to be brutally honest, my exit plan may be to say my good byes and find my way to the door either on my own or medically assisted.  I have shared this with my boys.  They understand.  I think quality of life and dignity far out way length of life.  

[BuffJim]

Question for @Parr8hed : What percent of your dialysis patients are type 2s?

[jsharr ★]

I will say that ChrisL is right about predisposed.  I led a VERY active lifestyle up until my late 40s.  Cycling, sailing, working physical outdoor jobs for the most part.  But I was pre diabetic no matter what I did.  So I live a normal life and try to watch my diet and deal with it.  I am Type II and have been for decades.  

[MoseySusan]

2 hours ago, ChrisL said:

 For those who are predisposed, I think the strategy shifts to delaying insulin as long as possible

I’m going to draw another parallel along the lines of predisposed. I know two people who drank until their liver gave out:  one who was in his 80’s and another in his 30’s. A different predisposition. It feels like a crapshoot sometimes, whether a person gets the body that chugs along or the body that sputters. 

[jsharr ★]

4 minutes ago, MoseySusan said:

I’m going to draw another parallel along the lines of predisposed. I know two people who drank until their liver gave out:  one who was in his 80’s and another in his 30’s. A different predisposition. It feels like a crapshoot sometimes, whether a person gets the body that chugs along or the body that sputters. 

“The fates conspire…”

[MoseySusan]

13 minutes ago, jsharr said:

Type II and have been for decades

I was under the impression that, once diagnosed, Type II is for the duration. 

[jsharr ★]

3 minutes ago, MoseySusan said:

I was under the impression that, once diagnosed, Type II is for the duration. 

That is bascially true.  Through diet and excercise a type ii diabetic can reach blood sugar levels taht do not require medication, but this is remisssion, not a cure.

Some interesting research going on that shows promise of a cure

https://www.utsouthwestern.edu/newsroom/articles/year-2021/beta-cells-diabetes.html#:~:text=In Type 2 diabetes%2C the,die from an autoimmune attack.

[MoseySusan]

8 minutes ago, jsharr said:

“The fates conspire…”

mr and I were just talking about how shifting the narrative away from outside agents of destiny toward a naturally derived existence has eliminated the facet of cruelty from the story. Those fates are capricious AF. But DNA, not so much. 

[ChrisL]

3 hours ago, MoseySusan said:

I was under the impression that, once diagnosed, Type II is for the duration. 

Not necessarily.  My sister that I refer to as Bitch Sister once gloated that she beat diabetes as she was on metformin, lost weight & improved her diet and was taken off metformin.  This all happened in her 60’s.  She gloated to me & two other sisters  we just weren’t as disciplined as she was.  

I asked her when were you diagnosed prediabetic?  She said about three years ago (late 50’s).  I told her you’re not predisposed like us, yours was lifestyle induced and you corrected it with diet lifestyle changes.  She disagreed of course until we all told her we were prediabetic in our 30’s.  This blew her mind as she didn’t realize we had been fighting diabetes for decades at that point.  My middle brother was also diagnosed pre diabetic in his late 50’s and became diabetic in his 60’s.  He’s fat, out of shape & eats like shit so likely will remain diabetic.

So long story short, I believe if your diabetes is lifestyle related and not predisposed, you can beat it. Bitch Sister did.