Hi Novo (do you mind if i call you that?)
Good questions! I'm really please you want to know about type 2 coz i think that although some people know quite a lot aboiut the form of diabetes they have got, we're all a little hazy about the ones we haven't got.
Type 2 diabetes differs from type 1 in that it we type 2s still produce some insulin, maybe not as much as we need, but some. The ammount your pancreas is still pumping out kind of determins your treatment. If your insulin levels are pretty much normal, you can control your blood sugar levels with diet and exercise, if it's a bit less than enough to cope with you may take tablets such as Metformin or gliclazide or a combination of any number of drugs, both tablets and injections like Byetta or Victoza. If your insulin output is suffiently low that this isn't enough, you may inject insulin, as if you were type one.
The other problem is insulin resistance, which might be a cause of type 2 diabetes. In some people (of which i guess i'm one) the insulin you do produce isn't getting the glucose out of your bloodstream and into your muscles properly, and this can be aggrivated by having more than average body fat. This isn't to say that only overwieght people get type 2 diabetes, but i suppose that if you have the potential to be insulin resistant, you're more likely to become type 2 if you are overweight. Put it this way, there are lots of large people out there who arn't diabetic, and there are lots of thin type 2s, so it's not the be all and end all. This is also probably the reason for all the people who claim they've been cured of diabetes...they got fitter, lost wieght and ate better so that their insulin could now handle the process of moving glucose about to an acceptable efficency for thier new diet. If they were to backslide they'd probably struggle again.
Metformin in particular and Byetta and Victoza as well i think, are generally thought to reduce insulin resistance.
I think that HbA1c targets are much the same, although perhaps a little stricter, i think we're supposed to be somewhere below 7. Perhaps it's the case that it's easier for type 2s to achieve target levels than type 1s, but i don't know. I think, and i've got a copy of the NICE guidelines around somewhere, that if your go above 7 you start on a scale of treatment, first it's diet and exercise, then if that doesn't work metformin, then if that doesn't work more metformin, and if that doesn't work metformin and gliclazide (gliclazide causes the pancreas to pump out more insulin, this is good in the short term but in the long term it may cause your pancreas to wear out faster, making you more likely to have to take insulin sooner) or metformin and byetta, excetra...
The threat of insulin injection tends to be a bid of a boogyman for some of us, i was assured that most type 2s were doomed to end up on insulin within 5 years of diagnosis, well, i've made it to two and i'm still on the lowest dose of Metformin, so i don't think i'll beleive everything a DSN tells me. When i was first diagnosed they thought i might be type 1 so i managed to get my head around testing and injecting, or at least i prepared myself for it, only to be told that i needed to learn how to swallow massive tablets instead. My last Hba1c was 6.8, i was astonished, i'm due for another test in september and i think it'll be higher, but i think it'll only mean taking more metformin.
I don't test, much, only when i'm worried or i've had a windfall of test strips. I can't get them on prescription so i have to forlk out 25 pounds a pack for them. The only reason that i've got a meter at all was because they thought i was type 1 for 24 hours when i was first diagnosed. My PCT has decided that type 2s who are not taking insulin don't need to test, so we can't get strips prescribed. When i do test, i usually find i'm hyper and it scares the bejeezus out of me, which is one of the reasons they don't let me do it...The other thing about Metformin is that because it only lowers insulin resistance, it doesn't make the pancrease release more insulin, so you don't hypo.
Morning readings tend to be high (and in my case i'm happy if it's less than 10), this isn't because insulin resistance is high, i don't think it varies on a day to day basis. It's simply because like everyone else, you liver throws out glucose (glycogen? I can't remember, this will be why i failed a level biology) in an effort to get you started in the morning. Unfortunately nobody told your liver you were diabetic and to hold back on the stuff a bit. Struggling with the dawn effect is something that all of us diabetics have in common. Also complications, which hang over your head like a big black cloud, especially when you're first diagnosed.
(Ok, don't read beyond here if you don't like moany type 2s...I'm not picking on anybody, or complaining about anybody in particular (except that i've got diabetes and i don't want it!) Fast foward to the bottom of the paragraph where i explain that all types of diabetes are as maddening and as tough as each other, just for slightly different reasons.)
Sometimes we think we get a raw deal, some people seem to treat us like we're moaners who should be greatful we're not type 1. After all, we can't be that bad coz we don't have to have injections four times a day. On the other hand, those of us who arn't injecting can really only control our diabetes through diet. The meds can help us, if if want to control our blood sugars daily, we have to be strict (ish) about what we eat. We can't change our insulin doses to match our menus. I can get away with a little bit of chocolate or a little bit of cake, but if i want more (and i know i will) and eat it, i'll end up feeling terrible for days, and i'm putting myself a risk of complications if i don't limit myself. One of the best lessons i've learnt from this board and esspecially the meets i've been to is that no type of diabetes is better or worse or more severe than another, they're all pretty darned miserable.
Like in type 1, all type 2s are different, we don't all respond to the same treatment or have the same issues with our condition, sometimes your blood sugar is just weird, and there's bound to be people who don't see diabetes the same way i do.
Rachel
