Type 2 Progression or something else?

[Mark T]

Recently I?ve been noticing my numbers going up a little. They are still within what most people will find an acceptable range, but I?m wondering if this is progression or something else?

I haven?t changed my diet, my exercise levels are if anything, higher. My weight is the same and actually dropping a little. So those don?t account for the change. Possibly stress might play a

Previously my 2 hour level would be at or near to my pre-meal level; I estimated my peak at probably 1 hour (but I never confirmed it).

Now, I?m not back below the pre-meal even at 3 hours and I did a measurement exercise and found the peak at much nearer 1.5 hours (doing that is a bit heavy on strips, but it was useful information).

My HbA1c?s have gone from 5.5% to 5.8% to 6.1% and I?m due my next in a month?s time (but I can guess where it will go).

Pre-meals and fasting readings are mostly in the 5?s, so that?s hardly bad.

So is this how Type 2 usually progresses?

 

[trophywench]

Well - it's a YMMV one isn't it? - as nobody can actually tell !

Firstly - nobody ever said your BG should be back to pre-meal levels at 2 hours? - or did they and I've missed that? The post meal test is to establish a) when it occurs (1 hour, or 1.5, 2 hrs etc) and thereafter, b) how quickly does that peak subside?

Think your previous results indicate that your Phase 1 insulin was OK and so was your Phase 2. But your new results seem to indicate that your Phase 1 might be decelerating? - or something; greater insulin resistance all round maybe?

There are a good many things it could be, like maybe you need 3 Metformin, or maybe your pancreas needs some help with meals (so Gliclazide or similar, or reduce carbs/change GI of carbs) or stress (which definitely has an effect) or the ambient temperature (meaning your body generally isn't working as efficiently as it does when it's warmer) or you could be either sickening for something or have something happening in your internal organs that you can't see can't feel but is causing inflammation - any or all of these conspire against us!

I mean does your BG stay stable if you took a couple of random readings a few times in between the 'before and after meals' routine? (yeah even unto the middle of the night) Have you actually been able to nail it to definitely being restricted to ONLY a mealtime issue?

 

[Mark T]

Thanks trophywench 🙂

Yes I?m aware it?s a bit of an YMMV.

There is nothing that states your BG should be back to baseline 2 hours after a meal (my PCT?s recommendation is <11 at 2 hours) however, that was what used to happen with me. Now it doesn?t ? so that?s a change. I?m just wondering if anyone else on the forums had similar experiences. There are a few that started on Met and progressed to insulin (due to no fault of their own).

It could be a failing phase 2 response. I hope not, but I don?t think its insulin resistance because I assume that would be associated with weight gain (I could be wrong of course). Previous tests (unfortunately not an OGTT) seemed to indicate that my insulin resistance wasn?t particularly high anyway.

Regarding, am I stable generally outside of meals? Well the only suitable measurements I have are before bed and fasting readings. Generally they are fairly close together (within the meter tolerance anyway). I haven?t done an overnight in quite a while but that was generally stable as well.

Yes, it suggests I need something else for post meal spikes.

Btw, what I never wrote was that my consultant considers me to be a Type 1.5, although my GP has me as a Type 2. Who knows what the truth of it is!

 

[trophywench]

The T1.5 inference is interesting! and frankly I'd be much more likely to believe your consultant than your GP.

However having said that, I don't think GP systems have a coding for T1.5 so when they get one they probably code it as whatever is most appropriate to the person's treatment rather than it being exactly what you are. The danger there though is that anyone who isn't an Expert would treat you as a T2 for anything and everything, which is not the case. So if the PCT said eg T2s don't get test strips .......

Any chance of seeing your consultant again soon-ish and chatting in depth about your situation?

 

[DeusXM]

The two hour postprandial is to see if your insulin response is 'normal' - I think generally, T2s should aim for a 2 hour pp reading equal or better than their premeal reading, and T1s should also aim for the same but may need to cut some slack as most bolus insulins work for 3-5 hours.

I wouldn't necessarily say your diabetes is progressing or you have a wrong diagnosis. The unfortunate fact is that sometimes your body just changes how it wants to work, and it may change again. If you're a T1 or T1.5, this becomes very apparent very quickly, but it can also happen with T2s too.

Your A1C is still in 'good' territory, but it may be worth re-evaluating your diet or medication for the time being. I don't really hold with this notion that T2 'always' gets worse, it seems to be the sort of thing perpetuated by doctors who think insulin should be a threat rather than a tool.

 

[RachelT]

"I don't really hold with this notion that T2 'always' gets worse, it seems to be the sort of thing perpetuated by doctors who think insulin should be a threat rather than a tool."

I agree, one of the first things i was taught on the DESMOND course was "Well, of course you'll all be on insulin within 5 years. There was this one bloke who wasn't, but he ran marathons....". Which obviously put the fear of god into us. But you're right, it is a tool, not a punishment.

The other point is that i'm not sure that much of the NHS is even aware that type 1.5 even exists. I've not yet seen a patient discharged through our hospital pharmacy with a history of type 1.5, and our diabetes consultants are pretty on the case.

 

[Emmaathome]

I was on insulin within 3 months - so I guess a "threat" of being on insulin within 5 years would have been gratefully received in my case

I'm a T2 on all records, although the DSN believes I'm probably a 1.5 too. Guess it makes no difference if I'm taking insulin now anyway

I hope you get to the bottom of the changes and are able to sort out to your satisfaction...

 

[everydayupsanddowns]

I was on insulin within 3 months - so I guess a "threat" of being on insulin within 5 years would have been gratefully received in my case

I'm a T2 on all records, although the DSN believes I'm probably a 1.5 too. Guess it makes no difference if I'm taking insulin now anyway

I hope you get to the bottom of the changes and are able to sort out to your satisfaction...

Might be worth following up though Emma, for access to T1 style courses whch would be more appropriate for you perhaps?

Plus you are less likely to get hassle over strips if your records say 1.5 rather than 2 I'd expect.

 

[Northerner]

It should also be added that some people are described as having 'double diabetes', where they are diagnosed as Type 1, but have a significant degree of insulin resistance. When it comes down to it, as Emma says, the main thing is that your medication needs are recognised and you are able to keep your levels under control. 🙂

 

[trophywench]

I agree wholehearedly with Mike here.

The NHS are on such a money saving kick these days (which I do understand the need for - BUT) if in addition to the strips and meter issues, someone suddenly decides it would be OK to stick all T2s on this or that insulin because it's cheaper - then you'd potentially be fighting that too.

 

[Mark T]

Throwing back on topic here 🙄

Although I agree that it is useful to have a correct classification because the PCT's treat Type 1 and Type 2 differently from a budget point of view.

I've always assumed that progression of Type 2 only really occurred if your control was not good. Ok, there is cell loss due to natural programmed cell death (after a certain age this is a higher rate then cell creation) but otherwise with pure Insulin Resistance there was no reason why they should progress.

My father did say that he started on tablets and ended up on insulin within 5 years and that he had been "naughty". However, I do wonder if it was actually inevitable and all he did was speed the process up.

I'm due to see the consultant on the 28th August which is soon enough since my numbers are not that bad really. Although if I do a dietary adjustment to hold the numbers down I can see me getting slapped wrists again

 

[Northerner]

...I've always assumed that progression of Type 2 only really occurred if your control was not good. Ok, there is cell loss due to natural programmed cell death (after a certain age this is a higher rate then cell creation) but otherwise with pure Insulin Resistance there was no reason why they should progress.
...

I would imagine that most of the data that has ever been collected will weigh heavily on the side of 'it always progresses, people eventually need insulin', simply because of the sheer number of people who get Type 2 and are either unwilling or incapable of making the necessary adjustments to their diets and lifestyle etc. to keep a good HbA1c, or they do not receive the support and education (even if they are willing and capable) they need. So, just as the HCPs like to tell T2s that testing will make them depressed and obsessive based on a statistical analysis that may be wholly unrepresentative of a person's individual situation, so they tell everyone that progression is inevitable

Progression for some may be inevitable, whereas others may only pay lip service to control and live long and complication-free lives, due to the luck of the draw. But I believe that people can change their future given the right encouragement, knowledge and application. 🙂