Type IIs Progressing to Insulin

[MikeyBikey]

I have seen a quote that 50% of Type IIs progress to insulin. Has anyone else seen this or have a reference? I would have thought it was far, far less!

 

[Toucan]

I read this recently in Roy Taylor's book 'Life Without Diabetes'.
He says that according to 'official guidelines' a person newly diagnosed with Type 2 has a 50:50 chance of being on insulin injections within 10 years.

My doctor also gave me a similar message a few year's ago when I was first diagnosed. It was actually a great incentive to make me go and do something about it, and try and make sure I wasn't in the wrong 50%!

 

[trophywench]

Oy! I resent the inference that insulin is somehow 'wrong' ! LOL At least T2s still have their own, some of us don't. The fact that your bodies can't use it efficiently is an entirely different matter as you know.

You have to remember that an awful lot of these stats (lies, damn lies and statistics …) are 'elderly' and all the folk now known to be LADA or simply initially wrongly diagnosed just cos they were over 21 at the time, would have been included in the 'T2 who are now on insulin' category.

 

[Neens]

I guess the other factor may be - if the statistics are taken to include T2D who are on insulin for short part of treatment/ if they have been ill/ operation etc. there are some things that mean metaformin cannot be taken and at this stage there would be a change in the medication.

As @trophywench says it isn't 'wrong' - I don't think Kay meant it that way though ... and as a T2D who had insulin mentioned as a possible action in my first DN appointment and someone who is useless fingerpricking, I also appreciate it is scary and something we would rather not have to experience. It used to be used as a sort of threat - if you don't do this you will end up on insulin - and although T2D would all prefer to be medication free it is not always possible if our body has high IR. Despite trying our best.

I know @MikeyBikey is just asking about a statistic and not trying for a debate on the insulin factor so not trying to incite one - just want calm waters this Saturday afternoon. 😉 Just noticed the LOL @trophywench and am aware now that nobody has actually offended you!


Not come across this 50% statistic or in 1st 10 years after DX myself, but am aware that there are people who get diagnosed and make no changes, these may well end up needing the extra medical intervention.

PS 99% of statistics are made up!

 

[DaveB]

Hi, I agree with trophywench that a lot of those 'T2s' will be LADA and hence on insulin. I'm one of those wrongly listed as T2. I quite often on various forums see T2s who say they are overweight and on insulin. It's very likely that they have insulin resistance thru the excess weight and the insulin will be helping a little. In those cases if the weight came down it's likely the insulin would no longer be needed so that isn't diabetes progressing as it does with LADA. Bottom line is those stats mean little.

 

[Toucan]

Oy! I resent the inference that insulin is somehow 'wrong' ! LOL At least T2s still have their own, some of us don't. The fact that your bodies can't use it efficiently is an entirely different matter as you know.

Sincere apologies @trophywench, I certainly didn't mean my remark to be interpreted that way. I need to be more careful in my choice of words,
Since being on the forum and learning a little bit more about Type 1, I have the utmost respect for you all, and I know that we type 2's have it easier in some respects.

 

[trophywench]

Kay, quite honestly, I reckon that T2 is one helluva more complicated thing than T1 to cope with!

 

[rebrascora]

I wonder how much lower that percentage would be if the NHS actually gave people appropriate dietary advice on how to manage their Type 2, rather than some vague suggestion of cutting down on sugar and cakes and using the "healthy eating plate" guidance rather than telling people to eat low carb.
Of course there are some people who have no interest in changing their way of eating and are happy to inject increasingly huge amounts of insulin into their system whilst remaining morbidly obese. I certainly know at least a couple of them Sometimes I think we forget that the people on this forum are very proactive about managing their diabetes but are not necessarily representative of all Type 2 diabetics. I am sure there are plenty of members here who know other Type 2s who eat whatever they fancy and just expect the tablets or insulin to deal with it.

 

[Eddy Edson]

Oy! I resent the inference that insulin is somehow 'wrong' ! LOL At least T2s still have their own, some of us don't. The fact that your bodies can't use it efficiently is an entirely different matter as you know.

You have to remember that an awful lot of these stats (lies, damn lies and statistics …) are 'elderly' and all the folk now known to be LADA or simply initially wrongly diagnosed just cos they were over 21 at the time, would have been included in the 'T2 who are now on insulin' category.

Hang on ... not all T2's make their own insulin, and the progression of T2D "classically" has been regarded as insulin resistance => beta cell death due to something-or-other (lipotoxicity maybe) over time in some people => increasing insulin insufficiency => more meds needed over time, including insulin.

So T2D isn't just insulin resistance; it's insulin resistance leading, in some people, to insulin insufficiency, and over time, no insulin. And it's only when insulin resistance does progress to insulin insufficiency that you have actual T2D.

The medical view has been: for people susceptible to the progression, you can slow it down via meds and lifestyle changes, and maybe you can reverse it at the "pre diabetes" stage, but other than that you're on a journey to needing external insulin and it's just a question of whether you fall off yr perch before arriving there.

Eg: I think this is probably a good summary of how things have been understood until recently https://care.diabetesjournals.org/content/32/suppl_2/S151

In type 2 diabetes, β-cells fail to adapt to impaired glucose tolerance. This failure appears to be related to a reduction in insulin secretion per islet as well as a reduction in the total number of islets. Progressive loss of β-cell function and, to a lesser extent, reduced β-cell mass lead to worsening glycemic control and development of complications. Although they lower glucose, current therapies do not completely abolish this progressive loss of β-cell function

Roy Taylor's stuff seems to demonstrate that this picture isn't correct for some T2D's. Clearing fat from the pancreas can reboot beta-cell function and increase beta-cell mass, if you're lucky, hopefully for the long term.

 

[trophywench]

Well all T2s do produce their own insulin to begin with and though I've always known that eventually the beta cells may give up the struggle, why on earth do medics push things lie Gliclazide and other such more modern drugs, which cause the body to actually whack out more and more insulin? And tell patients they are a good idea?

Sound bats to me and always has! Counterintuitive, innit, surely?

 

[Neens]

I wish I understood it as well as you do @Eddy Edson - although having read that ^ maybe I am happy in ignorance! 😱
When I was first diagnosed this is how I thought it would go, (as you describe). Then in reading materials I gleaned that remission or much lower level HbA1c would counter some of the internal non-functioning, like the hope I have enough beta cells left... and that through intervention (meds) and healthier lifestyle we could stave off all possible complications and live as long as we were going to anyway. Hesitant to post this but about to hit reply anyway.

 

[grovesy]

Remission/Reversal is a new concept and there has still been no long term follow up of Professor Taylor's trail.

 

[Eddy Edson]

Well all T2s do produce their own insulin to begin with and though I've always known that eventually the beta cells may give up the struggle, why on earth do medics push things lie Gliclazide and other such more modern drugs, which cause the body to actually whack out more and more insulin? And tell patients they are a good idea?

Sound bats to me and always has! Counterintuitive, innit, surely?

I don't really know anything about those meds, but doesn't it make some kind of sense to bash the beta-cells into pumping out more insulin while they still can? Assuming it doesn't wear them out more quickly or something ... dunno.

 

[trophywench]

Well as long as it doesn't cause em to wear out more quickly Eddy, but we don't know that. Surely any thing or body which has to run faster to stand still, will get exhausted?

 

[Eddy Edson]

I wish I understood it as well as you do @Eddy Edson - although having read that ^ maybe I am happy in ignorance! 😱
When I was first diagnosed this is how I thought it would go, (as you describe). Then in reading materials I gleaned that remission or much lower level HbA1c would counter some of the internal non-functioning, like the hope I have enough beta cells left... and that through intervention (meds) and healthier lifestyle we could stave off all possible complications and live as long as we were going to anyway. Hesitant to post this but about to hit reply anyway.

I reckon that's the right attitude. But I'd also check out the Roy Taylor remission/reversal-via-weight-loss stuff https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation or his new book: https://www.ncl.ac.uk/magres/research/diabetes/reversal/#lifewithoutdiabetes

It won't work for everyone, and as @grovesy points out, there's only been a two year follow-up to the big trial so far, so nobody can say for sure if it's permanent with maintained weight-loss. But it's worked for me - so far 🙂

(Do note that even though it's normally coupled with a fast weight-loss approach via a short-term 800 cal per day liquid diet, that's not an essential feature. Eg: Anything which removes enough weight over a few months is good enough, so long as the weight loss is maintained.)

 

[Eddy Edson]

Well as long as it doesn't cause em to wear out more quickly Eddy, but we don't know that. Surely any thing or body which has to run faster to stand still, will get exhausted?

In any case, if I was prescribed them, I'd *really* want to know the answer to that question ...

 

[grovesy]

I don't think they know that, the effect is not predictable on Blood Sugar, at least in my experience.

 

[Neens]

Kay, quite honestly, I reckon that T2 is one helluva more complicated thing than T1 to cope with!

And I feel the same about T1 - I think that's more complicated. I guess we can't compare or judge what we haven't got. (Not that anyone is), it is a difficult condition no matter what type you have. Living well with either(any) takes a lot of persistence and care. When I see what some members are having to do on a daily basis with T1, I am amazed at what you have to do to manage your diabetes. I guess it is because there is so much to learn I am only reading up on T2 and so only learn the T1 experience via this site. My friend is very private about it all and the people I know working with T1 I only know of the routines they have to manage to get through the day.