Diabetes Self-Management Blog

It was 2:30 AM last Friday, and I was being bombarded with alarms. No, I wasn’t dreaming. My insulin pump was telling me it was low and my continuous glucose monitor (CGMS) was telling me I was low.

Sometimes, technology can be too much of a good thing.

I was, of course, glad to know that I was sliding into hypoglycemia before I got to the fuzzy-headed, shaky sweats stage, but I do have glucose tablets and gel on my nightstand and could have stayed in bed. However, I did have to crawl out of my nice, warm bed to put insulin in my pump.

Note to self: Check level of insulin in pump before going to bed.

Back to the CGMS, however. That was the second time I’d been awakened in the early hours by an alarm telling me my blood glucose had slipped below the range I had set. Seems it’s time (again) to change my basal rates.

I needed to lower my basal rate and could not, for the life of me, remember how to do it on my relatively new pump. So I e-mailed Abby the trainer, who immediately called me back.

“Change your diet?” she asked.

“Yeah,” I acknowledged. “That, plus the seasons are changing, it’s the fortieth anniversary of the Age of Aquarius, and the moon is in the sky.”

Herself a pumper, Abby commiserated, saying she’s constantly having to change her basals for some odd reason or another.

There’s a saying that the only thing consistent about diabetes is its inconsistency.

Go ahead. Prove me wrong. Do the same thing and eat the same foods at the same times for two days in a row. Tell me your blood glucose is the same both days. Betcha it isn’t.

I remember weeks when I couldn’t get my blood glucose down. I ran high and giving myself insulin in an attempt to bring my blood glucose down was like dumping the stuff into a black hole: Nothing happened. Then, as if by magic, the insulin miraculously began to work—and I couldn’t keep my blood glucose up. The latter happens, of course, overnight. It doesn’t make for a good night’s sleep.

It wasn’t until I starting pumping nine-plus years ago that I realized how sensitive our bodies are to changes. Changes in diet; changes in the weather; changes in stress levels; changes in other things that are happening in our lives…I’m not sure all health-care providers realize that.

People with Type 2 diabetes have other changes. I wish I had been told early on that it would likely require medication and then additional medications and, finally, insulin (and then additional insulin) to keep my blood glucose levels in a decent range. While the word is that Type 2 diabetes is progressive, it’s more like beta cell failure is progressive.

For that reason, diet and exercise may work—for a while. And one pill may work—for a while. Combinations of pills may work—for a while. This much insulin may work for now, but may not later. Over the years, my body has required more insulin to help me metabolize the same amounts of food. A sandwich that used to take two units of insulin now takes four times that much.

An article published in the Southern Medical Journal in 2004 points out that “It is the inability of the endocrine pancreas to compensate for peripheral insulin resistance that leads to hyperglycemia and the onset of clinical diabetes. It is increasingly believed that this ß-cell failure is at least partly genetically preprogrammed, rather than driven by or a consequence of insulin resistance.”

What that means in “English” is that Type 2 diabetes occurs when your pancreas is unable to manufacture enough insulin to overcome your body’s resistance to it, and that the failure is partly genetic rather than “it’s all your fault because you got fat and lazy.” Although it does help to remain active and eat more healthily than most Americans do. Whether they have diabetes or not.

Had I been told that beta-cell deterioration was inevitable (as were the resulting changes), I might not have felt (been made to feel?) like a failure because I kept needing more…well, crutches, as it were.

In 1998, the results of the 20-year-long, 5,000-subject United Kingdom Prospective Diabetes Study (UKPDS), which followed people with Type 2 diabetes, was released. You may have heard that the study proved that intensive management reduced the risk of complications in people with Type 2 diabetes (just as the Diabetes Control and Complications Trial—or DCCT—proved with Type 1 diabetes). Which is great.

But another fact that emerged was not as well publicized: “There is an increase in blood glucose levels with increasing duration of Type 2 diabetes—an upward trend noted in both the conventional and intensive treatment groups of the UKPDS,” said an article in a 1998 issue of Diabetes Care.

Intensive treatment included increasing the treatment dosing or adding treatments if a person’s blood glucose rose above target.

So, as time elapsed, even people with good control, who were being closely monitored, required more and/or multiple drugs (including insulin) to maintain blood glucose control. Apparently, there’s nothing those of us with Type 2 diabetes can do about it: Even with good control, it’s likely to take more and/or different drugs to maintain good blood glucose control. It’s just those crazy beta cells continuing to poop out.

Perhaps, one of these years, science will discover a way to change that.

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Comments
  1. Dear Jan. Your article is uplifting in a way since blood sugar control does on occaision depend on the phase of the moon and it does not get better with time and this is probably not our fault. God surely did a good job when he made the normal pancreas. Being a diebetic it is hard to see how a normal pancreas controls the BG in the normal range at all times. I wonder if it would be possible to use the continuous meter readings and put the pump on automatic control to create an artificial pancreas? Or if stem cell reasearch is allowed again to have our dying pancreas’ rejuvenated.

    Posted by CalgaryDiabetic |
  2. Thank you for this informative insight. As a Type 2 I recently began taking my diet, meds and exercise seriously (after a 10.6 A1c! and the threat of the needle.) In the last 2 months I’ve lost 22 pounds - living on lettuce, tuna fish and soups. 3 mi/day on my treadmill also makes a big difference…I hate the thot of injecting but have come to the conclusion that this progressive disease is truly that. I’ll continue to try and dodge the needle for as long as possible. You article is so informative…I too have felt like a failure when 1st diagnosed. All this reminds me of a philosophy I cherish…ITS NOT ALL ABOUT ME!

    Posted by GrayingChap |
  3. I’m trying to come to terms with the fact that Type II is progressive. I was diagnosed 2.5 yrs ago w/ a 13.5 A1c, and was able with diet and excercise to get it to 5.8 six months later. To say I was scared into watching my diet and activity would be an understatement. I have read, since my diagnoses, that it is progressive, and I have watched one of my brothers preceed me down this road, but I keep hoping that I might not be typical.

    It’s nice to hear someone who has been there, and not just a well-meaning person who wants to tell various horror stories, talk about it. While I would rather avoid the whole deal, that isn’t in the cards…

    Thanks for helping me see the progression as not about something I have done, or will fail to do, and keeping me on balance.

    Posted by JimBob |
  4. Having been diagnoised with type 2 I have worked hard with diet and exercise,both which have helped greatly. However, for no obvious reason I see spikes for which I cannot see any reason. This article may give some insight as to why. This battle will never end. Those darn beta cells.

    Posted by EZRACER |
  5. The Indian herb gymnema sylvestre is claimed to rejuvenate flagging pancreatic beta cells. I don’t know if it actually does or not, but it’s definitely worth testing more thoroughly.

    Posted by Type2for5years |
  6. I’ve been a Type 1 for two years now due to removal of my pancreas. At first pricking and sticking was awful, to be honest. My hand would shake and it would take me 10 minutes to give myself one little shot. But as time went on, I got better at it and it doesn’t hurt any longer. That is, most of the time. Every now and then it HURTS for no known reason. But taking insulin is not that bad. Really. I’m up to walking four to five miles a day and feel great but I do have the same unexplainable highs and lows you talk about. At a class I took recently, I learned that exercise, as well as food, are like medicine to my body and both have an effect on my blood glucose, not only for today but for three months from now. My main point is to not fear taking insulin. It’s a blessing to me now that I’ve learned how to take it. That took a while and I’m still learning but it does make sense when you get the hang of it.

    Posted by Sharon |
  7. I’m a type 2 who has been through all the stages…first control–diet and exercise, second–addition of oral meds–progressively increasing them, and finally– insulin. My doctor told me early on that thin diabetics go through the stages more quickly than do others. So why is there so little information about the problems associated with us thin diabetics?

    Posted by thin one |
  8. Hi Thin One

    I wish I could address the subject of thin people with diabetes. Unfortunately, I’ve never had to deal with “thin” and “diabetes” at the same time. :-(

    How long did it take you to progress through the stages? Could you have LADA (Latent Autoimmune Diabetes of Adults)? See http://www.diabetesselfmanagement.com/blog/David_Spero/Is_it_Type_2_or_is_it_LADA to learn more about it.

    I also had a researcher tell me once that Type 1 comes on very slowly in adults, whereas in children it’s very fast.

    Whatever type you have, however, the most important thing is to have the proper treatment to keep your blood glucose under control.

    Jan

    Posted by Jan Chait |
  9. Valuable post and great letters. Progression of Type 2 diabetes may be inevitable in some people. Others seem to get better if they can keep their blood sugar in the normal range.

    I have seen people go from needing metformin to not needing any medication. This kind of improvement may not be possible for everyone - I think the autoimmune (Type 1) element gets in the way for a lot of people diagnosed with Type 2.

    Beta cells are often able to regenerate. Many drug companies are working on drugs that promote beta cell regeneration. And we know that bariatric surgery stops diabetes completely in some people.

    Of course, the sooner you get started on treatment and self-management, the more Beta cell function you will have left, and the better chances of avoiding progression.

    David

    Posted by David Spero RN |
  10. How could we know if we are late onset type I or type II ? I think if we have abdominal obesity it is assumed that we are type II ? Another thing is the insulin consumption in Type II is maybe much higher than type I?

    Posted by CalgaryDiabetic |
  11. I am gratiful for your information on the net.
    I have been diagonized with diabete type two and I am just scared. Please Help!!

    Thank you.

    Harriet

    Posted by depora |
  12. Hi Harriet. You seem to be experiencing the normal emotion after being diagnosed with diabetes. I suspect we all were scared. I know I was! What I found most helpful in combating that fear was learning all I could about diabetes: What it is, what things affect it, what the different medications do, etc. Connecting with other people who have diabetes (i.e., in a support group) can be beneficial as well. Have you seen a diabetes educator? A registered dietitian who specializes in diabetes? Get an educator and dietitian who also is a certified diabetes educator (the person will have the initials “CDE” after his or her name). Are you most afraid of complications? Keeping your blood glucose under control can lessen those risks. Of being unable to eat your favorite foods? There are ways to do that.

    Also, I hope you’ll keep coming back here: There’s already been a wealth of information posted–with more to come!

    Jan

    Posted by Jan Chait |
  13. Cal, you can have Type 1, you can have Type 2, and you can have both Type 1 and Type 2. The best way to tell if you have Type 1 is to be tested for antibodies. Also, while most Type 2s are overweight and most Type 1s are not, people with diabetes actually come in all sizes–just like the general population.

    Posted by Jan Chait |
  14. Dear Jan. If one was tested for antibodies and pronounced to be type I instead of type II what would this piece of information be useful for treatment. I am sure that that something in the treatment should be different. Ketone testing maybe?

    Posted by CalgaryDiabetic |
  15. Calgary, I don’t know, unless your health plan covers things for type 1s (such as insulin pumps) that it doesn’t cover for type 2s. Or to determine early on what type you are if there is some question so that the proper therapy can be prescribed. My endocrinologist once told me it didn’t matter what type I was; using whatever it took to regulate my blood glucose was most important. As far as ketones go, research has shown that type 2s also get them, although not as frequently as type 1s.
    Jan

    Posted by Jan Chait |

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