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A common question I hear is, "Why does it seem like my diabetes pills and other injectable diabetes medications don't seem to work as well over time?" This is commonly referred to as "pill failure" or "beta-cell failure" by endocrinologists.
Recently, I met a woman who was upset that no health care provider or diabetes educator had explained to her, at the time her diabetes was diagnosed, that diabetes is a progressive disease. She thought that if she "behaved herself," her diabetes could be cured, or at least stay in holding pattern.
But type 2 diabetes is progressive in nature. Even if a person has high blood glucose levels at the time of his or her diagnosis, he or she is often able to manage the diabetes by losing weight, maintaining a healthy diet and exercising. Whether that's possible depends on what I call the "state of the pancreas" and how well the beta cells are functioning. I've only seen a few people control diabetes by diet and exercise alone for more than 20 years. But most people I see who've controlled their type 2 diabetes this way eventually also need oral diabetes medications, non-insulin injectable diabetes medications or both, an average of 7 to 10 years after the initial diagnosis. Of course, this varies per individual, and everyone is different.
The longer you have type 2 diabetes, the less responsive the beta cells are, and, over time, the insulin producing beta cells in the pancreas are no longer able to release enough insulin. This happens even with the assistance of oral diabetes medications and non-insulin injectable diabetes medications. Oral and injectable diabetes medications are not insulin and work in various ways to stimulate the production of insulin and the absorption of insulin into the cells, to reduce the output of glucose from the liver, to slow the absorption of carbohydrates, and even to spill extra glucose out of the kidneys. At a certain point in the progression of diabetes, insulin or insulin in combination with the other oral diabetes medications is necessary to control blood glucose levels.
When people who take oral diabetes medications progress to needing insulin, they often feel as if they've done something wrong to prompt this transition. Unfortunately, it's just the progression of diabetes and can't be avoided in those instances. Insulin is a hormone and generally doesn't interact with other medications; the primary side effect is hypoglycemia. Hypoglycemia can occur with some of the oral diabetes medications, too. But insulin does not cause diabetes complications; it's high blood glucose levels that are responsible for complications. Insulin is a helpful and necessary tool in the management of type 2 diabetes.
Nancy Klobassa Davidson, R.N.
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Thank you for sending this article to my email. I have five children. When I had the third child I had gestational diabetes that was controlled by food intake. Then I had two later in life babies and I had to use insulin during the pregnancies because I was worse and you can't take oral med's. After the last child, who is now fifteen my diabetes never went away so I was put on medication's. A lady that told me about nutrition said that if I get worse and have to take more insulin it would be because I didn't follow my diet. The opposite of what you said in this article. I am now 52 and have very serious diabetic issue's. I have to take 50 mm which is one needle full of insulin to get my number down by 100. Obviously, I need to see an endocrinologist because I don't think that insulin is even helping me anymore. I also have an enlarged liver but it is not from acides. It is due to my sugar levels, my cholesterol levels and I am sure that it is also due to my having had blocked bile ducts with pancreatitis both acute and chronic over the years. I am going up to a well known hospital to find out why my liver is 22 cm. and hopefully they will be able to help me with my liver and high sugars. I loved this article because it doesn't put blame on the diabetic.
CONFESSION: As a newly diagnosed T2 diabetic - this article was fairly discouraging. I've been reading & researching & am not naive even to believe that after being diagnosed I can be "cured" per say but in Dec 2014 my A1C was 10.3. The labwork for the end of Jan A1C was - 8.8. And, I got my labwork results from yesterday this morning. I was thrilled to hear that my A1C is now 6.7. I know this is not a stopping point, but after reading this article -- don't feel as happy as before. Trying not to project that progression will get the best of me even when I do diet, exercise, check BG w my meter, & take any meds required -- but unless I misunderstood the article...seemed to say that a diabtic's body could start to reject the meds & progress & complications might take effect. UGH! Frustration!
This is the best article I have read about Diabetes. Now I know what to expect. I was controlling my Type II but gained weight, now it is out of control. I am very active and eat healthy. This Friday I have a Doctors Appt. and I am sure I will be put on medication.
Type 2 DM is caused due to insulin resistance or sensitivity, so why add more insulin? The liver will dump glucose into the pancreas and over flow into other organs. Life style changes such as getting 8 hours of sleep daily and lite exercise help tremendously. Once a week you should do a high intensity workout to burn the glycogen stored in the muscles. Diets such as the paleo diet or a modified low carb will help lower inflammation and blood glucose. DM is manageable, don't fall for the doom and gloom. Stay healthy, my friends.
I took insulin for a time, & found it to be of no use whatsoever. And I gained unneeded pounds. When I got my eating better under control, I stopped taking the insulin. (Although I still take other diabetes meds.) My blood sugar is much better now than it ever was with the insulin injections.
Dr. Mark Hyman is a doctor who gives a different spin on diet and diabetes. He claims that food gives us diabetes and we need to change our diet. It IS possible to control and end diabetes in his opinion. He is not a traditional doctor. See his website. His book, called "The Blood Sugar Solution" tells how all this has been going on due to the food corporations loading food and beverages with addicting substances(sugar and salt).
He calls the problem "diabesity". It give hope. I recommend everyone look at his information. :)
I started out with Metformin, and read an article akin to Ms. Nancy Davidson, and went directly to the utilization of long acting NPH, and fast acting (Humalog or novolog).
I have had diabetes for 18 years, and have done well with using insulin albeit long acting in conjunction with fast acting. Before most meals, I routinely take 5 units of fast acting insulin. I always keep my carbs down! Staying away, most of the time, with my diet of bread, potatoes, fruit, and high carbs! I was recently told that when you are first diagnosed with diabetes, you have had it for about 10 years before it becomes problematical. (USC Endocrinology Department)
I was diagnosed 16 years ago and so far have been lucky in controlling it with diet and exercise. However I was told 16 years ago that there may come a day when I would need meds or insulin. For those of you who say you weren't told it may have been mentioned once but you may have been in shock just learning you had diabetes and didn't absorb all the information at that time. I wish you all well
Does that mean once insulin is started I will always be insulin dependent?
I was diagnosed with DM2 in 2011. After diet and exercise changes and a significant weightloss, I have maintained a 5.8 for the last year. In all my extensive reading and educational classes, I was never provided the information that I not only possibly, but probably, will need to go back to meds and potentially insulin.
Thank you for sparing me from a future shock.
I feel so sorry for how "Depressed" feel at the beginning of your long run of diabetes control. Your doctor is unable to tell you everything about diabets in one 10 to 15-minute visit--a global health care issue. Look for a facility with a chronic care model. There will a team of doctor, nurse, pharmacist, health coach and nutritionist to help you improve your self-management.
I was never told that I will go on insulin when I was officially diagnosed. Actually I was never told anything at the beginning. I was told to take metformin and watch what I eat. Now I know after reading this, it only gets worse. Depressing.
If DM II is a progressive disease no matter how hard we try to slow down the progression, can I say this is part of aging or Beta cells fatigue?
OK I understand that Diabetes is a progressive disease.I have type 2 and recently started taking insulin to control my numbers. What are the next steps in the progression of this disease. More Insulin?. Lost limbs then death?
I work for a kidney transplant doctor and he says insulin ruins your kidneys. That combined with the info in this article is EXTREMELY discouraging.
And doctors, and even worse nurses, seem to want to make you feel as though it IS your fault that you have diabetes in the first place and that it kind of serves you right for having it. My mother when she died at 93 still felt like she was "bad" because her doctor kept telling her she was going to get diabetes if she didn't eat better and lose weight.
I was listening to Governor Huckabee tout a diabetes kit that cured his type 2 diabetes. Is that possible?
If you have Type 1 diabetes, no, you cannot go back to pills.
If you are type 2 diabetes before now became type 1 put on insulin is this permanent?Is there a chance to go back with the pill and not taking shot?
I am diabetic in the sense my fasting glucose is higher than it should normally be; but not very high. I do not take insulin nor any medicine. I take every day a bowlful of salad consisting of broccoli, bitter melon, carrots, spinach, almonds, walnuts, amongst other things.
I have been able to maintain A1C in the range of 5.4-5.8. Of course, I do take at least half-a-mile walk every day after dinner. I am a professor and keep my health as fit as fiddle to fight.
I think the drugs we are given to help manage diabetes, in turn are slowly what ends up killing us. I've had high blood pressure since 1996 and have taken a gazillion different meds to lower it and none have ever worked. 2007 my feet began stinging so bad I wanted to die, most times now they still feel the same. Always told that I did NOT have diabetes, BG under 120. ONE month ago, I was just told I DO have diabetes! Really??? Now I'm taking Metformin 1000mg a day, and my blood sugar is always around 113 to 120, and I have a headache and backache and my feet still sting/burn! Of course the blood pressure is still high. 164/105 most everyday, sometimes higher.
thanks.. I'm at that stage now.. I am so depressed. I went from 318 pounds when diagnosed down to 255. Been taking metformin 750 mg 2 in the morning and 1 at night. My sugars had been doing well with exercise and diet, now I struggle to keep below 200 after eating. Bruce Smith
I am a former Certified Diabetes Educator. On the first and subsquent visits with individuals who were diagnosed with diabetes I stressed that diabetes is a progressive disease and the most important thing was to control blood sugars to prevent complications. I am not sure how many people actually heard that it was a progressive disease. It was difficult at times to encourage individuals who had controlled their BS for many years and now neede change in medication. I tried to be the encourager.
That's SO disappointing. I thought diet/exercise would mean no insulin but this article makes it seem inevitible. I work in Urology and the transplant doc told me that insulin ruins your kidneys. What a truly wicked disease.
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