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Old 01-09-2010, 04:09 AM   #1
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How long before Type 2's go on medication/insulin?

How long can Type 2's get away with control on just diet and excercise? the reason i ask is because i was diagnosed in October 2009 but reading stories on sites, some Type 2's go on medication and insulin quite quicky, how do the medics decide when who should go on what? I had my first HbA1c result this week and have been told by my DN to see her in 6 months time (i am on diet and excercise atm). Do they just see how well you do in your lifestyle change and then if that doesn't work, then they decide to put a Type 2 on medication? initially she told me that it could be years before i would need to go on insulin, if this true then why do some go on it so soon?

 
Old 01-09-2010, 06:06 AM   #2
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Re: How long before Type 2's go on medication/insulin?

This is such an individual disease. You sound like you have a really good doc and that you were caught early. There are many reasons why some folks go on meds right away. Firstly, many people are only diagnosed much later in the process. Their sugars are very high (in the teens or higher - 200s in the US) and they need to be brought down quickly. Even in those cases, sometimes people get off the medication with lifestyle changes, but they were put on meds immediately to bring the sugars down.

In some cases, diet and lifestyle are not enough. This doesn't mean the folks didn't do the job right, it just means that their diabetes progressed more quickly. There is no way to tell if it will progress fast or not. In many cases D is a progressive disease. You can do everything right and still end up on meds or insulin. In other cases, people live the rest of their lives simply leading a healthy lifestyle.

From the sound of things, you are working hard. If, in time, you do require meds, don't look on it as a failure. Sometimes no matter what you do, the disease progresses. It's like that old saying - "Eat well, live right, die anyway".

You may never need to go on meds. And if you do, you may never need to go on insulin. Just keep working at it. Meds, insulin, and/or complications are not inevitable.
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Last edited by Cora1003; 01-09-2010 at 06:06 AM.

 
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Old 01-09-2010, 10:41 AM   #3
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Re: How long before Type 2's go on medication/insulin?

Dittoing Cora yet again, lol !

Dewing, there is no correct answer to this question. So many factors go into this, including heredity, weight, luck, your horoscope, etc. Many people can go for years and years without needing medications; some people need medications right away; some people need insulin eventually while some never need it. There are just too many variables to predict. As Cora pointed out, going on medications would NOT be a failure on your part, it'd just mean that all the factors combined to make it necessary for your particular case.

I know there are some people who can watch every single bite of food they eat forever, and that's wonderful, but I'm of the philosophy that one needs to live a reasonably normal life. That doesn't mean one eats everything indiscriminately, but going on an extremely low-carb diet and eliminating entire groups of foods doesn't strike me as the best way to go. Our bodies need a wide variety of nutrients to prevent other diseases...we don't live in a diabetic vacuum! So do the best you can today, and try not to worry that much about the future.

Ruth

 
Old 01-10-2010, 06:17 PM   #4
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Re: How long before Type 2's go on medication/insulin?

I have been controlling type 2 diabetes via diet/exercise for almost 10 years. A friend of mine has used diet/exercise for 19 years.

Controlling what/how much you eat and exercise will go a long ways in allowing you to stay diet/exercise controlled for a very long time, especially if you were diagnosed in the early stages.

 
Old 01-15-2010, 12:22 PM   #5
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Re: How long before Type 2's go on medication/insulin?

Quote:
Originally Posted by Misty800 View Post
I have been controlling type 2 diabetes via diet/exercise for almost 10 years. A friend of mine has used diet/exercise for 19 years.

Controlling what/how much you eat and exercise will go a long ways in allowing you to stay diet/exercise controlled for a very long time, especially if you were diagnosed in the early stages.
How do you manage to control your diabetes with diet and excercise for so long? are you very strict with yourself in what you eat? how much excercise do you do? i hope to be able to control it the same way but not sure if i am strict enough to do so but i am being careful.
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Old 01-15-2010, 02:30 PM   #6
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Re: How long before Type 2's go on medication/insulin?

Quote:
Originally Posted by dewing View Post
How do you manage to control your diabetes with diet and excercise for so long? are you very strict with yourself in what you eat? how much excercise do you do? i hope to be able to control it the same way but not sure if i am strict enough to do so but i am being careful.
Most of us are capable of doing what we want to by making up our minds we are going to do it. I made up my mind I was going to get the blood sugar back down to the non-diabetic range and keep it there. Easier said than done! I have had A1C as low as 5.2 and as high as 6.3 since the original diagnosis at A1C 7.

I was very strict with my diet, ate only 3 oz lean meat and 1/2 cup each of 2 green veggies for lunch and again for dinner for a long time (small serving oatmeal for breakfast), lost 65 lbs. Few years later I gradually added back some of the higher carb foods in very small amounts checking blood sugar to see what the foods were doing to my count.

One thing that helped me was finding the amount of carbs per meal that my body could handle without going too high. I aimed for a non-diabetic range of 120 or less 2 hours after meals. 32 individual carbs per meal is about right for my body.

Testing, testing, testing is very important for success. I tested before meals and 2 hrs after meals in an effort to narrow down the list of foods that raised the BS the least and stayed in the non-diabetic range. This will work for those diagnosed in the early stage of diabetes, maybe or maybe not for those who have very high numbers, on meds and/or insulin.

After finding out what various foods did to the BS I figured out a formula giving foods points for each gram carbohydrate based on how well my body could handle them.

For instance bread was given 6 points per gram carbohydrate, spinach 1 point, etc. I planned meals and measured/weighed food I was going to eat, added up the total points and added to my blood sugar number before the meal. If the total was higher than what I wanted my blood sugar to go, I reduced the portion size or omitted a food.

I walked treadmill 1 mile after each meal (let food settle 1 hr before exercise). If for some reason my blood sugar was higher than I wanted it to be 2 hrs. after meals I walked it back down on the treadmill. I never went to bed with a number out of non-diabetic range, always walked it back down.
There are times you will be eating away from home and not have a choice as to foods offered and BS will be higher, walk it back down as soon as possible. Sustained high readings will cause damage.

One very important thing was that I put an "invisible zipper in closed position" over my mouth when in presence of food other than at mealtime. This can be done, hard, but worth all the effort. Keeping a log book of BS and foods, portion size, etc. per meal you will soon see where you need to make adjustments.

Last year my A1C was 5.9 all year, then the last one in December was 6.3. I am having a hard time getting back on a strict diet after being able to enjoy a variety of foods plus some desserts for the past year. I am not on my strict diet right now, been cutting back on foods I know I should not have very much of and will see what my next A1C is. If it is still too high I will go back on my strict diet with the invisible zipper in closed position.

Do not dwell on what you cannot have to eat, enjoy what you can eat and keep BS under control!

All of the above sounds like a lot of trouble, it really is not, just takes getting in the groove, sit back and take the ride!

Feel free to join me, I have faith you can do it too!!

Last edited by Misty800; 01-15-2010 at 02:40 PM.

 
Old 01-15-2010, 04:39 PM   #7
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Re: How long before Type 2's go on medication/insulin?

Quote:
Originally Posted by dewing View Post
How long can Type 2's get away with control on just diet and excercise? the reason i ask is because i was diagnosed in October 2009 but reading stories on sites, some Type 2's go on medication and insulin quite quicky, how do the medics decide when who should go on what? I had my first HbA1c result this week and have been told by my DN to see her in 6 months time (i am on diet and excercise atm). Do they just see how well you do in your lifestyle change and then if that doesn't work, then they decide to put a Type 2 on medication? initially she told me that it could be years before i would need to go on insulin, if this true then why do some go on it so soon?
I have been a Type II for 25 years-first diagnosed age 35 ish . I was okay on diet/excerise (with weight loss) for about 10 years. Then to metformin and now metformin & glipizide. Have always struggled with weight and have an extremely difficult time controlling weight-up and down etc. From what I have seen Type II's can be all over the place meds, no meds, insulin, no insulin etc. Diabetes is progressive and seems to progress differently for all. It is my understanding that blood sugar levels and A1C's are key in doctors deciding treatment including meds. Sounds like your medical people have you on a plan and will be working with you to get things under control. Best of luck- alot of Type II's never go on insulin. I heard a lecture several years ago from a national diabetes specialist who said that we should look at insulin as nothing more than a tool to deal with our disease -- and further added if your doctor "threatens" you with having to have insulin if you don't behave find yourself another doctor. Ask questions, find out what you can. RES

 
Old 01-15-2010, 05:04 PM   #8
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Re: How long before Type 2's go on medication/insulin?

wow that is very strict, i'm not sure i can be that strict as i eat out a lot but i will give it a good go. My first HbAic last week was 6.7% and i hope in 6 months with continued weight loss etc i will be lower. I don't quite understand how you worked out points to grams with food, can you give me an example please? also you mention that sustained high levels cause the damage, over what period of time is this? ie does it mean if the levels don't drop down quick enough say after 2, 3 or 4 hours?
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Old 01-16-2010, 04:43 AM   #9
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Re: How long before Type 2's go on medication/insulin?

12 years.

First 8 just by losing weight and keeping it off, mild exercise
Last 4, diet and exercise. I tried meds for 6 months and they did nothing, so back to diet and exercise.

I will find out the next step at the end of the month. In some ways I would like meds that worked.

 
Old 01-16-2010, 05:59 AM   #10
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Re: How long before Type 2's go on medication/insulin?

Quote:
Originally Posted by dewing View Post
wow that is very strict, i'm not sure i can be that strict as i eat out a lot but i will give it a good go. My first HbAic last week was 6.7% and i hope in 6 months with continued weight loss etc i will be lower. I don't quite understand how you worked out points to grams with food, can you give me an example please? also you mention that sustained high levels cause the damage, over what period of time is this? ie does it mean if the levels don't drop down quick enough say after 2, 3 or 4 hours?
Thank you all people for your replies. I have a question for Misty800, what in your opinion are non-diabetic levels? I have heard many different variations (I live in the UK so it's mmol for us) but i've heard from 4 - 7 before meals and no higher than 8.5 post-meal, 2 hours (some say 7.8 is more on the non-diabetic range) but what are most people's ideas of non-diabetic level and are they achievable only by very very hard work?
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Old 01-16-2010, 07:41 AM   #11
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Re: How long before Type 2's go on medication/insulin?

Quote:
Originally Posted by dewing View Post
Thank you all people for your replies. I have a question for Misty800, what in your opinion are non-diabetic levels? I have heard many different variations (I live in the UK so it's mmol for us) but i've heard from 4 - 7 before meals and no higher than 8.5 post-meal, 2 hours (some say 7.8 is more on the non-diabetic range) but what are most people's ideas of non-diabetic level and are they achievable only by very very hard work?
Here is my understanding of what is going on in your body and what glucose levels do

I look at levels 2 different ways.

The first is what do high levels do to your arteries, kidneys, eyes, limbs etc. Whether your levels are at 7 or 8, I don't think much more damage is being done. I think at levels like 10, 11 and higher, damage is being done to the arteries. But at 6,7 or 8, I think it is very limited. Based on what you have posted, I don't think damage is being done to your system here.

The second is what do high glucose levels do to your pancreas. As a T2, your pancreas' islet cells are producing insulin. However, high glucose levels are toxic to islet cells. A paper I read showed that 7.8 and above was a level that was toxic to islet cells and is a level above which you want to stay as short as possible in order to preserve insulin production. If you have continuous high levels, eventually you will kill off insulin production. Again, I think 7.8 vs 8 is not a huge factor, but if you are continuously high you are slowly damaging insulin production. Remember, you are in these ranges for a small amount of time during the day. To make this as short as possible, low GI foods will help since you won't get spikes.

Then you have to find a balance. You can eat a meal that will spike you to 10 for an hour and drop you to 6 at 2 hours. Or one that will bring you to 7.5 for 3 hours. Which one is better ?

I would not worry if I am at 7.5 or 8.5 2 hours after my meal. Focus on the weight loss. Focus on eating good carbs in moderate amounts and focus on regular, non strenuous exercise since that is is what will optimize weight loss.

With the weight loss you will slowly become less insulin resistant. You will require less insulin to keep your levels in check. You will have less moments of the day where levels are a bit high. This will delay or even eliminate the need one day for insulin.

Does this help or make any sense ?

Last edited by itotito; 01-16-2010 at 07:47 AM.

 
Old 01-16-2010, 09:08 AM   #12
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Re: How long before Type 2's go on medication/insulin?

Yes it does thank you. I hate it when i get a high reading but it's not every day and at least most of the time i have a fairly good control. I am trying to learn about the low GI foods and i know i have a long way to go but all this learning is helping me and it's thanks to everyone on here who has replied with their advice as there is so much i didn't know about diabetes and would never have known unless i came on here. I wish they would find a cure for diabetes sooner rather than later :-(
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Type 2, diagnosed October 2009 at fasting glucose of 7.8. First HbA1C, 6.7%

 
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