Type Two or not Type Two?

By | 15 April, 2011

Around twenty-five years ago in a doctor’s surgery somewhere in the East Midlands:

A typical T2

A typical T2

‘Well Mr Gnome, we have the results of your tests, and I’m sorry to tell you you’re  diabetic.’

‘So?’

Even as I asked the stupid question a poorly remembered vision of my grandmother’s leg, adorned with an ulcer as big as my childish hand, flashed across my mind.

‘You’ll need to control your diet, and I’ll give you a prescription for some Metformin and some Gliclazide that will help.  You’ll really need to reduce your sugar intake too!  I’ll make an appointment with a dietician for you.’

‘Bugger!  No more Mars bars!’

So it began.

-oOo-

This article is prompted by our Beloved Leader’s recent blog [I like this “beloved leader” stuff! -Tim] about the ‘invisible diabetics’, the poor souls who are without support and fall below the radar of the NHS.  I would hazard a guess that most of those lost souls will be Type Two (T2) diabetics (T2 was formerly known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes); unlike the majority of Type Ones (T1) who were, or are, diagnosed in childhood, and are supported, at least to some extent, from the day of diagnosis.  There may well be some lost T1s, but they are, thank Gaia (delete and insert whichever deity you prefer), probably few and far between.

Now I appreciate that many of the readers of this blog are pretty knowledgeable about diabetes, and are all reasonably intelligent (some of you terrifyingly so), but the vast majority of you are T1s and may not have an insight into the problems of us T2s.  Believe me, it took me a long while to reach the point where I could actually accept that there was a real difference between T1 and T2 diabetes, but in truth, the only real commonality between them is hyperglycaemia.

Diabetes Mellitus, in both its guises, is a failure of the body to process blood glucose into usable energy.  (Yes, I know that’s a simplistic definition, but there may be people reading this who aren’t as knowledgeable as the rest of us.)  The difference is in the cause; in the case of  T1s it’s down to a dysfunctional pancreas; in T2s the causes can be much more complex.

We’ve all heard the cry, ‘If he wasn’t such a fat bastard he wouldn’t be diabetic!’ but did you know that obesity can be one of the symptoms of T2?  I just threw that in to point out that you shouldn’t make snap judgements, I also know several T2s who are built like racing snakes.

Having said that though, obesity can play a part in causing T2; in combination with other physiological problems it leads to insulin resistance.  Rather than a failure of the body to produce insulin, it’s a failure of the body to use the insulin it produces to process the glucose in the blood.

So, much as it grieves me to admit it, T2s, especially in the early stages of the condition, can’t claim to be members of the Pancreatically Challenged Hordes (or hoards as our Beloved Leader would have it!) [Thanks for pointing out my crappy spelling Terry! -Tim]  Thankfully, by the time T2s become insulin dependant, I firmly believe they can claim membership of that august body.

The worst part of T2 diabetes as it affects the general population, is that it can go undiagnosed for long periods, meaning that real physiological damage can already have been caused before any treatment starts.  In fact, it’s not uncommon for patients to visit the doctor complaining of the side effects rather than the diabetes; macular degeneration, nephritis, and neuropathy can all be established before other symptoms are recognised.

I would guess the most common symptoms though, are the continual thirst and the need to pee, but being so hyperglycaemic you start falling asleep in your soup can be a symptom, and be pretty funny too!  The killer is, that once that damage is done there’s no way to reverse it, and every time your BGL exceeds 13 mmol/L, the damage increases and you start to fry your kidneys.  It’s not only the physical problems though; the creeping effects of neuropathy can cause anything from marital stress to severe depression.  Sadly, that’s a part of the problem we share with T1s.

By far the best way of treating T2 is to manage the diet and increase the exercise, but that’s not always possible, and for many T2s the pattern from diagnosis onwards is a continual battle to reduce the BG levels.  Metformin helps, but one of the side effects of the drug is something similar to irritable bowel syndrome, it’s not pleasant and often the user develops a sensitivity to it that increases the effect to the point the drug has to be discontinued.  The next step is insulin dependence.

One of the major differences between T1 and T2 diabetics is the size of the insulin doses required.  Whilst a T1 will often measure their dose to the half unit, a T2’s insulin resistance can increase to the point where they are injecting quantities that would have a T1 dead in minutes.  Basal doses of Lantus up to ten times that of other SUoPU members, and similar quantities of NovoRapid have been noted on this site alone.

Where T1s walk a knife edge in trying to maintain their balance between hypo and hyper, a T2 struggles continually to pull down their BG to reasonable levels.  For a T2 it’s probably a case of managing the doses to provide the maximum utilisation of the insulin with the minimum number of injections.

In the end though, both T1s and T2s share the curse of hyperglycaemia, but T2s don’t run anywhere near as much risk of regular hypoglycaemia that is the bane of the T1.  Though we may be at opposite ends of the chart, we are on the same axis; the Brotherhood of the Banjaxed Body gives us a common bond.

19 thoughts on “Type Two or not Type Two?

  1. Profile photo of KaitakeKaitake

    Thank you for sharing 🙂 I found this post very enlightening, and it has definitely helped me understand a bit more about the issues T2s face.

  2. Profile photo of TimTim

    I’d forgotten I’d given you the power to edit your own articles Terry – I got the surprise of my life when I logged in this morning and saw the picture!

    Anyway, that aside – thanks for writing it; I too now know a little bit more about Type Two!

  3. Profile photo of AlisonAlison

    @Teloz That was fascinating, thanks Terry. I always think T2 is underestimated in the impact it has on people and the seriousness with which it’s treated. While it’s important to distinguish between the two conditions, I’ve always been happy to lump myself in with T2’s for lobbying purposes – you’re such a populous bunch who are multiplying rapidly and expensively that government feel they have to do something. As a much rarer T1, jumping on that bandwagon means I get my diabetes voice heard much more often in government than if I was campaigning as T1 only. So thanks Terry, you have your uses 🙂

  4. Profile photo of MikeMike

    Thank you Terry.. As @tim mentioned we T1’s perhaps know a little more about the challenges you and others with T2 face each and everyday just like us.

    We also got to know a little more about @teloz too.. Hurruh! 【ツ】

  5. Profile photo of Hairy GnomeHairy Gnome Post author

    Thanks everyone! I hope the addition of a picture was a nice surprise @Tim, I know he’s ugly, but it was the best I could do at short notice. 😛

    @Alison – Pleased to be of service ma’am, always a pleasure to be of service to a lady. (Blushes coquettishly)

  6. Profile photo of TimTim

    When I saw it my first reaction was to attack my monitor with a shovel; but then I noticed it was you and stopped! 😉

  7. Profile photo of Annette AAnnette A

    Surely the caption should read ‘An atypical T2’, no? For if all T2s are as typical as our tel, then we’re all off to hell in a handcart 😉 .
    But a really interesting article. Knowing two very different T2s (one was not overweight at diagnosis,or having any symptoms, still not overweight, on tablets (was put straight on them) and keeping bgs fairly steady (with a prior knowledge of all things diabetic – he’s my Dad, so knew all the diet and scare story bits from my childhood!); the other very overweight, was a bit overweight at diagnosis, has put on major weight, but that is mainly due to inability to do any exercise following a disabling stroke, on tablets, and my sister keeps his bgs in check to whatever extent she can (my brother-in-law)) its useful when discussing with them to have this sort of background knowledge.

  8. Profile photo of CecileCecile

    @teloz: Regardless of what @tim says, I think you’re cute enough to play a role/roll? in that new series aimed at type 2 youngsters, Teloztubbies 😀

    My Type 2 father was superfit & sinewy (lifelong wanderer of mountain trails) at diagnosis; nowadays he’s a senile & incontinent 83 – a good thing (the senility, at least), ’cause some evenings he’ll obstreperously refuse to drink his pills and throw them in your face, while a few minutes later he’s clean forgotten that he’s joined the resistance army, and he’ll swallow them quite meekly (previously, when he still had memories of his mother’s diabetic amputee brother, I could tote a picture of a gangrenous foot and say: “Remember Uncle Jakobus!”)

  9. Profile photo of SiobhanSiobhan

    Thanks for this very interesting posting Hairy Gnome. I’m a Type 2 who seems to be heading towards insulin dependency (long story). I didn’t realise that there was a big difference in the quantity of insulin T1 and T2’s have to take.

  10. Profile photo of RichardRichard

    I’m a T2 insulin dependant, only been on insulin for about 5 months

    the worst thing for me, is that nothing seems consistent, for 3 or 4 days i can have what seems like good control, then on day 5 i will take a blood test and it will be between 13 & 16 for no real reason.

    sometimes i can take 12 units of insulin with a meal and all is ok, other times i can take an extra 15 or 20 units and it have almost no effect.. one time recently at 8pm i took a blood test at 16.1, decided i would take a correction dose of 20 units and at 10pm i was 16.4

    in the past 5 months i have not had a reading below 5.9 no matter how much insulin i take.. so needless to say i am struggling a little

  11. Profile photo of Hairy GnomeHairy Gnome Post author

    @ckoei – some people consider their body to be a temple; mine’s a rotunda! Teloztubbies sounds good, especially if I got paid for it!

    @altobunny – I take a basal dose of 150 units of Lantus each night, and 100 units of NovoRapid before a meal. My BG levels still vary wildly though, over the last few days I’ve gone from 16 mmol/L to 3.2 mmol/L and all points between. Scary stuff! 😉

    @searley – I know exactly what you mean, the graph for my BG levels looks like an outline drawing of the Alps!

      1. Profile photo of Hairy GnomeHairy Gnome Post author

        Quite apart from my grave doubts about the morality of killing whales, I don’t think that whale blubber custard is something I would be happy to consume. I’m quite sure I can maintain the rotundity of my corpus by other means. 🙂

        1. Profile photo of CecileCecile

          Fear not – Teloztubbies only do ethical eats: their whale custard is made with the stranded variety (they also do a flash-food deep fried haggis, using sheep that’ve been struck by lightning)…

  12. Profile photo of LesleyLesley

    Hi Terry, nice to meet you – and thanks for your insight into the differences between T1 & T2.

    High basal insulin requirement is a good “niche indication” for an insulin pump. With the right consultant even T2’s can get funding.

    “They” are also developing simplified pumps that deliver basal only, so T2’s struggling on tablets may be willing to go onto insulin sooner if they don’t have to inject, and therefore regain control and avoid further complications. I think this has great potential. See the input website (Articles & Studies) for research on T2’s and pumps.

  13. Profile photo of RosieRosie

    I’m one of the people reading this who aren’t as knowledgeable as the rest of you! Thanks for the new insights.

  14. Profile photo of ClareClare

    Interesting that several people are mentioning their Type 2 fathers, I have one too. I always wondered if one day I might get T2 myself, so imagine my surprise and annoyance when I developed T1 instead at 31! Although my Dad’s dad developed T1 in his fifties, so you’re never too old. I too am surprised at the lack of support for T2s and the active discouragement of frequent blood glucose testing really angers me.

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