When Hearing Type 2 Diabetes

Language is interesting. Evolutionarily, we’ve learned how to convey and receive information with as little language as possible. Whether it be vocalizations, use of our bodies, whatever the means may be, we can infer a good amount of information without speaking words.

Animals do this as well. While they may not speak words, they definitely communicate information, and infer it.

Humans evolved advanced language to help expand our understanding of our surroundings beyond the basics of communication and inference. It’s part of what makes our higher intelligence special. It’s part of what has expanded our curiosity beyond what’s immediately obvious around us.

So why am I waxing on about this? Well, when we say certain things, in just a handful of words, a lot of information is exchanged. There’s a point in this F-16 AGGRESSOR training exercise where the presenter explains 2 pilots exchanging just 2 words is enough information to take action.

When someone says Type 2 Diabetes, there’s a few things that tends to get inferred, for better or for worse.

  • It’s the fat kind
  • The problem is too much insulin in the body
  • Insulin resistance is an issue
  • Restrictive diet
  • Diabetes safe diet
  • Must lose weight
  • Chronic Lifestyle Disease
  • Curable/reversible/remissible
  • Self-inflicted

A lot of this is based on increasingly outdated information.

A lot of those points revolve around obesity being a cause of Type 2 Diabetes. The fact is many people have some level of insulin resistance. Type 2 Diabetes is a level of insulin resistance resulting in persistently high blood glucose that crosses the HbA1c threshold of diabetes diagnosis (6.5%). This can happen in any body type, including athletes.

Just ask Sir Steve Redgrave , winner of gold medals in 5 consecutive Olympic Games.

Many T2Ds do have elevated insulin production to compensate for the resistance. However, not all. Not too long ago, I saw an image of a Twitter post by a doctor who allegedly treats diabetic patients, who claimed prescribing insulin to T2D was inappropriate because the problem is too much insulin. So he makes it a goal to get his T2D patients off of insulin use. Given my endocrinologist has a similar goal for me, my suspicion is he has a similar belief.

This seems to be based on some research that found high blood glucose and high insulin secretion can promote insulin resistance. While this is true, this is primarily a factoid that’s more useful for T1D patients using carb counting for insulin dosing, where they track their insulin to carb ratios, which can change based on time of day and blood glucose levels.

But if you assume a T2D has too much insulin and treat based on this without verifying, your treatment could be ineffective.

My C-Peptides are low normal. When I say low normal, I mean in a Standard Range of 1.10 to 5.50 ng/mL, my result was 1.12 ng/mL. And this is while on a T2D drug that promotes insulin secretion (GLP-1 RA). But my endo wants me off of insulin.

So yeah, a T2D can require the use of insulin. Some T2Ds produce so little insulin on their own that they adopt a T1D style regiment on top of their T2D treatments (but this doesn’t make them T1D). I don’t seem to be there, though.

But many T2D just need the right medication without the use of insulin. And this can be complicated. Lifestyle changes can also contribute to management pretty well. What got many T2Ds into this position was the adoption of a lifestyle that didn’t work well with their bodies. Primarily, low activity or sedentary behavior, along with a diet that might as well be considered disordered eating with the amount of daily carb consumption.

There was a fairly recent meta-analysis study that asks the question of what if we have the order of cause and effect wrong between obesity and insulin resistance? We know insulin resistance is heavily genetic, and for many people, a diagnosis will be unavoidable (refer, again, to Sir Steve Redgrave). I wish I had the link to the paper, but it proposed that insulin resistance may promote behaviors that lead to obesity, worsening the condition over time until blood glucose levels are persistently high enough for a diagnosis. There needs to be study for this, but it flies in the face of our obsession with monitoring our weight.

Hearing that you have a chronic disease is pretty hard. Even with the misconceptions around T2D, it weighs heavily on mental health. Trying to do everything “right” and seeing little to no results, or even backwards progression can lead to burnout, or even full on depression. Trust me, I’ve run the gamut of this over the last 17 or so years since my diagnosis.

When you come across a T2D that’s not caring about their management despite their numbers not being where they should be, just be aware they could be going through some stuff. It’s most likely not laziness or not caring. Rather, this is a hard thing to deal with. Non-diabetics really don’t know how tough this thing can be. It’s always there, always hanging over us. And sometimes we beat ourselves up over having bad results, reaching a point where we decide well if it’s just going to do this, why bother trying to do better?

So I’ve kinda knocked down some of the common misconceptions around Type 2 Diabetes.

  • It’s primarily genetic
  • Lifestyle can accelerate complications leading to diagnosis, but not cause it
  • Management can be achieved purely with lifestyle changes in some people
  • Losing weight doesn’t always help (but doesn’t hurt either)
  • You can’t “cause” or “catch” Type 2 Diabetes
  • There is no cure
  • There is no easy fix
  • It’s a constant battle
  • The diabetic isn’t a bad person

The cool thing is we have so many tools at our disposal, now. Unfortunately, there’s a lot of people that would rather we not have our tools. Managing T2D is easier than ever before, provided we have access to our medications and our technology. The sad thing is many of the people use the misinformation as the reason for their hinderance.

Diabetes is hard. T1D is hard. T2D is hard. MODY, LADA, T3 and all its subvariants, PCOS, etc are all hard.