You're welcome.

dx 5/95 = diagnosted with Type 2 diabetes May 1995

metformin+... are the medications I am on: metformin (Glucophage),
Actos, lisinopril, plus diet and exercise.  Actos and lisinopril are
recent additions to help improve my control.

Guy

<loralspam@ozconnect.net> schrieb im Newsbeitrag

one more question.
Seen that T2 Diabetes is progressive, and supposing I can go down to 90 Kg.
Is there any chances after that, that I can live a 'normal' life without
medicines  ?? How  'damaged' is my pancreas at this stage ?
Will it be able to 'produce again' the insuline needed ?

Nobody in my family is diabetic and I myself have never been so far.

Thanks for the answers.

John.

The insulin resistance may be mostly reversible with weight loss.  
Other damages such as loss of beta cells are probably not reversible.

What values were you seeing two weeks ago?  How often did you measure
blood glucose?  Did you monitor just the fasting level in the morning,
or did you also measure before and after meals?

Diabetes can be diagnosed in several ways.  One way is fasting blood
glucose greater than 126.  Another way is non-fasting readings greater
than 200.  Or a high value in a glucose tolerance test (OGTT).

Have you ever had a glucose tolerance test run?

You said earlier that a doctor had said you had "subclinical diabetes."  
How long ago was that, and why did the doctor say that?  That must have
been the result of some test?  Terminology and diagnosis levels have
changed over the years.  What was once considered "borderline" diabetes
is now diagnosed as full blown type 2 diabetes.  There is an
intermediate state between completely normal and type 2 diabetes that
is now called "impaired glucose tolerance."  That seems to be a
precursor to diabetes if not managed well.

The problem in diagnosis is the way diabetes works.  As your insulin
resistance increased, your pancreas kept pumping out more insulin to
keep the blood sugars under control.  As long as the pancreas was able
to generate enough insulin to overcome the insulin resistance, your
blood sugars remained normal.  Now you have apparently reached the
state where the pancreas can no longer generate enough insulin to
overcome the resistance.

Good question, and I don't know that there is any statistically clear
answer.  I'm 60, so have some interest in that question myself. ;-)

The problem with statistics is that the rate of onset of complications
depends in good part on how good your control of blood sugars is.  
Standards for control have changed.  For example, the UKPDS study
showed much lesser rate of complications for "well controlled"
diabetics.  That study defined "well controlled" as HbA1c < 7%.  Most
of us here are after tighter control.  For myself, I would consider an
HbA1c of 7% to be wildly out of control; my personal goal is < 5.5%.

The rate of complications is clearly dependent on how good your blood
glucose control is.  The rate of some complications seems to rise
sharply with HbA1c over x%, while other complications are reported to
have a more linear relationship to HbA1c.  The one thing that is clear
is that the closer to normal your blood glucose is, the lower the rate
of complications.

I'm trying the best I can to keep my readings well within the range for
a non-diabetic person.  That's all I can do.

"John" wrote in part ...

Now, is there any of these 'damages' which are 'reversible' or shall I
order a cophin.... :-(((((
________________________________________________________________

A lot of study has gone into that question and the answer by all seems to be
"maybe, sorta".  Recent studies *do* indicate that control of post prandial
glucose levels (one and two hours after eating) can have the greatest
influence on inhibiting future complications.  In the case of heart and
kidney disease, the risk can be reduced dramatically by keeping blood sugars
within a normal (non-diabetic) range, and diabetic neuropathy (tingling in
the feet and hands) can and have been nearly reversed.  As to sexual
dysfunction, that is a matter that concerns the nature of the problem.  If
it is primarily "nerve damage" related, then it is possible to reverse or
improve the condition.  But, if it is related to blood vessel damage, it may
not be reversible.  It just depends on the underlying condition.

Always remember, the three most important things to a diabetic are:

Diet
Exercise (often)
Meds (if needed)

Arnie -

John wrote in message ...

Well my first post had all the bad news, this post has all the good news..
. or sorta good news at least.

In the U.S.,  the "statistically average" newly diagnosed Type 2 Diabetic
(T2) has had sustained, uncontrolled blood sugars for 7 years before anybody
notices.

(Of course that's a guess, but it's the guess they teach the doctors in
U.S. medical schools)

That means the "statistically average" U.S. diabetic has suffered 10 years
of hidden damage due to high Insulin Resistance and 7 years of  damage due
to high blood sugars.    That's why so many U.S. diabetics also have
neuropathy, kidney problems, eye problems, and often prior heart attacks
when first diagnosed.

You have the benefit of the German health system which seems to have watched
you closely enough to spare you the damage of those 7 years of uncontrolled
high blood sugars.    That is a tragedy for U.S. diabetics,  an occasion of
relief  (celebration? ? ?) for  you.

It is extremely difficult (mostly for political considerations) to identify
folks in the Standard Type 2 Diabetic Progression before they start losing
control of blood sugars.   There is no good consensus among the doctors as
to which of the poorly understood tests could be used.    There is no
consensus as to whether they should be used.  (Too many false positives)

The best test is to do surgery,  cut open the pancreas, and inspect the beta
cells for Amyloid Polypeptide deposits!    I make this ridiculous statement
to impress you with the difficulty of the task.

A second test is the Glucose Tolerance Test.   This is expensive, time
consuming, and makes many patients extremely sick for several hours.  It is
not suitable for routine screening of the diabetic-prone population.

The only simple blood test (combined fasting Insulin and fasting blood
glucose) returns false positives.

Many undiagnosed T2 are first diagnosed when undergoing surgery or when
admitted to a hospital for some other reason.   My next-door neighbor is a
Physician Assistant who has found several unsuspected T2 when preparing
folks for surgery in the hospital he works at.

But if your blood sugars are close to normal when tested,  they won't "find
you".   The best time to test is 2 hours after a carbohydrate-rich meal.
That's not usually when they do the blood tests.

Why your blood sugars went crazy.

  I would guess that a diabetic like you would experience a 25 mg/dL jump
in blood sugars for each  1 unit of insulin he "lacks"

  If you need 100 units per day  (a reasonable approximation), and you can
make 102 units per day,  you will have episodes of high blood sugar, but
would have a reasonable chance of exhibiting normal blood sugars when tested
at random times during the day.

If you lose some beta cells, and can only make 98 units per day,  you could
conceivably have high blood sugars all day long.

Ingest a slug of fast carb (e.g.  three glasses of orange juice) and you
will spike sky-high.

When the declining "supply" falls below the "need", you "suddenly" have high
blood sugars.   Perhaps if you had fanatically tested your blood sugars at 1
and 2 hours after each meal in recent months, you might have seen a trend of
rising sugars.

You caught your disease early,  you have a good chance of living a
near-normal life.   If you work hard to knock down your Insulin Resistance,
and otherwise pay attention to the factors (blood pressure, lipids)  which
amplify the effects of past damage, you have a good chance to live a long,
pain-free life.    That means, in addition to the "lose fat/gain
muscle/exercise/ration carb/take meds"  sermon I preached in my last post,
you should or must:

   a.  Reduce your blood pressure below 120/80.
        Use ACE and/or ARB inhibitors if you need meds

   b.  Control your lipids:

      i.  Total cholesterol under 200 mg/dL
    ii.   LDL under 130 mg/dL,  best if under 100 mg/dL
   iii   HDL over 45 mg/dL
    iv   Triglycerides under 150 mg/dL,  best if under 100 mg/dL
    v   Triglycerides/HDL ratio under 3.0  (if measured as mg/dL)

 Of course, it is understood that you will control your blood sugars.   You
never want to be above 140 mg/dL.   You work to keep your HbA1c below 6.5,
(below 6.0 is best)

This is hard.    Many, perhaps most diabetics do not follow these
recommendations and die prematurely, in pain.

When you read about the effects of T2 on the  "statistically average"
diabetic in books and magazines,  you will mostly be reading about the
diabetics who do not take care of themselves.

Regards
 Old Al

    The destruction of beta cells is somehow associated with the presence
of Insulin Resistance and (I think),  production of excessive amounts of
self-generated insulin.   The beta cells are "poisoned" by the precipitation
of Amyloid Polypeptoid within the beta cells.   See IAPP on Google.

Here's a nice one:

http://www.usc.edu/hsc/info/pr/1vol7/722/diabetes.html

One interpretation of evidence I have seen on the Web is that an attack on
Insulin Resistance reduces the rate of destruction.    My guess is that
knocking down Insulin Resistance drops your insulin requirements and thus
slows the rate of damage.     Maybe knocking down Insulin Resistance also
affects the mechanism as well as the rate.

When they tested metformin as a "preventative" for Type 2 in susceptible
folks,  it delayed the onset of full-bore diabetes thus indicating that it
slowed the rate of destruction,  i.e.  they had fewer than expected clinical
trial participants progress to full-bore T2,  (a Progresssion which
according to Slide 10 in http://www.medscape.com/viewprogram/145  is caused
by continual destruction of betas).

However, they had several groups in the test and the
change-in-lifestyle-only group had "twice" the effect.

That implies (IMO, not something I read on a medical site) that the low-carb
folks are also slowing the damage.

In my "belt AND suspenders" engineering approach** to this situation, that
means you should consider all of the attacks: fat loss, muscle gain,
exercise, low carb and metformin.

However, the final answer to your question is "ask your genes".    You can
always reduce the damage by a vigorous attack.  Whether or not you can
freeze it completely is up to your genes.    Frank Morris and Marco Polo,
two of our sometimes T2 posters, seem to be doing a good job with the
approach!

(**  Repeatedly testifying in front of a Fire and Explosion Committee to
defend newly-designed Chemical Plant processes changes your approach to many
of life's problems. . .belt AND suspenders approaches start to look
extremely logical)

Regards
 Old Al