I have a friend. Here is her info.

48 year old, 120 lb female. Diagnosed type 2 about 8 years ago, when she weighted 170 lbs. She had some kind of tumor in her ear, she was hospitalized, they did blood work, her sugar was 600 and they immediately put her on meds.

They told her she was type 2. This is what she is now on.

In the a.m. Amaryl 4 mgs, Janumet 500

In the afternoon, she takes Actos, 30 mgs at noon.

At night she takes 1000 of Janumet, along with 9 units of Lantus.

Her doctor has previously told her he wants her on short acting insulin, she has always said "NO".

And she loses weight very easily.

Up until she went on vacation to Jamaica, her fasting numbers were 120 or so. Sometimes even 95. She NEVER takes her sugar after that (even thought I explained that she needs to and it's a post prandial reading), she said her doctor told her not to take her sugar after the fasting reading because she was driving herself crazy. So the fasting number is the only number we have.
Oh, we have a1c. She is 6.2 (down from 6.5) and that was two weeks ago. She gets an a1c every 3 months.

So her eating habits are as follows.

4 small meals a day plus two snacks. And she'll eat a piece of fruit before bedtime. Her breakfast is one bowl of oatmeal. And she drinks Fenugreek tea all day long. So up until 10 days ago, her fasting reading was no more than 120, and sometimes even less.

So her son takes her on vacation to Jamaica (oh, I asked her if she drank, because who goes on vacation and doesn't drink?)

Let's say she arrived in Jamaica 10 days ago on a Sunday. Sunday night she had exactly one drink. A glass of wiskey and soda. The next morning her sugar was 95.

She had NO MORE ALCOHOL for the next 7 days.

HOWEVER, after that one reading of 95 on a Monday morning, every single morning when she got up and took her blood sugar, it was 250 to 285.

Every single morning.

Of course I asked her "What the heck changed from New York to Jamaica, I mean, you HAD to be doing SOMETHING different to get that big of a reading. From a reading of 95 to jump to 250 or so, I said "what did you do different?" She said "Well, instead of 4 small meals, I ate 3 huge meals."

I said 'what do you mean by huge?" She said 'oh my god, you know that I eat a bowl of oatmeal every morning, right?" I said 'yeah, one bowl of oatmeal"

She then said "Well, there was no oatmeal, so I ate whatever they served and they served these huge breakfasts, these huge lunches and big dinners.

So I said "Oh, you dramatically changed the way you were eating while you were on vacation??" She said "well, only the size of the meals".

I said 'well the size of the meals means a great thing, but the big clue is what happened when you returned home and ate like you did previously"

She said: "Oh, when I came back, it is now going down. The first morning she came back it was 135, and the second morning it was 130.

So now that she is back home, her sugar is going down. She also said "This same thing happened when I was on vacation in the Dominican Republic for one week, my sugar went UP"

So I said "Well, now that you know what happens, stop eating these big meals" She said "but how can I do this?"


I also said "if you knew you were going to be eating big meals, why didn't you up your Lantus by a few units? That med is supposed to prevent spikes in your blood sugar" She didn't think of it.

I just sighed. See, I know me. I haven't had a vacation in 20 years, but if I were to go on a cruise, I would know AHEAD of time, what they served and what I would be eating, and there wouldn't be any big meals for me. I know what I eat. But that's me.

So did I give the correct information?

Thanks much

That is alot of oral meds for typeII

When a person gets to that level of oral meds, and has trouble with spiking sugars... that means the pancreas is not working.
The oral meds can only do "so" much.

I bet she had alot of huge CARB meals! Also in the tropics they drink alot of juices...which have alot of sugar. Diabetics need some good fats and protein with meals. The fats keep the food in the stomach longer, and prevent the spikes.

She will probably have to go on Humalog soon.

Some younger typeIIs often have some type I mixed in there.
I've met 2 nurses who were diagnosed with type II and really were type I and ended up on only insulin and dropped all oral meds. (one was in her 30's and not overweight at all). Autoimmune disease eats away at the pancreas in some people.

Thanks much Mrs. D. Her doctor has been trying to get her off of orals and on humulog for a long time. She is resistant.

I am printing out your post for her to read.

And I do thank you so much.

Melody

Melody
You are a good find. Keep working to talk to her.

Donna

Thanks hon. I do try to be. I have a friend who is over 75 and her daughter asked me to bring my meter and test her mother. Her sugar reading was 157. The daughter's eyes went up, my eyes went up, the mother asked me 'what does it say?" and I said: "when did you last eat?" and she said "2 hours ago". I said "Let's wait one more hour". Oh, she's over 200 lbs by the way.

So we waited another hour (meaning, her sugar should have done DOWN), her sugar went up.

So the daughter was motioning to me "don't tell her, don't tell her" and I'm going "why on earth not, she's a diabetic"

And since I could not tell her I said "well when is your next blood test?" and she said "Oh, I don't want to go". (What can I do???)

But, she had an accident, went into the hospital, they took her blood, they then asked her "Are you a diabetic? and she emphatically said 'NO"

So they took her word and went on to fix other stuff that was happening to her at the time.

Hey, if people don't want to know, don't care to know and have BIG deniability going on, nothing I can do.

I can only help the people who want to be helped. Anything else is counter-productive and has no effect. I learned this a long time ago. I don't stick my nose where people don't want my nose to be stuck.

Now here is where it gets interesting. I printed out Mrs. D posting and brought it to my friend (the one who went on vacation)

She read the whole thing and she looked at me and said "she thinks I should go on insulin?"

I then said "well, more and more researchers are now telling patients who have type 2 to go on insulin (especially if the sugar is all over the place), INSTEAD of the orals because oral meds can cause potential side effects that insulin does not cause. And basal insulin, well, it's a start.

She then said 'I want to go off all my meds"

I then stuck my nose where it doesn't belong and reminded her

"Remember the last time you did that?

A few years ago she got tired of checking her sugar every day, got tired of meds, got tired of the one shot of Lantus (remember she weighs 120, so there is NO weight issue here), and she did her own experiment (kind of like what I did for 7 weeks but in her case she put her meter away)

I said "You did not take your blood sugar, you did not take any meds at all, you tried to control it withe diet and remember what happened??"

She said slowly "yeah"!!

Want to know what happened to her? She collapsed and they rushed her to hospital where she was in a coma and her sugar was 600.

So I said "You are NOT attempting any more experiments unless you talk everything over with your diabetic practictioner."

She said "but you did an experiment". I said "With the approval of my doctor, the people at Cornell and my sugar was 111 and I was on 5 units of Lantus.

BIG DIFFERENCE THAN YOU RIGHT NOW!!!

She said "but if you could do it, why can't I", "I don't want to take meds"

I said 'No one wants to take meds, but let's talk about what's happening with your pancreas".

I then explained just like Mrs. D has explained in many of her postings.

When I left, she finally understood that MY pancreas has nothing to do with HER pancreas. That MY diabetes has nothing to do with HER diabetes.

We are all different, at different levels of diabetes care management and we each have to do what we each have to do.

Even with the perfect diet, well, the pancreas does what the pancreas does.

She is only 48 and she's afraid of going on Humalog.

So after all that talk, I said to her 'Your mom had diabetes right?" She said "yeah" , I said "you have diabetes, right?" She said "yeah, why"?

I said "your son must get tested. On a regular basis. There is some genetic factor that might be going on and it's better to know now than be surprised later"

She jumped up and said "No, I will not have that, I don't want to know".

I said "But your son HAS to know". He is newly married, they want kids. (I was gentle, believe me), I appealed to the rational side of her brain and not the emotional side.

I said "and listen to me, things change, new research happens every day, they are trying to develop an insulin pill so people might not have to take injections any more (I'll say anything to her to get her to have her son test his blood sugar)

She then said "I heard that right now they are doing pancreas transplants" "why can't they give me a new pancreas".

I then SLOWLY explained "that is only done to the Type 1's right now" and you do know that when you have an organ transplant, you have to be on anti-rejection drugs for the rest of your life?"

She said 'why". Then I explained that our bodies can reject anything that we were not initially born with and people who get new hearts, new lungs, new organs, well they have to go on anti-rejection drugs which in themselves have certain side effets so ONE DOESN'T JUST WALTZ into a doctor's office and announce "I want a new pancreas"

Anyway, at least she is not going off of her meds any time soon, thank goodness.

But I wish the son would get tested.

And I have another friend who is 53, who is extremely obese, who never gets tested, and whose mom died at age 53 from diabetes after having MANY amputations.

See the pattern going on here?

Very frustrating.

Melody

this is a reminder Melody... when you explain stuff to people:

The pancreas eventually burns out. The oral drugs only work by stimulating more insulin from the pancreas. The Metformin does something extra by reducing gluconeogenesis in the liver. But amaryl, and others like glucotrol, stimulate more insulin output.

When the pancreas reaches a certain point, it stops making insulin (this is called burnout by some) and then you HAVE to use externally supplied insulin from then on. The pancreas can be damaged by autoimmune disease or other things too.

When the oral meds fail there really is no other choice.

Mrs. D.

A quick question. When you say the pancreas eventually burns out, are you indicating that this happens to EVERYBODY?, or just people with type 2 diabetes?

And if you mean people with Type 2, does this means that EVENTUALLY, everyone (as we get older and older and older), we ALL will be put on humalog? Or, as in my case, I take Lantus.

I know many people in their 80's who were diagnosed with Type 2, who never took an oral med, their sugar reading doesn't go above 170 and yet, they have neuropathy and are going for light therapy.

I met an older gentleman once (with his wife), at a bus stop, and as I often do, I struck up a conversation because there was a hour wait for the bus, it was a beautiful day, and why not talk to people??

He said he was a diabetic since the age of 30, he was now 75, he is not on insulin, he takes oral meds AND HE HAS NEVER HAD ANY KIND OF COMPLICATIONS.

How odd, right?

And what else can a person do, if one is type 2, eats correctly, takes their Lantus and doesn't WANT TO HAVE THEIR PANCREAS BURN OUT??

lol

Melody

What happens when people get old....is that if they have insulin resistance , the body tells the pancreas to put out more and more insulin (even when no drugs are given), and eventually the Islet cells can't do this anymore and die. So yes, even without drugs the cells die or burn out.

Doctors can monitor this by taking fasting INSULIN levels, to show how much is going up this way. The theory is that insulin somehow fails at the cell membrane to help glucose enter the target cells of the body that need it, signals are sent and a hormone stimulates the pancreas to make more and more insulin and eventually the pancreas burns out.

Type II diabetes starts this way. It is just that many doctors don't do the fasting INSULIN level... some don't even know how to interpret it. Those who become diabetic earlier as type II just have a faster decline than older people. I think genetics drives most of this.

In fact some doctors today don't like the oral meds much except for metformin (which has other actions that are desirable too) because they CAUSE a form of insulin resistance and therefore weight gain.(which becomes a vicious cycle)

Ah, so a person who does not have diabetes, insulin resistance, etc, like my mother, HER WHOLE FAMILY, never had any kind of diabetic related stuff going on at all, but on my father's side, we had my grandmother (age 80) and my father (age 80), and neither was obese. So Cornell told me "you have a genetic component going on"

So it comes, once again, down to genetics (which we can't fight I gather).

And can I extrapolate that because I take 8 units of Lantus before I go to bed, and I don't any oral meds, that I am giving my pancreas some sort of break, so it doesn't have to work so hard?

Am I heading in the right direction here?

Thanks much if this can be cleared up.

And believe me, between my sprouting fenugreek and my other sprouts, and eating the way I'm eating, I am trying to have my pancreas not work so hard.

I shall continue to fight the good fight!!!
lol.

Melody
P.S. There are several so called experts who say that if one goes completely raw, one can reverse diabetes. It's EXTREMELY difficult to go completely raw, like those raw vegans.

I like my piece of chicken, my little piece of bison, and I actually feel better after consuming SOME animal products.

The Lantus at night is to keep your blood sugar more normal all day long inbetween meals. This takes care of the glucose the liver makes when food is not available. This is called a basal insulin.

The bolus at meals with fast acting insulin like Humalog is for what is needed when a person eats...When the pancreas is totally burned out, no bolus with meals occurs. So the Humalog replaces that. When a person follows strict diets, the meal does not require a real spike of insulin...the diet helps control this. This is why the proper snacks are important, and small meals more often. Things like nuts, cheese, protein, etc tend to not spike insulin like crackers or cookies do. Also slowing the stomach emptying can help reduce insulin spikes (so nuts again and other good fats).

But in uncontrolled eating or large meals, or lots of carbs, a bolus of insulin has to come from somewhere.