> Also, they prefer to try medications like glucophage before they resort to insulin.
A couple of points: 1- the targets set by associations like the ADA actually assume the patients won't be able to make significant lifestyle changes; for example the ADA A1C targets are higher than for healthy patients. The diet changes they preach are not that radical, e.g. cake is bad for you but you can have a really tiny slice and offset it by not eating bread. This belief isn't that unreasonable; FDA requires that medical labeling be targeted at a 5th grade reading level.
2 - And glucophage is much easier for patients to manage than insulin both in dosing regime and simply caring for the drug.
3 - Finally the insurance companies' actuaries have figured out that maintenance therapy of this nature has the best cost/outcome ratio.
To that last point: I had "adult onset type 1" due to an autoimmune condition. The endocrinologist I was sent to was only interested in maintenance therapy and not at all in looking for root cause, even though I presented with a body fat of about 14%. She finally admitted that even if she did look into it the insurance companies would hassle her for going off the reservation without a good excuse.
But my no-insurance primary doctor and I and a rheumatologist were able to dig into root cause and now I am "cured" (of diabetes at least) thanks to treating the underlying condition (note: this is glossing over a lengthy period of unpleasant work). Which is actually cheaper for the insurance companies, but honestly how many patients have the training to be able to be involved in their care to this degree?
I would really like to know more about how you and your doctors cured your condition.
I’m fascinated by endocrinology and rheumatology. We know so little!
If this is true, insulin pumps for Type 2 diabetes don’t help, because they can only add more insulin, when the fundamental problem isn’t lack of insulin, but lack of response to insulin.
Edit: I'd add that type 2 is associated with increasing insulin resistance, causing the pancreas to work harder. Over time, this can cause the pancreas to essentially burn out, at which point exogenous insulin would be needed. Type 2 diabetics who are able to manage the associated risks - namely diet and exercise, almost universally focused on losing weight - can often improve or even reverse the disease altogether.
I'll also add that this is not the entire discussion of diabetes. There's an increasing recognition of forms of diabetes outside of the known definition of type 1 and type 2. A so-called "type 1.5" is being further delineated and may explain why some type 2s don't behave the way we think they should.
Most T2's are resistant to the normal level of insulin in the blood, and must compensate by introducing ever more insulin until it reaches a high enough level to overcome the resistance and it acts to absorb glucose. Normally this is done through medications that either 1) increase the amount of insulin your pancreas secretes, or 2) decrease your insulin resistance (via the liver, IIRC).
As such, most T2s maintain a higher continuing level of insulin than non-T2s. Thus an insulin pump like that in the article will work for both T1s and T2s alike, but the insulin dose for T2s simply will be higher than for T1s.
Many patients are able to achieve stable control of their glucose and HbA1c on metformin (Glucophage) alone. However especially for type II DM patient needing insulin, finely controlling glucose levels might reduce long term risks as mentioned above and in the paper [1], and a pump might indeed be far superior to the typical injected insulin regimen. Interestingly, there are trials on clinicaltrials.gov about pumps in type 2 DM sponsored by MedTronic (which makes sense) [2].
As a disclaimer, I am not an endocrinologist or internal medicine guy at all. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920779/ [2] https://clinicaltrials.gov/ct2/show/NCT01182493
This is simply a cost question. In countries where the healthcare gives out the required pumps/injectors and medication for 'free', it is usually a cost/benefit tradeoff.
On the other hand: Not providing proper insulin dispensers costs a lot more in the end. The world has moved from simple throw away injectors (i mean the ones with no proper dosage dispensers and bottles as a storage medium) for years and the benefits far outweigh the cost of relatively simple modern injectors or pumps.
> maybe because it is felt that the patient is partly to blame for the disease
Since there is a very big spread in onset age even for overweight people it would be very bad for a doctor to have these kind of thoughts
Well in the last 3 months, I DID learn new eating habits, lost 15 kilos and had my meds cut from 6.5 tablets per day to 0.5 tablets a day working with a doctor and having good control on blood sugar. The big AHA is that progressive changes have to be made in how you eat rather than necessarily so much in what you eat.
In general, unless you have significant beta cell death already, it IS possible to mitigate or reverse effects of type 2 diabetes and this is vastly preferable to pushing organs beyond limits through drugs or insulin.
Only asking as it would be helpful for others.
A more general book with good advice on nutrition that is perhaps easier to follow -- but not specific to diabetes -- is "The Whole Foods Diet: The Lifesaving Plan for Health and Longevity" by John Mackey , Alona Pulde, and Matthew Lederman.
Good luck to you and your mom! It helps a lot in making lifestyle changes when family, friends, and neighbors are supportive. See also the book "The Blue Zones of Happiness: Lessons From the World's Happiest People" for a bigger picture view on that.
Good sleep is another part of the puzzle -- see Matthew Walker's book "Why We Sleep: Unlocking the Power of Sleep and Dreams" on that. Essentially, good sleep gives you better self-control during the day -- as well as helping your health in many ways including regarding diabetes.
Maybe sub with alcohol sugars if needed.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
https://link.springer.com/article/10.1007%2Fs13300-018-0373-...
Well, isn't that a sane first approach ?
I mean, yes, if it fails, find a workaround. But I don't see how __healing__ is a bad objective for a doctor.
Sure, it will kill you more slowly than you'd die if you didn't get that insulin in the short-term, but it's definitely not a "solution". Diabetes is caused by insulin resistance. What do you think more insulin is going to do to your body in the long-term?
The ultimate/only good solution is to make you insulin sensitive once again.
Sad fact: patients that don't manage to change their liefestyle or are too far into the disease will stay on insulin until they die.