NickJ Posted February 21, 2010 Share Posted February 21, 2010 Sorry man, brain-fade, and I'm not even low! Smarties, not Sweeties. http://www.amazon.com/Farleys-Sathers-Smarties-Candy-2-5/dp/B000NLM13K Oh, another hate on this..... Have ya seen the price of test strips?? It makes primers seem like a bargain! Your insurance won't cover them? Mine treats them just like any other prescription- a copay and done. My doc gives me a prescription for 200 a month, and the VA gives me another 200, which they say is enough for 90 days. My doc did recommend those candies. Thanks for moving this so it could keep on. Link to comment Share on other sites More sharing options...
Neomet Posted February 21, 2010 Author Share Posted February 21, 2010 All good Mark, thanks for moving it. It has turned into a (really good) discussion. Nick, insurance picks up some of mine but not all. Supposedly better this year. I'll see as it is about time to get some more. Link to comment Share on other sites More sharing options...
Paul Santiago Posted February 21, 2010 Share Posted February 21, 2010 i usually keep 'payday' bars stashed. Enough sugar for the occasional "oh crap, my sugar's dropping", and no melting chocolaty mess. Glove box, range bag, saddle bags. An emergency notification card is good to keep around also. Link to comment Share on other sites More sharing options...
GrumpyOne Posted February 21, 2010 Share Posted February 21, 2010 Being fairly newly diagnosed with type II, there are still some questions I haven't had a chance to ask my doc yet. Does anyone know if type II changes to type I over time? I'm keeping my sugar pretty well regulated by diet and the Metformin and Glipizide pills. Link to comment Share on other sites More sharing options...
Neomet Posted February 21, 2010 Author Share Posted February 21, 2010 (edited) No, as they are caused by different things. Type 1 is an autoimmune disease caused when white blood cells attack and destroy the insulin producing portions of the pancreas so that it completely ceases to function. Type II has different etiology. Type II is still subject to the same complications as Type I so keep it well under control. Edited February 21, 2010 by Neomet Link to comment Share on other sites More sharing options...
kimel Posted February 21, 2010 Share Posted February 21, 2010 Hey Everyone, Great info here! I am not a diabetic but work and play with several so it is good stuff to know. Please, please, please do the medical (pre-hospital and otherwise) community a HUGE favor and get a Medic Alert Bracelet or necklace. It is a TON easier to deal with a "unconscious subject" call if we know there is a pre-existing medical condition which might be responsible. And this isn't just for diabetics but for anyone with a medical condition be it an aspirin allergy, food allergy, diabetes, on up. Those USB stick type gizmos are okay but not everyone carries something that will read a USB stick with them in their response units (yet) and it is a whole lot easier to just find the tag. Chances are your USB tag won't be read until you hit the hospital...and maybe not even for awhile after. A lot of stuff can happen in the mean time. They don't cost a lot and we are all trained to look for them. http://www.medicalert.org/ Thanks! Link to comment Share on other sites More sharing options...
Gary1911A1 Posted February 21, 2010 Share Posted February 21, 2010 Oh, another hate on this..... Have ya seen the price of test strips?? It makes primers seem like a bargain! My apologies for turning this into a drifting discussion. But the Reli-On Micro strips are <$24 per 50 at WalMart. The Reli-On Micro meter is also very cheap and quite good. Pretty fast to show the reading, doesnt need coding, and it uses absolutely the smallest drop of blood. It has become my favorite meter, and it uses the cheapest strips. Can these be used to test on your forearms or are they used for fingertips? I hate using my fingertips. Link to comment Share on other sites More sharing options...
NickJ Posted February 21, 2010 Share Posted February 21, 2010 Oh, another hate on this..... Have ya seen the price of test strips?? It makes primers seem like a bargain! My apologies for turning this into a drifting discussion. But the Reli-On Micro strips are <$24 per 50 at WalMart. The Reli-On Micro meter is also very cheap and quite good. Pretty fast to show the reading, doesnt need coding, and it uses absolutely the smallest drop of blood. It has become my favorite meter, and it uses the cheapest strips. Can these be used to test on your forearms or are they used for fingertips? I hate using my fingertips. I've tried the "alternate site" testing and found it to be 10-15% off from the finger tip sticks, on the high side. Link to comment Share on other sites More sharing options...
Gary1911A1 Posted February 22, 2010 Share Posted February 22, 2010 Thanks Nick, I guess if I have to spend less money and use my fingertip maybe I can use that as an excuse for poor trigger control. Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 22, 2010 Share Posted February 22, 2010 No, as they are caused by different things. Type 1 is an autoimmune disease caused when white blood cells attack and destroy the insulin producing portions of the pancreas so that it completely ceases to function. Type II has different etiology. Type II is still subject to the same complications as Type I so keep it well under control. Type 2 diabetes is also reversible quite frequently when the problem that caused it is addressed directly. Too much insulin all the time = very bad things. Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 22, 2010 Share Posted February 22, 2010 No, as they are caused by different things. Type 1 is an autoimmune disease caused when white blood cells attack and destroy the insulin producing portions of the pancreas so that it completely ceases to function. Type II has different etiology. Type II is still subject to the same complications as Type I so keep it well under control. Type 2 diabetes is also reversible quite frequently when the problem that caused it is addressed directly. Too much insulin all the time = very bad things. You're confusing Type II DM with secondary Diabetes which develops due to other medical conditions or medication therapy; i.e. hyperthyroidism, prednisone or other cortico-steroid use, and which usually resolves when the underlying condition is successfully treated.... If someone is diagnosed as pre-diabetic, there's an opportunity to turn things around. Once things progress to Type II DM, that disease isn't reversible, though it may be able to be controlled without insulin, and in some cases without medication for a while, assuming that there are sufficient changes in diet, exercise and hydration to maintain a normal blood glucose level. That balance tends to be fragile though -- knock off the exercise, change the glycemic index values of your diet, get sick or injured -- and you might need medication to get you through. Some Type II diabetics are temporarily put on insulin during hospital stays (often when surgery is involved) to assist them in maintaining normal blood glucose values.... Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 22, 2010 Share Posted February 22, 2010 I am most definitely not confusing the two Nik. If it can be controlled without insulin and without medication, and you don't have any of the effects of it - how is that not (for all intents and purposes) cured? Replace the words "insulin sensitivity" with "sunburn." If you get a sunburn, how do you get rid of it? Stay out of the damn sun! If you are insulin resistant, how do you get rid of it? Increase your insulin sensitivity by changes in your life style. When one has to choose a life of diabetes vs. a life of exercise and nutrition - I would hope the majority of people would say the exercise and nutrition is worth it.... Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 23, 2010 Share Posted February 23, 2010 I am most definitely not confusing the two Nik. Yeah, you are. Secondary diabetes has identified causes and is a temporary state..... If it can be controlled without insulin and without medication, and you don't have any of the effects of it - how is that not (for all intents and purposes) cured? Control tends to be temporary and easily disrupted. Where Type I will kill quickly, if insulin is not provided, Type II will kill more slowly -- by one or more of the consequences of living in a hyperglycemic state. The majority of folks diagnosed with Type II DM cannot get it under control with lifestyle changes --- and often it's not a matter of them not being willing to..... Once you've been hit with the diagnosis, there are (often silent and) progressive systemic changes. Suggesting that folks ignore that ("Type II is also reversible quite frequently when the problem that caused it is addressed directly") is both misleading and dangerous, especially since the causes of Type II DM have not yet been definitively identified. (We're still operating on theories here -- cause and effect have not been established. There's evidence that dietary changes and exercise help -- but that's not exactly a cure) The disease is progressive -- so that even if one can achieve exceptional blood glucose control without medication, there's no guarantee that that can be maintained for a lifetime -- which is specifically what's required to avoid the very serious complications of not monitoring and treating the disease. The sequelae (heart attack, stroke, kidney disease/failure, blindness, peripheral vascular disease, amputation, impaired ability to fight off infection) of not treating the disease are simply too serious.... There is no cure for this chronic disease at this time. There are multiple treatment options -- and many people live for a long time with the disease while avoiding the complications, by taking ownership of monitoring and maintaining an acceptable blood glucose level. Replace the words "insulin sensitivity" with "sunburn." If you get a sunburn, how do you get rid of it? Stay out of the damn sun! If you are insulin resistant, how do you get rid of it? Increase your insulin sensitivity by changes in your life style. You're comparing an injury with a disease here.... When one has to choose a life of diabetes vs. a life of exercise and nutrition - I would hope the majority of people would say the exercise and nutrition is worth it.... I'm not buying that it's a choice for all of the patients I've seen..... Link to comment Share on other sites More sharing options...
Neomet Posted February 23, 2010 Author Share Posted February 23, 2010 I'll line up with Nik on this. Not a doc but had this since 1968 and have read if not all, certainly the majority of the studies on this. Control most definitely is not to be confused with cure. Even if one follows the new uber-tight controls recommend by most endos this only reduces the incidences of some of the secondary complications. It has practically no impact on the increased likelihood of of a cardiac event and the risks of other secondary complications are only reduced, not brought down to levels found in the general population. Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 23, 2010 Share Posted February 23, 2010 Ok Nik, First let us establish what causes Type II Diabetes? Link to comment Share on other sites More sharing options...
GrumpyOne Posted February 23, 2010 Share Posted February 23, 2010 Hey Everyone, Great info here! I am not a diabetic but work and play with several so it is good stuff to know. Please, please, please do the medical (pre-hospital and otherwise) community a HUGE favor and get a Medic Alert Bracelet or necklace. It is a TON easier to deal with a "unconscious subject" call if we know there is a pre-existing medical condition which might be responsible. And this isn't just for diabetics but for anyone with a medical condition be it an aspirin allergy, food allergy, diabetes, on up. Those USB stick type gizmos are okay but not everyone carries something that will read a USB stick with them in their response units (yet) and it is a whole lot easier to just find the tag. Chances are your USB tag won't be read until you hit the hospital...and maybe not even for awhile after. A lot of stuff can happen in the mean time. They don't cost a lot and we are all trained to look for them. http://www.medicalert.org/ Thanks! They gotta make 'em in plastic for me to get one. I work with high voltage/amperage, not gonna wear any metal! Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 23, 2010 Share Posted February 23, 2010 Ok Nik, First let us establish what causes Type II Diabetes? Unknown etiology -- multiple theories..... Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 23, 2010 Share Posted February 23, 2010 This will likely be a long post because I'd like to define everything to make sure we are on the same page. Insulin is a hormone made in the pancreas and released into the blood under a number of circumstances. Insulin is the major nutrient-storage hormone. It does a lot, but it's primary minute to minute job is to regulate blood sugar from going too high. Whenever blood sugar rises, the pancreas pumps insulin into the blood to drive the sugar into cells and reduce the amount in the blood - lowering blood sugar. It does this by binding to and activating insulin receptors located throughout the body - mainly on muscle cells. These insulin receptors are proteins. When insulin binds to them it activates them, causing them to move sugar from the blood into muscle cells for storage. Think of them as tiny pumps. Without insulin to activate them, they don't work and sugar accumulates in the blood. Insulin resistance is a condition in which the insulin receptors require more than the normal amount of insulin to activate them. When you eat, food travels from your mouth, through your stomach, and into your small intestine. Your digestive system then breaks the food down into it's various components. Protein turns into amino acids, fats turn into smaller fatty acids, and carbs turn into glucose (sugar) - in order for them to be absorbed into the body. Your body can't absorb complex carbs as they are, they must first be reduced to their basic subunits, which are sugar molecules. In other words, 100 grams of carbohydrate becomes 100 grams of sugar (over half a cup). This sugar them passes through the walls of your small intestine and into your blood. Adding a half cup of sugar to your blood will obviously make your blood sugar rise. Your body reacts to this and the elevated sugar levels induces the pancreas to pump insulin. That insulin travels through the blood over the receptors on the surfaces of cells and binds to them and pumps the sugar into the cells as we've already established. Where this becomes a problem is when you eat a carb source, your digestive tract breaks it down into sugar and moves it through the blood. Your blood sugar rises as normal and sends a signal to your pancreas. Your pancreas pumps the insulin into the blood and still everything is working properly. Then the insulin washes over the receptions but isn't able to activate them. If the receptors aren't activated they won't pump the sugar out of the blood and into the cells, which means your blood sugar stays high. This in turn continues to nag at your pancreas for more insulin. Your pancreas succumbs to the bludgeoning and produces more insulin until it finally produces enough to activate your stubborn insulin receptors. At this point the sugar in your blood begins to fall slowly as the receptors pump it into the cells. Eventually your system is back in balance, but at the expense of a ton of insulin to get you there. Insulin receptors aren't fixed things on the surfaces of cells. They're made inside the cells in response to their need for insulin action. In other words, when there isn't much insulin in the blood, sensors in the cells up-regulate the production of "docking stations" for insulin. On the other hand, when there's lots of insulin in the blood, the cells don't need to make as many "docking stations" (down-regulation). Another example of this is when you walk into a room and the guy in there has an excessive amount of cologne on. Given time you don't notice the smell as much. If you walk back out of the room for a minute and in again, you're hit with the smell again. The scent didn't change, just your perception of it did. In other words when insulin receptors are bombarded with excess insulin the receptors down-regulate requiring more insulin to activate them, which further down-regulates them and so on. If this cycle continues, there will ultimately be a point at which the amount of insulin required to activate the receptors will be more than the pancreas can possibly produce. At that point, diabetes ensues. It is the ultimate expression of insulin resistance. Excess insulin...largely the consequence of eating a diet that contains much more sugar and starch than a stone-aged metabolism (which is unfit to the task) can handle. Given the current state of affairs that most people survive largely on cookies, candy, cake, ice cream, pie, bread, pasta, pizza, cereal, potatoes, etc...it's no surprise that the incidence of diabetes has risen 10 times in the last 30 years. It's simply a matter of biochemistry. If excess insulin is causing the problem, reduce the insulin levels, and lo and behold, people get better. Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 23, 2010 Share Posted February 23, 2010 Jake, that's a lovely theory --- but the research hasn't confirmed that it's really that simple..... Current thinking on Type II DM includes the concept that insulin resistance is caused by a hereditary defect in in insulin receptors -- this defect is apparently a universal finding in patients with Type II. (For the truly interested, the majority of cases are polygenic, some monogenic types have also been identified.) That finding precedes the development of impaired glucose tolerance and Type II DM by as much as 3-4 decades. Insulin resistance -- as you pointed out -- stimulates a compensatory increase in insulin production by the pancreas. At some point a beta cell defect results in a decrease of insulin secretion to a level that's insufficient to overcome the hereditary insulin resistance, leading to hyperglycemia and diagnosis. Since the cells are starved for glucose at this point, the liver also checks in to lend a hand, by upping its production of glucose, causing increased hyperglycemia in fasting and after meal periods.... Big points here: By the time a patient gets to a diagnosis, an awful lot of damage has already been done -- because often the patient has been in a hyperglycemic state for years --- and a cure is not possible at this point in time. Managing blood glucose levels and delaying/minimizing complications are the goals of treatment.... Also -- while Type I diabetics need to adjust their insulin dosage in order to "cover" whatever carbohydrates they consume, none of them can avoid taking insulin by eliminating carbohydrates from their diet. In Type II, you can't fix the insulin resistance -- so improving the diet and adding exercise will certainly help with glycemic control, but will not provide a cure.... If a friend of mine got diagnosed with Type II DM in your neck of the woods, I'd strongly recommend they see you for assistance in improving their diet and improving their activity level. It's clear that you know a lot (might well be an expert) on those topics. I would not however tell them that their disease could be cured by diet and exercise, and I'd strongly recommend that at a minimum they find and consult an endocrinologist, a diabetes educator, a cardiologist, and a regular physician.... Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 23, 2010 Share Posted February 23, 2010 Whether pure research has proven it or not is largely irrelevant to me and is no surprise - considering where funding for medical research often comes from. I understand where you are coming from, but I refuse to believe that a disease (which literally is not found in hunter-gatherer societies) is genetic and incurable. I also find it hard to believe that insulin resistance is a purely genetic trait just from a basic physiology stand-point - there has been a lot of evidence to the contrary. The best experiment would be to get your insulin sensitivity measured right now, go on a very low carb paleo diet for a month or two (I'm talking 50-75g of carbohydrate a day for a full size male human), and then re-measure your insulin levels. (Note: these must be fasting insulin levels). Notice, I'm strictly talking type II here. There are some strong connections between type 1 diabetes and gluten intolerance (among other things), but I haven't done enough research into that to form an educated opinion yet. I suppose for the time being we will have to agree to disagree until better information is out there. Link to comment Share on other sites More sharing options...
bdo Posted February 23, 2010 Share Posted February 23, 2010 (edited) Whether pure research has proven it or not is largely irrelevant to me and is no surprise - considering where funding for medical research often comes from. I understand where you are coming from, but I refuse to believe that a disease (which literally is not found in hunter-gatherer societies) is genetic and incurable. I also find it hard to believe that insulin resistance is a purely genetic trait just from a basic physiology stand-point - there has been a lot of evidence to the contrary. The best experiment would be to get your insulin sensitivity measured right now, go on a very low carb paleo diet for a month or two (I'm talking 50-75g of carbohydrate a day for a full size male human), and then re-measure your insulin levels. (Note: these must be fasting insulin levels). Notice, I'm strictly talking type II here. There are some strong connections between type 1 diabetes and gluten intolerance (among other things), but I haven't done enough research into that to form an educated opinion yet. I suppose for the time being we will have to agree to disagree until better information is out there. There is plenty of evidence to support the hypothesis that certain types of Type II DM have a genetic component to it. The genetic component in these certain types don't necessarily mean you will lose insulin sensitivity, but you have an increased predisposition to it. This is why the family history can be important to finding out those are are at risk. If you have two populations that are genetically isolated from each other, and one population gets the disease, that doesn't really discount the genetic component of the disease. Who is to say that one population has the gene, and the other does not? There have been multiple genes that have been linked to the MODY type of diabetes. Also, insulin receptors are not sugar pumps. They work through secondary messenger systems to translocate GLUT receptors to the cell surface which does the work. ETA: I'm not a doctor, just a lowly M-2. Edited February 23, 2010 by bdo Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 23, 2010 Share Posted February 23, 2010 Whether pure research has proven it or not is largely irrelevant to me and is no surprise - considering where funding for medical research often comes from. I understand where you are coming from, but I refuse to believe that a disease (which literally is not found in hunter-gatherer societies) is genetic and incurable. I also find it hard to believe that insulin resistance is a purely genetic trait just from a basic physiology stand-point - there has been a lot of evidence to the contrary. The best experiment would be to get your insulin sensitivity measured right now, go on a very low carb paleo diet for a month or two (I'm talking 50-75g of carbohydrate a day for a full size male human), and then re-measure your insulin levels. (Note: these must be fasting insulin levels). Notice, I'm strictly talking type II here. There are some strong connections between type 1 diabetes and gluten intolerance (among other things), but I haven't done enough research into that to form an educated opinion yet. I suppose for the time being we will have to agree to disagree until better information is out there. Jake, I get that you care about people in general, your clients, friends and acquaintances in particular, and that you'd like to improve the health and welfare of as many people as you possibly can. What you're failing to see however, is how dangerous some of your generalizations are, and how little you know about diseases and their very real consequences. That's the part where we're going to have to disagree --- because the health of my friends, acquaintances and fellow board members is important enough for me to take issue with "exercise and change your diet and all will be fine...." This is at least the second time you've sent that message -- the last was the kidney stone discussion -- and the simplicity of the message ignores the very serious consequences of not addressing the problems comprehensively. Diet and exercise and hydration are important components of a comprehensive treatment plan, but they can not be the entirety of the treatment plan..... Link to comment Share on other sites More sharing options...
Jake Di Vita Posted February 23, 2010 Share Posted February 23, 2010 Nik, The methods that I preach are not found in the classical clinical setting as you may be used to. These methods, however, are used every day on real people with very real results. So is the fact that you don't agree with it supposed to convince me otherwise in face of countless testimonials? That of course doesn't even take into consideration your total lack of acknowledgement of evolutionary biology. I've suddenly lost interest. How about you give your information, I'll give mine, and we'll leave it to the reader to make their own decision - as it should be. Link to comment Share on other sites More sharing options...
smokshwn Posted February 23, 2010 Share Posted February 23, 2010 Nik, The methods that I preach are not found in the classical clinical setting as you may be used to. These methods, however, are used every day on real people with very real results. So is the fact that you don't agree with it supposed to convince me otherwise in face of countless testimonials? That of course doesn't even take into consideration your total lack of acknowledgement of evolutionary biology. I've suddenly lost interest. How about you give your information, I'll give mine, and we'll leave it to the reader to make their own decision - as it should be. Countless testimonials.....you mean all that anecdotal evidence from the unregulated health/fitness industry?? The bottom line is this, exercise and diet can play a very significant role in reducing/reversing many of the sypmtoms associated with a disease. But to summarily dismiss peer reviewed medical research because you disagree with its funding source is an elementary idea at best and potentially very dangerous to those who would take your advice in lieu of other medically supported evidence. To glibly suggest that this discussion is simply a matter of opinion, dismisses the fact that we are not discussing a training program or suggestions for skill improvement. We are discussing very complex disease processes that require comprehensive attention and treatment. Link to comment Share on other sites More sharing options...
Nik Habicht Posted February 23, 2010 Share Posted February 23, 2010 Nik, The methods that I preach are not found in the classical clinical setting as you may be used to. I've been hanging out in the world of alternative medicine for the last ~ 20 years or so, when appropriate. Does that count? I'm pretty certain that the classic clinical setting doesn't provide all the answers for all patients, neither am I willing to abandon it for most patients. Some patients may benefit from alternative medicine in addition to the classical clinical setting... These methods, however, are used every day on real people with very real results. So is the fact that you don't agree with it supposed to convince me otherwise in face of countless testimonials? If they're real results, they should be able to be reproduced in research studies conducted by anyone, anywhere, right? Care to point toward one? No? O.k. so, you're putting your faith in anecdote over science.... That of course doesn't even take into consideration your total lack of acknowledgement of evolutionary biology. How have I not acknowledged evolutionary biology? Diet plays a role in managing diabetes, probably plays a role in the ever earlier development of Type II DM that we're seeing --- I think I've said that in most of my posts. It's not the sole concern in managing the disease though.... I've suddenly lost interest. O.K., I get that..... Link to comment Share on other sites More sharing options...
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