April 13, 2011

Type 2 Diabetes: From Old Dogmas to New Realities – Part 1

Suffice to say, dramatic changes have occurred in our understanding of the onset and progression of prediabetes over the last decade. Lightening speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control.

However, even with all of this change many old dogmas hang on. It’s time to be aware of the new realities.  Here I’ve focused on two common old dogmas and the new realities.

Old Dogma: Type 2 isn’t the serious kind of diabetes. Typically diagnosed later in life people just need to follow a healthy eating plan, lose a few pounds and perhaps over the years, they’ll need a “diabetes pill.”

New Reality:  Recent research underscores that type 2 is a progressive disease and the progression is typically kicked off nearly a decade before type 2 is usually diagnosed. Insulin resistance, due to excess weight, mixed with a positive family history, are the common culprits. Prediabetes and type 2 is now  being diagnosed in younger adults and even our children.

By the time of the diagnosis of type 2 most people have already lost half to three-quarters of their insulin making pancreatic beta cells. Expert guidelines from American Diabetes Association and the American Association of Clinical Endocrinologists now recommend starting on a blood glucose lowering medication to treat the insulin resistance at diagnosis. And this isn’t your grandmother’s or great uncle’s diabenase or orinase (or any sulfonylurea) which puts more insulin into the circulation. The recommendation from both organizations is to start with a medication to treat the central problem in type 2 – insulin resistance - to curb the production of glucose from the liver. The most commonly prescribed first drug to accomplish this goal is metformin.

Over the years it’s now known that insulin production will dwindle further. Most people will need a progression of blood glucose lowering medicines over the years to make the best use of the insulin they continue to make. As the saying goes, if you live long enough with type 2 you'll need to take insulin. Do be aware that experts now know that prediabetes and type 2 is about a lot more than simply insulin and glucose. Many other hormones and organs are involved. To learn more read my article in Diabetic Living, How to Lower Morning Highs for an explanation.

The good news: research shows early, aggressive management to control blood glucose can slow disease progression. To learn more read my article in Diabetic Living, Treat Early, Treat Often. While medications are important for glucose control, healthy eating, losing a few pounds and being physically active always offers a BIG assist.

Old Dogma: Blood glucose control is goal number one and diabetes is all about glucose control.
New Reality: Having type 2, it’s said, is an equivalent risk factor to having had a heart attack or stroke.  The most common complication of type 2 is heart and blood vessel diseases, not blindness, kidney disease or an amputation, as is the common notion.

Research has shown that to get and stay healthy over time people with type 2 need to focus squarely on their ABCs – A for glucose control (the A1C result), B for blood pressure (B) and C for blood cholesterol. Studies show that when people think diabetes they think glucose. They don’t make the link between diabetes and circulatory problems. Yet, three-quarters of people with diabetes have high blood pressure and the most common cause of death for people with type 2 is heart attack or stroke.

Bottom line: The most important new reality for prediabetes and type 2 diabetes is: Take action as early as possible after diagnosis. Don’t delay, don’t deny. Get and keep your blood glucose, blood pressure and blood cholesterol in recommended target zones.