American Diabetes Association Guide to Insulin and Type 2 Diabetes. Marie McCarren
Carb: carbohydrate. One “carb” has about 15 grams of carbohydrate.
CDE: certified diabetes educator
D2: type 2 diabetes
Dr: doctor
Dx: diagnosis, diagnosed
Endo: endocrinologist
esp: especially
FBG or FBS: fasting blood glucose/sugar
GP: general practitioner
Hypo: hypoglycemia, blood glucose level that is too low
I: C: ratio of insulin to carbohydrate
IMHO: in my humble opinion
MDI: multiple daily injections
Meds: medications
OMG: oh my gosh
PM: afternoon, evening
Puffers: people who use inhaled dry insulin powder
Pumpers: people who use insulin pumps
RD: registered dietitian
Reg: regular insulin
Rx: prescription
T2: type 2 diabetes; T2s are people with type 2 diabetes
U: units. Insulin doses are measured in units
w/: with
YMMV: your mileage may vary
NEXT: INSULIN DEFICIENCY
Years before your diagnosis, you started to lose beta cell function. Your insulin production dropped. When you were eventually diagnosed with type 2 diabetes, your insulin production was probably about half of what it should be.
If you had not been insulin resistant, then that might have been enough. But because you were insulin resistant, you had “relative” insulin deficiency. This means that relative to your needs, the amount of insulin you were producing was not enough. It wasn’t enough to keep your liver from releasing excess glucose. It wasn’t enough to cover the glucose spikes after meals. Your blood glucose levels were too high all the time.
In contrast, people with type 1 diabetes have absolute insulin deficiency. When they’re diagnosed, they’ve lost about 90% of their beta cell function. Within a year or two of diagnosis, their bodies stop producing any insulin.
MEDICATIONS
You may have been prescribed metformin when you were first diagnosed. This drug keeps the liver from releasing too much glucose. Other diabetes pills make your body more sensitive to insulin. Some diabetes pills stimulate the beta cells to secrete more insulin. These will work for a while. But as you get older, you lose more and more beta cell function. Even with the help of diabetes pills, your body can’t produce enough insulin for your needs. This is not your fault. It’s the nature of type 2 diabetes.
When your body makes too little insulin for your needs, you’ll need to supplement it with injected (or inhaled) insulin. As the years go on, you will become more like a person with type 1 diabetes. Your body will be making little to no insulin. You’ll no longer be simply supplementing with injected insulin; instead you’ll need to supply your body with all of the insulin it needs through injections or inhalation.
SUBJECT: RESISTANCE?
FROM: LK
If most of us are type 2 diabetics with insulin resistance, then why are we injecting more insulin into our bodies? Am I missing something? Why am I pumping more insulin into my body if my body will just reject it?
FROM: LN
When your cells are resistant, it’s as if you have added another lock. Your pancreas produces more and more insulin to break through the resistance, resulting in burnout. Now, even though, hopefully, you have reduced the insulin resistance, your pancreas may no longer be able to produce enough insulin to meet even your now normal needs, which is why T2s sometimes need to inject insulin in addition to what the pancreas produces.
FROM: C
Like in a war, the more bullets you shoot at something the better your chance of getting a hit. Your body initially tries to overcome the cell’s resistance by producing more insulin. This works for a while until your pancreas wears out. At that point, you have to take injections just to feed your cells and stay alive.
FROM: SR
WONDERFUL QUESTION!!! I recently started insulin. My old doctor brushed off my request for an explanation. I have an appt with a new doctor. You asked what I was wondering and was afraid to ask!
IS IT TIME?
How will you know that your diabetes has progressed and that your current diabetes plan is not enough? Look to your blood glucose levels. Diabetes management revolves around blood glucose levels because study after study has proven that the closer your blood glucose levels are to the normal (non-diabetic) range, the lower your risk of developing diabetes complications such as kidney disease, eye problems, and nerve damage. Getting your blood glucose levels down often improves triglyceride levels, too.
There are two types of tests that will tell you what your blood glucose levels are.
Home Monitoring
You can check your blood glucose levels yourself with your home monitor. The goals for most adults are
Before meals: 90–130 mg/dl
1–2 hours after the start of a meal: less than 180 mg/dl
Note: Your doctor might set different goals for you.
A1C: An Average
The second way to keep track of your blood glucose levels is with an A1C test. It shows your average blood glucose level over the previous two to three months. It’s like having a hundred glucose checks every day averaged out for you. Here’s how it works.
There’s always some glucose in your blood. The same is true of people who don’t have diabetes. Glucose links up with the hemoglobin in your red blood cells. If you have a lot of glucose in your blood, more of your hemoglobin will have glucose attached to it. Once the glucose is attached, it’s there for the lifespan of that red blood cell, which is 120 days at most.
In a person who doesn’t have diabetes, about 5% of the hemoglobin is glycated (has glucose attached). In people who have diabetes, that percentage is higher. How much higher depends on the person’s average blood glucose levels.
In general, the goal is to have an A1C less than 7%. Your doctor may set a different goal for you.
If you’re a healthy adult, your goal might be less than 6.5%.
If you’re planning to get pregnant, your goal will be to have an A1C close to 6%.
If you’re an older adult with other health problems, you may be advised to keep your blood glucose levels a little higher.
If you’re meeting your blood glucose goals and your control is stable, have an A1C test done every six months. If your treatment plan has changed or you’re not meeting your goals, have an A1C test done every three months. Blood draws for A1C tests are done at a lab or in your doctor’s office. There are home collection kits, too. (For a list of these and other diabetes care products, see the American Diabetes Association’s Resource Guide, published every January in Diabetes Forecast and on www.diabetes.org.)
SUBJECT: A1C
FROM: dd
You