Talk:Type 2 diabetes/Archive 2

There is something I don't understand.

Why would insulin be used to treat diabetes type 2 when that disease is characterized by insulin resistance? Wouldn't that make things worse (because insulin-resistant cells do not respond properly to insulin and therefore putting more insulin into the blood of an insulin-resistant person might actually make things worse)? ScamsAreHorrible172 (talk) 07:52, 3 September 2017 (UTC)

See "and relative lack of insulin.[6]" There is also a lack of insulin. Insulin resistance cells do not respond normally to insulin but I would assume not all cells are completely insulin resistance. QuackGuru (talk) 15:08, 3 September 2017 (UTC)

Coming in late, but: in type 2 diabetes, insensitivity to insulin means that more insulin is produced by the pancreas, because blood sugar levels run high (which stimulates insulin production). Eventually, this results in the beta cells dying off, meaning the body can't make enough insulin to manage blood sugar, requiring injected insulin to compensate. IAmNitpicking (talk) 14:29, 29 June 2021 (UTC)

Numerous factual errors in this article

1. Obesity does not **cause** diabetes neither does a lack of exercise. This is just the usual ignorant slander. Obesity and a lack of energy to perform physical activity are both symptoms of high insulin levels, which is associated with insulin resistance. Type 2 diabetes is even more strongly determined than type 1 but I bet the type 1 article doesn't claim type 1 is caused by being underweight and over-active.

Interestingly the wikipedia article on hyperinsulinemia actually gets the facts about type 2 right! https://en.wikipedia.org/wiki/Hyperinsulinemia

2. Not all type 2 diabetics are insulin resistant. A minority are insulin sensitive. Type 2 is characterised by a genetic fragility of the person's pancreatic beta cells. (The genes and associated causes are variable both within racial groups and across them so yes it's that vague: diabetes describes the symptom not the cause).

An example source: http://diabetes.diabetesjournals.org/content/52/1/102.short

3. Insulin resistance does not necessarily lead to diabetes. This only occurs if the person has a genetic flaw that means they cannot produce the extra insulin required. Mayo clinic autopsies of obese non-diabetic cadavers showed they had 50% more beta cell mass than normal (i.e. they were capable of increasing their insulin production).

An example source: http://care.diabetesjournals.org/content/29/3/717.short

4a. Exercise is not always effective but it's certainly worth trying.

An example source: http://care.diabetesjournals.org/content/29/6/1433.long

4. There is no insulin resistance. This theory was devised in 1932 before home glucose meters. Human insulin is maintained in a homeostatic range of 70 mg% to 140 mg% by the central nervous system (hypothalamus). Within this range blood sugar may change as frequently as every 60 seconds. The Dexcom continuous glucose meter, though very helpful, average five one-minute readings and displays a single reading. Therefore, it misses a substantial number of rapid oscillations. There is no model in biology in which sensitivity to a hormone changes after birth. There are abnormal insulins (congenital) but the infants do not survive. This is logical as insulin is required for the entry of glucose into all cells, except neurons, which absorb glucose directly. The majority of patients thought to have Type 2 diabetes do not. Doctors have been taught not to investigate the cause of the blood sugar disorder beyond doing a HgbA1c test of a simple glucose tolerance test. These are entirely worthless. The basic testing required: C-Peptide (fair accuracy), Dexcom CGM, modified GTT with insulin, gluocose and glucagon levels. When this is done most "Type 2 patients" turn out to have either Nesidioblastosis or Hypothalamic (Spontaneous) Hypoglycemia. See my textbook: "Disorders of Blood Sugar" (most online booksellers)or view my YouTube presentations (www.chicodiabetes.com). See Puglianiello and Cianfarani, 2006, Review of Diabetic Studies. Central Control of Blood Glucose. Roberto Victor Illa, M.D. — Preceding unsigned comment added by 98.244.61.51 (talk) 04:49, 9 October 2015 (UTC)

The downsides to exercise are: an obese person is too heavy for their joints and ligaments so exercise before losing weight can cause damage (and pain)! And in the short term the effect of exercise is unpredictable: it can raise or lower blood glucose levels!

4b. Diet, specifically a carbohydrate controlled (i.e. low or very low) is the primary treatment.

5. There is no need to reduce saturated fat intake in order to manage diabetes. This is the standard Ancel Keys religion and has been so discredited that even the ADA is finally taking notice.

6. The UKPDS ia a *terrible* study to cite. The study was flawed and the conclusions drawn from it even more so. In summary:

- It attempted to lower blood glucose levels using drugs alone. The side-effects of those drugs more than cancelled out the benefit.

- The targets were in any case still well above levels at which diabetes would be diagnosed.

- Most patients in the study failed to meet even those lax targets.

- No attempt was made to control blood glucose levels using diet (no doubt because this wouldn't have allowed the sponsoring companies to sell more drugs) and neither was any attempt made to achieve normal blood glucose levels (HbA1c ~5%).

- The entirely unsupported conclusion drawn was that lowering blood glucose levels had no positive benefit: a conclusion that absolutely cannot be drawn from this flawed study.

It's laughable that the UKPDS too the stance that "mortality itself was not considered a relevant outcome" and deliberately ignored any possible harm!

Example source: http://www.diapedia.org/introduction/the-university-group-diabetes-program

You need a new medical 'expert' for this page if this is the 'quality' of material he produces. — Preceding unsigned comment added by Countbrass (talk • contribs) 08:16, 28 December 2013 (UTC)

May be try bringing this to the attention of the World Health Organization.[1] When they change their position we will follow suit. Doc James (talk · contribs · email) 12:59, 5 September 2016 (UTC)

The Who does not say that type 2 diabetes is caused by eating too much. Did you actually read the "source" for the false information? http://www.who.int/mediacentre/factsheets/fs312/en/ it says that life style changes help with blood sugar control, aka strict diet and exercise is the **treatment** of diabets NOT the cause. The original poster is correct, this article has false and misleading information and lists sources that do not corroborate what is stated in the article. Meskarune (talk) 19:06, 25 November 2016 (UTC)

It says "is largely the result of excess body weight and physical inactivity."[http://www.who.int/mediacentre/factsheets/fs312/en/

We say "Type 2 diabetes primarily occurs as a result of obesity and not enough exercise."

Not sure what the issue is? We by the way are required to paraphrase by law so we cannot say the exact same as WHO. Doc James (talk · contribs · email) 23:42, 25 November 2016 (UTC)

Moved here until refs found

Lifestyle

• very limited sleep or no sleep at all has been shown to increase insulin resistance and insulin deficiency in the blood. —Preceding unsigned comment added by 69.225.80.86 (talk) 05:38, 17 January 2011 (UTC)

Coffee consumption appears to lower the risks for Diabetes Mellitus type 2. --AdeleRako (talk) 17:19, 25 April 2014 (UTC)

===Medications===

Some drugs, used for any of several conditions, can interfere with the insulin regulation system, possibly producing drug induced hyperglycemia. Some examples follow, giving the biochemical mechanism in each case:

• Atypical Antipsychotics - Alter receptor binding characteristics, leading to increased insulin resistance.
• Beta-blockers - Inhibit insulin secretion.
• Calcium Channel Blockers - Inhibits secretion of insulin by interfering with cytosolic calcium release.
• Corticosteroids - Cause peripheral insulin resistance and gluconeogenesis.
• Fluoroquinolones - Inhibits insulin secretion by blocking ATP sensitive potassium channels.
• Niacin - causes increased insulin resistance due to increased free fatty acid mobilization.
• Phenothiazines - Inhibit insulin secretion.
• Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
• Somatropin - May decrease sensitivity to insulin, especially in those susceptible.
• Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia. They also cause increased insulin resistance due to increased free fatty acid mobilization.

Doc James (talk · contribs · email) 04:40, 10 January 2011 (UTC)

the reference for this is, it includes some other drugs as well. Adh (talk) 00:15, 7 February 2012 (UTC)

References

Add a "Research" section?

Shouldn't there be a section about research into the condition? Such as for documenting that such as [2] doi:10.1038/nature13540 -- 65.94.171.126 (talk) 10:09, 18 July 2014 (UTC)

Broad international perspective

I recommend the following book for a broad international perspective useful for this article:

• Jared Diamond, The World until Yesterday: What Can We Learn from Traditional Societies? (especially the eleventh chapter: "Salt, sugar, fat and sloth"), Penguin Books, 2012 (ISBN 978-0-141-02448-6).

Sher man 3312 (talk) 13:52, 23 August 2014 (UTC).

Portal bar

I recommend the following portal bar to be added below the navigation templates: {{Portal bar|Biology|Medicine|Health}}.

Sher man 3312 (talk) 13:52, 23 August 2014 (UTC).

Semi-protected edit request on 16 October 2014

Insulin was actually discovered in 1916, by Nicolae Paulescu, 5 years before the two Canadians started their research. http://en.wikipedia.org/wiki/Insulin 139.149.1.232 (talk) 12:56, 16 October 2014 (UTC)

Not done: he didn't isolate it. Read the whole article Cannolis (talk) 13:04, 16 October 2014 (UTC)

Lancet

doi:10.1016/S0140-6736(14)61335-0. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Sounds suitable for inclusion. JFW | T@lk 20:11, 20 December 2014 (UTC)

JAMA

Blood pressure lowering in DM - systematic review and meta-analysis: doi:10.1001/jama.2014.18574 JFW | T@lk 22:33, 10 February 2015 (UTC)

"high waist-hip ratio"

In Cause -> Lifestyle, the first paragraph is:

A number of lifestyle factors are known to be important to the development of type 2 diabetes, including obesity and overweight (defined by a body mass index of greater than 25), lack of physical activity, poor diet, stress, and urbanization.[4][13] Excess body fat is associated with 30% of cases in those of Chinese and Japanese descent, 60-80% of cases in those of European and African descent, and 100% of cases in Pima Indians and Pacific Islanders.[3] Those who are not obese often have a high waist–hip ratio.[3]

My focus being on the very last sentence of that paragraph. It seems a bit out of place; on first reading it I was confused and thought that there was some kind of connection between waist-hip ratio and diabetes. Which naturally, there is, given that it's an indicator of obesity, but it seems a bit out of the blue. I think it should be removed, or at least moved elsewhere. — Fuebar ^{[talk | cont]} 17:43, 13 March 2015 (UTC)

Obesity is usually defined by BMI however hip waist ratio is another measure thus I do not see concerns with this. Doc James (talk · contribs · email) 23:19, 13 March 2015 (UTC)

I'm not referring to the presence of such a statement, but rather its location in the article. It doesn't seem to be related to the sentence before it and caused confusion for me upon my first read. It might serve the article better if removed or placed elsewhere. — Fuebar ^{[talk | cont]} 18:55, 15 March 2015 (UTC)

It is related to obesity and BMI so unclear? Doc James (talk · contribs · email) 19:49, 15 March 2015 (UTC)

Low carb diet as diabetes therapy

Not a single word about low carb diets as diabetes treatment in the article.

Here you can see a different opinion:

Study: Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base

URL: http://www.nutritionjrnl.com/article/S0899-9007%2814%2900332-3/fulltext

Abstract:

"The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed."

People has the right to know. It is not a fringe theory, but a full fledged tratment for diabetes. Posibly it has it's downsides, but medication also do. For example, look at this:

http://blog.drbrownstein.com/metformin-and-diabetic-drugs-increase-mortality/

"A recent article titled, “14-Year Risk of All-Cause Mortality According to Hypoglycemic Drug Exposure in a General Population” assessed the safety data of diabetic drugs over a 14-year time period. The authors studied 3336 participants and 248 deaths over a 14-year time period.

The scientists compared the all-cause mortality risk in non-diabetic versus diabetic subjects. The found that untreated diabetics had a 222% increase risk of all-cause mortality. Diabetics treated with Metformin had 128% increase risk of death. Diabetics treated with sulfonylureas (e.g., Glyburide, Amaryl, Glucotrol, Glynase, DiaBeta) had a 70% increase in all-cause mortality. Diabetics treated with insulin had 329% increase in all-cause mortality."

We shall have the right to know and the right to choose.

Sincerely,

some fat dude. --189.213.114.161 (talk) 05:19, 14 June 2015 (UTC)

We state " A diabetic diet that promotes weight loss is important.[59] While the best diet type to achieve this is controversial,[59] a low glycemic index diet has been found to improve blood sugar control.[60]" A low glycemic index diet is a type of low card diet. Doc James (talk · contribs · email) 07:56, 14 June 2015 (UTC)

Added specifically low carb diet supported by this review. Thanks Doc James (talk · contribs · email) 07:59, 14 June 2015 (UTC)

Behaviour programmes

doi:10.7326/M15-1400 Mostly benefit those with previous poor glycaemic control, and need to be >10h. JFW | T@lk 21:31, 7 October 2015 (UTC)

Gut microbiome

doi:10.1210/jc.2015-4251 JFW | T@lk 14:59, 7 March 2016 (UTC)

Moved

This "although diabetes is a more heterogeneous condition than was thought formerly."

To here [3]

Adjusted the words to simplify. Not about type 2 DM specifically but about DM generally. Doc James (talk · contribs · email) 23:29, 17 July 2016 (UTC)

Hi, thanks. That's fine. However, I suggest re-instating something along the lines of 'Obesity and overweight, combined with not enough exercise are key risk factors, although genetic predisposition also plays an important role. rather than 'Type 2 diabetes is primarily due to obesity and not enough exercise in people who are genetically predisposed' which, to me, implies that these factors only act if you are genetically predisposed. As I understand it that isn't correct - your genetic background can maybe double the impact of adverse risk factors but genotyping only adds modestly to risk prediction. I'd be happy with any wording that conveys that lifestyle and genes mutually interact with both playing significant roles. Adh (talk) 19:19, 18 July 2016 (UTC)

The WHO ref says "is largely the result of excess body weight and physical inactivity." NIH says "Type 2 diabetes develops most often in middle-aged and older people who are also overweight or obese... Scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes."

How about "Type 2 diabetes primarily occurs as a result of obesity and not enough exercise. Some people are more genetically at risk than others." Doc James (talk · contribs · email) 19:41, 18 July 2016 (UTC)

yes that sounds fine. Thanks Adh (talk) 20:31, 18 July 2016 (UTC)

References

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App template

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Been in place a fair bit of time. Also it does show on mobile. User needs consensus for its removal. Doc James (talk · contribs · email) 18:11, 31 December 2016 (UTC)

At the least, it conflicts with policy regarding external links, see my edit summary. — Godsy ^(TALK_CONT) 16:23, 1 January 2017 (UTC)

It does not conflict with the co-founder's IAR policy. QuackGuru (talk) 16:40, 1 January 2017 (UTC)

I disagree and do not see a single one of those as applying. Doc James (talk · contribs · email) 13:36, 3 January 2017 (UTC)

There seems to be no policy reason to disallow it, and the app is proving very useful. As a small scale test of the banner, this use seems ideal. Carl Fredrik 💌 📧 12:28, 4 January 2017 (UTC)

Appears we have consensus to keep it on this page. Doc James (talk · contribs · email) 17:24, 12 January 2017 (UTC)

I just saw this conversation. I also agree to keep it. Best regards. --BallenaBlanca (Talk) 17:28, 12 January 2017 (UTC)

Discussion has also moved here Doc James (talk · contribs · email) 17:10, 13 January 2017 (UTC)

ACP guideline

doi:10.7326/M16-1860 JFW | T@lk 11:19, 3 January 2017 (UTC)

Semi-protected edit request on 3 January 2017

References

Armintarrah (talk) 18:22, 3 January 2017 (UTC)

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. Sir Joseph ^(talk) 18:24, 3 January 2017 (UTC)

Overtreatment

Review in Circulation - discusses overtreatment doi:10.1161/CIRCULATIONAHA.116.022622 JFW | T@lk 10:23, 10 January 2017 (UTC)

QG added the following today

A large number of people are being treated intensively even though the possible risks of medicine surpass possible benefits.

References

This is hot off the presses and not pubmed-indexed yet. My library doesn't have access to it. So I apologize but I am commenting but have not read this ref yet. Questions - is this a MEDRS source or is it an opinion? It is important to keep sugar levels down, chronically -- this is something doctors struggle with, with their patients, as patients cannot see the damage being done by poor sugar management but chronic mismanagement ends up causing the terrible complications we all know about (retinopathy, nephropathy, circulation problems that lead to loss of limbs, etc) Jytdog (talk) 23:27, 10 January 2017 (UTC)

See "This review article will outline an EBM framework to guide clinical decision making to enable individualized medical treatment decisions concordant with the aims of patient-centered and personalized health care, increasing areas of national priority.15,16"[4] It is a review. If you have any specific questions about the text you can eventually get a copy of the PDF file. QuackGuru (talk) 00:17, 11 January 2017 (UTC)

Can you please provide some more meaningful content? Per RELTIME is this a very recent thing, a growing trend since X date etc? is there a reason why people are being overtreated? do we have documented harms? You can do better than the snippet above! Jytdog (talk) 00:24, 11 January 2017 (UTC)

See "Although risks are unique to each therapy, the most common side effects of intensive glycemic control reported in clinical trials were severe hypoglycemia and weight gain, both attributable to higher rates of insulin use among these patients.31,33"[5]

See "However, achieving tight glycemic control is not an end in and of itself, and may represent overtreatment if the patients who have achieved HbA1c levels <7% have minimal potential for benefit, are exposed to greater risk of harm, or have life expectancies shorter than the time horizon to benefit. A closer examination of the data indeed shows that many of these individuals who have achieved tight glycemic control are likely being overtreated; those with the most potential for harm and the least potential to benefit are being treated too intensively."[6]

Later it says "This implies that many of these multimorbid and frail older adults are unlikely to experience the potential benefits of intensive glycemic control, but nonetheless are exposed to the potential harms of therapy, including hypoglycemia and decreased quality of life attributable to the treatment burden itself."[7] QuackGuru (talk) 00:40, 11 January 2017 (UTC)

oh!, so is this a problem mostly in older people? that would be a very useful thing to say and makes sense. Jytdog (talk) 00:44, 11 January 2017 (UTC)

I cannot find where the source says it is mostly a problem in older people. QuackGuru (talk) 00:46, 11 January 2017 (UTC)

Hm! I don't want to keep bothering you. Great that you have access to this. Please go ahead and restore - whatever you can do to add context would be great. i'll work on it too when i can get the ref. thx for talking. Jytdog (talk) 00:47, 11 January 2017 (UTC)

If you are going to get a copy soon then you can restore it and add more context. QuackGuru (talk) 00:50, 11 January 2017 (UTC)

I just dug harder at my library and got to it. will work on that tomorrow. Jytdog (talk) 01:04, 11 January 2017 (UTC)

Yes many people get overtreatment in some countries well most are undertreated in others. Maybe better on the subpage.Doc James (talk · contribs · email) 10:32, 11 January 2017 (UTC)

added it here - basically says too many people ignore the guidelines that say base glycemic control on life expetancy and other factors - takes at least 9 years to see benefit at minimum and probably longer. Jytdog (talk) 02:13, 12 January 2017 (UTC)

The same content can also be added to the "Diabetes management" page. QuackGuru (talk) 02:49, 12 January 2017 (UTC)

 Done Jytdog (talk) 05:27, 12 January 2017 (UTC)

Lancet seminar

doi:10.1016/S0140-6736(17)30058-2 JFW | T@lk 14:01, 2 June 2017 (UTC)

And a parallel article on DM2 in children and adolescents doi:10.1016/S0140-6736(17)31371-5 JFW | T@lk 14:01, 2 June 2017 (UTC)

Note on vegetarian diets

The article currently states "Vegetarian diets in general have been related to lower diabetes risk, but do not offer advantages compared with diets which allow moderate amounts of animal products."

I think this misrepresents the referenced article. That article mentions several advantages of vegan diets, for example: "Vegan diets have gained acceptance as a dietary strategy for maintaining good health and managing disease conditions ranging from cardiovascular disease to cancer [1]. Vegan diets may prove useful as medical nutrition therapy in treating the conditions of metabolic syndrome, including obesity, diabetes and cardiovascular risk [3,4,5], and may confer protection against inflammatory conditions such as rheumatoid arthritis (RA) [6,7]."

Nowhere does the referenced article suggest that other diets also have these advantages, except as pertaining to diabetes.

Further, the phrasing of our article may mislead the reader into thinking that any moderate-meat diet is an effective way to manage diabetes. In fact, the article states that similar [improvements in metabolic conditions in type 2 diabetes patients] to vegan diets "have been achieved with other diets including the Mediterranean diet, a low-carbohydrate/high-protein diet, and a vegetarian diet." In other words, these are specific diets. — Preceding unsigned comment added by 2001:4B98:DC0:43:216:3EFF:FE79:1171 (talk) 15:35, 6 June 2017 (UTC)

Absolute lack of insulin in Type 1

Is in contrast to the relative lack in type 2 (in type 2 insulin levels may be high with high BS, problem is more initially resistance to insulin). In type 1 the problem is absolute decreases in insulin below baseline (not a relative lack). Dozens of sources support this such as[8]. Absolute lack of insulin DOES NOT mean no insulin. Doc James (talk · contribs · email) 22:50, 25 June 2017 (UTC)

• A 2011 textbook[9]
• Another 2011 textbook[10]
• Another 2011 textbook[11]
• 2014 textbook[12]

Doc James (talk · contribs · email) 03:45, 26 June 2017 (UTC)

Semi-protected edit request on 29 June 2017

Please consider changing "Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or A1C.[3]" to " "Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or Glycated Hemoglobin A1C.[3]" 198.153.148.7 (talk) 06:02, 29 June 2017 (UTC)

Done. Doc James (talk · contribs · email) 16:22, 29 June 2017 (UTC)

Benefit of prevention is limited

doi:10.1001/jamainternmed.2017.6040 JFW | T@lk 22:02, 6 November 2017 (UTC)