The stories I've heard and the questions people ask during education sessions are the inspiration for my blog posts. I know for sure that I have learned as much or more than I've taught over the years.
This is probably the most asked question I get from a person with diabetes. Or more likely it comes as the statement “I am going to get off these medicines”.
I get it- nobody wants to be reliant on a medicine for the rest of her life. And if there is something that can be done to avoid it, we all want to know what that is.
The trouble is, the answer to that question depends on a lot of things. Of course, diet and exercise are going to play a part, but there are a few other things that are just as (if not more) important predictors of a person’s need for diabetes medicines. Things like
-how much diabetes is in the family,
-how advanced your diabetes was when it was found
-how long you’ve had diabetes.
A family history of diabetes is the first strike against you. You have this strike the minute you’re born and there isn’t a thing you can do to change it- we don’t get to pick our parents! If you’re born into a family with diabetes, chances are you inherited traits that make it difficult for your body to clear sugar from the blood. And if that’s the case you may need medicine to help you do that. You should know though that having a family history of diabetes doesn’t make it certain you will develop it too.
Type 2 Diabetes is a progressive disease. It starts as pre-diabetes where the beta cells that release the insulin needed to keep sugar cleared from the blood are struggling to keep up with the sugar demand. (See pre-diabetes) These beta cells are in trouble and are wearing themselves out trying to keep sugar in the blood at a healthy level. It’s estimated that by the time most people find out they have diabetes they have already lost half of their ability to make insulin- the beta cells have worn themselves half out! But this didn’t happen overnight. Many people are in the pre-diabetes state for as long as 15 years and don’t have a clue. If your diabetes was caught early- in the pre-diabetes state- and you were able to make changes that lightened the load on your beta cells, chances are you can make it a while without the help of medicine. But if your diabetes was not caught in the pre-diabetes state it’s possible that your beta cells have been damaged to the point that you will need help from medicines to make what insulin you are still making work better.
For the same reason, if you’ve had diabetes for several years (especially if it was uncontrolled) it is more likely that your beta cells have fought all they can fight and you’ll require medicine or maybe even insulin if you’ve progressed to the point of not making much.
I often use the phrase “3 strikes and you’re out” to describe the “why” of diabetes. The first strike is a family history. The second strike is being overweight- carrying around extra weight makes it harder for insulin to do its job of clearing sugar and this adds to the load on the beta cells. And the third strike is not being active enough. Regular activity burns the sugar trying to build up in the blood. If you get to a point in your life where you’re not active enough, the beta cells have to take on the load of burning this sugar. If you have a family history, you are overweight and you aren’t active, chances are very good that you will develop diabetes. We can’t choose our parents but we can choose to strive for a healthy weight and to move as much as possible and that could possibly be enough to avoid medications.
Some people have more room for improvement in the area of lifestyle changes than others. For example, a person who drinks sweet drinks throughout the day, eats a good deal of high calorie/low nutrient foods, and has a sedentary lifestyle can make good progress towards blood sugar control with lifestyle changes and might be able to avoid medications. But someone who already watches her diet decently well and tries to stay active may have to take the next step to medication to get control.
We all want the best control on the least amount of medicines. Medicines come with side effects and cost but I invite you to think about their benefits also. Remember those beta cells struggling to make enough insulin to keep sugar cleared from the blood? Some medicines can make your body respond better to your own insulin (improve insulin resistance), and cut down on the extra sugar your body naturally releases- both issues that start in pre-diabetes. These medicines actually lighten the load on those tired and weary cells and could help prolong their lifespan if taken in time. This could be just the thing a person with a family history of diabetes needs to give his beta cells a fighting chance of living out the remainder of his life and avoid having to take insulin from an outside source.
It’s estimated that less than half of prescriptions for diabetes medicines are filled and taken as they were prescribed. This may be why only about a third of people with diabetes are adequately controlled. Every medicine has pros and cons and it’s important to discuss those with your provider and make an informed decision. The pro just may be worth the con!