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Type 2 vs. type 1

Discussion in 'Parents of Children with Type 1' started by Jenneve93, Sep 4, 2012.

  1. Jenneve93

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    First of all, I know that they are totally different conditions.

    My son has type 1 diabetes. He was diagnosed almost 7 years ago. He's doing great.

    My dad has type 2 diabetes. He was diagnosed about 20 years ago. He's not doing great. He does take insulin. Things are not good for him right now. He's stuggling with constantly swinging between highs and lows like a yo-yo, seizures, black-outs, etc. My step-mother and I were talking for quite a while last night & I realized how clueless they both are about things like carb counting, treating lows, etc.

    Without getting into too much detail about that (because I know this isn't the type 2 board) I'm just wondering that eventhough they are 2 completely different illnesses, how different is treatment between type 1 and insulin dependent type 2? Anyone know or have any information that might be helpful on this topic?
     
  2. BittysMom

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    My father who has type 2 has been on insulin for years. He has/had little to no knowledge about how it works or how to adjust it. Since my daughter was diagnosed last year I've started teaching him about the action of it etc. He still doesn't carb count. Its crazy. He had been running in the 4-500's and it was me, not his "endocrinologist" who told him to inject in a new spot. Immediately the insulin started doing it's job after years of high numbers. He has terrible Neuropathy and often falls. Now that his insulin actually absorbs, he has to watch for lows and I've gotten him tabs to keep all over the place. It's infuriating. I know very little about type 2 but considering the situation my father was in, I felt I could do little harm. I wish you luck in helping him.
     
  3. nanhsot

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    Well, once they are on insulin, I personally think they should be treated like a T1, but that rarely happens.

    IME most T2s are put on insulin on a sliding scale, so rather than being taught about what's going into their body, they are taught a more reactive way to treat.

    Personally I would start with the book "Think like a pancreas" and then get them a good solid carb counting book, not even necessarily one like the Calorie King (which is heavy in fast foods) but maybe one for those on the Atkins diet (I have one called The Low-Carb Bible which is really easy and includes recipes). You might find out his sliding scale and do some backwards math and find out what is I:C ratio is and help them see how they can do things differently. For example they may have been told to take 2 units for every meal, and to limit meals to 2 exchanges, an exchange in the old style is 15 carbs. So that would be 1:15. Then on his sliding scale it will say if BG is 100 take 2 units (the units for food); BG 150 take 3 unit; BG 200 take 4 units; BG 250 take 5 units, etc. So that means for every 50 over 100 take a unit, that's the correction.

    A sliding scale is just a simpler way of doing a correction and I:C ratio BUT with set food limits which NO ONE FOLLOWS. That's the real key here. On a sliding scale you should stick to a set number of carbs but no one is really taught how to count carbs. One day I sat down with a patient (and I am not an nurse nor a CDE nor a nutritionist!) and had this same chat and they were just soaking up all the information, no one had ever said anything of this kind to them, they had no clue. It was TOTALLY outside my practice scope but how could I not?? ...we were doing therapy at the same time though, so there!!)

    Now, I wouldn't take him OFF his sliding scale, but I would teach them what it means, i.e., you took 2 units but look, you just ate 8 exchanges because you had pinto beans. Getting him to understand the balance between the carbs and the insulin is key. No one teaches most T2s that, or they don't take it seriously, I have no idea.

    Can you tell this is a pet peeve of mine? I come across T2s all the time who simply are not given the tools to deal with their disease and their health is suffering. They are being treated with insulin and are essentially T1 by how their pancreas are working yet they don't know heads nor tails of how insulin works or how carbs affect them. They are told to "avoid sweets" so they buy sugar free cookies. They are told to avoid potatos so they eat more rice. Maddening!

    I'd start with some books, some simple carb counting, see if you can ferret out what their I:C and correction is from the scale, and go from there.

    eta: this all goes to pot if he's on NPH, and clearly the management changes on nph!
     
    Last edited: Sep 4, 2012
  4. Jenneve93

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    Thank you for your responses!

    This is essentially what I was discussing with my step-mother last night. I asked specifically what kind of insulin he was using and when, dosage, etc. He's using Lantus at bedtime and Novolin R at meals. I told her that it sounds like he's on a sliding scale. She had never even heard that term! We talked for a good 2.5 hours last night. I explained carb counting & how insulin and carbs work. I have "Think Like a Pancreas" and was telling her about it. I asked if they would read it if I got them a copy and she said yes, so I'm ordering it for them. You hit the nail on the head about the "avoid sugar" thing. Even if you are eating something "sugar free" that doesn't mean it's carb free. Something else that just infuriates me is that my dad's doctor doesn't tell them anything! Until his last appointment a couple weeks ago, they had never even heard of glucose gel or how to properly use glucagon. Whenever he would pass out or have a seizure, my step-mother and step-brother would just start shoving crackers, coke, and other things down his throat until he came back around. It's a wonder he never choked! Then as a result of all the carbs, he would shoot through the roof later. *sigh* I'm planning to go visit one weekend and take my books and things and just have an educating day. Hopefully we can work through this and get him on the road to being healthier. As it is, his body is so confused and fighting so hard against itself that it's really wearing him down.
     
  5. CAGrandma

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    Wow, Jenn your dad is lucky that you know so much about type 1 and actually have the information that he needs for his type 2. (I'm sure he would be even happier if you didn't have to need that info, if you know what I mean.)

    My grandson is 9, diagnosed at 2. I was diagnosed with type 2 about 7 years earlier. Since he has lived with us (along with his mom, the diabetes expert around here) I've learned a lot about the subject too. For my type 2 I have received NO education or information, but I've been lucky so far. From what I can see, it looks like type 2s on insulin basically are told to chase their blood sugar. Take a BG before a meal, take 1 unit if between 150 and 200, 2 units if between 200 and 250, etc. Don't eat sugar.

    What I don't understand is if our pancreas is still producing insulin, does that make any difference? Could someone whose pancreas is still sort of functioning follow the same procedures as someone with type 1?
     
  6. nanhsot

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    Not really, in Type 2 the body produces insulin but the body can't utilize it properly, it's less an issue of lack of insulin and more of inability to use what they have. The management starts out much differently and T2 really SHOULD avoid sugars/carbs. That's initially anyway.

    Once they are in need of exogenous insulin however, management should more closely follow T1 but rarely does as far as education in carbs and such. To me insulin is such a powerful drug it boggles my mind how easily tossed around it is. I had a nurse ATTACK me once at work once when I told her a T2 patient wanted to prebolus because he went so high the day before when insulin was delivered very late. She harshly told me "it doesn't work that way". Ummm, yeah it does. Education is lacking in lots of ways out there, not just for the patients.

    What I am personally uneducated on is if the uptake of insulin is still impaired when they are at the point of needed injected insulin (i.e. when the pancreas have stopped functioning adequately). I assume they then have a double whammy of not enough pancreatic function AND inadequate ability to utilize it, but I'm honestly not sure how that changes the management. Hopefully someone else does.
     
  7. sisterbeth43

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    I don't know what others do, but since my dd was dx'd as type 1, Ihave treated my type 2 about the same as type 1. I take insulin and metformin (it helps the insulin to work better), count carbs, check my bg at least 5 times a day. I am also trying to lose weight --have lost 40 pounds since I moved to CO almost 3 yrs ago. I agree that those with type 2 on insulin may have better results if they treat it like type 1. Counting carbs and taking insulin accordingly has really worked for me. My A1c is now 5.7--down from the 8 it used to be before I went on insulin.
     
  8. valerie k

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    I took care of my dad, and treated him just like I do matt. I cant believe at what my friends at work who have type 2 get info from thier drs.... its pathetic.
     
  9. Jenneve93

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    As wide-spread as Type 2 is, you would think doctors would be more on top of things. It's rediculous for these patients to be so uneducated in how to take care of themselves!
     
  10. Amy C.

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    The number one thing people with Type 2 diabetes should do is drastically reduce the carbohydrates they eat. Type 2 indicates that the body is challenged in dealing with carbs and consuming fewer or getting nearly all the carbs from vegetables is less stress on the pancreas -- helps with weight loss as well!

    I don't understand why doctors don't advise this.
     
  11. Jenneve93

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    My dad certainly doesn't need to lose weight. His diet is so challenging for him. He has to watch certain things because of diabetes. He has to watch certain things because of his heart (he had valve replacement surgery 20 years ago). He has to avoid certain things (particularly leafy green vegetables) because he's on blood thinners. It's a wonder he ever finds anything he can eat. :( When his blood sugar is high he simply doesn't eat at all because he's afraid of going higher and causing long term damage. He's just so frustrated right now and doesn't know which way to go. He really needs to take a diabetes management class again as well as see a nutritionist.
     
  12. Sarah Maddie's Mom

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    My elderly father is Type 2. He lives alone, doesn't cook much and at 87 isn't willing or even able to learn enough about nutrition to eat a sustaining diet of low carb foods. I personally eat a pretty low carb diet and I know first hand how expensive it is and how mindful I have to be about planning my diet. I think for many type 2s just eating low carb is simply not a viable option.

    To the OP, my Dad recently went off his fast acting and the Dr added back in the normal regimen of Type 2 oral meds ( I'd have to look up Dad's files to get the actual meds) and kept him on a small dose of lantus at night. Since making the change his bgs have been far better and he's no longer having the horrible lows that he had been experiencing for years. You might want to speak to your father's Dr if you see him constantly fighting lows and over correcting and running high.
     
  13. deafmack

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    I wanted to chime in here because while type 1 and type 2 are different the beta cells in type 2 eventually wear out and the person can become insulin dependent. In general people with type 2 get little to no education and that education is grossly inaccurate. You would not believe some of the things my type 2 friends tell me about diabetes. Of course they think those errant facts are correct and nothing I say will change their mind.
    To me carb counting and learning how to use insulin and how it works is essential for all people with diabetes regardless of the type.
    Type 2 can be very frustrating because of the lack of education about diabetes and the fact that it is a progressive condition so the education needs to be ongoing as the person's needs change.
     
  14. Jenneve93

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    ^I really wish there was a "like" button here. I agree 100%!
     
  15. Lynnieg123

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    My mom is also Type 2 and I am often shocked at her lack of diabetes knowledge and how she has put my T1D daughter's well being in danger due to her thinking she can treat them the same. Just this weekend my daughter's BG was 90 and my mother gasped and said she thought that was too low and she should have sugar. I said 90 is pretty normal and my mother said, "oh, no, when I'm at 90 I'm shaky and I need sugar." I wanted to tell her maybe if she wasn't 250+ lbs and eating chips & popcorn all the time that probably wouldn't happen but I bit my tongue. It's infuriating. She also never heard of glucagon and thought chocolate was an effective way to boost her sugar quickly.
     
  16. deafmack

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    You are right about what you say, the reason your mother feels shaky at 90 is because if she is constantly running in the 200's 90 will feel like a low. If she were to come to a type 2 board such as on the American Diabetes Organization or Diabetes Daily or DLife she would learn from those on the forums how to test, and count carbs, etc. They also learn about insulin from those with Type 1. I can't believe some of the things I get from my friends with type 2.
    About the chocolate thing raising blood sugar, well it will raise blood sugar but it will not be the chocolate but the sugar will only the rise will be delayed by the fat content. I remember when I was first diagnosed, there was this girl who would treat every low with Snicker's bar and I don't mean the mini ones, but the full size ones. Then her blood sugars would spike into the 300's and then she would have to give herself insulin to correct the resulting high.
    It was the best lesson to me for treating lows. Of course since I am allergic to corn i carry things that do not have corn in them and you can bet I don't use candy bars.
     

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