Question: I just started taking Lantus insulin from a pen. Before I was only taking diabetes pills. I am so confused because I thought I was a Type 2 diabetic, but now that I am taking shots and my pills, does that mean I am an insulin dependent diabetic? Carla
You ask a good question here that sometimes causes confusion amongst diabetes sisters. Am I a type 1 or a type 2? Type 1 and type 2 diabetes are similar in many ways in that they both affect blood glucose metabolism, but in actuality they are very different disease processes.
First of all, let me state that WE ARE ALL INSULIN-DEPENDENT WHETHER WE HAVE DIABETES OR NOT. To not produce sufficient insulin or if insulin isn’t getting into the cells, the muscles and metabolic processes in the body cannot function. Not having enough insulin is incompatible with life. Everyone needs insulin to live, thrive, and be healthy. With diabetes a person may be insulin deficient, (type1) or insulin resistant (type 2), or a combination of both. In either case therapeutic interventions are needed to replace and manage insulin production levels when a person is diagnosed with diabetes.
Type 1 diabetes could also be described as insulin-deficient diabetes. The beta cells in the pancreas cease to function to produce insulin and other regulatory hormones that are necessary for the physiological body process known as carbohydrate metabolism and glucose uptake into the cells of the body to use as energy. Food intake, physical activity, emotional stress, inflammation from illness or infection, menses, pregnancy, and menopause all have an affect on blood sugar and other hormone levels in a woman’s body. Research has led to the belief that type 1 diabetes is most likely caused by a genetic predisposition to a defect in the autoimmune system, where the beta cells of the pancreas are attacked and destroyed by a virus, similar to a mumps virus. At around 24 months after exposure to such a virus in susceptible people, the beta cells die out because they cease to reproduce themselves. Hence, type 1 diabetes is present for the rest of the individual’s life. Hormone replacement therapy, in the form of injected insulin, whether by bottle and syringe method or insulin pump, must replace the deficient insulin production no longer supplied by the pancreas. Type 1 used to be called juvenile diabetes, but can occur in people of all ages, not just children. Type 1 diabetes diagnosed in adults is also known as Latent Autoimmune Diabetes of Adults (LADA).
Type 2 diabetes causes insulin resistance, where the pancreas may very well be making more than enough insulin, but it is not getting into the cells. Type 2 diabetes is actually a much more complicated disease process than type 1 diabetes because it involves so many different metabolic functions. It is triggered by several metabolic factors that affect the liver, heart, muscles, digestive tract, as well as the pancreas. Type 2 diabetes often causes overproduction of insulin to combat the effects of obesity caused by heredity, poor diet, insufficient physical activity, cardiovascular disease and other risk factors. This overproduction of insulin exhausts the beta cells in the pancreas and stresses the body beyond a point of healthy recovery. Eventually the pancreas is no longer able to make enough endogenous (internal) insulin on its own, so exogenous (external) insulin must be introduced in the form of injected insulin in addition to taking some of the oral medications.
When you have type 2 diabetes, oral diabetes agents are recommended when diet, exercise, and weight loss alone are no longer working to control your blood glucose levels. They are not a substitute for a healthy balanced diet and exercise, but they do provide an added boost to help your body utilize the insulin it needs to get your BG levels in control. Some oral agents used to treat type 2 diabetes are designed to target insulin resistance and unlock the cells to receive insulin, others are used to stimulate sufficient insulin release from the pancreas, and others are used to target carbohydrate breakdown in the gut. All of them are intended as therapeutic interventions to control elevated BG levels and to elicit metabolic control. It is important to understand that some oral diabetes medications are used to help squeeze insulin out of the pancreas, or to help carry insulin into the cells where it is needed and are useful only as long as they are able to get the job done. Eventually, other oral agents or injections may be introduced to the therapeutic regimen. It is not uncommon for a woman with type 2 diabetes to be on one or more oral agents, plus insulin, and a gut hormone injection such as Byetta or Victoza.
Some sisters can control or prevent milder forms of type 2 diabetes (often referred to as pre-diabetes) without medications by maintaining a healthy weight, eating a proper diet, and engaging in regular physical activity and exercise.Generally, a person with type 1 diabetes will not require oral medications to control their blood sugars. In extremely rare cases, a type 1 sister with advanced duration diabetes might be placed on Metformin if her body is stressed and her doctor determines that she is exhibiting insulin resistance.
It seems to me that you still have type 2 diabetes. However, it is always a good idea to ask your doctor to clarify and discuss all diabetes and health related advice and information she/he gives you. Ask your doctor to refer you to a certified diabetes educator (CDE) in your community to help you learn and understand about your diabetes. She/he can become a valuable partner in your self-care journey. In the meantime, refer to reliable diabetes information websites, such as the resource links listed on the Diabetes Sisters website. Attend a Diabetes Sisters PODS Meet-up if you have one in your area. If not, you may wish to inquire about starting one where you live. It is very healing and empowering to meet with other women who share similar challenges and concerns about their health and wellbeing.
Thank you for asking your question and good health to you!