My new doc:"Type 2 diabetics have hard time gaining weight"

Foamroller

I can't even... everything I've seen, read and watched so far is saying that T2 have a hard time losing extra fat. Are there any examples that he is right ?

To make sure I heard him right, I asked if he was sure he didn't only talk about T1. Nope. He repeated that people with T2 have a hard time gaining weight.

When I told him about my daily fasting window and doing keto/lowcarb, he said: "Be careful not to get orthorexia". Although I can understand general concern, I'm totally flabbergasted and a bit let down. Guess I'm looking for another new GP

Dragonwolf

o.O

Yeah...drop him like a sack of bricks...

The only situation I can see where a T2 Diabetic would have a hard time gaining weight is if they've already destroyed their pancreas to the point that they don't produce any of their own insulin anymore (and thus suffer from the same issue as T1 Diabetics). However, I don't think it's particularly common that a T2 Diabetic would get that far and actually need to gain weight, as to get to that point, the vast majority are already overweight and the act of losing weight typically takes a lot of the strain off of the pancreas and allows it to heal. In my experience, though, other things start failing, too, and weight in general becomes the least of the patient's worries.

And the orthorexia comment? Egads. Not cool. Sadly, responses like that seem to be a knee-jerk thing for a lot of doctors. An orthorexia warning is a first for me (usually it's about how it's unsustainable or will make me keel over with a heart attack), though.

KittensMaster

What utter nonsense

That is the some very strange advice from a Dr.

I had to fire my first internist.

mcpostelle

I don't have much knowledge in T2, but I can agree that doesn't sound right unless your metabolic system is completely screwed. But the orthorexia comment was completely uncalled for. How is meat bad for you? I would see about switching docs too.

GaleHawkins

That would be funny iF on Sat Night Live type show.

People that got to doctors for medical advice are at serious risk of being harmed.

I am down to give me the lab results and I will take it from there. Thanks to living in a state of nutritional ketosis I require NO Rx meds.

wabmester

I like him.

Isn't beta cell dysfunction pretty much the definition of T2D? Why would it be different than T1 in terms of insulin and weight gain?

Sunny_Bunny_

In T2 the pancreas does still produce insulin. Typically it produces even more than normal. With T1, the pancreas is essentially dead. It produces no insulin at all. With new diagnosis there is a "honeymoon period" where you still get some production but you never know how long it will last before all the beta cells have been killed off. My daughter had a very brief 1-2 month honeymoon period.
As far as why it's different with weight gain, T1's that have good enough control that they are able to keep an A1c of 8ish or better will probably not have much trouble with weight loss. The higher the blood sugar, the less insulin they are likely taking and then they are in constant ketosis. Yep, it's ketosis that causes T1's to lose weight.
However, they are also having constant high blood sugars from not taking enough insulin. It's common for adolescent girls to do this on purpose to lose weight. Because if they take insulin properly, they will gain weight just like any other over indulging carb eater out there.
This is how my daughter went from pre T1D weight of 190 lbs to current weight of 112 lbs.

wabmester

I assume the doc just meant that lack of endogenous insulin makes it hard to gain weight.

I guess part of the problem might be with the T2D label -- seems like a pretty arbitrary diagnosis when it's still in the form of reversible insulin resistance rather than beta cell failure. Do they call T2D beta cell failure something else?

Dragonwolf

Sunny_Bunny_ wrote: »

In T2 the pancreas does still produce insulin. Typically it produces even more than normal. With T1, the pancreas is essentially dead. It produces no insulin at all. With new diagnosis there is a "honeymoon period" where you still get some production but you never know how long it will last before all the beta cells have been killed off. My daughter had a very brief 1-2 month honeymoon period.
As far as why it's different with weight gain, T1's that have good enough control that they are able to keep an A1c of 8ish or better will probably not have much trouble with weight loss. The higher the blood sugar, the less insulin they are likely taking and then they are in constant ketosis. Yep, it's ketosis that causes T1's to lose weight.
However, they are also having constant high blood sugars from not taking enough insulin. It's common for adolescent girls to do this on purpose to lose weight. Because if they take insulin properly, they will gain weight just like any other over indulging carb eater out there.
This is how my daughter went from pre T1D weight of 190 lbs to current weight of 112 lbs.

Also, the big/defining difference between T1D and T2D is that T1D is an autoimmune condition. The body has attacked the pancreas and destroyed the beta cells. T2D doesn't have this autoimmune component and the pancreas and beta cells have died due to being overworked and/or "suffocated" from fat build up (not just any fat, but the fat from the same or similar mechanisms that cause NAFLD) or damaged by pancreatitis.

wabmester wrote: »

I assume the doc just meant that lack of endogenous insulin makes it hard to gain weight.

I guess part of the problem might be with the T2D label -- seems like a pretty arbitrary diagnosis when it's still in the form of reversible insulin resistance rather than beta cell failure. Do they call T2D beta cell failure something else?

Advanced T2D, basically. Or insulin-dependent T2D. Also, insulin resistance and T2D aren't technically the same, though they are on the same spectrum. You can have IR without (yet) having T2D. The difference is largely in how able your body still is to control glucose swings.

Difficulty maintaining/gaining weight is only a symptom of T2D after the pancreas has died (as you said, lack of insulin). If you haven't controlled it by then, odds are very good that you're well on your way to other issues, like heart attack, neuropathy, and Alzheimer's. Until that time, a hallmark of T2D is an overproduction of insulin, not underproduction.

Sunny_Bunny_

@Dragonwolf is right on the money there.
I tend to get very long winded so I didn't go into the whole autoimmune explanation but that is really the root of the difference between the 2. One never turns into the other and one is not worse than the other, unless you consider the need for injections worse or the lack of potential reversal... But they both suck!
The way T2D is managed may change in such a way that it more closely resembles T1D at a glance. But the underlying autoimmune condition puts the T1D at risk of other autoimmune diseases.
I thought I'd share my daughters "progress pics". She is constantly praised for her weight loss because people assume it's been done purposely in a healthy way.

Sunny_Bunny_

It's a little hard to see just how much smaller she is, but if you look at that left arm, you can really tell.

KenSmith108

Now if we want to get even more questions going, lets introduce T1 1/2 or Latent autoimmune diabetes of adults (LADA).
From what I understand it's T1 that happens slowly in adults, usually it takes test to confirm it.
Now my pancreas , I'm hoping there is still enough insulin production left after I lose weight that I can get off insulin injections. For now I'm down to 10 units 2x but can't seem to go lower or my bg#s swing to much. I'm reducing my other oral meds slowly.
I'm T2 with a tired pancreas. 32 years of poor control will do that to ya.

Sunny_Bunny_

KenSmith108 wrote: »

Now if we want to get even more questions going, lets introduce T1 1/2 or Latent autoimmune diabetes of adults (LADA).
From what I understand it's T1 that happens slowly in adults, usually it takes test to confirm it.
Now my pancreas , I'm hoping there is still enough insulin production left after I lose weight that I can get off insulin injections. For now I'm down to 10 units 2x but can't seem to go lower or my bg#s swing to much. I'm reducing my other oral meds slowly.
I'm T2 with a tired pancreas. 32 years of poor control will do that to ya.

It's just my opinion but I think the T1 1/2 thing is stupid. People are generally already confused by the differences and how each works. Introducing another definition is just dumb! If it's caused by autoimmune disorder, then it's still T1. Why does it matter if it's not as quickly progressing? If the beta cells are being destroyed because the immune system is attacking them... T1, done! For that reason, they may get a few years of honeymoon period, but it's still the same disease. They just get the benefit of getting a little help from their pancreas for a while.
I had a lady try to argue with me, I wouldn't play cuz there is no point when someone is set on their misinformation, that her husbands T2D wouldn't turn into T1D, but it would eventually turn into T1 1/2... So now some people think this new term was created for insulin dependent T2's.

KnitOrMiss

@Sunny_Bunny_ It totally breaks my heart to see your daughter's weight loss. She was a beautiful form before, could make have done with some toning and such, but now, if I saw her arms like that, it would scare me. I know you've said the same. I hate that society is obsessed with being unhealthfully skinny. I happen to like and enjoy my curves. (sigh/hugs)

Sunny_Bunny_

KnitOrMiss wrote: »

@Sunny_Bunny_ It totally breaks my heart to see your daughter's weight loss. She was a beautiful form before, could make have done with some toning and such, but now, if I saw her arms like that, it would scare me. I know you've said the same. I hate that society is obsessed with being unhealthfully skinny. I happen to like and enjoy my curves. (sigh/hugs)

Thanks. I'm trying to be patient with her. She's had a rough time. I don't even know if she really manipulated it so that she would lose on purpose once she figured out that's what happens or if it's just from poor management due to the stress and challenges of having to do so much. This year has actually been better than last but much more improvement is needed.

Foamroller

Ty for all the input. I learn new stuff every day!

The experience being dissed, made me realize that if it wasn't for the internet and having the opportunity to meet other souls with many of the same problems here and other boards, I woulda felt very alone. I only know one guy who's lowcarber IRL, but he's like semi-pro athlete so he can eat almost anything anyway.

Thx, I feel less alone with my struggles

Sunny_Bunny_ wrote: »

However, they are also having constant high blood sugars from not taking enough insulin. It's common for adolescent girls to do this on purpose to lose weight. Because if they take insulin properly, they will gain weight just like any other over indulging carb eater out there.

But isn't it dangerous to be so high in BG ? Or do they feel when it's borderline ?

KittensMaster

Diabetes is very complex and I'm doing all I can to stay far from it

Sunny_Bunny_

Foamroller wrote: »

Ty for all the input. I learn new stuff every day!

The experience being dissed, made me realize that if it wasn't for the internet and having the opportunity to meet other souls with many of the same problems here and other boards, I woulda felt very alone. I only know one guy who's lowcarber IRL, but he's like semi-pro athlete so he can eat almost anything anyway.

Thx, I feel less alone with my struggles

Sunny_Bunny_ wrote: »

However, they are also having constant high blood sugars from not taking enough insulin. It's common for adolescent girls to do this on purpose to lose weight. Because if they take insulin properly, they will gain weight just like any other over indulging carb eater out there.

But isn't it dangerous to be so high in BG ? Or do they feel when it's borderline ?

My daughter will feel totally normal until BG is around 400. So, if it happens a lot they don't even realize it. Same with lows. If lows happen a lot, the sensitivity to it is lost. My daughter runs so high so often that she feels low as she approaches normal range. Her low feeling can start as high as 150
And yes, it's definitely dangerous. She makes me crazy.

Dragonwolf

Foamroller wrote: »

But isn't it dangerous to be so high in BG ?

Yep, but that's why that kind of insulin manipulation for the purpose of weight loss is considered an eating disorder (has a name and everything -- diabulimia).