Talk:Diabetes mellitus type 2

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Contents 1 Type 1/2, what's the big deal? Confusion on the ground 2 history of this refactoring 3 with regret, I told you so 4 Clarification 5 Why was my reference to hydrogenated oils removed? 6 Research link removed 7 Diabetes Type II is curable 8 Cure discussion, part II 9 Cause of improvement in the case of modest weight loss 10 I am looking for the typical presentation of type 2 diabetes. How is it usually diagnosed? What brings the patient to the doctor? 11 What percentage are fat? 12 1/3 of US children remark. 13 Discovery of Genes Conferring Type 2 Risk

[edit] Type 1/2, what's the big deal? Confusion on the ground

What is the 'big' difference between type 1 and 2? i understand most of it is because of the insulin intake but i'm very confused@

In brief: Type I results from an inability to produce insulin. Type II results from an insensitivity of cells to whatever insulin is produced. - Nunh-huh 22:08, 8 Mar 2004 (UTC)

[edit] history of this refactoring

the following are extracted from the diabetes talk page

Sometimes I wonder how the Diabetes pages should be organised. I'm in favour of separate pages for Type I and Type II, because they're hugely different diseases.

• Diabetes (disambiguation)
• Diabetes Mellitus (disambiguation)
• Diabetes Mellitus Type 1
• Diabetes Mellitus Type 2
• Complications of diabetes
  • Diabetic nephropathy
  • Diabetic retinopathy
  • Diabetic neuropathy
  • Atherosclerosis in diabetes
  • Diabetic encephalopathy
• Diabetology and Diabetologist

Any ideas? Jfdwolff 10:35, 9 Mar 2004 (UTC)

I'm still thinking about it, and still looking at what has been done so far. At the moment, all I can be reasonably certain of, is that Types 1 and 2 should be split off in a fashion similar to what has been done with Gestational Diabetes. As such I have already merged that material in the general article into this one. Possibly sometime in July, the middle paragraph of the Type 2 section of the general Diabetes article could be deleted, and a link similar to the one for Gestational_diabetes could be put in. I just want to get the thoughts of others before actually doing anything on it. If it works well enough, I can do the same thing for Type 1 as well.

--Coro 03:01, 25 Jun 2005 (UTC)

[edit] with regret, I told you so

It's an unpleasant thing to point out and I regret doing so, but I feel so strongly about it that I'm willing to be a bit impolite.

The very first comment on this new article's talk page illustrates the point I have made (see diabetes talk page at "whench diabetes" and sporadically earlier). DM is itself a mess, most layfolk are thoroughly confused about it (eg, "it's some kind of sugar problem", ...) and its seriousness (eg, "You mean I could go into a coma and die from this?!!!"), about differences between the two most common types (eg, "Will I have to use needles for insulin? Yuck!"), about complications (eg, "I can really go BLIND??!!"), about the (current) chronic and unremitting quality of living with any variety, ... The breakout of Type 2 from the diabetes article has made worse WP's attempt to address these confusions, and this first comment is an especially apt illustration of the issue. I left an extended comment at diabetes talk (@rerefactoring needed).

This article, as it currently stands, is inadequate and requires major work. The is no coverage of complications, of typical treatment, of the studies which demonstrate that getting as close as possible to normal glucose values is hugely beneficial in reducing complications, etc. Much work is needed. ww 18:03, 14 December 2005 (UTC)

[edit] Clarification

This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years.

Insulin continues to be produced in the later years, right? If so, this sentence, and the sentence on the Diabetes page, should be reworded as such (at the least--it's still not a great sentence): This is a more complex problem than type 1, but since insulin is still produced, it is sometimes easier to treat, especially in the initial years.

In fact, a substantial portion of Type 2s eventually lose (all or nearly all) insulin production and become insulin dependent. They are thus, Type 1+2 or Type 3 or Type 2ID or any of a collection of ad hoc shorthand terms, most of which have little wide use. Poor phrasing, is one of those things about which most anyone can Be Bold! and correct. The technical stuff is a somewhat harder; being bold is good, but getting the facts right is perhaps better. In such cases, perhaps one should Be Bold!, But Accurate? ww 18:07, 21 December 2005 (UTC)

[edit] Why was my reference to hydrogenated oils removed?

My wife removed hydrogenated oils from her diet and went into remission of type II as verified by th Loma Linda VA. I gave research references. What was the perceived problem with my edit? Is it so surprising that a dietary change could reverse an illness? Above posted by User:71.104.11.155 22:00, 12 May 2006

The relationship between diet and type 2 diabetes is not understood to the degree necessary to make statements like that. I recommend that your wife continue her hydrogenated oil free diet while monitoring for a possible relapse with her doctor. I hope it stays in remission. Pasado 07:57, 29 May 2006 (UTC)

[edit] Research link removed

I have removed the following link, as this is speculation that it may develop into a future treatment. There are many promising leads in research for diabetes, not all of which result in changes to existing treatment methods. Wikipedia is not a news service and so should not be reporting on each "latest research". To do so (when not yet developed into a tried and tested treatment) is speculation and so, to me, seems in breach of the Nor Original Research policy (WP:NOR). Of course if the findings are creating widespread comment from other scientists, then it would have notability and deserve inclusion (but one news story on a single research paper does not constitute accepted change in clinical practice)

• Chemical in Gardenia Fruit Raises Hopes for Type 2 Diabetes Treatment

David Ruben ^Talk 12:39, 7 June 2006

Perhaps Wikinews would be a better placement for this link.

—The preceding unsigned comment was added by 71.137.192.41 (talk • contribs). 17:53, 6 July 2006

[edit] Diabetes Type II is curable

The second sentence of the article (as I write this) is misleading. It says Diabetes Type II is not curable. There are different meanings for the word 'curable'. The authors seem to care only about the narrow (typically drug-oriented) meaning in which 'curable' means that people with the disease can take a potion and have the disease go away without attention to lifestyle. The other, more useful meaning for 'curable' is that the disease can be driven into a durable remission by whatever means, including by adhering to a wise lifestyle (mainly diet).

Under the more useful meaning of the word 'cure', Diabetes Type II is definitely curable, by which we mean that the person's blood sugar is always within a healthy range, and there is no insulin resistance. This is achieved by adopting a major, permanent shift in diet, often with the help of some orthomolecular supplementation.

Also, the authors do not mention the theory that the most important mechanism of the disease is the fact that the kidneys, in their attempt to dump excess sugar from the blood, also allow excess elimination of minerals and other micronutrients, and that it is the resulting chronic deficiencies in these micronutrients which cause much of the severe damage from the disease.

For a fascinating and humorous talk on curing Diabetes Type II through diet and supplementaion, in other words, through Orthomolecular Medicine, see this talk video by Julian Whitaker, M.D.

--Dave Yost 20:34, 31 July 2006 (UTC)

Even supposing for one moment that I accepted Orthomolecular Medicine, which I don't, it does not claim to be a perminant cure but an (alternative) method of controlling or managing the condition. Even in those patients with excellent control of their sugar levels (diet, weight loss, medication), there is still an increased risk of macro & micro vascular complications (good control reduces but does not entirely eliminate the risks). So no, conventional view, is that one does not cure either the diabetes or its indirect morbidity/mortality effects, just manage the issues. A successful islet cell transplantation in a type I diabetic might effect a true cure, but that's speclation/development for now.David Ruben ^Talk 01:01, 1 August 2006 (UTC)

Concur with DR on this. Cure implies -- after treatment -- that the condition is gone. Useful or not useful won't apply to actual cures, whatever the mechanism. Not currently possible, though I'm fascinated by Yost's claim that insulin resistance can be normalized. Would love to hear more. ww 03:39, 1 August 2006 (UTC)

I get the impression it's well-established that insulin resistance can be reversed with diet and exercise. Type 2 diabetes is a threshhold by which insulin resistance has become a pressing health concern, as determined by fasting glucose, glucose response, circulating insulin, or whatever other means is used to evaluate the condition. Presumably, wouldn't returning to normal levels of these indicate that the condition has disappeared? Sure, insulin resistance could return, and perhaps some people are more *prone* to insulin resistance than others, and certainly perhaps some permanent damage from the higher circulating glucose may remain. But, if the condition we define as Type 2 diabetes itself is no longer observable, has it not been cured? Frankg 20:58, 16 November 2006 (UTC)

Only if the underlying reasons for the condition have been removed is a cure truly effected. It isn't enough to control the symptoms, as Diet & Exercise does. A true cure would eliminate the need for further control. --Coro 19:51, 19 November 2006 (UTC)

But as far as I know, diet and exercise operate under the same mechanisms in type-2 diabetics as they do in people who have never exhibited impaired glucose control. Virutally everyone will exhibit health problems sooner or later if they don't exercise or attend to their diet appropriately. It seems like under this philosophy, type-2 diabetes will not be "cured" until we find a way to allow everyone to "let themselves go" without detrimental effects. :) Or is there some other factor at play here? Frankg 20:07, 19 November 2006 (UTC)

With non-diabetics there is no insulin resistance to be reversed. That means that non-diabetics are tangibly less vulnerable to loss of eyesight, or the need for amputation, both of which are long-term effects of uncontrolled glucose levels in Type 2 Diabetes. With Type 2, the penalties for having a sub-optimal lifestyle tend to be more severe. --Coro 21:46, 20 November 2006 (UTC)

I was under the impression that insulin resistance had a spectrum of severity, of which every individual has a different magnitude. Once an individual has crossed a given threshhold of insulin resistance, they would be considered a type-2 diabetic. Is there such thing as an individual that is immune to any change in insulin sensitivity? Frankg 17:33, 21 November 2006 (UTC)

Clinically, this is exactly so. Some people are able to conrol their insulin resistance with diet, exercise, and weight loss. That it's controlled does not mean the insulin resistnace has vanished. Letting go of the diet, exercise, weight loss business will cause it to return. Others have more severe cases of insulin resistance and require drugs to get into some kind of control. Still others... But you get the picture. Why this range of clinical behavior is seen is not at all clear. There is observed a strong heretible component to Type 2 which suggests genetics as the underlying cause; this remains obsucre as well. But if genetics (in some combination -- several genes have been found) is the underlying cause, cure would seem to be out of bounds entirely. At least in some sense. When we add in variations is susceptibilty to diabetic complications, the clinical picture is still further confused and still less predictable. Cure is misleading and wrong-footed terminology in the current context. Those who use the term will be thought either 1) lacking understanding or 2) peddling unsupportable promises (regardless of their details) to the desperate and vulnerable. The term should be avoided in favor of control, which better captures the situation. Anyway, in the current context, cure is not appropriate for this article. ww 06:40, 20 March 2007 (UTC)

I'm seeing some article edits pertaining to whether the condition is curable or not; I'm wondering if anyone else wants to chime in. Frankg 04:06, 20 March 2007 (UTC)

See above. And let's have a go at the left margin, eh?

[edit] Cure discussion, part II

Per the margin comment, I'm continuing on here. Regarding insulin resistance, what about individuals whose glycemic control has returned to normal after a period of diet and exercise? Likewise, what about individuals whose diabetic symptoms do not return even after returning to old bad habits? While some diabetics may have genetics to blame, it seems like nobody is immune to the potential for insulin resistance, and, likewise, many are able to correct the situtation. I understand your point about salesmen of false quick-fix cures, but I feel like claiming insulin resistance is entirely uncurable implies that there is no hope for those with this kind of condition. Frankg 10:38, 20 March 2007 (UTC)

The normal condition is that, regardless of diet / exercise / weight, the insulin/glucose system operates so as to keep glucse within rather tight bounds. And in so doing, the many other effects of insulin are also appropriate. Someone who has increased glucose uptake in the relevant cells by exercise, and kept the glucose load down by diet, has made no change in the underlying situation. Cells which were resistant are still resistant, but their environment is being deliberately manipulated so dodge round the problem somewhat. No improvement in other problems such as insuficient response to insluin in its other effects. There is no difference in principle between this and alteration of environment by use of drugs; there is just a more natural alteration of environment than with drugs. But this is a philosophical distinction, not in a sense a real one.

As for your comment about no hope, you are quite wrong. We now know, with great confidence, after many large and extensive studies, that the rate and risk of complications (eg, blindness, kidney failure, infection, amputation, etc) go to normal levels if glucose is kept close to or at normal values. Perhaps this means that glucose toxicity is the key issue, or perhaps not, but which is the case is irrelevant in this instance. Tight control of glucose levels typically requires more and closer attention than many diabetics can manage while coping with the rest of life's issues.

We now have a wide variety of treatments, from drugs to diet and exercise protocols which have considerable efect. None of these is perfect or alwasy effective in every patient, and there is any case very often a progression of severity (or at least response to assorted treatemnts) in Type 2 diabetics, which complicates things quite a bit. Nonetheless, there is considerable hope. More than in many cases of poorly healed broken ankles or dietary issues post gall bladder removal, or cases of persistent infection and reinfection from which some people suffer. ww 14:06, 20 March 2007 (UTC)

"Cells which were resistant are still resistant"...isn't overall sensitivity restored over time, assuming steady control of glucose levels, and absent some kind of genetic disorder? Cellular turnover, etc. Frankg 14:17, 20 March 2007 (UTC)

[edit] Cause of improvement in the case of modest weight loss

The article currently states: Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (5 - 10 lb); this is almost certainly due to currently poorly understood aspects of fat tissue chemical signalling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity.

I am concerned by the "almost certainly due to...": Is there a reference for this? What reason is there to believe that the improvement is not because the increased physical activity and improved diet that typically going along with the weight loss results in reduction of insulin resistance and thus improvement in diabetes symptoms? Chartreuse green 03:08, 16 August 2006 (UTC)

At the moment, there is very littel which is known with certainty about Type 2 and its correct treatment. Patinets vary widely in their response to treatment, there appear to be several sifferent 'strains' of Type 2 in the sense that the clinical course can be (sort of) classified into assorted groups (though this may be another variation of the previouse point about different patient response). And so on.

Weasel word comments like this are about as good as anyone can actually do, though there are many who make much stronger claims for various reasons, ranging from "I've got something to sell" to "I think I understnad this stuff and I'm willing to stride confidently out onto the plank". It's a mess, and caution is learned early by those without an ax to grind. ww 21:33, 18 October 2006 (UTC)

(This has not always worked.)

[edit] I am looking for the typical presentation of type 2 diabetes. How is it usually diagnosed? What brings the patient to the doctor?

   * No early symptoms - many people have Type 2 diabetes without knowing it
   * Early mild symptoms - from moderate blood sugars (which are still dangerous and lead to serious complications):
         o Skin rashes
         o Skin infections
         o Athlete's foot
         o Poor skin healing
         o Urinary tract infections
         o Candida
         o Thrush
         o Dry itchy skin
         o Flaky skin
         o Skin ulcers
         o Peripheral neuropathy
         o Paresthesias
         o Foot tingling
         o Foot numbness
         o Hand tingling
         o Hand numbness
         o Blurred vision
         o Sexual problems
         o Erectile failure
         o Unusual vaginal dryness
         o Premature menopause
         o Absent periods
         o Poor healing - any type of difficulty healing of minor infections, injury or after surgery.
         o Weight loss
         o Weight gain
         o Drowsiness
         o Malaise 
   * Later more extreme symptoms when blood sugars get higher:
         o Excessive thirst
         o Excessive urination
         o Dehydration
         o Bed wetting - in children
         o Excessive hunger
         o Tiredness
         o Weight loss
         o Severe blurred vision
         o Muscle cramps
         o Muscle aches
         o Headaches
         o Irritability
         o Tiredness
         o Fatigue
         o Muscle weakness
         o Acne - often worsens from diabetes and improves once sugars controlled
         o Sexual problems
               + Erectile failure
               + Unusual vaginal dryness 
         o Absent menstrual periods
         o Persistent fungal skin infections
               + Athlete's foot
               + Tinea
               + Thrush (Candida) 
   * Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) - a very severe life-threatening complication of high blood sugars
   * Diabetic Ketoacidosis (DKA) - a very severe life-threatening complication of high blood sugars, requiring emergency treatment, which has very severe symptoms:
         o Nausea
         o Vomiting
         o Sweet-smelling fruity acetone breath
         o Breathing difficulty
         o Rapid Pulse
         o Abdominal pain - usually in children

http://www.wrongdiagnosis.com/d/diab2/symptoms.htm#symptom_list

(this comment left 18 October 2006 by user:74.60.79.208 and moved to the correct position by ww the same day)

[edit] What percentage are fat?

The article says most diagnosed are obese but I couldn't find that in the sources. Half the people I know who have were never fat they are just old. Is there any really facts on who gets it?

Clinical observation for generations indicated so close a connection (if not invariable) with obesity, that a former name for Type 2 was obesity-related diabetes. Another, of course, was adult-onset diabetes. Or non insulin-dependent diabetes. Which pretty much illustrates the confusing picture it presents. The most important issues are probably that heredity matters in Type 2 (very substantially) and that excess weight -- apparently most importantly fat in and around abdominal organs, not merely subcutaneous fat) is hormonally active in a way not previously understood, and that that activity has a close connection (as far as can be told now) with the development of insulin resistance.

There is also a connection with diet, almost certainly, and it's not just getting fat from not eating enough shoots and leaves. Perhaps it's white bread, or too much table sugar, or sugar in foods, or supersized portions as a marketing tool, something, but it may be both diet and a sedentary life, for Type 2 rates in the developed world seem to have begun to shoot up only in the last few decades, and lots of sugar, fat, and white bread was common before that. Or perhaps we are only noticing the statistical hangover of events from decades ago come to clinical attention with a diagnosis. The epidemiological research on such things is very difficult. ww 19:01, 5 March 2007 (UTC)

[edit] 1/3 of US children remark.

At the end of the intro someone very clearly stated "One-third of children in the USA have type 2 diabetes. [1]" I can find no such article on the irish examiner's online archives, and did not really expect to. The statement is absurd. According to the NIH (http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm) in 2005 for all ages there were 20.8 million cases of diabetes. If all of those were children it would still be under 1/3 (assuming a roughly 80 million children in the US). I assume this is simply a misquote of a comment on obesity in America and how 1/3 of children are at risk for type 2 diabetes. As I am new to Wikipedia I am holding off on doing edits until I better understand the community and its guidelines, I'll check back in a few days and delete if necessary. Vytrox 05:48, 5 March 2007 (UTC)

Hadn't noticed that, and I agree with your speculation as to how it came to be. Projections are often misunderstood. As for WP, there is a policy here to be bold. So jump in and correct it. The water's fine, if surprising now and then. Welcome aboard... ww 19:03, 5 March 2007 (UTC)

It is a misquote of the ADA statement that "1 in 3 Americans born in 2000 will develop diabetes in their lifetime if nothing is done to stem the tide". http://www.diabetes.org/I-decide-campaign.jsp Bollar 19:15, 8 March 2007 (UTC)

[edit] Discovery of Genes Conferring Type 2 Risk

The article currently states that Type 2 Diabetes is of unknown etiology. A recent Nature paper, authored by Dr. Rob Sladek of Mc Gill University) has identified four genes which explain a substantial portion of the disease risk (approx. 70%)

This wiki article should probably be updated to reference this information: The abstract for the Nature article is here: http://www.nature.com/nature/journal/v445/n7130/abs/nature05616.html

A press release from Genome Quebec is here: http://www.genomequebec.com/GQmedia/communiques/natureFev2007.asp?l=e&

A new study led by researchers at the McGill University Health Centre (MUHC) has identified four genes that increase the risk of developing type 2 diabetes

“Of the four genes we have identified, two are involved in the development or function of insulin-secreting cells and one plays a role in the transport of zinc, an important mineral required for the production of insulin,” says Sladek.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070212/diabetes_genes_070212?s_name=&no_ads=

Sladek said the findings will help identify people who risk developing Type 2 diabetes, since the gene variations might account for 70 per cent of the genetic risk associated with the disease.

—The preceding unsigned comment was added by 74.12.88.196 (talk) 22:32, 22 March 2007 (UTC).