It’s been another week full of questions and thank you all for engaging and wanting to learn more about diabetes. This week I’ve been asked by a few people why their type 2 diabetes is getting worse?
The story is actually quite similar amongst all of them. They have type 2 diabetes and are taking multiple diabetes therapies usually including insulin. They don’t know what to do to improve their glucose control and so reached out to find answers.
In order to answer this question, we need to understand how they got to this point in the first place.
Why your Type 2 diabetes is getting worse
Unless action is taken from a lifestyle perspective, for most people, your diabetes will get worse over time. You can add in extra medications to lower your glucose levels but each additional medication added to your treatment plan is a sign your diabetes is progressing.
In the video that accompanies this blog above you’ll see a graph plotting the progression of your diabetes. Usually the first major event is being diagnosed. Most of the time people just tip over the diagnostic criteria which is a HbA1c of 48mmol/mol. If you’re not familiar with HbA1c I’ve written a blog about it here.
The higher your HbA1c, the worse your diabetes control is. Sometimes people will be diagnosed with a very high HbA1c. However, more commonly, people will just tip over 48mmol/mol and receive their diagnosis. Your medical team may offer you one diabetes medication to help or you may remain diet controlled.
Keep in mind type 2 diabetes for 90% of people is linked to lifestyle. If you do not change your lifestyle after a type 2 diabetes diagnosis, you can only expect the disease to get worse.
So you have your diagnosis but change nothing with you lifestyle. Over the course of the next few months and years you’ll notice your blood glucose levels start to increase.
Your GP or medical team will then offer you additional medications to bring down your blood glucose levels. Each medication will bring down your blood glucose levels initially. Your GP or practice nurse may even say your glucose levels look good. However, we have not changed the underlying reason why your glucose levels were high in the first place. So over time your glucose levels will begin to creep up again. You then become locked into a cycle where only more medication will help control your glucose levels.
Some people will have good diabetes control with medication but it hasn’t changed the fact they need medication to achieve normal or near normal blood glucose levels. Take the medications away and suddenly the glucose will increase.
However, we are talking about those individuals who have seen their glucose levels increase over the years despite medication. This represents a problem because the body isn’t coping despite medical intervention. The time for change is now.
I want to use an analogy about this. Think of your diabetes control like a ship sailing through the ocean. You’re cruising along nicely when suddenly you feel the ship shake and hear a loud bang. You have struck ice and are taking on water. This is the metaphorical equivalent of being diagnosed with diabetes.
We now have 2 options. Option one is to try to throw the water out of the ship quicker than it comes on board. At first you start with a spoon. It works at first but unfortunately the hole in the ship worsens so you need a bucket now. The hole continues to grow and therefore you need more buckets. Then the buckets are no longer enough and so you use the ships pumps. Hopefully you have realised these water moving mechanisms are representing your diabetes medications. If the hole doesn’t get worse you may stabilise the amount of water coming in and continue your journey. However, you’re always taking on water and so it’s probably not the healthiest existence for this ship. In other words you need these devices to stop the ship sinking. If you stop throwing water overboard, the ship will go down eventually.
However, there is a second option. Fix the hole in the first place. The longer you leave it the bigger the hole becomes and the harder it will be to fix. It will reach a point where fixing it is no longer an option because it’s too big but you could still reduce its size to limit the amount of water coming on board.
However, if you had patched up the hole when you were first diagnosed, when you first struck ice, it would have been a much easier job.
Now the obvious difference with this analogy is once the hole is fixed on the ship the job is complete. With lifestyle change it is an ongoing process and will remain for the rest of your life.
Trust me though, the effort of doing that is easier than if you develop major diabetes complications long term. Not everyone will but for those that do, it is not pleasant and can really affect your quality of life.
If you don’t mind trying to control your blood glucose levels with medications and your glucose levels are ok, then this post isn’t for you. However, if your glucose levels are still high despite medical intervention it demonstrates a big problem. Your body cannot control its blood glucose levels despite multiple diabetes therapies. This is a big sign you need to take action.
Rarely do people just take diabetes medications. With type 2 diabetes comes many other complications including cardiovascular and renal problems. Therefore, your medication burden is likely to grow over time. I’ve seen patients taking 20 or 30 medications each day. Many of which are directly linked to their diabetes and high glucose levels. Had they acted before it was too late most of this could have been avoided.
Therefore, to answer your questions about what can you do to lower your glucose levels I’ll say this. First, speak to your medical team. They may be able to help. However, take a good look inside of you. In your heart of hearts are you doing enough? When was the last time you properly increased your heart rate? What is your fitness levels like? Are you overweight? How is your diet?
If you can hand on heart say you’ve done everything you can from a lifestyle perspective then ok. However, most patients I meet in a similar position know they aren’t doing as much as they could. It’s not easy! I know that. However, the alternative can sometimes be much harder.
I’m not saying lifestyle change will fix all your problems. However, there’s only so much medication can do for you. If you are taking high doses of insulin there isn’t many other options from there. At this point, it is likely down to you.