2) TYPE 2 DIABETES CONTROL
b, The Range of Severity of Diabetes
Type 2 diabetes is insidious in that most people with moderate type 2 diabetes just aren't "that sick", they don't feel sick. So why worry? But in actuality they are very sick; almost invariably with both type 2 diabetes and heart disease. The two are both present to some degree in almost every person with type 2 diabetes as heart disease and type 2 diabetes have common underlying causes and type 2 diabetes is also a causal agent for heart disease. One reference even went so far as to state that being diagnosed with type 2 diabetes was the life expectancy equivalent of having a major heart attack. So much for the concept that a person with type 2 diabetes not being "that sick".
About 70% to 80% of people with type 2 diabetes die from the heart disease which invariably accompanies the type 2 diabetes (by the term heart disease we are including all the diseases associated with large blood vessel disease: heart attack, heart failure, pulmonary embolism, stroke, peripheral arterial disease, etc.). So, when an individual faced with type 2 diabetes decides on how serious they want to be with their restrictions, it is important for the individual to look at the whole picture. So what is the whole picture? Look at the following point system:
1. diagnosis of diabetes +6
2. diagnosis of heart disease +6
3. diagnosis of PAD (leg pain, foot ulcers, leg clots) +5
4. injecting insulin required +4
5. family history of diabetes +4
6. blood pressure over 160/90 +4
7. more than 20% overweight +3
8. sedentary lifestyle +3
9. HDL cholesterol under 40 +2
10. lots of fat around the waist +2
11. ethnic background of African, Pacific Islander, Hispanic, or American Indian +2
12. triglycerides above 200 +2
13. doctor's prescription for anti-cholesterol drugs +1
14. LDL cholesterol above 150 +1Any individual with type 2 diabetes or "pre-diabetes" can just add up their points. At 5 to 10 total points only minor lifestyle modifications might be necessary. At 10 to 20, more lifestyle changes will be necessary. And at 20 to 25 still more life style changes will be required. Quite simply, anybody with a number above 25 had better make some significant lifestyle changes immediately. Now there is a caveat that all should be aware of; if a person with type 2 diabetes but a low number makes only minor modifications to their life style, the disease may well continue to progress, albeit at a slower pace. This is in line with the rule that the actions recommended to treat type 2 diabetes are identical to the recommendations to prevent it from getting any worse.
A person can be a slightly overweight "pre-diabetic" who only has blood sugar with a maximum of 150 and a good cholesterol profile. Moderate weight loss to "normal" weight, some moderate exercise, and avoidance of sugary drinks might be all that is required for this individual to at least temporarily control the disease. The key here is the blood sugar readings. If the blood sugar of the slightly overweight "pre-diabetic" are consistently below 110 before meals, consistently below 150 one hour after meals and the A1c is less than 5.5, then the disease is probably pretty well under control. It has to be noted that "under control" does not in any way mean the disease will not continue to progress. Dropping to a "low normal" weight, exercising religiously, and adhering to a strict diet give any individual with type 2 diabetes the best chance of reversing the progression of the disease.
The worst category of type 2 diabetes is represented by the obese individual on insulin who can hit 300 on their blood sugar levels and has already had some known heart disease or PAD. This person with severe type 2 diabetes who ignores the rules completely WILL have a low quality of life, WILL have complications and WILL die young. These severely impacted individuals need to take their cholesterol and blood pressure medication (including insulin), drop rapidly to a "low normal" weight, exercise religiously, and adhere to a strict diet in order to have any hope of leading a normal life with a normal life expectancy.
Of course "young" is a relative term. The life expectance of an individual with uncontrolled severe type 2 diabetes is probably about 5 to 10 years, with a lot of variation. So if the disease starts at age 65, then the equation is different than if the disease starts at age 40. At age 65 it might just be someone isn't willing to forgo the pleasures of an overweight sedentary life loaded with carbohydrates (complex food materials such as rice, corn, potatoes, wheat flour etc. which readily break down into simple sugars), sugars and fats. They might decide it just "isn't worth the effort" and just go on as before. That is personal choice we all have to make, just as smoking is a personal choice.
There were two siblings we know of that had late onset type 2 diabetes. One stubbornly refused to do what the physicians told her to do. She continued to smoke, continued to eat sweets, refused to exercise, and actually gained weight. She had both her legs amputated, went blind, had several heart attacks, and finally died a very miserable death at 72 after four months in the hospital and in a hospice. Now you might say that 72 isn't bad, but consider the quality of life that she had for the last 10 years of her life. Her brother also had type 2 diabetes and did most of what the physicians told him to do (he stopped smoking, watched what he ate, exercised in moderation, and kept his weight down). He died with a decent quality of life at the age of 84. It does make a difference.
This chapter: 2) TYPE 2 DIABETES CONTROL
a) Introduction
b) The Range of Severity of Diabetes
c) Current Expectations for a Person with Type 2 Diabetes
d) Summary of How a Person with Severe Type 2 Diabetes can Live Long
e) Specifics of How a Person with Severe Type 2 Diabetes can Live Long
f) A Fatal Error: Relying on Diabetes Medication
g) The Consequences of not Controlling the Disease
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