Those with type 2 diabetes might feel OK today. In fact, many people with this progressive disease don’t even know they have it.
“ ‘I feel fine right now’ — that’s what people tell themselves,” said Dr. Mark Kirkham, a Tanner Clinic family doctor with extensive experience in diabetes management.
For these in-denial folks, it will be a decade or two before the disease catches up with them, he said.
By controlling your type 2 diabetes while you still feel healthy, he said, “you’re making your life better down the road 15 years.”
It’s an effort that Dr. Kirkham acknowledges can be onerous and seem fruitless “because you don’t see any immediate benefits.”
Dr. Kirkham knows well the complexities of treating diabetes because he treats himself. He’s what you might call a type 1.5 — he was in his late 30s before he was diagnosed with type 1 diabetes.
So he understands that the three most effective treatments for diabetes — a change in diet, exercise and weight loss — can seem impossible to accomplish.
“Most type 2 diabetics are in their 40s or older,” he said, “and after 40 years of habits, it’s hard to change them. And society isn’t set up to change them.”
He adds, “It’s easy to say you need to do these things. It’s a whole different story to do them.”
How type 2 differs from type 1
The results of type 1 and type 2 diabetes are pretty much the same — the glucose (sugar) produced from the food we eat is unable to be absorbed into the cells of our bodies.
However, the mechanisms differ, said Dr. Kirkham. In type 1, the body simply does not produce insulin, a hormone that allows the body to absorb the glucose and turn it into energy.
Type 2 diabetics are producing plenty of insulin — it’s just not working. Dr. Kirkham describes this as “insulin resistance,” adding that it takes more and more insulin to do the same job. If the glucose can’t get into your cells it builds up in your bloodstream, resulting in high blood sugars, he adds.
Type 2 diabetes is an incurable disease — and thus a life-long struggle. While it can be controlled in many cases with exercise, weight loss and a change in diet, medication may be necessary, said Dr. Kirkham. And because it’s a progressive disease, insulin injections eventually may be needed to overcome the resistance.
Danger down the road
The high blood sugar of type 2 diabetes becomes dangerous about 10 or 15 years down the road, said Dr. Kirkham. The disease slowly destroys the smallest of our blood veins, which affects “anywhere tiny blood vessels are important — the retina in your eye, your kidneys, the nerve endings,” he said.
“It takes about 10 years or so of poorly controlled diabetes before you start to get the neuropathy (numbness) in your hands and feet, kidney disease and vision loss and blindness,” he adds.
Diabetes, he says, follow two destructive paths: One that causes circulation problems, which usually takes years to develop into something such as neuropathy; and the second is weakening of the immune system, which makes a diabetic prone to infections, such as infected foot wounds or sores in areas affected by neuropathy.
Any efforts at control do help
Dr. Kirkham explains that some patients, if they’ve had the disease long enough and despite how well they manage it, are likely to have some complications. “There is a direct relationship,” he says, “between how well diabetes is controlled, how long you’ve had it and how many complications you get.”
That’s why he encourages his patients to do what they can, understanding that every bit helps. “The longer you control it, the longer you can put off any of those complications,” he said.