{"id":52636,"date":"2020-09-08T09:04:25","date_gmt":"2020-09-08T13:04:25","guid":{"rendered":"https:\/\/asweetlife.org\/?p=52636"},"modified":"2020-09-08T11:49:11","modified_gmt":"2020-09-08T15:49:11","slug":"why-type-2-diabetes-gets-worse","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=52636","title":{"rendered":"Why Type 2 Diabetes Gets Worse"},"content":{"rendered":"

Type 2 diabetes is generally defined as a progressive<\/em> disease, that is, a disease that reliably gets worse over time. And in the majority of patients, that\u2019s exactly how it happens.<\/p>\n

The reason for this seemingly unavoidable decline is well-understood. The progression of Type 2 diabetes is defined by two related but distinct metabolic problems, each of which is both caused by and causes high glucose levels. The first is insulin resistance, which describes the body\u2019s own tendency to resist the hormone insulin. The second is the gradual loss of beta cell function, which reduces the amount of insulin that the body produces in the first place. The combination of these two declines leaves a patient less able to use insulin and less able to produce it, a vicious cycle if there ever was one.<\/p>\n

These declines result in a pattern that should be unfortunately familiar to longtime diabetes patients. Worsening fasting glucose levels and hemoglobin A1c prompt a doctor to prescribe a new medication\u2014maybe metformin or sulfonylurea\u2014which results in immediate improvement. But the improvement is usually short-lived. Over a period of months or years, glucose levels again begin to rise, and the doctor needs to increase the dosage. Eventually, the doctor prescribes a second medication, and perhaps a third, and, finally, the patient will begin to take most powerful glucose-lowering medication we have, insulin. At that point, the long-term complications of diabetes\u2014vision problems, neuropathy, kidney disease, and so on\u2014may seem inevitable.<\/p>\n

The progression of Type 2 diabetes is not, however, inevitable. There is compelling evidence that Type 2 diabetes can be halted and even \u201creversed.\u201d Our contributor Dr. Mariela Glandt is one of the pioneering doctors that have devised ways to stop the disease and dispel its symptoms<\/a>, chiefly by prescribing a very low carbohydrate (or ketogenic) diet. More extreme measures\u2014such as bariatric surgery and near-starvation diets\u2014have also been shown to reverse the progression of diabetes.<\/p>\n

If you\u2019re not ready for major lifestyle change, it\u2019s still worth knowing what factors lead to the worsening of Type 2 diabetes<\/a>. Type 2 diabetes progression isn\u2019t inevitable, and it also isn\u2019t random. We can benefit from the work of researchers who have studied which factors are most likely to lead to a worsening illness:<\/p>\n

 <\/p>\n

Age<\/h3>\n

Every study that we are aware of has isolated age as a significant factor in the rate at which diabetes patients experience declining glycemic control and health.<\/p>\n

To put it simply: the younger a patient is when he or she is diagnosed, the more quickly his or her diabetes is likely to become more severe.<\/p>\n

A 2008 Massachusetts study<\/a> found that the odds of significant disease progression \u201cdecreased by 40% with every decade of age.\u201d A recently published Chinese study<\/a> that followed over 7,000 patients for an average of 8.8 years found that study participants that whose condition had worsened were both significantly younger and had been diagnosed at a younger age. Those that had been diagnosed under the age of 40 were nearly twice as likely to worsen during the examination period as those that had been diagnosed later in life.<\/p>\n

Other studies have found that young age at diagnosis predicts risk of mortality and cardiovascular disease<\/a>. The bottom line: if you have Type 2 diabetes, the younger you are, the more serious your condition is likely to become.<\/p>\n

 <\/p>\n

Weight Gain<\/h3>\n

It may be unsurprising that weight gained after<\/em> diagnosis with Type 2 diabetes makes the disease more likely to progress quickly. The Massachusetts study followed about 700 patients that initially had not required medication to keep their A1c below 7.0%. A year later, about 200 of the patients had been put on their first diabetes drugs, and an analysis showed that weight gain was one of the most reliable predictors of which patients were among those 200. The researchers found that \u201ceach 1-lb increase in weight was associated with a 2% increased odds of progression.\u201d<\/p>\n

 <\/p>\n

Glycemic Control<\/h3>\n

The higher a patient\u2019s blood sugar, the faster the progression of Type 2 diabetes. This is an unavoidable fact, given that the doctors use measures of glycemic control as way of determining when to intensify pharmacological treatment\u2014and therefore of defining the meaning of diabetes progression.<\/p>\n

High blood sugars today beget high blood sugars tomorrow due to the vicious cycle of insulin resistance and Beta cell loss. High blood sugars prompt the pancreatic beta cells to release more and more insulin, which both results in increasing insulin resistance (as the body becomes desensitized to large amounts of insulin) and in beta cell function loss, as the cells themselves seem to get \u201cburned out\u201d from the extra effort.<\/p>\n

Nevertheless, because patients do have some control over their blood sugar, it means that they also have some control over the progression of their condition. Healthy diet and lifestyle decisions can naturally lower blood sugar<\/a>, oftentimes even more effectively than medicines can.<\/p>\n

 <\/p>\n

Cholesterol<\/h3>\n

We all know that cholesterol can impact the risk factors for negative outcomes such as heart disease, outcomes that people with diabetes suffer an unacceptably high rate of. However, the interaction between cholesterol and the eventual loss of glycemic control in diabetes is not fully understood.<\/p>\n

Nevertheless, we do have some data speaking to the question. The Chinese study mentioned above found that high LDL (\u201cbad cholesterol\u201d), low HDL (\u201cgood cholesterol\u201d), and high triglycerides were all correlated with diabetes progression. A follow-up of the \u201cnon-progressors\u201d in the initial study found that HDL and triglycerides remained significant, but not LDL. The Massachusetts study likewise found that \u201cprogressors\u201d had lower HDL and higher triglycerides.<\/p>\n

We don\u2019t know whether these suboptimal cholesterol numbers are actually driving the progression of diabetes, or if they are a mere side effect of the other lifestyle choices or health factors that themselves tend to worsen the condition. Either way, patients with diabetes can be confident in the wisdom of following the typical advice for lowering triglycerides<\/a> and increasing HDL<\/a> naturally: avoid sugars and simple starches, exercise more, and eat more healthy fats, such as those found in nuts, avocado, and oily fish.<\/p>\n

 <\/p>\n

Smoking<\/h3>\n

As the CDC reports<\/a>, \u201cpeople with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease \u2026\u00a0 smoking makes your diabetes harder to control.\u201d Anyone with diabetes that takes his or health seriously should stop smoking immediately.<\/p>\n

 <\/p>\n

Genetics<\/h3>\n

Probably the most powerful factor is an almost complete unknown: genetics. Doctors don\u2019t know why, given the same diet and lifestyle, two outwardly similar patients may exhibit such starkly different rates of insulin sensitivity and beta cell function. Each of us has our own unknowable genetic propensity towards diabetes progression. It\u2019s the luck of the draw.<\/p>\n

Genetic factors can be guessed at if you know your family\u2019s health history. Diabetes runs in families\u2014for example, people with two diabetic parents have a lifetime risk of nearly 70%<\/a> of developing the disease, compared to a mere 10% of the regular population\u2014and every relative with diabetes makes it more likely that you are especially susceptible. Genetic factors also predict<\/a> \u201crapid glycemic progression.\u201d<\/p>\n

Additionally, it is possible that non-white patients are more likely to experience rapid diabetes progression. Most American studies have found that non-white patients are likely to experience more negative outcomes and complications from Type 2 diabetes, but some analysis has suggested that those differences disappear<\/a> \u201cafter adjusting for socio-demographic and other variables.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

…<\/p>\n","protected":false},"author":437,"featured_media":52643,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"image","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1587],"tags":[],"yoast_head":"\nWhy Type 2 Diabetes Gets Worse<\/title>\n<meta name=\"description\" content=\"Type 2 diabetes progression isn\u2019t inevitable, and it also isn\u2019t random. We can benefit from the work of researchers who have studied which factors are most likely to lead to a worsening illness.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/asweetlife.org\/?p=52636\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Ross Wollen\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/asweetlife.org\/?p=52636\",\"url\":\"https:\/\/asweetlife.org\/?p=52636\",\"name\":\"Why Type 2 Diabetes Gets Worse\",\"isPartOf\":{\"@id\":\"https:\/\/asweetlife.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/asweetlife.org\/?p=52636#primaryimage\"},\"image\":{\"@id\":\"https:\/\/asweetlife.org\/?p=52636#primaryimage\"},\"thumbnailUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg\",\"datePublished\":\"2020-09-08T13:04:25+00:00\",\"dateModified\":\"2020-09-08T15:49:11+00:00\",\"author\":{\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/dad5417f3e14b1fd142730c7fa616283\"},\"description\":\"Type 2 diabetes progression isn\u2019t inevitable, and it also isn\u2019t random. We can benefit from the work of researchers who have studied which factors are most likely to lead to a worsening illness.\",\"breadcrumb\":{\"@id\":\"https:\/\/asweetlife.org\/?p=52636#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/asweetlife.org\/?p=52636\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/?p=52636#primaryimage\",\"url\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg\",\"contentUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg\",\"width\":2560,\"height\":1948,\"caption\":\"Why Type 2 Diabetes Gets Worse\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/asweetlife.org\/?p=52636#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/asweetlife.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Why Type 2 Diabetes Gets Worse\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/asweetlife.org\/#website\",\"url\":\"https:\/\/asweetlife.org\/\",\"name\":\"ASweetLife\",\"description\":\"The Diabetes Magazine\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/asweetlife.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/dad5417f3e14b1fd142730c7fa616283\",\"name\":\"Ross Wollen\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/3baf28ef14013e66fec763fe108e4bff?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/3baf28ef14013e66fec763fe108e4bff?s=96&d=mm&r=g\",\"caption\":\"Ross Wollen\"},\"description\":\"Ross Wollen is a chef and writer based in Maine's Midcoast region. Before moving East, Ross was a veteran of the Bay Area restaurant and artisanal food scenes; he has also worked as a food safety consultant. As executive chef of Belcampo Meat Co., Ross helped launch the bone broth craze. Since his diagnosis with Type 1 diabetes in 2017, he has focused on exploring the potential of naturally low-carb cooking. Follow Ross on Twitter: @RossWollen\",\"sameAs\":[\"https:\/\/x.com\/https:\/\/twitter.com\/RossWollen\"],\"url\":\"https:\/\/asweetlife.org\/?author=437\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Why Type 2 Diabetes Gets Worse","description":"Type 2 diabetes progression isn\u2019t inevitable, and it also isn\u2019t random. We can benefit from the work of researchers who have studied which factors are most likely to lead to a worsening illness.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/asweetlife.org\/?p=52636","twitter_misc":{"Written by":"Ross Wollen","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/asweetlife.org\/?p=52636","url":"https:\/\/asweetlife.org\/?p=52636","name":"Why Type 2 Diabetes Gets Worse","isPartOf":{"@id":"https:\/\/asweetlife.org\/#website"},"primaryImageOfPage":{"@id":"https:\/\/asweetlife.org\/?p=52636#primaryimage"},"image":{"@id":"https:\/\/asweetlife.org\/?p=52636#primaryimage"},"thumbnailUrl":"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg","datePublished":"2020-09-08T13:04:25+00:00","dateModified":"2020-09-08T15:49:11+00:00","author":{"@id":"https:\/\/asweetlife.org\/#\/schema\/person\/dad5417f3e14b1fd142730c7fa616283"},"description":"Type 2 diabetes progression isn\u2019t inevitable, and it also isn\u2019t random. We can benefit from the work of researchers who have studied which factors are most likely to lead to a worsening illness.","breadcrumb":{"@id":"https:\/\/asweetlife.org\/?p=52636#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/asweetlife.org\/?p=52636"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/asweetlife.org\/?p=52636#primaryimage","url":"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg","contentUrl":"https:\/\/asweetlife.org\/wp-content\/uploads\/2020\/09\/iStock_DiabetesMeds-scaled.jpg","width":2560,"height":1948,"caption":"Why Type 2 Diabetes Gets Worse"},{"@type":"BreadcrumbList","@id":"https:\/\/asweetlife.org\/?p=52636#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/asweetlife.org\/"},{"@type":"ListItem","position":2,"name":"Why Type 2 Diabetes Gets Worse"}]},{"@type":"WebSite","@id":"https:\/\/asweetlife.org\/#website","url":"https:\/\/asweetlife.org\/","name":"ASweetLife","description":"The Diabetes Magazine","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/asweetlife.org\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/asweetlife.org\/#\/schema\/person\/dad5417f3e14b1fd142730c7fa616283","name":"Ross Wollen","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/asweetlife.org\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/3baf28ef14013e66fec763fe108e4bff?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/3baf28ef14013e66fec763fe108e4bff?s=96&d=mm&r=g","caption":"Ross Wollen"},"description":"Ross Wollen is a chef and writer based in Maine's Midcoast region. Before moving East, Ross was a veteran of the Bay Area restaurant and artisanal food scenes; he has also worked as a food safety consultant. As executive chef of Belcampo Meat Co., Ross helped launch the bone broth craze. Since his diagnosis with Type 1 diabetes in 2017, he has focused on exploring the potential of naturally low-carb cooking. Follow Ross on Twitter: @RossWollen","sameAs":["https:\/\/x.com\/https:\/\/twitter.com\/RossWollen"],"url":"https:\/\/asweetlife.org\/?author=437"}]}},"_links":{"self":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts\/52636"}],"collection":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/users\/437"}],"replies":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=52636"}],"version-history":[{"count":6,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts\/52636\/revisions"}],"predecessor-version":[{"id":52644,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts\/52636\/revisions\/52644"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/media\/52643"}],"wp:attachment":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=52636"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=52636"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=52636"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}