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I haven't written much in here lately, but I did want to try to add my way of thinking of it to see if it helps some understand better what is going on...

Just wanted to add a little bit to what Ruth said, and explain another way of looking at it. Type 2 is a disease partly of genetics, and quite often of (sedentary lifestyle) and overweight/obesity. Think of the development of type 2 as a fault in your body's (liver, pancreas, etc.) ability to balance out the level of glucose in your bloodstream. From here I am going to try to describe some info out of a physician continuing education credit course from a few years ago and see if this helps to understand both the glucose tolerance test results and what happens as an individual develops type 2. I don't want to dive too deep into the vicious cycles by which the liver keeps dumping glucose into your bloodstream as a result of all this...but I do want to try to explain a little bit about the development and the tolerance test.

If you look at a plot of the development history of type 2, there are major problems taking place. Normally, the first will be a decrease in insulin sensitivity. The second, which follows, is an inability for pancreatic beta cells to not only provide the level of insulin needed to force the glucose from the bloodstream into the muscles for clearance, but eventually, those very cells wear out faster than people with normal response. That is the genetic problem that I am, and many others like me, are trying to stave off, slow down, prevent, etc.

OK, back to the history....this question gets asked over and over in here. If you look at a normal person, or say a person that will develop type 2 later on in life, years before any indication, you will see that the plasma glucose levels are maintained in an extremely tight range. Their fasting glucose is extremely consistent, their (pancreatic insulin) response after ingesting food is extremely r**** (synonym=quick) and a huge "spike" goes into the bloodstream. If you think better in numbers, lets say that fasting might be 85 mg/dL glucose, and within 30 min of ingestion a spike of insulin is released to counteract a rising glucose such that level never exceeds 115 mg/dL. As I said, the normal range of response is a very tight range.

Now, lets fast forward this. The first problem that will result in type 2 (typically) is that the insulin resistance increases, whether by weight gain, or inactive lifestyle, etc. This means that your muscle cells are not taking that glucose out of the blood as efficiently (think of them as having lost their "training" to do so). So, your body responds to this in two ways. The first, which has not been mentioned in here yet, is that that post-prandial "spike" vanishes, starting with only slightly elevated fasting glucose levels. (As a side note, the response to arginine and other amino acids still persists which is why some of the oral treatments are based on these strucutures--I am going off track, oops). Back to the vanishing spike, the reason that it vanishes is speculative, but presumably that is because your pancreatic cells are already performing at a higher level to (over)produce insulin to clear out that excess glucose. This way, your body's feedback mechanism still registers that the glucose is in the right range, meanwhile your pancreas is churning out insulin to compensate. The net effect is that in this state, one is hyperinsulemic, with normal glucose values and only slightly impaired adjustments.

If you follow the curves of post-prandial glucose readings and fasting readings as someone develops impaired glucose tolerance, the difference between those two levels increases (gap widens) and they start to "creep up" closer to 120 mg/dL, and finally when the fasting level exceeds 120 mg/dL, we assign that as type 2 diabetes. The problem is that this problem has been developing for (on average) 3-8 years prior to that. The big push now is for intervention prior to the diagnosis of type 2.

Let's go back to the issue of hypoglycemic reactions. Those are not the cause of diabetes. In this case, those are the result of the imbalance resulting in your body because of the factors that result in impaired glucose tolerance and type 2 diabetes. Its less common to have them when not on an oral medication (or insulin), but can happen. Typically, this is a result of the body's slower response to the glucose load and ability to adjust the levels by releasing a much larger than normal insulin response. During the progression of the development of type 2, when your fasting glucose and other responses may seem normal most of the time, there might be times when the pancreas has released a large amount of insulin to combat that huge glucose load, and then, afterwards, too much insulin is still left, and not enough glucagon has been released (or the response is delayed) such that now, your glucose levels are driven way down.

When an oral glucose tolerance test is administered, what is being examined is the insulin resistance. By gauging both the levels (mg/dL) at a specific time based on the glucose load (usually 75g or 100g), and the shape of the response curve (when the peak glucose level occurs) during the 30-60-90-120, etc. min (or 1-2-3-4 hr) measurement interval, it gives a "general" picture, based on probability, of how you are responding.

I agree with Mark on the first test concerning mikeb. If I were the recipient of a test that looked like that, I would make an appt. with an endocrinologist to work on addressing the issue. At no time should a 75g glucose load produce a 214 mg/dL plasma glucose level, if you have normal response. It's not my place to make a diagnosis here, but whether it's type 2 or impaired glucose tolerance is irrelevant to the issue that it should be treated aggressively.

As Ruth mentioned, you can have insulin resistance in thin people, and if not mistaken from what I remember of her postings over the years, Ruth is at a normal weight, exercises and type 2? I am sure she can tell you, as other diabetics can, just how important exercise is to trying to increase insulin sensitivity, and this applies regardless of whether your require exogenous insulin, or rely on oral meds coupled with your own endogenous insulin production.

DebbyLor--if I were you, I would be thankful that my physician is on top of this. I am not sure what your lifestyle and exercise is right now, but if you can improve it, the chances are that it will help that impaired glucose tolerance.

Just to give you my own perspective, I have fought the same battle as many of you--I was just much less wise once. I thought I could play the game with oral meds and manage my type 2 without exercise. I lost and paid the price with the development of heart disease leading to a heart attack at age 35. That was 3 years ago. I have lost 70 lbs to maintain a normal weight, and exercise every single day, running 3 miles or more. What this change in life has earned me is no more meds for hypertension, no more meds hypertriglyceridaemia, and no more meds for diabetes--but most of all, happiness. My post-prandial glucose never exceeds 125 mg/dL, my fasting is 85-88 mg/dL consistently. You would think I was normal, but I assure you that I am every bit as abnormal (as possible) :) Let's leave it at that, for your own interpretation. :D

As for diet or exercise, which is more important? This is dependent on the person, and type of dyslipidemia each of us have (there are different types), and the stage you are at in the progression of type 2. There is no clear cut answer for everyone, but in my case, it is exercise. I can go up in weight by 15 lbs, and as long as I exercise every day, my fasting glucose and post-prandial response is great. This is classic for those of us with metabolic syndrome where triglycerides will run rampant without exercise. If I gain just 5 lbs and drop my exercise down to every other day, and 1/2 the time spent for each session, then my impaired glucose tolerance returns (returned). That experiment was educational for me--it was conducted around Thanksgiving 2003.

Finally, am I cured? No :) There is no cure at the present time, I am genetically predisposed to become type II if I don't do what is necessary for a healthy lifestyle. If I discontinue what I do, as I mentioned above, the dysfunction will return in as short as a week. Had I taken action sooner, rather than waited until my fasting was 348 mg/dL for the diagnosis, I might have had a chance. The only event that made me fix my lackadaisical approach to diabetes was the heart attack. Having said that, I wouldn't trade those experiences and where I am at now away for anything.

Good Luck mike, Debby, (the posters who devote much time to answer: Ruth, Mark) and the rest of you in here concerned and doing the right thing to prevent later complications. Time for me to go to work ;)

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