One of the most common questions I get asked after people are diagnosed with type 2 diabetes is "Will I progress to type 1 diabetes when I need insulin?".
There's a couple of things to pick on here, but let's start by clearing up the myth that if you have type 2 diabetes, it is a given that you will one day need insulin. Having type 2 diabetes does not guarantee that you will one day need insulin. Many people with type 2 diabetes don't ever need insulin (and some people can actually reverse their diabetes!), so let's take that off the table.
The second thing then, is, if you do end up needing insulin, does that mean you have type 1 diabetes? Or in other words, would your diabetes have progressed from type 2 diabetes to type 1 diabetes?
The answer surprises most of my clients, because, no requiring insulin does not mean you now have type 1 diabetes. To understand why this is, let's quickly recap the difference between type 1 and type 2 diabetes.
In type 1 diabetes, the body attacks the pancreas, killing off the cells that would normally produce insulin. This means that insulin levels quickly go from normal and healthy levels, to suddenly dropping, and eventually no insulin is being produced at all. We can measure this by testing for autoantibodies (signs the body has been attacking itself) and measuring the levels of insulin in the body.
In type 2 diabetes, we are still producing insulin when we are diagnosed, and for years later (at least in most cases, unless someone is diagnosed very late). The reason that blood sugar levels increase is due to insulin resistance, we can think of it that we are still producing insulin, but our body isn't responding to it as well as it should be. Medications that we take for type 2 diabetes often rely on our own insulin production to work, and help our body continue to produce insulin, and to respond properly to the insulin we produce.
Over time, particularly if we are undiagnosed or not getting the right treatment, we actually start to produce more and more insulin, as you can see on the graph to the right, to combat the insulin resistance. This may go on for years, with our insulin output actually increasing and increasing. Our poor pancreas is working over time to help keep our blood sugar levels down!
As when we work ourselves too hard, our pancreas is the same. After working overtime for (in most cases) many years, the pancreas starts to slack of and produce less and less insulin. Again, this decrease may happen over a long time (until type 1, which is comparatively quick). At some point, it may be that your GP suggests you start taking insulin due to this low insulin production.
If you're blood sugar is well managed, this reduces the strain on your pancreas, meaning it's less likely you will end up needing insulin. However, it's important to remember that each individual with type 2 diabetes is unique, so the way one person's diabetes progresses does not mean that will be your diabetes journey.
If you're looking for help managing your blood sugar levels, finding healthy meals and snacks, understanding your condition or any other aspect of diabetes management, get in touch with us today and start getting in control again.