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With over forty years experience with Type I diabetes mellitus, insulin dependent diabetes, I have discussed the implications of this disease with many people. I have found it very interesting that many with overt signs and symptoms of diabetes, deny these signs and symptoms, and when finally diagnosed, fall prey to depression.

Interestingly, upon diagnosis of Type I diabetes, insulin dependent diabetes, once insulin injections begin, denial, if only to others, and not the diabetic himself, is not a great obstacle. Because “diabetes” is generally thought to mean “daily insulin injections”, it is a hard hitting diagnosis for the insulin dependent diabetic.

Many who are diagnosed with Type II diabetes, and do not have to take daily insulin injections, may have denied symptoms for many years, and because this patient does not, at first, require insulin injections, may tend to think that they have “just a little” diabetes. I think this way of thinking is a coping mechanism, and lessens the dreaded fear that all of diabetes may imply to this person.

In today’s world of ever increasing numbers of persons with diabetes, education, counseling and good medical care enable the newly diagnosed Type II diabetic to better understand a future life with diabetes, its progressive nature, complications and alteration of life style.

Among endocrinologists and diabetologists today, it is thought that Type II diabetics, depending on how high their fasting blood sugar and hemoglobin a1c values are, should be placed on daily insulin injections sooner rather than later. Of course, there remains controversy over this thought, mainly due to the fact that some residual pancreatic beta cell function may remain, and there is difficulty managing these types of patients, especially those who are fearful of beginning insulin injection therapy.

Combination therapy utilizing both oral anti-diabetic agents and insulin therapy is a well established therapy that will provide better control of blood sugar and daily management of diabetes. In this methodology, the Type II diabetic is slowly introduced to insulin injections, and with careful blood sugar control, this patient may find that additional energy and vitality, a general overall “I feel better” quality of life is to be achieved. If sufficient blood sugar control is not achieved with sulfanylurea or metphormin type oral agents, then insulin injection therapy will provide better control.

Those Type II diabetics who are obese and used to eating anything they desire and have established a more sedentary life style, seem to have a more difficult time in controlling their diabetes. Understandably, the diagnosis of diabetes, change in eating habits and strict control of medication schedule, diet and exercise, poses a big challenge to anyone’s life style.

Support through education and local support through membership in the American Diabetes Association, will greatly enhance confidence to the life of the newly diagnosed diabetic, whether Type I or Type II. Breaking down the walls of denial and entering into a healthy life change is an important aspect of good management in living with the daily illness of diabetes.

Because the American Diabetes Association and the Centers for Disease Control estimate that Type II diabetes comprises 80% of the diabetic population, future articles in this series will delve further into Type II diabetes, diagnosis, treatment, complications and future therapies.

Blood Glucose Values

70-110 mg/dl - Normal
120-125 mg/dl - Prediabetes
150-200 mg/dl - May be typical values found in Type II diabetes
Less than 70 to over 400 mg/dl – values found in overt Type I insulin dependent diabetes

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