There isn’t one. Plain and simple. New or old, latest or long established. Anyone who tells you differently is either not very informed, or more likely is trying to sell you something or recruit you to some ideology or other. Beware any such person; including medical folk who have been known to be pushing nonsense on those they talk to.
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background
Type 2 is a problem, with lots of cells in the body (about 2/3 of them) deciding to no longer listen to the body signals (mostly insulin) which tell them to absorb glucose (also called ‘grape sugar’ and the chemical from which all starch (eg, rice, grains, potato and tubers generally, …) is made) from the blood. Which leaves more glucose in the blood than should be there. That causes damage of various kinds in the long run if it’s chronically high (long term complications), and in the short run if it’s very high (even to the point of passing out).
But it’s difficult to speak of, unlike Type 1 diabetes which is simpler, because there are many degrees of Type 2. Some people’s body cells are only a little deaf to insulin, others more so, and many people progress in their deafness. So there are lots of sub-varieties of Type 2s…
After centuries of research, with most of the progress coming in the last 100 years, we have gotten to the point of understanding (most of) how the insulin signal is handled inside cells. It’s a complex chain of steps. And we understand how insulin is made, and at least some of the triggers that control its release into the blood. Another complex chain of steps. And we think we understand at least one of the ways this signalling business gets broken. We even have some drugs which make the broken signal chain work somewhat better (there are currently two) to increase the effectiveness of insulin in cells which have gotten, more or less, deaf to insulin.
Other than that, there is nothing known — by anyone, anywhere — which can fix the underlying breakdown in signalling which is the core of Type 2.
Because there are partially effective treatments, and because Type 2 varies as much as it does, there is confusion about it. And it will iikely continue until a fundamental breakthrough — maybe even a cure — is found.
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partially effective treatments
More insulin can force a partially deaf cell to, in effect, listen better. So any drug which evokes more insulin can help somewhat with getting blood glucose levels down. There’s a large group of them called ‘sulfonylureas’ which do just this (the first was found in the early 1940s).. And there’s even a new class or two of this sort of drug in the last few years (one even found in Gila Monster spit!!). And, because the liver puts stored glucose into the blood at the wrong times glucose level, a way to convince the liver not to do this would be useful as well. We have a couple of those drugs too (eg, metformin) which more or less work. But all of this assumes that the insulin producting cells are still working, and in some Type 2s they have stopped.
Another way to help with the glucose control problem (found in all starches, but not in all carbohydrates) is to reduce the amount of glucose (ie, carbohydrate) which must be controlled. So don’t eat lots and lots of carbohydrates, counting on your body to handle it all reasonably without any attention from you. Diabetics can’t do that anymore; they have to pay attention.
And, recent research suggests that one of the causes (maybe) for body cells becoming deaf is fat tissue, especially in and around the abdominal organs. Fat just under the skin and in thighs and such isn’t as much an issue. Anyway, that abdominal fat is, to most everyone’s surprise when it was discovered just recently, quite active. It produces several signalling chemicals, one of which tells cells to not listen as well to insulin. Why this should be, and whether there’s anything else going on, is still unclear. But it is clinically clear in real patients, that losing weight helps, especially in mild cases of Type 2. Most especially, apparently, when some of that abdominal fat is lost. And not much loss is required; even a few pounds or kilograms will generally do. There’s some kind of trigger effect operating here, but just what is not known.
So, these are the reasons for dietary changes in the recommendations for diabetics. it’s not that ‘sugar’ is poisonous to diabetics, it’s not; nor is it that no diabetic can eat normally ever again, tha’s not so either. But, instead of letting automatic body control systems manage it all, diabetics have to do it themselves. And they can’t get away with eating foolishly, the way they used to, sort of. That means changes in eating styles which are often hard.
The exercise thing is different. Muscle cells are one of the cell types which go deaf(ish) to the insulin signal. But, they have another ‘take glucose in from the blood’ signal, and that’s exercise. The effect is pretty clear and it lasts for several hours after the exercise too. So if you just ate 1/2 kilogram of some kind of starch (rice, grain, whatever), it will start appearing in your blood within 30 minutes or so, and will finally stop showing up when the starch is fully digested (about 2 hours or so). How to get all that starch into cells is a problem for diabetics, and exercise is way to do so. And not so much exercise either. Maybe a brisk 30 minute walk or the equivalent. The trick is to it regularly, every day or so. No exceptions, for the benefit from exercise doesn’t continue much beyond the day it’s done. So you have to do it all over again.
NONE of this is a cure, though. Type 2 diabetes, for the moment, is a condition which must be managed, not cured, since there aren’t any cures. Kind of like baldness, or poorly healed broken ankles. In the one case, there are all sorts of ‘cures’ from creams to massage to wigs to hair weaves to actual transplants of hair plugs. None works really well, but if we ever fully understood the mechanism which turns off hair growth in men, we might have one. In the other case, one must make as good an adjustment as one can; a limp, or putting one’s foot down a little differently, or even a cane or crutch.
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future cures
In Type 2s who have lost their own insulin production (a substantial fraction) the loss of internal insulin production can be repaired, as for Typw 1s. The nuisance way is to supply insulin from the outside. The ideal way is to replace the cells which are no longer working, and we can do that. Pancreas transplants will do the job, and there is active research (on stem cells, for instance) on finding ways to transplant only the insulin producing cells. there’s even been some experimental success, but it will be years before it becomes routine.
But the main Type 2 problem, cells going deaf to the insulin signal is still impossible to cure, even with a beta cell transplant. We have a few sensitising drugs, but they aren’t a complete solution, only a stop gap. There is research continuing on the underlying mechanisms, and there is some reason to hope that some real progress will be made. But at the moment, if your heredity is such as to predispose you (Type 2 is strongly inherited), and your cells start going deaf, there are no ways to force them to pay attention again, or at least to stop getting more deaf.
Type 2s should
start regular exercise,
lose weight (especially around the abdominal organs),
make sure that they eat sensibly (though no extreme changes are needed),
begin to watch their blood glucose with a glucose monitor, and
check in with a good doctor or physican’s assistant who can cope with the (currently) uncurable .and dangerous. Some don’t know much (avoid them), some won’t keep up very well (avoid them), and some get so frustrated that tehy flail away by putting their patients on this or that treatment more or less in the hope something will work (avoid them to). Patience is good in both you and your clinician.
