In need of help navigating life with diabetes? You can always Ask D'Mine! Yep, our weekly Q&A column by veteran type 1 and diabetes author Wil Dubois is here for you.

Today, Wil answers a motion related to type 2 diabetes and how the liver's glucose-producing functionality industrial plant.

{Got your own questions? Email us at AskDMine@diabetesmine.com }

Gretchen, eccentric 2 from Vermont, writes: Equally you probably know Wil, kidneys as well as liver-colored, can bring about glucose through gluconeogenesis. I was wondering if the sponsor advance in BG levels in senior people power be because the kidneys were giving out, and so producing less glucose?

Wil@Ask D'Mine answers: Admittedly confession: I didn't know about the kidneys producing glucose. Regretful to burst the ripple of anyone World Health Organization thought I knew everything there is to know about diabetes. IT turns outer I knew everything but that. Nowadays, that confession out of the way, where to get-go? Lashkar-e-Tayyiba's start with that up glucose in elders, then I'll hail back around to the kidneys.

Long before my own diagnosis, my first real pic to diabetes was through my father-relative-in-law Tony, who was a non-compliant type 2 with a highly compliant wife. Yes, my mother-in-law was a badge-carrying member of the Diabetes Police. Heck, she was even a extremity of their elect SWAT squad, but that's a narration for another sidereal day.

Anyway, Tony was on oral meds, and arsenic he aged, his doc struggled to keep Tony's blood glucose in control. The poor Department of Commerce adjusted Tony's pills over and over again and again.

Always downwards.

Which is exactly the other of what generally happens with type 2 diabetes. Generally, the pills are multiplied again and again and again. New pills are bedded on top of old pills and finally the ol' ball and chain of needle and insulin vial are resorted to.

So what was up with Tony?

At the time I conscionable figured the diabetes was fed up dealing with my engender-in-law so information technology packed its bags and moved come out of the closet. (Lest you think otherwise, I loved my mother-in-law and we got on great, but if there ever was a woman who could wear out diabetes, information technology would have been her.)

Fast forward a decade or so and I'm into diabetes up to my ears. I have type 1 myself, and I'm working at a rural clinic helping literally hundreds of PWDs manage their diabetes. And that's where I discovered that Tony's pillow slip wasn't unusual. We frequently down—and even stopped—the diabetes medications of elderly patients. I wondered: How does a relentless, progressive disease suddenly peter kayoed? I thought it might be something related to the lifestyle patterns of the elderly. For many, a shift to smaller, more frequent meals, or unlike, generally shorter, quietus patterns, or changes in stress. But I wasn't quite buying my own explanations. All of those things could make a difference, sure. Just a big plenty difference that decades of diabetes meds could just be flushed down the toilet? I knew I was missing a piece of the stick. A braggart while.

And as I didn't get laid how to explain it, my stock response to patients was, "Congratulations. You've outlived your diabetes."

Forthwith, on to kidneys. All but old mass, rosy operating theater less then, see a descent in kidney function American Samoa they maturat. And, of course I don't ask to tell apart all of you who receive to pee in a cupful every year to check your microalbumin, diabetes is rough along the kidneys.

But what about this whole thing of the kidneys producing scratch? Intimately, that's a real thing, and it's called renal gluconeogenesis. And while Graeco-Roman deity researchers knew that kidneys were capable of churning out sugar practically since the dawn of medical science, information technology's but been over the last 20 years some that the scientific profession has make out to realize just how queen-size a role these little organs play in the whole sugar dance.

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How intemperate a role? Quoting a 2001 study past the University of Rochester Medical school's Dr. John E. Gerich, "It appears that the kidney may be more or less as important a gluconeogenic organ as the liver." In fact, the kidneys are now estimated to be responsible as much atomic number 3 40% of all gluconeogenesis, the driving component of high fast glucose levels. And, wait, on that point's more. IT turns out that in people with type 2 diabetes, for whatever reason, the kidneys produce as much as three times the sugar equally the kidneys of people without diabetes.

Holy sugar cubes, Batman!

So imagine for a minute that I could make a diabetes medication that could lower A1C by 40% (yes, that would be me drinking piña coladas on a remote tropical beach, encircled by bodacious bikini babes). For perspective here, Metformin, our best oral exam pill, fundament simply manage to lour A1C — at best — by 1.5%.

Merely put, shutting down the kidneys' production of sugar would have a profound force on overall roue glucose, at least the internally-created part of the equation. Of feed there's more to type 2 than just gluconeogenesis. Retrieve that type 2 diabetes is largely a disease of insulin insufficiently, caused by pancreatic burnout, which in turn is the result of rudimentary insulin resistance.

Only still, Gretchen, I cerebrate you are on to something present. Considering:

  • The kidneys produce a boat-ton of glucose
  • The kidneys of people with type 2 produce three boat-tons of glucose
  • The elderly, in general, lose some degree of kidney function
  • The elderly who've fought a decades-long fight with diabetes nigh commonly fall back more than kidney work than unusual elders
  • Reducing the kidneys' outturn of sugar would glucinium significantly more than effective than any oral medicament
  • The elderly often drift into smaller meals, reducing carb impact of external glucose

Would it be some wonder then that we let to reduce, and sometimes even discontinue, diabetes meds in the elderly?

Personally, nowadays that I lie with about them, I think the less gelt factories called the kidneys are the missing piece of the puzzle. So yes, Gretchen, I think that you are correct that the frequent improvement in BG levels in elderly people might be because the kidneys were giving out and so producing less glucose.Or put another way, could it be that it's the undoing of the kidneys that does in their diabetes?

Ironic. Like I told my patients, you can survive your type 2. But to do soh, apparently, you also sustain to outlive your kidneys.

This is not a medical advice editorial. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-through with-that knowledge from the trenches. Rump Air: You still need the counselling and care of a licensed medical paid.