Got diabetes questions? You came to the right place! Ask D'Mine is our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil explores a so-called "lazy pancreas" as described by a doctor, and also how PWDs may need a tad more Vitamin D than other folks.

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Rita, mystery type from Missouri, writes: Since I was 18, I was told I had high blood sugar. The glucose tolerance tests would really spike and then come down over a 3 or 4 hour period. I was told I have a lazy pancreas. A recent blood test says I am not a diabetic, but I did some self-monitoring with a fingerstick meter and it shows numbers above 100 to 200+. What kind of doctor should I contact for this?

Wil@Ask D'Mine answers: A competent one.

Next question?

What? Oh. Amy and Mike say I have to do a little bit better job answering yours first. Something about details missing... So here goes:

"Lazy Pancreas" is not listed in the International Classification of Diseases database. That means it's not a real disease. I'm fine with bloggers talking about lazy pancreases, but I'm appalled that a doctor would tell you this.

But if you don't have Lazy Pancreas, what do you have? Let's see if we can sort this out. I'm guessing that the "recent blood test" that gave you a clean bill of diabetes health was a comprehensive metabolic panel (CMP), as it's the only common lab blood test that measures glucose. This test is usually drawn after fasting, so this tells me that your fasting sugar is probably OK. I don't know how old you are now, and a gentleman should never ask a lady about her age (although there's some controversy about whether or not I'm a gentleman), but we know from the oral glucose test that when you were younger your body didn't handle a sugar load well. Some of your fingersticks are all right, the ones around 100—and some are really not all right—the ones at and above 200.

Hmmmmmm.... Sounds like a first-phase insulin response failure to me.

What does that mean? It's the canary in the coal mine. And your diabetes canary just gasped, choked, and collapsed in its cage. May I suggest that you run for the mine shaft opening?

In all likelihood, type 2 diabetes is on its way to your house. You probably have pre-diabetes. But don't freak out on me. Dead canaries are a good thing. (Uh-oh, I bet the American Canary Fanciers Association is really going to flame me now.) What I mean by that is it's better dead canaries than dead coal miners, right? Early warnings are a good thing.

Here's how it works: type 2 diabetes will never win the Grand Prix. It's one of the more slow-poke diseases around. It takes a long time, as long as 15 years, maybe more, from when it starts until it's in full bloom. At the earliest stages, the first thing to go is the first phase insulin; that causes the after-meal sugars to creep up. Later the fasting sugars will creep up, too. Unchecked, the process grows until we get sugars bad enough to rate full-blown diabetes. But early pre-diabetes is hard to catch. Most lab tests that are part of routine physicals are drawn fasting, so during this protracted time when early pre-diabetes mainly affects after-meal blood sugars, it's often totally missed by the medical community.

But sometimes you get lucky. Sometimes you catch pre-diabetes early, before it becomes fully developed. And it sounds to me like this is what's happening to you.

What kind of doctor do you need? One who understand diabetes. One who will help you keep yours at bay as long as possible. One who won't tell you that you just have a "lazy pancreas" and leave it at that. Pre-diabetes is treatable, you need a doctor who will help you treat it.


Becky, type 1 from Arizona, asks: How much sun-time do you need for a vitamin D dose?

Wil@Ask D'Mine answers: Ten minutes a day, every day, at noon, sans sunscreen. Naked.

Which is why most people pop a pill to supplement their vitamin D needs instead.

Backing up, what's vitamin D all about? Well, it helps maintain the balance of calcium and phosphorus in your body, which in turn makes and keeps your bones strong. Too little vitamin D can cause Rickets in young people. For adults, being short on vitamin D has been tentatively linked to all kinds of bad shit like hypertension, multiple sclerosis, cardiovascular disease and even type 1 diabetes and type 2 diabetes! Or, maybe maybe not on the T2 front.

But regardless of the connection to other disease states, strong bones are a bonus for everyone. So you need your D. Other than nude sunbathing, where can you get your daily allowance of D? From pills. And from food and drink. But your options in the kitchen are pretty limited.

Some fatty fish, like salmon, tuna, and mackerel have it naturally, as do eggs. Oh, and cod liver oil has it, too. Back in the old days, many kids had to choke down a spoonful of cod liver oil a day to keep Rickets at bay. By all accounts it's awful stuff. Ironically, cod itself doesn't seem to have much vitamin D.

In the United States, most milk has been "fortified" with vitamin D since the 1930s. That means it isn't naturally occurring in milk, but has been added in as a public health measure. In fact, most Americans get whatever vitamin D they do have from fortified foods. And while that seems to have worked for decades, in recent years, vitamin D deficiency seems to be on the rise.

What's up with that? We've been fortified for 80 years. What changed? Well, it might be that the sun set on us. As a people, we used to spend more time in the sun. Even if most of our grandparents weren't sunbathing nude for ten minutes a day at noon, they got more sun than most of us do today. One of the thoughts behind our national vitamin D deficiency rates suggests our depleted ozone-induced skin cancer fears have led to a dual decrease in sun-time and an increased use of sunblock when outside. Or maybe the trend towards play inside over play outside is responsible.

Either way, low D is rampant and the classic supplements in food alone aren't keeping up. You may need to take more, but first you need to be sure you're one of the millions of Americans who are short on D. It's hard to feel vitamin D deficiency. Mild muscle and bone aches are the main symptom, but they don't show up until deficiency is quite severe. So ask your doc to check your vitamin D, as it does a body good - all you need is a blood test called a 25-hydroxy vitamin D test.

And if your body is low on D, and you don't like pills or fortified foods, and if you've got the time (and a high enough fence to keep the snoopy neighbors out), pretty amazingly, your body can actually synthesize vitamin D the way plants make glucose. Just by lying in the sun.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.