T2 and Insulin

I’ve been reading some of the post about the importance of starting on insulin early on if you are LADA to help perserve beta cells. Why would T2s not take insulin instead of oral meds to help perserve their beta cells? I know some T2s have good control with diet, exercise, and oral meds and never need to go on insulin, but alot do.

I am type 2 dx March 2007 and was only on pills for a short time. I was dx’ed by my GP and I insisted on a referral to an ENDO. He put me on Byetta for over a year but after Byetta quit having the desired effect I went to MDI Lantus and Novolog. I did this for over a year and when Victoza came out he moved me to Victoza and novolog. I have my ENDO visit today and will ask to go back to MDI Levemir/novolog.

I think alot has to do with the type of ENDO you have. My ENDO likes to stay on the cutting edge of what is available expecially if you are working hard to help control you diabetes.

Ralph DeFronzo, a leading researcher suggests that by the time most type 2 diabetics are diagnosed they have lost 80% of their beta cell function. He is also very vocal that most of the type 2 treatments are not going to stop the progressive loss of beta cell function. He in fact stood up to the ADA in 2008 when he gave his Banting Award speech and said that the ADA/EASD stepwise oral treatment protocol was a FAIL. He instead suggested that starting with the most effective treatment known (he likes metformin, a TZD (Actos) and a GLP-1 analog (Byetta/Victoza) offers the best hope of maintaining your beta cells. After that fails, you might as well just start insulin. A recent lecure by DeFronzo provides some data on how well different medication and insulin regimes maintain beta cell function.

I think in my case, if I am actually a type 2, I probably had lost virtually all my beta cells by the time I was diagnosed. No combination of diet, exercise or medication was ever able to restore normal blood sugars. And while we think that controlling blood sugar is the key to preserving beta cells, researchers now think it is a bit more complicated.

I would have thought that, for T2s whose main problem is insulin resistance, orals should work better than insulin, particularly if the T2 happens to be overweight. Insulin resistance–>you need more insulin–>causes continued weight gain. For T2s who are not overweight/who have lost their beta cell function, it seems like a more natural idea to go straight to insulin.

Personally, I think my problem right now isn’t insulin secretion but a combination of insulin resistance and a really overactive liver . . .

I’m not sure how wrong that is. I think it really depends on the type of Type 2. I was DX T2DM in July 2002, was on oral meds until January 2004, and have been on diet-and-exercise alone ever since. If I had really lost that much beta cell function, I doubt I would have been able to keep everything under people-without-diabetes levels for seven years without ANY meds or insulin. FWIW, my A1c at diagnosis was 7.8, so well above the non-D range.

One of the latest bits of research suggests that glucagon inhibition may be the way to control (T1) diabetes.

Studies have shown that insulin actually deteriorates organs in large amounts and its a growth hormone (so taking more often leads to more mass on your body). So, as many people with insulin resistant diabetes are already overweight, prescribing exercise, diet, and drugs tends to be the long-term preference.

For the record, I’m insulin dependent, but most of my family is insulin resistant and my mother is a CDE.

I believe, that the people who don’t want to go on insulin are in two parts of the disease, at least. First they don’t understand that this can be a positive good thing for them. The don’t understand or it hasn’t been taught to them what insulin will give to them. And second that going on insulin looks or feels as if you have failed. I used to think the same thing. “I would never go on insulin” were my words the first years of my diabetic life. But now, I have approached the subject, done my homework and realize that this just might prolong my life and bring a better quality to me. Am I excited about the prospect of giving myself an injection (shot) everyday, nope not at all. But I am also, more concerned about seeing — with my good eyes — my grandchildren, spending years with my husband, being able to walk on both my own legs through the mountains, and on and on. Let’s face it, there are good things to think about starting insulin if you have to.

I think there are at least several forms of Type 2, and you can’t make generalizations. I have a form of diabetes that is not classic Type 1, not classic Type 2, not LADA. I was never obese, and insulin did NOT make me gain any weight – it took away my ravenous appetite and I actually lost weight when I went on insulin. Last year, I had a major depression, and ate a lot of carbs, and did not take stellar care of my diabetes, and went into a coma. This does not point to good beta cell function. Plus, when I recovered, I ended up taking a little more insulin (in the 30’s of units) daily than before (20’s of units). This does not point to extreme insulin resistance, but I think I lost some more beta cells. So I call myself Type Weird. But I actually think it’s a form of Type 2 that has not been described.

I went on insulin within 5 months of my formal diagnosis because the sulfonylureas didn’t work. There were no other choices at the time. But at this point, after having been on insulin for 17 years, I’d just as soon leave it as is – if it ain’t broke, don’t fix it. I’d rather not risk the side effects and potential long-term effects of new drugs that haven’t been in use all that long, and can’t tolerate the potential GI effects of metformin. So, insulin it is!