It is a good question.

I think the answer is that we do not have very effective insulin sensitizers- which would be a more logical choice. Metformin does have some effect, but is not as effective as clinicians would like. We need a stronger drug in this class.

The default position, unfortunately, is to overcome the insulin resistance by giving excess insulin. Which then increases weight and worsens insulin resistance. It ends up as a vicious cycle.

Exercise and dietary choices also affect insulin sensitivity. And any weight loss strategy , eg bariatric surgery will help.

We probably underuse the bariatric surgery option- its long term results are surprisingly effective for Diabetes and Hypertension- but it comes with problems of it's own

Thank you very much, type 2 diabetes mellitus is a chronic progressive disease, at the time of diagnosis, 50% of beta cells are lost and the patients need insulin for insulin deficiency in spite of insulin resistance as add-on therapy together with metformin if not contraindicated. The new preparations with cardio-renal protective effects (SGLT-2 and GLP-1 like agonists) may reduce the unwanted higher doses of insulin and also reduce the mitogenic potential of some insulin.

Insulin resistance cause chronic hyperglycemia in patients that stimulate continuous insulin secretion in patient to compensate the blood glucose level. In due course of time, the efficiency of Beta cells will be decreased and concentration of plasma insulin level is going down. The insulin administration in patients will also decreased the complications in patients, so it is recommended for initial treatment of T2DM.

Follower

The problem in Type II diabetes is usually over consumption of refined carbohydrate i.e. flour and sugar. I did gastric reduction surgery and coupled it with a refined carbohydrate diet. After loss of about 25 lbs.(with 100+ lbs. to go) the signs and symptoms of diabetes disappeared. These individuals can best be described as refined carbohydrate carboholics. And the diet, not surgery is required. However, some addicts made shakes of sugar and cream because when they drank it "it could get through" the anatomical restriction I created. On the other hand, a female patient deliberately drank olive oil post op because she needed her weight to "defend herself" against her abusive husband. Most morbidly obese patients are addicted to refined carbohydrate but some need to drink olive oil to remain obese. We learned human obesity (Type II) is complex.

If in Type 2 Diabetes, the sugar level is very high...Its better to start with insulin in addition to Metformin....as it will decrease the complications and it will have legacy effect

Some times type 2 diabetes occur due to insulin deficiency not due to insulin resistance ,so insulin secretory drugs can be used but with time more insulin needed therefore,insulin can be used in such conditions

The progressive effects of diabetes on beta cell function and insulin resistance mean that oral medications become less effective with time. Best management of type 2 diabetes therefore inevitably results in consideration of the use of insulin

In addition to all what has been mentioned above:

Researchers from Harvard, Broad Institute of MIT and Massachusetts General Hospital have identified five genetic subtypes of T2 DM diabetes:

(i) Three are related to Insulin resistance (Patients had a bigger waist line).

(ii) Two are related to Insulin Deficiency (Thin Patients whose insulin resistance is

different from the obesity-related insulin insulin resistance.

Therefore, the line of management should be coherent with correct diagnosis (i.e the degree of emphasis on life style modification should be more for the Severe Insulin Resistant T2 DM).

Hi Pranita,

Attachted you will find an answer on your question: Why is insulin given in type 2 diabetic patient as it is insulin resistant diabetes.

Rob Weijers

Hi Pranita,

I forgot to include Fig. 1

Rob

First of all, not all patients with T2 DM have the same degree of insulin resistance. Studies showed that Asian people have earlier and more beta dysfunction than Latinos. In the other words, Asian diabetic patients need earlier insulinization to combat high sugar levels. Secondly, the natural history of T2 DM is started with insulin resistance during prediabetic stage; however, it will end up with progressive decline in beta cell mass and function. Hence, insulin would be added sooner or later down the road.

in type 2DM there is some sort of autoimmunity later on in disease so patients need insulin .

Hi

because of the progressive nature of the disease, there will be gradual decline in Beta cells mass and function

Hi Zainab Mahmood,

Your answer on this question is firm and simple. However, the background of the question is more complicated, because type 2 diabetes is characterized by a reduction in the functionality of all types of glucose transporters. After all, individuals with type 2 diabetes have significant lower values of both insulin-independent glucose removal rate (glucose effectiveness, the ability of glucose, per se, independent of changes in insulin concentration, to stimulate its own up-take by a mass action effect and to suppress its own release) and insulin sensitivity, compared to healthy controls [1]. For more information, read reference 2.

Rob Weijers

References

1. Bluck LI, et al. 13C- and 2H labelled glucose compared for minimal model estimates of glucose metabolism in man. Clin Sci 2005; 109: 513-521.

2. Weijers RNM. Type 2 diabetes: a status of long-term heat acclimation. EC Diabetes and Metabolic Research 2019; 3(1): 35-41

I have diabetes type 2 since 2004. I am only on diet and doing fine. Any drug is a wrong and lazy way as we need to go low carb diet and take a lot of fresh vegetables to reinforce our immunity system and the increase level of insulin. My diet includes also olive oil and omega 3. From my understanding, the main problem for diabetes type 2 is the fat in the stomach.

Insulin resistance is a feature of type 2 diabetes, and it can be present with prediabetes. Insulin is essential for enabling the body to use glucose effectively and prevent blood sugar levels from rising too high. When insulin does not work effectively, blood sugar levels can rise, and diabetes can develop.

Treatment with insulin and other drugs: – Daily insulin injections or using an insulin ...

Lifestyle treatments: – follow a treatment plan and medical advice; – follow an active, ...

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Insulin resistance: Causes, symptoms, and prevention