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In addition, over the long term, there is a legitimate question(s) about effects: since chemically forcing more insulin to be pumped out probably tends to reinforce even more insulin resistance in the body..again not desirable, since that keeps the negative feedback loop going that helps Type II diabetes get worse over time (that's why it's a 'degenerative' disease).

Plausible hypothesis. Do you know of any studies that suggest this?

As to diabetes being a "degenerative disease", I would say that this is highly variable amongst individuals, but without attention to diet and exercise, you are correct, many diabetics display an increased need for therapeutics and many Type II's wind up on insulin. Like most diseases, an indiviudal's severity and response to therapy can differ markedly, particularly diabetes.

Additionally, chemically forcing more insulin production does add to the longevity of those remaining islet cells...though no one, yet, knows how quickly it helps to shorten those lives. (Of course, once you've...eventually...lost all your islet cells, you're officially a Type I, I guess?).

I'm not aware that beta-islet cells can be "burned out" by sulfonylureas or through the natural history of Type II diabetes. I'd be interested in any hard data that shows this. Actually, you could test Type II's as sulfonylurea therapy fails (or dosages need to be increased) for their C-peptide and serum insulin levels which, if low, would indicate loss of endogenous insulin production.

Of the other Type-II pills, the most popular are the various insulin sensitizers. They help whatever insulin is there in the body, to work more like they are supposed to at the cellular level, to let glucose in to each cell to be used. These, too, have side effects: most (but not all) still can have weight gain associated with them; and most also require some form of periodic liver test to ensure no harm is being done there.

Yes, they do need to be monitored for liver damage (a test called an "ALT" is generally enough). If you remember Rezulin, the first drug in this class, it was pretty effective (more so IMO than Actos and Avandia), but caused fatal liver failure in enough people to remove it from the market.

On the subject of insulin sensitization (and, subsequently, decreased glucose intolerance), metformin (Glucophage) also helps to decrease insulin resistance though its primary effect is to hinder glucose production in the liver (gluconeogenesis). Metformin can be a highly effective treatment and is the only diabetic agent that can help in weight control. Those diabetics with some degree of kidney insufficiency (as measured by the serum creatinine and/or a 24-hour urine collection) should not take metformin as shouldn't patients with liver insufficiency or a bad pump - congestive heart failure, cardiomyopathy or decreased ejection fraction of the left ventricle for any reason - due to a potential, and dangerous, circumstance called "metabloic acidosis."

If you've let yourself go to also needing insulin to maintain control, that adds another layer of negative feedback on the body that isn't good over the long-haul; not to mention, it becomes easier to misjudge and go 'low'.

Many people present with severe enough diabetes that they have to be started on insulin from the beginning. Oral agents just won't cut it. You can expect more frequent trips to the doc for insulin dosage adjustments if ever on insulin and good blood sugar diaries are a must.

However, we need to remind ourselves...Many (maybe even, most?) Type IIs can really get back under control with strict diet and exercise, alone...with NO side effects, other than us having to behave ourselves and stay healthy! Even Type IIs already on insulin, can get their insulin use reduced that way; and if they keep going, possibly even get off it totally. Note, though, all this depends on how far you've let yourself go: if you've been Type II for less than 5 years or something, the above statements apply; if you've been Type II for 20 years, never modified diet and exercise, have already had one heart attack, 5 eye operations, and one amputation....then getting more under control will definitely help; BUT, you've almost certainly permanently damaged enough organ tissue that getting off of meds, permanently, is probably not attainable...though you CAN reduce them, and slow down further progression (and put off other operations as long as possible).

It all depends on how far you've let yourself go, before you make an honest effort at pulling yourself back. In Type II control, 'sooner' is way, way, way much better than 'later'...since 'later'...might be too late to work at all.

These generalizations are generally correct. Attention to diet and exercise will help any diabetic at any stage. It is absolutley true that control from the time of diagnosis is paramount in limiting target-organ damage and morbidity and mortality.


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