February 26, 2003
Type 2
Question from Ottawa, Ontario, Canada:
I have type 2 diabetes treated with diet, exercise and a sulfonylurea, and I frequently experience fasting blood sugar levels of 7.0-7.8 mmol/L [126-140 mg/dl]. I understand sulfonylureas works to assist insulin production. My concern is if my pancreas is being pushed to produce more insulin, it will be less and less able to produce insulin on it own so perhaps I might benefit more from a medication which helps the absorption of insulin. Since my hemoglobin A1cs are consistently 5.5-5.6%, and my weight is good, my doctor thinks I am doing great and is not concerned about insulin resistance, but I am.
How can it be established if I need a medication which works on the pancreas or a medication which helps my cells to become more sensitive to insulin? What do you think?
Answer:
Type�2 diabetes is a disease of insulin resistance and inappropriate insulin secretion. The latter usually develops after the former. Theoretically, both agents should work, to some degree. If the current medication is working well, you may not have to change anything. There are no human data to suggest sulfonylureas induce beta cell exhaustion prematurely, although this has been a theoretical concern. The best thing you can do is keep your glucose levels in good control. If you do that, I’m not sure there is data to say one agent is better than another.
Also, there are medications on the market that are a combination of both types.
JTL
