May 15, 2009
Pills for Diabetes, Type 2
Question from India:
Can oral medications for diabetes and exogenous insulin cause some instability or impairment in endogenous insulin’s production and secretion? Do type 2 patients who become IDDM (Insulin Dependent Diabetes Mellitus) and type 1 patients really need insulin sensitizers such as Metformin?
In patients with type 2 diabetes, there is both insulin resistance and inadequate insulin secretion. The exogenous insulin overcomes the resistance such that patients are commonly exposed to high insulin concentrations. Does it cause some decrease in endogenous insulin production? There is already an impairment. I guess it is possible to down-regulate insulin receptors in some areas. However, I am not aware that this is a big effect on insulin secretion.
I don’t like to think of patients going from type 2 to type 1 diabetes. I prefer to think of them as having type 2 diabetes and heading down the natural history of type 2 diabetes towards greater insulin deficiency. It is true that insulin sensitizers become less effective by the time patients with type 2 need to be on insulin therapy.