I am taking a sulfonylurea along with insulin, and my fasting C-peptide was 0.2 pmol and my stimulated value was 0.4 pmol. Recently, my blood sugar has come down to 101 mg/dl [mmol/L] (fasting) and 137 mg/dl [mmol/L] (postprandial), so my doctor reduced my insulin dose. My latest C-peptide result was 0.3 (fasting) and 0.4 stimulated). Is their any chance that my pancreas will improve after the sugar goes down or it will still deteriorate? What percentage of my pancreas is working? Why doesn’t my pancreatic function improve? Will it improve in the future or remain the same? Is there any other drug which improves pancreatic function?

Your C-peptide results seem to be less than brisk. However, your blood sugars sound like they are coming down into a good target range, which I would consider to be less than 140 mg/dl [7.8 mmol/L].

There are more standard ways of determining beta cell reserve. For instance, drinking a standard test meal, such as with one of the enteral feedings, and checking the C-peptide level 90 minutes later has become a standard test for determining beta cell function. Others check the C-peptide and insulin level after a meal. However, it should be noted that the insulin administered by injection will also be measured in a blood test for insulin.

In patients with diabetes, especially type 2 diabetes, there appears to be an improvement in beta cell function once the beta cells are unloaded from very high blood sugars. There are no medications which improve beta cell function as a primary mechanism. Some oral medications stimulate insulin secretion, but you already have to be able to secrete insulin in order for there to be a response. A feature of type 2 diabetes is the ultimate failure of beta cells over years of diabetes. Roughly fifty per cent of patients end up on insulin as a result.

I cannot tell you how long your pancreas will work. A reasonable approach is to monitor frequently. If sugars are in the target range, you are good for the short term. If, however, they begin to climb, it is important to monitor frequently, stay on top of them, and add therapy to keep sugars in the target range.

JTL