Diabetes Mellitus is a disease of glucose use by the body. One form of Diabetes is called Type I Diabetes Mellitus where the person afflicted does not make insulin. Insulin is the substance needed to allow the passage of glucose into muscle and fat cells. This kind of Diabetes is very dangerous but not as common as Type II Diabetes. In Type II Diabetes, there is generally a large amount of insulin production, but the insulin does not work where it should at muscle and fat. This problem is called insulin resistance. Most people with Type II Diabetes have a weight control problem and, in most cases, the problem runs in the family.
Type I Diabetes must always be treated with insulin. It is difficult at time to get a good result because insulin doses need to be matched with the person’s diet and activity on any given day. Fortunately, there are a number of very effective insulin preparations available now to help people do well with their disease.
Type II Diabetes should always be treated with oral agents, weight loss and exercise. Insulin should hardly ever be necessary in Type II Diabetes because the basic problem is insulin resistance, not a lack of insulin production. In my opinion, unnecessary use of insulin in treatment of Type II Diabetes is harmful to people for one very simple reason: insulin makes people hungry. High insulin levels act in a part of the brain where the sensation of hunger is controlled to make people want to eat constantly. They have a terrible time sticking to a diet. They gain more weight. They become more insulin resistant and blood glucose levels go out of control.
There is a simple blood test available to anyone with Diabetes Mellitus to measure the amount of insulin people make on their own. This test is called C-Peptide. This C-Peptide is a short chain of amino acids cleaved from the proinsulin molecule secreted into the blood stream by pancreatic beta cells after first pass through the liver. The C-Peptide has no known metabolic function, but simply serves as a marker of insulin production. So, if a person has a normal amount of C-Peptide in the blood stream, then one can deduce that insulin production is normal. People with Type II Diabetes Mellitus who are being treated with insulin and have a normal C-Peptide level are probably getting insulin they do not need. That extra insulin is harmful to them.
A test call Hemoglobin A1C is a reliable measure of blood glucose control.
A number of new patients with Type II Diabetes have presented to my office with high Hemoglobin A1C values. This should no longer be the case because a large number of effective oral agents are available to correct blood sugar abnormalities.
There are six classes of oral hypoglycemic agents, pills that can be prescribed to treat Type II Diabetes: Biguanides (Metformin), Sulfonylureas (Glipizide, Glyburide, and Glimepiride), TZD’s (Actos and Avandia), and DPP-4 Inhibitors (Januvia, Onglyza, Tradjenta,and Nesina). SGLT2 Inhibitors (Invokana, Faxiga,, Steglatro and Jardiance). AG Inhibitors (Precose, Glycet). These medications might all be used together to get good result. There are two classes of injectable medication that can be used with oral agents if necessary: GLP-1 Inhibors (Victoza and Truliciy) and an Amylin Analog (SymlinPen).