Rationale for early insulin use in beta cell preservation

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Rationale for early insulin use in beta cell preservation


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Old 07-25-2012, 14:41   #1
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Default Rationale for early insulin use in beta cell preservation

(What do you think? What is your opinion)

Early Use of Insulin to Improve Beta Cell Preservation

Early Use of Insulin to Improve Beta Cell Preservation

Loss of first phase insulin response (FPIR) has emerged as one of the most important factor in the pathogenesis of type 2 diabetes and occurs prior to the diagnosis of diabetes. Its magnitude correlates with the degree of beta cell dysfunction.15 Its consequences include:

a. Inadequate inhibition of endogenous glucose production.
b. Rise in non esterified fatty acids (NEFA) due to inadequate antilipolytic action of insulin.
c. Inadequate priming of insulin sensitive tissues leading to decreased glucose disposal.
d. Altered signaling capacity of hormones leading to insulin resistance.
e. Enhanced stimulatory action of glucagon on gluconeogenesis.
f. Enhanced post prandial hyperglycemia
g. Increased risk of micro and macrovascular complications.

It is also important to understand the correlation between levels of glycemia and loss of FPIR:

FPIR is mostly absent when the FPG is more than 109 mg/dl
When FPG is > 140 mg/dl 75% of beta cell function is lost.16
When FPG is > 180 mg/dl there is complete loss of FPIR.
When 2 hrs PG values are > 200 mg/dl there is marked reduction in FPIR.17
Even in subjects with IGT there is marked reduction in the FPIR.

Considering these facts it seems prudent that all attempts be made to restore FPIR. This would logically correct or mitigate all the consequences mentioned above. Additional benefits would include beta cell rest, reduced hyperinsulinemia of the late phase after ingestion of a meal, reduced production of islet amyloid peptide and improved insulin secretion over time.

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Old 07-25-2012, 15:13   #2
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I think it totally depends on what caused your diabetes. Many of us are insulin resistant so even with injected insulin we are still resistant to it and require very large doses which tends to add on weight which makes the IR worse. I do think a C Peptide test needs to be done on all diabetics and if you are deficient or very low in insulin production then by all means use insulin. If you are not then a Low Carb diet should be the first thing you try to lower bgs and lower IR.

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Old 07-25-2012, 15:51   #3
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My c-pep falls (or did 2 yr ago) smack in the middle of normal range (is that normal levels when FASTING, or when maxed out, however? That mid-norm was measured when my BG was 145, so how do I interpret THAT?).

I take metformin and low-carb, and need insulin on top of that, in order to minimize use of insulin. My weight is relatively stable. My TDD of insulin ranges between 11 U and 20U. Insulin only contributes to weight gain, to the extent that you push more glucose (AND PROTEIN) into cells.

Yes, I have antibodies. I also have cortisol-induced hyper-gluconeogenesis, ie hepatic IR. We each have our own combination of deficiency and resistance to contend with. I am not a fan of Sulfonylureas regardless of cause, however -- so for me, insulin is a better choice.

That's a REALLY good review article -- open-minded as to the causes of T2D! But I was sorry the author mentioned use of glibenclamide, as if it was a good thing!


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Old 07-25-2012, 16:09   #4
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Past editing time, but this:
I take metformin and low-carb, and need insulin on top of that, in order to minimize use of insulin.
... makes no sense. What I MEANT TO SAY was: I take met and eat low-carb, in order to minimize my use of insulin, but I do still need insulin.

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Old 07-25-2012, 16:47   #5
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If you are LADA like Foxi, you definitely will benefit from early use of insulin. It would be nice if when we were all dx'd we had a c peptide and a Antibody test to check for LADA. I started out with bgs in the 200's-400 with an HbA1c of almost 11. That was on a healthy vegetarian diet and tons of exercise. When I switched to a meat/fat diet my bgs went down. Since I am a Type 2, the bigger issue with me is my liver , not my pancreas.

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Old 07-25-2012, 16:54   #6
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re: jwag's remark about no longer being vegetarian, just want to add I am an ovo-lacto vegetarian, have been for 40 yrs and feel it is too late for me to change my perception of meat now. It can be done! I generally eat less than 40 g of carb per day.

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Old 07-25-2012, 18:22   #7
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Quote:
Originally Posted by kantim View Post

FPIR is mostly absent when the FPG is more than 109 mg/dl
When FPG is > 140 mg/dl 75% of beta cell function is lost.16
When FPG is > 180 mg/dl there is complete loss of FPIR.
When 2 hrs PG values are > 200 mg/dl there is marked reduction in FPIR.17
Even in subjects with IGT there is marked reduction in the FPIR.
I found this most interesting. Does this mean a 2-hour postprandial BGL of >109 mg/dL?

Many people on diabetes boards ask what normal blood sugar levels are, so if this is to be believed, perhaps we can give better advice about what a deteriorating first-phase insulin response looks like and what might be done to slow down or halt the progress of beta cell loss.

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Old 07-25-2012, 20:12   #8
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I've heard that by the time most of us are dx'd most of our Phase 1 insulin response may be gone. We probably still have Phase 2 response but that takes much longer. I guess the question is can lost beta cells be regenerated?

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Old 07-25-2012, 21:42   #9
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I think it will take time to change people minds, because insulin is seen like end of the road now by type 2 diabetics. There is a lot of resistance to be put on insulin.

But the article makes sense that maintaining low blood sugar may help maintain and maybe regenerate beta cells. There have been two studies I know of from insulin manufacturers promoting the idea of the use of insulin on pre-diabetes and early type 2 diabetics but that goes against the prevalent theory of reducing cost. I don’t think early insulin use will be standard treatment any time soon.

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Old 07-25-2012, 21:47   #10
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Quote:
Originally Posted by Miss_Blue View Post
I found this most interesting. Does this mean a 2-hour postprandial BGL of >109 mg/dL?

Many people on diabetes boards ask what normal blood sugar levels are, so if this is to be believed, perhaps we can give better advice about what a deteriorating first-phase insulin response looks like and what might be done to slow down or halt the progress of beta cell loss.
I think FPG = FBG, Fasting Plasma Glucose. So the 109 is reference not to post postprandial but fasting values.

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