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policebox 05-02-2012 11:41

Insulin injection versus beta-cell stimulating drugs
Im interested to hear your opinions about using drugs to stimulate pancreatic production of insulin versus insulin injection therapy.

The group of drugs used to stimulate the pancreas into producing more endogenous insulin is called secretagogues and in part include: sulfonylureas (Amaryl, Glucotrol), meglitinides (Prandin); GLP agonists (Byetta, Victoza); DDP-4 inhibitors (Januvia, Tradjenta).

Setting aside other factors, such as cost or side-effects unrelated to this topic of discussion, where do you weigh in on the controversy of secretagogues causing ones already distressed pancreatic beta-cells to burn out faster due to continuous stimulation to produce insulin?

On the other hand, where do you weigh in on the controversy as to whether injection of exogenous insulin takes pressure off ones already distressed pancreatic beta-cells and extends their lives?

Although all discussion is welcomed and appreciated, Im particularly interested in in hearing what your healthcare providers have recommended and any reasoning they may have given for their recommendations (or whether or not this subject was even addressed by your provider). Its not required, but if you have sources to any research articles or websites that you used to help form your opinion, Id appreciate you including them.

MCS 05-02-2012 12:41

I am my own health care provider. I fully believe my over active production of insulin prior to being Dxed is what caused the inflammation in my arteries and prompted me to have a quadruple by-pass. So to answer your question from my prospective, neither one. If I can maintain normal BG's thru diet alone thats the road I'm taking. Sometime in the future if needed I will use insulin while still maintaining my LCHF diet, so as to minimize its use.

jwags 05-02-2012 12:51

My doctor has me on Metformin since it has the least side effects. When paired with a Low Carb Diet and exercise it works very well for me. I recently read a study that many doctors now are backing away from sulfyonyureas because of the hypos they cause, not the beta cell burnout. I have seen lots of different diabetics on all sorts of meds and insulin regimens. I am not sure taking insulin before you need it, actually improves your outcome. Many of us still produce insulin we need to eat in ways that preserve that insulin. Many people have told me if I only used insulin then I could eat all those forbidden carbs. Well, I am pretty happy with a LC diet and will stay with it as a managment tool. Now , I would like to be able to consume carbs once in awhile on vacations, but that is another story.

VeeJay 05-02-2012 13:02

I manage my own diabetes. I have not discussed drugs other than metformin with my doctor - in order to say that I will not take it unless it's really needed. And so far it's not.

To address the insulin stimulating drugs issue. I have read on the forum the experiences of others who have a problem with going hypo with these drugs. My opinion is that one should preserve as much as possible their own insulin production. If the reason for taking these drus is to increase carb consumption, then that's a poor reason, and an unhealthy one.

I don't know why some doctors prescribe them as a matter of course, and others don't. Could be how persuasive the pharma reps are in his local. Surely it can't be because they've done their own research and conclude that this is a good route to take their diabetic patients on. But, then we all know that most diabetics are not much interested in changing they way they eat.

Regarding taking insulin instead of these drugs, my opinion is that the insulin would be the better choice. I would look at it as a supplement to my own (low) insulin production, thereby perserving as many beta cells as possible for as long as possible.

uttam 05-02-2012 13:42

when i was dx type 2 , my first doc told me to go on insulin then i visited 2 more doctors all of their answers were insulin. but i insisted to stay on oral drugs. after 6 months of oral drugs and LCHF my BG were well controlled but this time i insisted my doc to put me on insulin because there were bone and skin left on my body, i looked so ugly .
after 15 days of insulin some of my friends have started telling me i look little better than before.

Shanny 05-02-2012 14:55

I manage with LCHF and metformin. I will not be found using any drug that hammers my ailing pancreas for more insulin. If the time comes when adjustments to my way-of-eating no longer control my blood glucose, I will move on to insulin.

diabetes86 05-02-2012 15:06

As to your question

My endo acknowledged that there is a question as to weather pills will burn out the pancreas sooner, he did not know the answer.

He did say that he likes insulin better, but most people wont do insulin until after they have to.

policebox 05-02-2012 15:09


Originally Posted by Shanny (Post 95845)
I manage with LCHF and metformin. I will not be found using any drug that hammers my ailing pancreas for more insulin. If the time comes when adjustments to my way-of-eating no longer control my blood glucose, I will move on to insulin.

I've heard conflicting opinions about the diagnosis of my DM, the doctor I trust in the most believes I am a late onset type I. Although I was able to manage my impaired fasting blood glucose for a few years through diet and exercise, last year it ultimately developed into DM.

She diagnosed me with DM T1 and we discussed my treatment options. She felt beginning basal insulin therapy would be the better option, but left the avenue of oral drug therapy open if I wanted to avoid insulin therapy, adding that she felt oral drug therapy would probably, at most, only postpone my need for insulin by a few years.

I opted to try oral drug therapy and did so for about a month. Although I had a modest improvement with my blood sugar, I was not seeing the results I wanted fast enough, especially since I did a lot of reading about DM during that month and was eager to prevent future complications of diabetes.

Although I never experienced any side effects, from what I read during my research convinced me that taking a sulfonylurea did not sound like a particularly good solution. Your sentiments agree with my doctor's opinion. Overtaxing an already struggling pancreas did not seem logical, especially since the only serious downside I saw to insulin therapy was taking an injection. But I rationalized it was silly to deny myself a superior treatment option, simply because of fear or the lesser convenience of taking a pill.

After you’ve injected yourself for first time and notice finger-stick tests are more painful than the average injection, it becomes no big deal. In fact, it's fun to whip out a needle and jab yourself in the stomach (okay that part isn't fun)... what I mean is when you do it in front of your squeamish friends and they react as if you are some sort of super human.

moon 05-02-2012 15:45

I was on glipizide for a short time because my numbers were very high and needed to come down. It was at urgent care that they prescribed it, and when I saw an endocrinologist, he said it was fine for the very short term, but he wanted me off it for the very reason we've discussed. I was able to drop it after about a month, but it did do its short-term job. Had I not been able to maintain control via diet and metformin, I would've gone to insulin.

PowerPumper 05-02-2012 15:55

It's not an easy question to answer and may depend on the patient.

On one hand, insulin injections will give the pancreas a break, but on the other hand, injecting insulin is notoriously inefficient. The chances of promoting insulin resistance and weight gain -- conditions we are trying to fight -- increase.

My recipe is a very LCHF diet, a small basal and maybe even bolus suppliment, metformin, and Victoza. I'd watch very frequently and lower as needed insulin first followed by victoza then metformin last.

*John is not a doctor. Don't trust anything he says!

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