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Combination of medicine and Insulin for T2D

5K views 11 replies 8 participants last post by  jademuffin 
#1 ·
Have seen a recent article in Indian weekly Magazine (The Week -Health July Edition).

Article says - "According to a study published in the Journal of the American Medical Association, adding insulin to metformin as a second line of treatment in T2D patients is associated with increased risk and mortality compared with adding the drug sulfonylurea"

1. Has anyone read similar article and understood the facts and figures on this? Would like to understand Insulin intake for T2D patients has any relationship with Cradiovascular complications.

2. Is there any difference the way the Insulin is managed within body through a) Direct intake(injection) and b) Induced production through medication such as Metformin.
 
#2 ·
adding insulin to metformin as a second line of treatment in T2D patients is associated with increased risk and mortality compared with adding the drug sulfonylurea
Okay - this is a two-ton truckload of horsefeathers. My guess is that the ones publishing this garbage are selling the sulfonylureas.

Sulfonylureas carry the increased risk all by themselves. They force increased insulin production from pancreases which are already ailing, for T2D patients who are by nature insulin-resistant! More insulin is not what is needed for these patients - what they need is metformin which unlocks the cells to receive the insulin, enough of which is often already available. What else they need is metformin to coax the liver to lighten up a little on its glucose dumps. They DO NOT NEED sufonylurea drugs.

Metformin is the single solitary safest drug for T2D patients, and if they progess to the point where they are insulin-deficient along with being insulin-resistant, then injected insulin is required. At no stage of this scenario is a sulfonylurea drug ever indicated.

And if you think you've tripped my trigger this morning, you're right! :mad: :mad: :mad: Sorry and I'm stepping down from the soapbox now.
 
#7 ·
Metformin is the single solitary safest drug for T2D patients, and if they progess to the point where they are insulin-deficient along with being insulin-resistant, then injected insulin is required. At no stage of this scenario is a sulfonylurea drug ever indicated..
The more I learn about type 2 and insulin dependence, the more I get confused. From what I understand a type 2 can still produce insulin, but the cells won't take up the glucose because they have become resistant to insulin. Then why would a type 2 need more insulin? I can understand why type 1s need insulin, because they don't produce it on their own, but don't type 2s produce more and more insulin to try to keep up with the cell's resistance?

And if a type 2 proceeds to a state where they aren't producing enough insulin, wouldn't that make them type 1?

I want to become a molecular endocrinologist now at the age of 60. Where do I sign up? :)
 
#3 · (Edited by Moderator)
Metformin is the single solitary safest drug for T2D patients, and if they progess to the point where they are insulin-deficient along with being insulin-resistant, then injected insulin is required. At no stage of this scenario is a sulfonylurea drug ever indicated.
Is there another drug, in the same class as metformin, but without the nasty gastric side effects of metformin.

After 15 hours of non stop diarrhea, i believe i'm going to get off of it. Just saying, waiting for the doc to get in his office to discuss it with him.
 
#4 ·
Metformin comes in two forms. The standard drug and an extended release version. The extended release version is noted as being kinder in respect of the gastric features and if you find the normal version too 'interesting' asking your doctor for the extended release version is a good first move.
 
#8 ·
As I think I've said in other posts, I'm pretty certain that type 2 diabetes isn't one condition. It's a whole grab bag of blood glucose related problems that I don't think even the experts could catalogue completely.

Anyway, the issue we have in the common case is a combination of insulin insufficiency and insulin resistance.

In the old school way of thinking us poor type 2s start of with resistance and our pancreas works overtime to deliver insulin that we more or less ignore. And as a result, over time the machine starts to break down and can no longer deliver what we need.

So, we may need to inject insulin and if we're (as we almost certainly will be) still insulin resistant, that injection has to push past the resistance in the same way as our natural stuff that the injection is augmenting (or ultimately replacing) does.

Type 1 diabetics have an autoimmune reaction to their beta cells and their body destroys the insulin producing cells.

Type 2s don't have the autoimmune reaction and 'merely' burning out their pancreas doesn't give them that issue, just a need for insulin augmentation. For instance, at the start of my condition I needed a little insulin to bring my figures under control. Once there and with a sensible diet, my need to inject insulin has gone.

It might seem academic to some degree but that extra feature for a type 1 means the path to a long term answer to the problem will almost certainly be different for them.
 
#10 ·
Being a T2 on insulin and Met. for the last 14 years. I whole hartedly agree with Shanny. Why am I on insulin because My pancreas BURNED out trying to lower BG from "eating Healthy" and no longer makes insulin. So I need to inject insulin to live, and I still have IR so I take Met.
 
#12 ·
Article says - "According to a study published in the Journal of the American Medical Association, adding insulin to metformin as a second line of treatment in T2D patients is associated with increased risk and mortality compared with adding the drug sulfonylurea"
I join Shanny on the soapbox for this load of nonsense. My diabetic educators pointed out the increased risk with these drugs.

2. Is there any difference the way the Insulin is managed within body through a) Direct intake(injection) and b) Induced production through medication such as Metformin.
You should know a few things about what Metformin does. It does NOT "induce production" of insulin. The drugs that stress the pancreas to produce are the SULFONYLUREAS. What Met is known for is (1) helps to reduce insulin resistance in cells and (2) helps the insulin already being produced to do a better job.

However, it should be noted that it does it's job best when combined with a lower-carb intake. If I over-carb, I get the gastric side effects. Eat low carb as I normally do (less than 40g a day), and everything is fine.
 
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