Type 2 diabetes is a chronic metabolic disorder characterized by hyperglycemia or high blood sugar levels. It is caused by a combination of genetic and lifestyle factors such as obesity, sedentary lifestyle, and poor dietary choices. One of the key features of type 2 diabetes is insulin resistance, which is the inability of cells to respond to insulin properly. In this article, we will explore why insulin resistance occurs in type 2 diabetes, how it can be measured, and why insulin injections may not be effective for patients with hyperinsulinemia. We will also examine the side-effects of insulin injections and how some oral anti-diabetic medications can help to reduce insulin resistance.
Case Study: Managing Type 2 Diabetes without Insulin
The case of Mrs. Shobha (name changed), a 55-year-old female, is a prime example of how type 2 diabetes can be managed without the need for insulin injections. Mrs. Shobha was diagnosed with type 2 diabetes in 2004, during a gallbladder surgery. She initially started taking oral medication to control her blood sugar levels, but eventually had to switch to insulin injections (Human Mixtard) as her diabetes progressed.
Despite taking all necessary precautions, her insulin doses kept increasing, and by 2014, she was taking almost 110 units of insulin per day. However, she started developing acute pain in his belly area due to excessive insulin injection. She visited several renowned hospitals but nothing seemed to work. It was only in August 2017 when she was referred to Dr. Anirban Biswas that her condition started improving.
Dr. Biswas conducted a C-peptide test to determine the functioning of her pancreas and used Free Style Libra Gluco proximity sensor on her arm for monitoring glucose variation 24X7 for 15 days. The C-peptide test confirmed that her pancreas was functioning well and secreting enough insulin within the body. However, her body was not absorbing the insulin, and the glucose intake was not being utilized by her body tissues and was being mixed in her blood.
Dr. Biswas took various measures to control self-generated insulin, extract extra glucose out of her body through medication, and reduce her external insulin intake to zero within 4 months. Today, Mrs. Shobha's diabetes is well-controlled by oral medication only.
Managing type 2 diabetes without the need for insulin injections requires a thorough understanding of an individual's health condition. It involves making lifestyle changes, such as a healthy diet and regular exercise, and taking medication as prescribed by a physician. Additionally, it is important to regularly monitor blood sugar levels to make necessary adjustments to the treatment plan. The case of Mrs. Shobha is a prime example of how proper diagnosis and treatment can help manage type 2 diabetes without the need for insulin injections. It is important to consult with a healthcare professional before making any changes to your treatment plan.
Why is there insulin resistance in type 2 diabetes?
Insulin is a hormone produced by the pancreas that helps to regulate blood sugar levels by allowing glucose to enter cells to be used as energy. However, in type 2 diabetes, cells become resistant to insulin, which means that glucose is unable to enter cells efficiently. This causes glucose to build up in the bloodstream, leading to high blood sugar levels. There are several factors that contribute to insulin resistance in type 2 diabetes. One of the main factors is obesity, which is associated with chronic low-grade inflammation that can interfere with insulin signaling pathways. Other factors include aging, genetics, physical inactivity, and poor dietary choices, particularly those high in refined carbohydrates and saturated fats.
How can insulin resistance be measured?
Insulin resistance can be measured using a variety of methods, including fasting insulin levels, C-peptide, HOMA-IR (homeostatic model assessment of insulin resistance), and euglycemic clamp studies. Fasting insulin levels are typically measured after an overnight fast. Higher fasting insulin levels indicate insulin resistance.
C-peptide is a protein that is produced in the pancreas when insulin is created from proinsulin. In individuals with insulin resistance, the pancreas may produce more insulin to overcome the resistance. As a result, C-peptide levels may be higher than normal in individuals with insulin resistance. HOMA-IR is a calculation that takes into account fasting insulin and glucose levels. It is a simple and inexpensive method for assessing insulin resistance. Euglycemic clamp studies are considered the gold standard for measuring insulin resistance. This method involves infusing insulin into the bloodstream at a constant rate while glucose levels are maintained at a constant level.
Why are insulin injections not very effective in patients with hyperinsulinemia?
Insulin injections are commonly used to treat type 2 diabetes when other treatments such as lifestyle modifications and oral medications are not effective. However, in patients with hyperinsulinemia, insulin injections may not be effective in controlling blood sugar levels. Hyperinsulinemia is a condition in which the body produces too much insulin in response to high blood sugar levels. This can occur in patients with insulin resistance, as the body tries to compensate for the reduced effectiveness of insulin by producing more of it. However, excess insulin can cause a range of side effects, including weight gain, hypoglycemia, and insulin resistance. In patients with hyperinsulinemia, insulin injections may lead to further insulin resistance and worsen the condition. Additionally, insulin injections can cause weight gain, which can further exacerbate insulin resistance.
What are the side-effects of insulin injections?
Insulin injections can cause a range of side effects, including hypoglycemia, weight gain, and injection site reactions.
1. Hypoglycemia, or low blood sugar, can occur if too much insulin is injected or if a meal is skipped or delayed. Symptoms of hypoglycemia include shakiness, sweating, confusion, and dizziness. 2. Weight gain is a common side effect of insulin injections, as excess insulin can cause the body to store more fat. This can lead to further insulin resistance and make it more difficult to control blood sugar levels. 3. Injection site reactions such as redness, swelling, and itching can also occur. These reactions are usually mild and resolve within a few days.
How can oral anti-diabetic medications reduce insulin resistance?
1. Metformin:
Metformin is a commonly prescribed oral anti-diabetic medication that can help reduce insulin resistance in type 2 diabetes. It works by reducing glucose production in the liver and improving glucose uptake and utilization in muscle and adipose tissue. Metformin is usually the first-line medication for the treatment of type 2 diabetes, and it is often used in combination with other drugs to achieve optimal glycemic control. In addition to its glucose-lowering effects, metformin has been shown to have other beneficial effects on health, such as reducing the risk of cardiovascular disease and certain cancers.
2. Pioglitazone:
Another group of medications that are commonly used to treat insulin resistance in type 2 diabetes are the thiazolidinediones, or TZDs. These drugs work by increasing the sensitivity of muscle, liver, and adipose tissue to insulin, leading to improved glucose uptake and utilization. TZDs are often used in combination with other oral anti-diabetic agents to achieve optimal glycemic control. Commonly prescribed TZDs include pioglitazone and rosiglitazone.
3. GLP -1 Agonists:
Other medications that can help reduce insulin resistance in type 2 diabetes include GLP-1 receptor agonists, which stimulate insulin secretion and decrease glucagon secretion, leading to improved glucose control. Examples of GLP-1 receptor agonists include liraglutide, exenatide, and dulaglutide. These drugs are usually given by injection once or twice daily. Now, there is an oral drug semaglutide in this group which can be taken once daily.
4.DPP-4 inhibitors :
DPP-4 inhibitors are another class of oral anti-diabetic agents that can help reduce insulin resistance. These drugs work by blocking the action of an enzyme that breaks down GLP-1, leading to increased levels of GLP-1 and improved glucose control. Examples of DPP-4 inhibitors include sitagliptin, vildagliptin, and linagliptin.
In conclusion, insulin resistance is a major contributor to the development of type 2 diabetes, and it can lead to serious complications if left untreated. Insulin injections are not very effective in patients with hyperinsulinemia, and they can have some side effects. However, there are several oral anti-diabetic medications that can help reduce insulin resistance and improve glycemic control. These drugs should be used in combination with lifestyle modifications, such as diet and exercise, to achieve optimal health outcomes. Patients with type 2 diabetes should work closely with their healthcare provider to develop a personalized treatment plan that meets their individual needs and preferences.
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