Understanding Type 2 Diabetes, Insulin and Medication Selection


Diabetes is complicated! If you’ve recently been diagnosed with type two diabetes, you’re probably feeling overwhelmed, but please remember that you’re not alone! This article helps you to understand your diagnosis of type two diabetes, the role of insulin in maintaining proper blood sugar levels, and the best way to select medications that lower your A1C and help you lose weight.

Everything about type two diabetes has to do with the effective use of insulin. “Type two diabetes” essentially means that your body isn’t producing enough insulin or isn’t using insulin properly. By the time a person is officially diagnosed with type two diabetes, their body has probably been losing its insulin function or decreasing its insulin supply for a long time, so your doctors will work with you to help preserve as much pancreatic beta function as possible, thereby allowing you to postpone the use of insulin for as long as possible.

Insulin is a very important hormone that is made in and secreted from your pancreas. Insulin has the “power” to “open the door” to your cells and allow glucose (your body’s main form of energy) to enter into the cells and supply them with energy. If your body’s insulin isn’t functioning properly, then the “door” to your body’s cells won’t open up to let the glucose enter. Without glucose, your cells won’t get the energy they need to function properly. Many people refer to insulin as a “key” to the cells, and without this “key” the glucose will remain waiting, forming a crowd, outside of the cells since there’s no other way for glucose to get inside the cells except for through the locked door.

When the glucose (mostly coming into your body from the food you eat) gathers outside of cells in your blood stream, it gets hectic (imagine a swarm of students in the hallways of a school with no one to let them inside their classrooms where they function best!) and results in hyperglycemia. People with type two diabetes run the risk of having complications with high blood sugar – too much glucose in the blood stream due to lack of insulin function or insulin resistance. Low blood sugar, hypoglycemia, is also a serious concern for people with type two diabetes because your body needs energy to function properly. In short, insulin helps your body regulate its blood sugar levels and energy levels by allowing glucose to enter cells – either to be converted into ATP and used immediately as energy, or to be stored for later use.

Insulin is produced by the pancreatic beta cells. At the time of diagnosis, your insulin levels and function may be “normal,” but over time, your beta cell function may decrease. So, when it comes to treatment options for type two diabetes, insulin is not the enemy! It might be a very appropriate, efficient, effective treatment option to help your blood sugar remain “normal” and to help your cells receive the energy they need! Also, with the incredibly small needles available today, don’t let “needle phobia” prevent you from receiving the insulin you may need as the needles are relatively painless.

If you’d prefer other treatment options to insulin, you’re in luck – there is an immense number of medications that help lower your blood sugar levels. Keeping track of the generic medications, name-brand medications, or even the different classes of drugs can be daunting. I recommend learning about the main pathophysiological defects of type two diabetes and then talking with your doctor about which area of the body you’d like to focus on improving in order to lower your blood sugar levels. The eight core pathophysiological defects of type two diabetes are:

1. Decrease in incretin effect
2. Increased lipolysis
3. Increased glucose reabsorption
4. Decreased glucose uptake
5. Neurotransmitter disfunction
6. Increased hepatic glucose production
7. Increased glucagon secretion
8. Impaired insulin secretion

Write down these core defects. By learning these eight defects and selecting medications based on which core diabetes defect(s) the medication addresses, you will save yourself from having to learn hundreds of oral treatment options for type two diabetes. When you visit your doctor, ask him/her which medications will give you the biggest bang for your buck – which medications can simultaneously control multiple core defects of type two diabetes? Which oral medications work in multiple ways to control blood sugar levels? With your current treatment regime, are there any of these eight core defects that your medications aren’t addressing? Ask your doctor to ensure that he/she informs you on the best medications that address all of these core defects. Combination pills are available to help you control multiple core defects in the convenience of one pill. One medication that only addresses one diabetic defect is insufficient; to truly control type two diabetes, you cannot ignore any of these pathophysiologic defects.

When you present your provider with the list of eight pathophysiological defects that you’d like to “rectify,” he/she will be impressed with your scientific knowledge, your personal research, and your interest in improving your health. Also, your provider can help you to understand why each of these defects are so important to address. Similar to the lifestyle advice your diabetes educator has given you – eat right, exercise, sleep well, laugh a lot, etc. – it’s not a single lifestyle change or single medication that will control your blood sugar levels. Multiple mechanisms of action working together in the body will create the best results for proper blood sugar regulation. Teamwork always wins 🙂

One final piece of advice for living well with type two diabetes – take advantage of the medications that can help you to lose weight as an additional benefit to improving glycemic control. Medications in the GLP-1 receptor agonist class and the SGLT-2 inhibitors class both have secondary endpoints in their clinical trials that show significant weight loss for persons living with diabetes taking these types of medication. Your doctor may receive free samples from drug companies, ask your doctor to try one of these medications that offers weight loss as a secondary benefit, in addition to significantly reducing your blood sugar levels.

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