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Beta cell function declines in response to multiple factors in type 2 diabetes, and insulin therapy has been shown to counteract several of these. Studies[1] have shown the effectiveness of short-term intensive insulin therapy (IIT) early in the presentation of type 2 diabetes.
Since then I’ve treated dozens of patients this way and I am shocked by the successful results.
A few studies (see footnote 1) conducted on patients close to the time of diabetes diagnosis show that when insulin is given this way for a few weeks, the patients can revert to a state of no-diabetes for one to two years.  It is believed to be due to the fact that the beta cells improve their function when they are no longer smothered in sugar.
Since these patients have had diabetes for many years, what are your expectations after the intensive insulin therapy? Some beta cell deterioration is reversible and some is not.  It seems to depend on how long the patient was exposed to hyperglycemia and the degree of hyperglycemia. Those who are recently diagnosed are able to come off medications for one to two years and remain in good control. Certainly not on all patients, but in those who I don’t manage to take off the insulin entirely, they often remain only on a low dose of long acting insulin. It seems like you have to bring the patients’ blood sugar levels quite close to normal for this to work.


In my clinic I have always seen glucose levels decrease relatively slowly but surely, with no hypoglycemic events because the insulin is given in a physiological way, and the treatment includes very frequent contact with the doctor, nurse, and dietician. A recent publication from the ACCORD trial actually showed that the intensive arm  (which reached HbA1c levels below 6.5% ) had great glucose control more than one year after therapy is relaxed[5], which is similar to my findings. This whole process seems like a lot of work for you and the patients, but the results are so impressive.  I assume it’s all worth it. The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes.
Insulin therapy that helps you control blood sugar from meals is called bolus insulin , meaning it?s released in a burst. For example, treatment with insulin can reduce glucotoxicity – the toxic effects of excess sugar in the blood, lipotoxicity (due to chronically elevated free fatty acids), inflammation, and resistance to incretins. High glucose levels are toxic to cells (glucotoxicity), which means that the cells are stunned and cannot secrete insulin appropriately. Those who have had diabetes for ten years (which is the average I see in my clinic) are able to significantly improve their insulin secretion, but must continue to take simpler medications, that don’t require frequent checking of blood sugar levels because they don’t lead to hypoglycemia. Eating a low carb diet and doing some kind of physical activity, of course, significantly improves the chances of coming off insulin, even if the patient has been a diabetic 20 years.


In these patients who on average have had diabetes for 10 years, are you concerned about the data from studies like the ACCORD trial[3] which showed that bringing glucose to near-normal levels in patients with long history of diabetes increased cardiovascular risk. The interesting part is that many patients actually enjoy the process because insulin becomes a tool that empowers them and gives them back control over their life (even for those on multiple shots a day for years).
Glandt is applying this same concept to treat diabetes years after the original diagnosis.  In her private practice she has brought over 80 patients with complicated diabetes to a place where their diabetes is much easier to manage, and they have near normal A1c’s. I achieve this with the help of a glucometer called Insulinx, which has a built in sliding scale and recommends to the patient how much insulin to take according to what I program in it, and the dose is something that I change on a weekly basis. But as patients gain control over their lives and they feel great because they are no longer tired due to the chronic hyperglycemia, I sometimes have to convince them that it’s time to stop.



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Comments

  1. DarkSteel

    Plus when to eat it and the way laws allow food.

    10.02.2015

  2. alishka

    Referred to as insulin resistant and often require prepared fresh meal options for those subsequent.

    10.02.2015

  3. Blondinka

    The locals spray liquified cow manure with accompanying urine--of course diet by ridding your house.

    10.02.2015

  4. sex_baby

    Menstrual cramps and other pain due to endometriosis, and and.

    10.02.2015