Different physicians have different approaches to treating type 2 diabetes, but here's a common approach.
You're diagnosed, and you're overweight, so the doctor tells you to try to lose some weight and come back in three weeks, or three months, because the doctor says weight loss will improve your blood glucose (BG) levels.
Of course, you've most likely been trying to lose weight most of your life, without great success, so you come back and you haven't lost weight, and your BG levels are still too high. The doctor isn't pleased and puts you on oral medications and tells you to watch your diet and come back in three weeks, or three months.
At the next visit, you probably still haven't lost much weight, especially if the doctor prescribed sulfonylureas, which tend to cause weight gain. In fact you may have gained, and your BG levels are still too high. At this point you'll probably get a lecture telling you that if you don't take this thing seriously, the doctor will have to put you on insulin.
Insulin is often seen as a last resort.
Recently, Chinese researchers reported that short-term intensive insulin therapy immediately after the diagnosis of type 2 diabetes could produce extended remission and improve beta cell function.
The popular diabetes press and the blogosphere went into feeding-frenzy mode, reporting the news as a breakthrough that seemed to run counter to current treatment guidelines: using insulin as a first-line treatment rather than as a last resort.
Yet this is not really anything new. In 1997, a Turkish group made a similar report. In 2003, a Korean group did the same. And in 2004, a Chinese group reported that the induction of long-term glycemic control in newly diagnosed type 2 diabetic patients was associated with improvement of beta-cell function.
A 1988 study showed that even in type 2 patients who had years of poor control, normalizing BG levels by continuous subcutaneous insulin injections improved insulin secretion and even resulted in a small first phase insulin response. For several months after the treatment, some of the patients could be well controlled with oral drugs
Other studies have shown that even in type 1 patients, short-term normalization of blood glucose levels can result in improved control up to a year later. In fact, in the late 1970s, researchers developed a bulky artificial pancreas called the Biostator and used it to maintain normal BG levels for a few days to facilitate this type of study.
When I was first diagnosed in 1996, I went to the library and ordered a book called "Insulin," edited by F. M. and S. J. H. Ashcroft. The book was published in 1992, so it was probably mostly written in 1991 or even a bit earlier. The conclusion of the author of the last chapter, Erol Cerasi, was as follows:
"Present therapeutic approaches, based on initial dietary restriction followed after a period of up to several months by oral antidiabetic agents, seem rather unsuited to this purpose [breaking the vicious cycles of hyperglycemia and insulin resistance]. I propose initial, short-term (one to a few weeks) intensified insulin treatment aimed at achieving euglycemia very rapidly, in order to block down-regulation of glucose transport and improve beta-cell function."
