Why Insulin in Type 2 DM?
Why is Insulin used in Type 2 Diabetes Mellitus?
Let's begin with the basics on how Insulin works:
TYPES OF DIABETES MELLITUS
TYPE 1 DIABETES MELLITUS
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TYPE 2 DIABETES MELLITUS
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Commonly 2nd and 3rd decades of life
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Commonly 6th and 7th decades of life
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Caused by autoimmune destruction of pancreatic beta cells
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Caused by insulin resistance at peripheral adipose and muscle tissues
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Insulin levels- Decreased
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Insulin levels- increased
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Based on the common differences between the two entities, it would seem that the mainstay of treatment for Type 1 DM is insulin (which it is) and that for Type 2 DM would be anything other than insulin ( given the already elevated insulin levels).
Conventional treatment of Type II Diabetes Mellitus starts with:
1.Lifestyle modifications - Exercise, eating healthy, decreased consumption of alcohol and tobacco.
2.Oral hypoglycemics – some of which decrease insulin resistance and some of which increase pancreatic secretion of insulin.
3.Insulin
1.Lifestyle modifications - Exercise, eating healthy, decreased consumption of alcohol and tobacco.
2.Oral hypoglycemics – some of which decrease insulin resistance and some of which increase pancreatic secretion of insulin.
3.Insulin
Now answering your specific question:
Why is Insulin used in Type 2 Diabetes Mellitus?
This can also be paraphrased to – why are oral hypoglycemics such as sulfonylureas (which increase pancreatic secretion of insulin), used in Type 2 DM, given that there’s already increased insulin levels within the body??
The answer to this question is not simple but stems from research-hypothesized theories of the pathophysiology of Type 2 DM.
The pathophysiology of type 2 DM is more complex than it appears. Multiple studies done on Pima Indians[1] [2] (a group of Native Americans living in an area consisting of what is now central and southern Arizona, known to be the most genetically predisposed race to Type 2 Diabetes Mellitus) , illustrate the complex pathophysiology of Type 2 DM. The entire spectrum of pathophysiology appears to be based of the image given below.
As is evident from the diagram, the pathophysiology of Type 2 DM in its it's most severe stage involves a failure of beta- pancreatic cells which causes a net insulin deficit in the body, (this stage was prevalent in Pima Indians.) Thus arises the need for insulin and insulin secreting hypoglycemics in type 2 DM
![Image result for paTHOPHYSIOLOGY OF dm TYPE 2](https://lh5.googleusercontent.com/ETJB-wXvRkNfgr8EBl-JRxyngsN5ARdfPvaVgufN0x7I1jTo0gufDCXvRZrXAYlg8wqFzkceux2MUlz415i0Ckbn9__jpE1Aa8PqGFn5BGug5xzBe8H6fRxMO_Np0pRcGCw9GhGQle7FdSd8_A)
By Dr Jason D'Cruz
By Dr Jason D'Cruz
References:
1)Weyer C, Bogardus C, Mott DM, Pratley RE
The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest 1999; 104:787–794pmid:10491414
Baier LJ, Hanson RL
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