Why Some Type 2 Diabetics Need Insulin: An In-Depth Analysis

People with type 2 diabetes often require medication to manage their condition, despite the pancreas's continued insulin production. Medications help by enhancing insulin sensitivity, improving insulin production, or reducing glucose production in the liver. However, these treatments are essential for managing blood glucose levels and preventing complications.

Understanding Type 2 Diabetes

It is crucial to know the basics of diabetes mellitus, particularly how the pancreas handles glucose. The pancreas only produces insulin, which aims to lower blood glucose when it rises after eating. However, cell membranes are not permeable to glucose, necessitating the use of glucose transporters, known as GLUT, which act like keys to allow glucose entry from blood to cells. Imagine your home (cell) as a supermarket (body) where you buy food (glucose).

In a healthy process, you store the food (glucose) in various places like pots and cupboards (muscle glycogen) and pantries (adipose tissue). However, if you have too much food, your pantry (adipose tissue) gets full, making it difficult to store more food. This situation reflects type 2 diabetes, where insulin is present in sufficient quantities but there is a slowdown in glucose absorption.

The Role of Insulin

Insulin acts as the key (GLUT4) that opens doors (glucose transporters) in muscle and adipose tissue cells, enabling the rapid entry of glucose. In type 1 diabetes, a complete lack of insulin leads to weight loss, ketoacidosis, and the loss of glucose and fats via urine. For this condition, exogenous insulin is necessary.

Type 2 diabetes, on the other hand, involves having too much insulin due to obesity. While insulin functions correctly, there is a delay in glucose absorption, which leads to excess circulating glucose being converted into fat by adipose tissue. This results in the accumulation of glucose and fats in the visceral adipose tissue and liver, increasing blood glucose levels post-meal.

Consequences of Persistently High Blood Glucose

Persistent hyperglycemia can have several detrimental effects:

Overloading the pancreas, which tries to produce more insulin, potentially leading to pancreatic failure and requiring insulin supplementation. Protein glycation, where higher glucose levels impair protein function, causing damage to various organs and tissues such as arteries, nerves, and kidneys. Increased blood pressure due to the high solubility of glucose, which raises the risk of vascular accidents such as strokes.

Treatment Approach

The primary goal of treatment should be to address the underlying causes, which are closely linked to obesity and a sedentary lifestyle. Reducing food intake and increasing physical activity can help achieve weight loss, which may lead to better results if around 15% of body weight is lost. Small, mixed meals and avoiding high-glycemic index foods can also aid in managing blood glucose levels.

Glycemic control is important but should not be the sole focus. Achieving sustainable weight loss can provide more substantial benefits and help improve overall health.