Type 2 diabetes: Why insulin therapy is so difficult to manage

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So, your doctor told you that you need insulin therapy for your Type 2 diabetes. This is a common problem and likely to be more so in the coming years. About 29 million people in the U.S. have Type 2 diabetes, and another 86 million have prediabetes. About one in four people with Type 2 diabetes is on insulin therapy, and another one in four likely needs to be.
What does it mean to be on insulin therapy, exactly? And whose fault is it? Could you have prevented this? Will insulin actually work? These are frequent questions people who need insulin therapy ask, and, as someone who has treated people with diabetes for years and has been working to improve its effectiveness, I will do my best to help you answer these questions. I also have been working to develop a better way to personalize dosing for insulin.
Diabetes is a condition in which your pancreas fails to secrete a sufficient amount of insulin to help you to maintain normal blood glucose, or sugar in the blood, which is transported to various parts of our bodies to supply energy.
There are many causes of insulin deficiency, but the most common is Type 2 diabetes. The main risk factors for Type 2 diabetes are family history, weight and age.
In fact, most overweight or obese people in the Western world will never develop diabetes. Weight is a very important, yet misunderstood, risk factor for diabetes. The foods you eat are usually less relevant than the weight itself. The American Diabetes Association, for example, recommends that you limit the amount of sugary drinks you drink, including sodas, fruit punches and even sweet tea.
Further, most people in the world with Type 2 diabetes do not fulfill the diagnosis criteria of obesity; rather, their weight exceeds the capacity of their pancreas to maintain sufficient insulin secretion. Your pancreas may have less insulin-secreting capacity than your neighbor’s, making you more likely to get diabetes when you gain weight.
Type 2 diabetes is a progressive condition as, over time, the pancreas tends to secrete less and less insulin. In the early stages, when your pancreas can still secrete some level of insulin but not enough to maintain normal blood glucose, losing 5-10 percent of your body weight and more importantly, keeping that weight off, can slow the progression of your insulin deficiency. Even with weight loss, in the majority of cases, diabetes does eventually progress to the point where you will need to use medications.

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