NEJM

The New England Journal of Medicine publishes these papers, some free, some on subscription, and the abstracts are tantalising sometimes.

Optimal Insulin Treatment in Type 2 Diabetes

Michael Roden, M.D.

Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

Patients with type 2 diabetes have peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells. During meals, reduced first-phase insulin secretion results in postprandial hyperglycemia and in a 35% decrease in hepatic glycogen storage.1 A 55% increase in nocturnal hepatic gluconeogenesis drives excessive glucose production and fasting hyperglycemia.1 Ultimately, in 90% of patients with progressive beta-cell insufficiency, lifestyle changes and oral drug therapy are insufficient, and patients require exogenous insulin supplementation to achieve a glycated hemoglobin level below the recommended 7% target.

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I'm not going to pay for it 'cos I'm a stingy Scot and a T1. Mind you, even if I was a T2 with money to burn, I don't know if I'd be rushing to spend it on reading such dire predictions. If anyone has deep pockets and it turns out to be a low-carb recruiting tool, please let me know!

All the best,

fergus

Thank you, pheonix :?:
Two things come to mind with this.
Firstly, I think it's reasonably certain that exogenous basal insulin would benefit a great many type 2 diabetics who otherwise might struggle to maintain safe blood sugars. The hypoglycemic effect, combined with the lessened demand for endogenous insulin makes a great deal of sense in prolonging pancreatic function and reducing hyperglycemia. It may have little if any benefit in reducing hyperinsulinemia or insulin resistance, both of which may be as important for long term health, but that's another issue.
The second thing I suppose was what appeared to be the acceptance, in the link you posted, that diabetes was progressive and therefore exogenous insulin was largely inevitable anyway. While it may have some statistical truth in so far as that often appears to be the prognosis for many, it does tend to conflict with the experience of many here and elsewhere who seem to have stopped or even reversed this progression.
I'm not sure if that's what you mean by my 'purpose', but if so, I'll take it as a compliment.

All the best,

fergus