Is there U-turn from Insulin Back to Pills in Diabetes?
Sibel Ertek and Sevki Cetinkalp
Affiliation: Turkish Ministry of Health, Sanlıurfa Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, 63100 Esentepe, Sanlıurfa- Turkey.
Keywords: Amylin, beta cell, glucotoxicity, insulin, oral antidiabetics, type 2 diabetes.
Type 2 diabetes is characterized by insulin resistance together with progressive loss of beta-cell function. After
recognition of gluco- and lipo-toxicity, attention was focused on the preservation and/or restoration of beta cell function,
especially at the early stages of the diabetes, with better beta-cell reserve and in the absence of complications. Early
treatment of glucotoxicity with insulin was searched by early insulin treatment studies, and these studies have some promising
results, pointing the possibility of “remission” of diabetes in some patients. According to the results of these
studies, patients with early diagnosis of diabetes, the ones with better beta cell reserve, patients with low tendency for
“insulin-abuse” could make “U”-turn from insulin to pills or even drug-free life. Criteria to turn back to pills could be
listed as disappearance of diabetic symptoms, daily insulin need < 0.25 unit/kg, euglycemia in both fasting and postprandial
state, and better beta cell function. The main problems in early insulin treatment are the ‘’insulin resistance’’ of
both patients and doctors, hypoglycemia, weight gain and increased appetite. Meanwhile, hyperinsulinemia desensitizes
receptors and causes worsening of situation in a vicious cycle of insulin resistance and hyperglycemia. Therefore, patients
should be selected properly and U-turn could be performed in relevant conditions explained in the text. It could be possible
to see early insulin treatment and U-turn strategies in future guidelines for type 2 diabetes.
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