Type 2 no Insulin Type 2 on Insulin

Why pills before insulin?

There is a medical term called pleotrophic effects.  It means other benefits than the ones listed.  For example, let’s talk about metformin.

Metformin lower sugars and is used for diabetes.  But, how does it really work?  How does it lower sugars?  Well, we can say intelligent things like, it decreases gluconeogeneis in the liver, lower insulin resistance all over the body, blah blah blah.  So, it does those exact things and it lower sugars.  However…..there is more to the story.

Metformin also improves lipids, a little.  It decreases inflammatory markers that lead to heart disease.  Well, hold on a second, then why don’t we use this medication for heart attack prevention or use it to lower cholesterol?

Because these are the pleotrophic effects.  These effects are not 100% proven via clinical trials, but we have so much data that we physicians know that this is part of the reason why we use metformin first line in diabetes.

Most medications have these extra effects, we just don’t know about them.  Some maybe good and others maybe bad, but we are learning.

This is why when we choose a medication or a medication class, we factor all of these things into our decision.  Well, the good endocrinologists do anyway.  Some may make their decisions on other factors like cost, less hassles of phone calls, time with patient, etc…

Insulin is at the other extreme.  It probably has the least positive pleotrophic effects and some negative effects, so we use it last in our treatment plan.  Insulin causes weight gain.  No benefits for lipids, heart disease, etc… Just the benefits of lower sugars and the benefits that go along with that.

Another close medication to insulin is the sulfonaureas.  These are the same as insulin, not much positive pleotrophic effects and just negative side effects.  They do lower sugars, but that’s about it.  They do cause weight gain.

So, next time you see your doctor, make sure all of these are factored in and ask why you are taking these medications and not others.

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