The Denver Gazette

ADVICE Dear Dr. Roach:

Email to ToYourGoodHealth@med.cornell.edu.

About 15 years ago I was diagnosed with Type 2 diabetes, and began years of increasing numbers of medications and higher doses, until all but one is maxed out. The Jardiance, metformin and Rybelsus I take are at their max doses, and the Tresiba is close. About six months ago, my doctor decided to find out how much insulin my body makes. It turns out I make adequate insulin but I’m insulin resistant. I can find little about this. My BMI is north of 40. Of course, I know I need to lose weight but have not been successful at it. — N.V.P.

Answer: Type 2 diabetes is a disease of insulin resistance. Most people with Type 2 diabetes, at least early on in the disease, are able to make normal amounts of insulin; in fact, insulin levels tend to be higher than normal, because of the resistance to insulin. However, people with Type 2 eventually are unable to make insulin fast enough to bring the blood sugar down, especially after a meal. This combination of insulin resistance and inability to quickly make large amounts of insulin causes the blood sugar to rise.

Your doctor has you on four medicines to try to help bring your blood sugar down. Empagliflozin (Jardiance) works by preventing your kidneys from absorbing all the blood glucose, so you literally lose blood sugar into the urine. Metformin works predominantly by preventing the liver from making sugar. Both of these therapies reduce the amount of insulin your body needs to make.

Semaglutide (Rybelsus and others) blocks a protein called GLP-1. This has several effects, including increasing insulin secretion. Degludec insulin (Tresiba) is an ultra-long-acting insulin. Insulin can be prescribed at very high levels if needed.

There is a class of drugs you are NOT taking. This class (the TZDs, such as pioglitazone) works primarily by reducing insulin resistance. They are not often prescribed due to concerns about heart failure. Honestly, I am not sure more medication is right for you. Even a moderate increase in your exercise combined with a little less food (especially less sugars/starch) will have a significant impact on your blood sugar.

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2021-10-21T07:00:00.0000000Z

2021-10-21T07:00:00.0000000Z

https://daily.denvergazette.com/article/282432762354142

The Gazette, Colorado Springs