Are Insulin Sensitizers Useful Additions to Insulin Therapy?

John W. Richard, Philip Raskin

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Patients with type 2 diabetes are often overweight and less insulin sensitive, making high doses of insulin necessary to control glucose levels. Because the weight gain associated with insulin therapy can impede therapy progress through worsening insulin sensitivity, insulin sensitizing agents have emerged as useful additions to insulin therapy. Metformin acts through suppression of hepatic glucose production, especially hepatic gluconeogenesis, and increased peripheral tissue insulin sensitivity. The addition of metformin to insulin therapy reduces hemoglobin A1c, total daily dose of insulin, and reduces or prevents the weight gain associated with insulin treatment. Thiazolidinediones (TZDs) act through PPARs to regulate gene expression and increase insulin-stimulated glucose uptake in peripheral tissues, hepatic insulin sensitivity, and insulin sensitivity in adipose tissue through suppression of fatty acid production. TZDs are effective additions to insulin therapy. Each agent must be considered carefully when adding to an insulin regimen.

Original languageEnglish (US)
Title of host publicationClinical Dilemmas in Diabetes
PublisherWiley-Blackwell
Pages79-90
Number of pages12
ISBN (Print)9781405169288
DOIs
StatePublished - Mar 31 2011

Keywords

  • Edema
  • Fracture
  • Gluconeogenesis
  • Heart failure
  • Hyper-triglyceridemia
  • Lactic acidosis
  • Metformin
  • Thiazolidinediones

ASJC Scopus subject areas

  • Medicine(all)

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