Why do some patients with Type 2 diabetes need insulin while not benefiting from a sulphonylurea?
Forty percent of patients with Type 2 diabetes will require insulin at some point in their lives. As Type 2 diabetes progresses, insulin secretion decreases, insulin resistance increases, and the beta cells of the pancreas, which have usually lost 50% of their function at time of diagnosis, progressively fail. This of course leads to the loss of glycaemic control with oral agents and the need for insulin. Guidelines recommend combination oral therapy with insulin and initiating insulin early, when HbA1c remains minimally elevated on maximal oral therapy and lifestyle modification. It may however be acceptable, based on risk/benefit and quality of life considerations, to allow older persons to run their HbA1c s a bit higher. Sulfonylureas lower blood glucose in patients with type 2 diabetes by directly stimulating the release of insulin from the beta cells of pancreatic islet tissue. Primary failure of sulfonylurea therapy may occur if beta-cell function becomes severely impaired. A sul
