Thank you for the links Modo.

I noticed that they said that high insulin levels are very bad but they ignore the fact that insulin levels have been high in someone with type 2 diabetes because of elevated blood glucose levels. The effect of having high levels of blood glucose, which are ameliorated by exogenous insulin, causes glucotoxicity through oxidative stress of lowering blood glucose levels quickly.

The supposed studies also looked at the elderly and not younger active people. They also did not mention the type of insulin and how good their glucose control is. If they took something like NPH or mixed once or twice a day then they would probably have horrendous unpredictable control.

The idea is to use the new insulins in multi-dose therapy. A background dose is taken to keep a stable level of insulin all day long, while carbs are counted and a rapid acting like aspart is taken before eating. This is the best way to have tight glucose control without using a pump and an interstitial monitor.

This is the method that is indicated. Obviously there is a lot of teaching needed and the individual must have a supreme commitment to tight control. Many people think that taking a needle is worse than taking a pill. So if they can take a few pills in the morning and a few pills at night they will usually opt for metformin because of the lack of commitment needed. So if insulin is to be the best choice there is a huge commitment that must be made if they take MDI.

The idea behind taking insulin is to take it so you keep your glucose levels within a certain range all the time. This also requires lifestyle changes, such as diet and exercise to increase insulin sensitivity so there is not the dilemma of taking buckets of insulin to bring down massive spikes. A big part of how diabetics are injured through their disease is through large blood glucose excursions. The oxidative stress, caused by reducing glucose levels quickly, is detrimental.

So using massive amounts of insulin and not modifying food and lifestyle habits is detrimental. Anyone can bring their glucose down from whatever it may be by adding more insulin. In the end this adds weight (fat).

Like you said type 2 is a complicated disease that affects individuals and addressing must be done tailored to the individuals. Many concepts are the same, to successfully stay healthy the concepts must be framed within the individual's context to be successful.


I see you may be set against insulin, but the knowledge of type 2 diabetes has progressed, and is progressing very fast; it is now known that insulin near the time of diagnosis has showed better results than traditional therapies used along with lifestyle intervention.

I know that metformin is the oldest and safest oral anti-diabetic, which has many more benefits than people know about. I know it is easy on the pancreas because unlike sulfonylureas, biguanides do not cause the pancreas to secrete insulin they work by increasing sensitivity and on the liver.

So although in theory insulin is the best choice there is too much variability when dealing with individuals whether they have the commitment to deal with the disease.

In relation to the OP. He needs to discuss with his diabetes team what is the best choice for him and what he is willing to do. Metformin may be his best choice, or maybe an intensive insulin regimen. Maybe his diet is crap and the guidance of the dietitian may solve all his problems. The fact that he bikes will help him have that much more control over diabetes.