First let’s explain how glucose gets into your cell. When you eat carbohydrates your body releases insulin. The glucose transporters in the cell migrate to the cell’s surface in response to the insulin to transport the glucose into the cell. When you have type 2 diabetes the glucose transporters do not respond to the insulin signal which results in high levels of glucose circulating in your blood. Since your cells are not receiving glucose they are sending out a signal saying they need glucose for energy. Your liver then creates glucose and releases it into the bloodstream. Your pancreas also releases more insulin in response to higher glucose levels.

You now have high levels of insulin and high levels of glucose in your blood. If your cells aren’t taking in the glucose then your body will store it for later. Insulin is also a fat storing hormone. Insulin triggers the liver to release VLDLs – Very Low Density Lipoproteins that carry triglycerides and cholesterol. We store fat in the form of triglycerides. High levels of insulin will result in fatty liver disease. This is also the reason people taking insulin injections gain weight. Insulin makes our body store fat.

As we gain weight our fat storage cells called adipocytes or adipose tissue, create cytokines. These are hormones that regulate adipose tissue metabolism. Cytokines also cause inflammation in the body. Meanwhile, the high levels of circulating glucose are causing oxidative stress throughout the body.

Two popular medications prescribed are Metformin and Glyburide.

Metformin works by stimulating the glucose transporters to migrate to the cell’s surface allowing the glucose to enter. It also acts on the liver to decrease glucose production. Metformin is then cleared through the kidneys.

From MicroMedex: “Glyburide stimulates functioning pancreatic beta cells to produce insulin, reducing blood glucose. Although the blood glucose lowering effects of Glyburide continue during long-term administration despite a decline in the insulin production response, the mechanism has not been discovered. It is thought that extra-pancreatic effects may be involved.”

If you are insulin resistant why would you want even more insulin circulating in your blood?

Metformin lowers vitamin B12 absorption and also causes a folate deficiency. This in turn causes an increase in homocysteine in the body. Homocysteine is an inflammatory marker. A healthy homocysteine metabolism requires vitamin B6, vitamin B12, and folate.

If you decide to take medication make sure your doctor is monitoring your vitamin B12, folate, renal function (kidneys), hepatic function (liver), homocysteine, and C-reactive protein (inflammatory marker).

Or you can manage your Type 2 diabetes with diet.