Why does type 2 diabetes medication stop working? What to do?

By: Dr. Sarah Brewer

December 10, 2020

Everyone with type 2 diabetes has a different experience. Some find it relatively easy to keep their blood glucose levels within the ‘normal’ range, while others struggle to maintain good control despite adding in more medications. This difference is partly due to your diet and lifestyle and partly due to the genes you have inherited. In many cases, it also depends on
your weight as obesity accounts for 80–85% of the overall risk of developing type 2 diabetes. 1  

Weight loss can improve how your medication works
When you are overweight, fat builds up in your liver, causing it to produce too much glucose. 2 Excess fat also spills over from your liver to your pancreas where it accumulates and switches off the genes that regulate insulin production. This process, dubbed the Twin Cycle Hypothesis by Professor Roy Taylor of Newcastle University, is now believed to trigger type 2 diabetes. 3 Losing excess fat can greatly improve your insulin production and help other body cells – especially muscle cells – to become less resistant to its effects so your glucose control improves.

If your diabetes medication is not working as well as you would like, and you are overweight, losing at least some excess fat will help to improve the situation.

In the Diabetes Remission Clinical trial (DiRECT), 306 people with type 2 diabetes (who were on medication but not on insulin) were asked to follow a strict diet (825–853 kcal/day formula) for 3–5 months. 4 This was followed by a 2–8 week gradual food reintroduction period and then a long-term weight loss maintenance program. As blood glucose and blood pressure readings improved, their antidiabetic and antihypertensive drugs were tailed off
under medical supervision. At the start of the study, the average weight of participants was 223 lbs (101 kg). After twelve months:

  •  None of those who gained weight during the study achieved remission of their type 2 diabetes
  • 7% of those who lost 0-11 lbs (0-5 kg), achieved remission and had stopped all their antidiabetes drugs
  • 34% of those who lost 11-22 lbs (5-10 kg) achieved remission
  • 57% of those who lost 22-33 lbs (10-15 kg) achieved remission
  • 86% of those who lost 33 lbs (15kg) or more achieved remission.

Overall, almost half of participants achieved remission to a non-diabetic state, 73% stopped taking all their antidiabetes drugs, 17.6% needed just one diabetes drug and only 8.8% still needed two or more antidiabetes medications. This approach also resulted in 68% remaining off their antihypertensive drugs at 12 months.

So, if your medication isn’t working and you are overweight, the best thing you can do is to ask your doctor for support in following a weight loss diet. There appears to be a window of up to 10 years from developing type 2 diabetes during which weight loss can reverse the condition. After this time, damage to insulin-secreting beta cells caused by the build-up of fat
may become permanent. 5

Never stop taking any prescribed medication without the permission and supervision of your doctor.

What’s the best diet?

To improve 2 diabetes control, avoid high- glycaemic-index (GI) foods whose carbohydrates are broken down quickly to cause a rapid increase in blood glucose levels, such as sugary snacks and drinks, white rice, white bread and potatoes.

Include plenty of high-fibre, low-GI sources of carbohydrate such as fruit, vegetables, wholegrains and pulses, as well as low-fat dairy products, oily fish, lean meat, eggs, nuts, seeds and healthy fats such as olive oil.

Protein-rich foods have a powerful satiety effect, triggering the release of intestinal hormones that make you feel full for longer. Protein also stimulates your metabolic rate so you release more energy as heat. In fact, an astonishing 25% to 30% of the energy derived from eating protein is lost as heat during its metabolism, compared with 6% to 8% of the energy derived
from eating carbohydrates and 2% to 3% of the energy derived from eating fats. 6 These two effects mean that a higher protein, lower carbohydrate diet is increasingly recommended to help combat overweight and obesity.

Before making any dramatic changes to your diet, talk to your doctor so they can monitor your need for medication as your weight comes down.

Exercise can improve how your medication works

Exercise stimulates your metabolism, burns more glucose as fuel and improves insulin resistance. Aim for a minimum of 150 minutes (2.5 hours) of moderate intensity physical activity (such as brisk walking, cycling dancing or gardening) throughout the week, in bouts of 10 minutes or more. As you get fit, aim to do more – ideally the equivalent of an hour’s brisk walking on most days.

Spend less time sitting down – have walking meetings and use a standing desk to help you become less sedentary.

If you are on medication, ask your doctor’s advice on how increased physical activity might affect your blood glucose levels.

Where do natural approaches fit in?

Before prescribing any medicines for type 2 diabetes, your doctor may, where appropriate, give you the chance to improve your glucose control using diet and lifestyle changes alone. You can find out how people with type 2 diabetes are getting their glucose under control in the Winning Type 2 Diabetes Together group on Facebook.

1) https://cks.nice.org.uk/topics/diabetes-type-2/background-information/risk-factors/
2) https://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/
3) https://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible
and https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30662-X
4) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2817%2933102-1/fulltext?elsca1=tlpr
5) https://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible
6) https://www.ncbi.nlm.nih.gov/pubmed/12174324?dopt=Abstract

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