Insulin would be okay, but would take much adjusting for a T2.  Theres
always the risk of a hypo though not very often for a T2.  Then you have
the problem of needing more insulin to combat the IR which in turn causes
weight gain.  Then you have the cost of the insulin itself.  You could use
Regular but you need to take that 30mins prior to eating and it's not very
fast acting.

good luck

RK,t1 pumper

"Some patients lose their responsiveness to sulfonylurea" means exactly what
you thought.     When too many beta cells die,  none of the  pills can force
the remaining fraction to produce enough insulin.

One of the leading theories of T2 cause is that you have a genetic defect
which causes the premature death of your beta cells at a rate which is tied
to the amount of insulin you ask them to produce.    Your best chance of
keeping beta cells alive is to take the load off them.   Beta cell
stimulants tend to increase the load.   If you want to protect them,  you
want to supplement your natural supply with injected insulin and otherwise
cut the load by reducing your Insulin Resistance   (BTW:  High I.R.
increases heart attack risk so don't ease off in your fight against it just
because your sugars start to look good).

Insulin injections are tricky but a T2-still-making-his-own-insulin can
expect to be able to avoid hypos.     Folks like me have to inject exactly
as much insulin as we need lest we go high.   A little mistake in guessing
the dose can send us low really fast.   That's the kind of insulin therapy
you are trying to avoid when you remark on beta cell burn out causing
insulin dependence.

When "supplementing",  folks in your present situation deliberately shoot
less insulin than they need and rely on their beta cells to make up the
shortfall.   That takes the load off the beta cells while doing much to
avoid hypos.

You didn't mention Symlin which is really aimed at folks using insulin right
now but also is expected to be used by T2 in the future.   It does not act
to increase insulin supplies but still helps a lot with after-eating sugars,
and also works to cut appetite.   Most users report weight loss.

Note that there is some evidence that T2 have a beta cell repair mechanism
operating.   Their actual problem is that the death rate is greater than the
repair rate so they suffer a net loss of beta cells.   High Insulin
Resistance amplifies this imbalance.  If you really wipe out your Insulin
Resistance,   there are clinical trials which suggest that you start
rebuilding your supply instead of watching it slowly decrease.   Insulin
supplementation is thought to have the same effect.

Citation for Insulin supplementation helping with beta cell burnout:

Take the test at

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2867

,    pick answer "8",   read the explanation which represents clinical proof
that insulin injections protect beta cells.

Sorry for the awkward format but I can't locate a direct cite for Dr.
Reaven's work.

FWIW,  Uncle Enrico went through this logic process some time ago;  picked
insulin,  and is quite happy with his choice,  i.e.

" . . . From: Uncle Enrico <Uncle@nospam.com>
Newsgroups: alt.support.diabetes
Date: Sunday, June 05, 2005 12:45 AM
Subject: Re: Need comments from the group.

I was on your same dosage of Glipizide for several years and had two or
three hypos a week, particularly with exercise. I always had to carry
glucose tabs. I gained weight with Glipizide and often had ruined exercise
outings because of the hypos. The effect of Glipizide seemed to be a little
too unpredictable, no matter how closely I monitored things.

Then, a well-respected endo visited my diabetes support group and told  me
and others that Glipizide and other sulfonylureas had these
characteristics--weight gain and hypos. She said she preferred beginning
with insulin sensitizers like Metformin/Glucophage, and then only going to
insulin pushers like Glipizide if diet, exercise and Metformin didn't work.

I soon began taking Metformin,  went on a strict slow carb/low carb diet,
along with 1 to 2 hours of daily exercise, gradually reduced my Glipizide to
a very small amount, 1.25 mg a day, as I lost 45 pounds in 10 months.
Despite the small amount of Glipizide, I still got hypos.

I did some research into the benefits of "early insulin therapy," discussed
it with my doctor, and am now taking a small dose of insulin in the morning
only, to deal with my dawn phenomenon. I've eliminated the Glipizide and am
keeping my weight down. My last A1C before going on the insulin, and while
still taking 1.25 mg. of Glipizide was a 5.3. The insulin has improved my
morning and afternoon numbers, so I'm expecting a better A1C on the next
test.  I have had absolutely no hypos with the small dose of insulin I take
each morning.

All the professionals I've talked to, my doctor, 1 endo and 2 diabetes
educators, believe that I'm on the right path. A Dr. Richard K. Bernstein,
M.D. has advocated this approach for many years. He has a book  titled
"Diabetes Solution" that I've closely read and refer to often. Bernstein
advocates small doses of insulin and a strict low carb/slow carb diet for
both his Type I's and II's.

There is ample research to support the value of early insulin therapy.
Leading endocrinologists support this treatment. My goal is to preserve my
ability to produce insulin rather than burning out what I've got left with
sulfonylureas. I'm not suggesting anyone do this. I'm just telling you what
has worked for me.

Frankly, I don't think that early insulin therapy would have been right for
me if I were still seriously overweight. More insulin could make weight loss
harder and increase my problem with insulin resistance. I feel comfortable
with this program because I have reached a normal weight and continue to
maintain it.

By the way, modern syringes are virtually painless. There is an emotional
barrier that causes diabetics to resist insulin treatment that I believe is
unjustified given research data showing the efficacy of "early" rather than
"last resort" insulin therapy.

Type II
Dx'd 5/98
Insulin and Metformin
Diet: I prepare all my own food: slow carb/low carb. Lean protein and
lots of slow carb vegetables, nuts, olive oil.
Recently added Blueberries to the diet.
Exercise: daily walking and or biking--one to two hours.
Height: 5' 7"  Weight: 158 pounds, down from 203 ten months ago.
A1C 5.3. . ."

Regards
 Old Al

I moved to insulin earlier than necessary to avoid Beta cell burnout. I
used Glucotrol or Glipizide for 6 years and am glad to be rid of it.

Insulin gives me the control I need that sulfonylureas never provided
all that well. Glipizide/Glucotrol gave me hypos way more often than
insulin ever has.

I recommend that you lose the excess weight so that you can improve your
insulin sensitivity and only have to inject small doses of insulin. The
smaller the dose, the better uptake you get from the insulin. The less
insulin in your system, the more sensitive you will be to it.

Check out Dr. Bernstein's website info on "The Laws of Small Numbers" re
this issue:

http://www.diabetes-book.com/book/chapter7.shtml

Would Byetta be a candidate in this case?  

Not using itmyself  but am interested in the possible gains from this
med.  

RB

She likely thinging of avandia which makes your insulin more sensetive
rather firing up your pancreas. I also know this a pill out now which
combines metformin and avandia

Byetta is expensive---$2400 a year based on my last reading. Byetta is
recommended for those getting poor control from sulfonylureas and
metformin. Perhaps that is your situation. Frankly, I prefer to wait and
see how a new drug behaves in daily use in a large population before I
try it.

In the meantime, insulin is a proven alternative and offers beta cell
rest, something your pancreas might enjoy.

The one downside besides hypos was mentioned by RK. Some Type II's will
overeat and begin injecting more and more insulin resulting in weight
gain and increased insulin resistance. This is a bad thing to get into
especially for the heart.

One has to be careful and conservative with insulin. I've managed to
keep my weight down through strict carb control, exercise and low dose
insulin. As I said before, I had many more hypos with sulfonylureas and
I was often hungry. The effect was especially unpredictable when I
exercised. With insulin, I can adjust for the exercise much more precisely.

By the way, the new needles are sharp and way less painful than a finger
stick. Often there is no pain at all. My favorite is the BD Ultra-Fine
II short needle. I get the 3/10ths cc syringe that holds no more than 30
units. I rarely need more than 10 units with low carbing and exercise.

Most days I get by with 5 units of N and 5 of R. Two of these $23 vials
last me five months and they're available OTC  in most states as are the
syringes.

Many diabetics appeciate the benefits of Lantus because it's peakless,
and I can see their point. My problem is that Lantus costs twice as much
as what I'm using, and only has a 30 day shelf life. I'd have to throw
away 75% of a vial unused. My frugal nature won't tolerate that. Besides
that, I make use of the peak in R and N and find it helps control my
"dawn phenomenon."

"As I see it I have two additional treatment options:  Insulin, or
beta-cell stimulants such as Byetta or Glipizide.

My long-term concern with the beta-cell stimulants is accellerated
beta-cell burnout resulting in eventual insulin dependence.  The"

The two are very different.  Both prompt insulin output but in very
different ways.  Byetta doesn't cause lows as it has no effect when
glucose falls below a certain level.  Byetta is a mimic of a  hormone we
all produce in the gut after eating.  Unlike the other class of drugs,
those hormones are known to stimulate beta cell reproduction and one of
the great hopes for that class of mimics is that will happen oppisite to
burn out and even maybe to reversing cells already lost.

Go for Byetta!!!!!  It will control your BG and help you absorb your natural
insulin level better than anything on the market currently that I know of.

Check it out for yourself.