In Type 1 diabetes mellitus, which therapy is typically initiated?

In Type 1 diabetes mellitus, which therapy is typically initiated?

• A. Metformin
• B. Lifestyle changes alone
• C. Sulfonylureas
• D. Insulin therapy is initiated in Type 1 DM.

Answer: (D)

Type 1 diabetes presents with autoimmune destruction of pancreatic beta cells, causing an absolute deficiency of insulin. Because there is little to no endogenous insulin to regulate blood glucose, the essential treatment from diagnosis is exogenous insulin replacement. Insulin in Type 1 is needed to prevent hyperglycemia and ketoacidosis and to enable glucose to enter cells. Metformin, while a mainstay in type 2 diabetes to reduce hepatic glucose output and improve insulin sensitivity, relies on some endogenous insulin activity and functioning beta cells; it does not address the complete lack of insulin in type 1. Sulfonylureas stimulate remaining beta cells to release insulin, which is ineffective when beta-cell mass is severely diminished or absent as in type 1. Lifestyle changes are important for overall health but cannot control hyperglycemia without insulin in type 1. Thus, initiating insulin therapy is the standard approach in Type 1 diabetes.

Type 1 diabetes presents with autoimmune destruction of pancreatic beta cells, causing an absolute deficiency of insulin. Because there is little to no endogenous insulin to regulate blood glucose, the essential treatment from diagnosis is exogenous insulin replacement. Insulin in Type 1 is needed to prevent hyperglycemia and ketoacidosis and to enable glucose to enter cells.

Metformin, while a mainstay in type 2 diabetes to reduce hepatic glucose output and improve insulin sensitivity, relies on some endogenous insulin activity and functioning beta cells; it does not address the complete lack of insulin in type 1. Sulfonylureas stimulate remaining beta cells to release insulin, which is ineffective when beta-cell mass is severely diminished or absent as in type 1. Lifestyle changes are important for overall health but cannot control hyperglycemia without insulin in type 1.

Thus, initiating insulin therapy is the standard approach in Type 1 diabetes.