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FDA Approves New Drug for Type 2 Diabetes 267

Posted by ScuttleMonkey
from the sweet-ideas dept.
Neopallium writes to tell us that the FDA has approved the first of a new kind of treatment for type 2 diabetes. From the article: "JANUVIA belongs to a new breakthrough class of prescription medications called dipeptidyl peptidase-4 (DPP-4) inhibitors that improves blood sugar control in patients with type 2 diabetes. JANUVIA enhances a natural body system called the incretin system, which helps to regulate glucose by affecting the beta cells and alpha cells in the pancreas. Through DPP-4 inhibition, JANUVIA works only when blood sugar is elevated to address diminished insulin due to beta-cell dysfunction and uncontrolled production of glucose by the liver due to alpha-cell and beta-cell dysfunction."
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FDA Approves New Drug for Type 2 Diabetes

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  • by kypper (446750) on Wednesday October 18, 2006 @07:48AM (#16482879)
    Here's the PubMed [nih.gov] link to the Merck Research in the Journal of Clinical Pharmacology.
  • Another downside of obese life eliminated...now if they could just make a pill that would make fat people look attractive at the beach, there'd be no limits to the future of American corpulence!
    • Re: (Score:2, Funny)

      by tygerstripes (832644)
      As The Onion put it: I wish someone would do something about how fat I am [theonion.com].
    • by quigonn (80360)
      That "pill" is called alcohol, and makes _any_ woman more attractive.
    • Hmm... I must've missed the memo that stated that only obese people get type II diabetes. Must've been circulated only through the accounting department, eh?
  • Can someone who understands this translate it for me to english, because I tried reading the article but didn't understand it, and since my father has type-II diabetes it would be interesting to understand what it's all about.
    • I'll take a shot (Score:4, Informative)

      by QuaintRealist (905302) <quaintrealist@gmail . c om> on Wednesday October 18, 2006 @08:45AM (#16483319) Homepage Journal
      disclaimer: I am a pharmacologist. I do not work for Merck or any other drug company. I do work for an ICU specialist group.

      This drug works by decreasing the amount of sugar produced by the liver. In most type II diabetics the liver produces too much, for reasons we only partly understand. It also makes the pancreas produce more insulin in response to high blood sugar. This mechanism is also defective in type II diabetes, again for reasons poorly understood. It does these things by a new mechanism of action, and is the first drug that affects the first problem I listed above.

      Does your father go to an endocrinologist? Diabetes is still not as well understood as we would like, and this is the third brand new treatment for diabetes in the last couple of years (one of them is for type I diabetics only). There are a lot of new options out there.
  • While being fat does appear to have a correlation with type2 diabetes, genetics appears to have a greater effect. I am not fat, but have suffered from type2 for a number of years. Any medical advances dealing with this are most welcome.
  • Brain aneurism! (Score:4, Insightful)

    by tygerstripes (832644) on Wednesday October 18, 2006 @08:07AM (#16482977)
    O...kaaaay. So. We have these alpha & beta cells who aren't doing what they're supposed to do - they're producing too much glucose (or not preventing the liver from doing so), so the body's natural insulin isn't enough. So, when that happens, it would be good if the "incretin" system kicked in to regulate these naughty cells - but DPP-4 normally stops the system doing that (to a degree). So, this Januvia stuff stops the DPP-4 that stops the incretin stopping the dysfunctional cells, meaning Januvia indirectly stops your these cells from producing too much glucose.

    *faint*

  • Actually... (Score:5, Insightful)

    by PreacherTom (1000306) * on Wednesday October 18, 2006 @08:09AM (#16482983)
    Folks, this is some pretty big news in biotech. While not a cure for cancer, over 20 million people have diabetes. Just taking insulin is a tricky business, and even in the best of cases leads to necrosis (cell death) in the hands and feet, along with blindness and kidney failure. Think of it like a pendulum...the more you mess with it, the farther it swings - like steroids. This works on fixing the problem without that pendulum swing. It's worthy of a front page.
    • by javilon (99157)
      At $4.85 per tablet, once a day, that is about $150 a month. This certainly can't be afforded by all of those 20 million people, but the ones that can, will make for nice profits for the company. I just hope that they lower the price a bit in the future. With this huge potential market, they should be able to.

      • Re: (Score:2, Insightful)

        by Anonymous Coward
        will make for nice profits for the company.

        Which, of course, may be the very reason why the treatment exists at all. If you want something, a good way to get it is to make it worth someone's while to do so.

      • by jayhawk88 (160512)
        Also something like this is probably only going to be used for people with very severe cases. I've got diabetes but I can easily keep my blood sugar in the 90-120 range by just watching what I eat and taking something called Amaryl.
    • This is type 2 diabetes we're talking about. More than 95% of these people are overweight/obese. The cure for these people is to lose the weight! Wkae me up when there's a cure for type 1 diabetes that doesn't require immunosuppresion therapy.
      • Re: (Score:2, Informative)

        by CyberZen (97536)
        Explain all the thin, old people with type II, then.

        Really, I'm sick of this "lose a little weight and the diabetes is gone ingorance. Type II is not fully understood, and is made worse by primarily two things:

        1) Weight
        2) Time.

        Even a thin person who has type II, or a type II who loses all of their excess fat, will worsen with age.
      • by dfghjk (711126)
        And for those people, if they didn't have type 2 diabetes then maybe losing the weight might be easier. Perhaps if the medical community wasn't so invested in fighting diets that are successful in helping people with just such conditions...
    • People could just eat a proper diet and less crappy foods. Especially avoiding things with that poisonous High Fructose Corn Syrup that manufacturers love to use. This isn't about obesity, it's about diet.

      While I wouldn't go so far as to say type 2 diabetes can be totally prevented, it's generally a self inflicted disease. And our society isn't helping either because the crappiest foods are often the easiest to get (eg. fast food).
      • by boingo82 (932244)
        We do our best to avoid HFCS and Trans Fats and it's amazing how difficult that can be. We've only found one brand of bread that doesn't contain HFCS. Most salad dressings are full of it. We've yet to find ketchup without HFCS.

        They didn't put this crap in food at all 30 years ago - and you saw much less Type II diabetes.

        • Yes, it's a huge problem. Bread makers use HFCS to preserve the freshness and moistness of the bread. For the most part I make all my own bread. You don't need any special equipment, you can do it all by hand and you don't even need a pan to cook it in if you don't care about the shape. There is practically nothing to a bread recipe. After cooking it keep it in the refrigerator for longer shelf life.

          I don't use salad dressings or ketchup so I can't comment much there. In fact, since I started eating
          • by boingo82 (932244)
            Just curious, what do you do for work food? I'm about 50/50 on my eating habits now - half is organic baby greens and thai stir fry and organic whole grain rice and nectarine-tomato-onion homemade salsa - and the other half is birthday cake and crap from the snack drawer at work. I'm terrible at bringing things to eat and also don't want to eat anything that will sit on my breath all day. We don't usually have leftovers either as my husband is one of those people who will eat ALL of whatever I make, no matt
      • by dfghjk (711126)
        of course, it would help if the US gevernment wouldn't be recommending a diet that causes type 2 diabetes.

        It's so common to hear people recommend a "proper diet" and blame "crappy" foods. The problem is that people don't know what either of these are, even many who correctly identify them as a problem.

        It's common to see someone eating a lunch consisting of nothing more than a bowl of rice. They can certainly be given credit for avoiding the Big Mac and fries, but they're still eating a meal of 0% protein
        • It's common to see someone eating a lunch consisting of nothing more than a bowl of rice. They can certainly be given credit for avoiding the Big Mac and fries, but they're still eating a meal of 0% protein and 90+% carbs.

          You shouldn't be eating white rice anyway. Brown rice does in fact contain protein and a number of other nutrients. Ideally it should be combined with beans or something similar to provide a complete protein.

          Of all the sweetners used in soft drinks, sugar/corn syrup is the only one that'

          • by dfghjk (711126)
            "You shouldn't be eating white rice anyway. Brown rice does in fact contain protein and a number of other nutrients. Ideally it should be combined with beans or something similar to provide a complete protein."

            I agree, but from a glycemic index point of view you shouldn't be eating rice at all. There are far better sources of complete proteins than rice and beans. Of course, that doesn't help the vegetarian. I am certainly not one of those.

            "Aspartame (Nutisweet) really is listed as a poison in many countr
        • Getting brain damage (such as Parkinson's) from aspartame doesn't sound too nice.
    • by suv4x4 (956391)
      Folks, this is some pretty big news in biotech. ... It's worthy of a front page.

      You know, the linked article is spam. It's not even a genuine news article and contains 20 or so paragraphs, each beginning with "JANUVIA does this and that".

      If this is worthy of front page on Slashdot, well that's pretty sad for Slashdot I think.
      • Here's something on the topic [cnn.com] a little easier to swallow. Yes, losing weight is the way to prevent diabetes. Once you're rolling full-bore, though...it's kind of hard to deal with weight issues when your metabolism is, by definition, massively messed up. Not to mention that weight loss is a SYMPTOM of diabetes.
    • It's only a cure for Type 2. Other cures for Type 2 diabetes include "not eating so much crappy food that you become a hulking lardass". Yes, there are a few people with Type 2 that aren't hulking lardasses, but generally, the second type is due to poor diet and general lack of self-control.

      From diabetes.org: The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising.

      But, for the lazy asses who got themselves into this mess to begin with,
    • even in the best of cases leads to necrosis (cell death) in the hands and feet, along with blindness and kidney failure

      No it doesn't. That happens when people don't take enough insulin. Then the sugar level in their blood gets too high. A lot of people with diabetes constantly walk around with about 2-3x as much sugar in their blood stream as what's normal.

      Sugar is sticky. So it sticks to the insides of the blood vessels. When a blood vessel is coated with enough sugar on the inside, it won't be ab

    • This is really cool news indeed. I should also mention that if you're diabetic and haven't read this collection of 6 articles, you might be able to save your feet and eyes and kidneys. It's non-commercial, just a collection of papers and a diabetic writer who's putting it together.

      http://www.phlaunt.com/diabetes/ [phlaunt.com] Most important conclusion: If you can keep blood sugar controlled enough, Type-2 need not deteriorate. Don't reply until you've read the article and references.

      I will be on the lookout to see
  • by ascotan (1015049) on Wednesday October 18, 2006 @08:24AM (#16483097)
    It's an upstream inhibitor of glucagon. Glucagon signals the body that it has low blood sugar. It tells the liver to produce sugars in response, because the body thinks you're in a fasting state. In a normal person glucagon is inhibited when you eat food, because insulin is released. Insulin tells the body - 'It's Dinner Time!!' - and you're liver production of sugar stops as blood sugar is used up. Apparently this system gets screwed up in people with diabetes, as the balancing act between insulin and glucagon doesn't work properly. Therefore this medication will help the body realize, that when blood sugar is high, to stop liver production of sugars (and possibly tell the pancreas to release insulin), which should aid diabetics in controlling blood sugar levels.
    • by catman (1412)
      Thanks - no mod points for me, please mod parent up max!

      Let me add: Some times a movie may show a diabetic with a "low"[1] getting an injection in the emergency room. That injection is not insulin, because that would kill him, it's glucagon, which stimulates the liver to release glucose.

      The rest of us would do well to give him a non-diet sweet drink, a piece of candy, or almost any kind of food.
      Unfortunately some type 1s have died in police custody because cops mistake a low for a roaring drunk.

      [1] This [umich.edu]
  • Why the hostility? (Score:5, Insightful)

    by BenEnglishAtHome (449670) * on Wednesday October 18, 2006 @08:28AM (#16483121)
    The medicine is great for the people that need it, I'm sure. But let's go off on a tangent; I see a number of posters already are doing so.

    Why are so many slashdrones so terribly hostile toward diabetics? It's not possible to post a story mentioning diabetes without various people posting inaccurate information ("Being lazy and getting fat causes diabetes!") combined with hearty invective ("You're sub-human slobs and you all deserve to die!").

    (Just for the record, obesity is associated with diabetes but is not the cause. Diabetes is a failure of various regulatory mechanisms and heredity plays a big part. There's lots of good research that indicates the process of becoming diabetic tends to make you fat rather than the reverse. And treatment is severely problematical, often because common drugs cause massive weight gain, a problem this new drug is supposed to address.)

    So why all the bile poured out on diabetes sufferers? I really don't understand it. There are lots of other diseases that make people unattractive or can be partially blamed on lifestyle, but I don't see anyone jumping on the "People get cancer because they're stupid!" or the "All alcoholics should be shot!" bandwagons, even though those ideas make about as much sense as condemning diabetics for being sick.

    What's up? Anyone want to clue me in?
    • Re: (Score:3, Interesting)

      Another point so often left out is the sugar content in foods today. Modern food is chock a block with high fructose corn syrup. Virtually all food contains it at this point. It's a major contributing factor for diabetes and is something largely outside the ken, never mid the control, of the average person.

      When someone contracts Type-II diabetes, don't just ask how much they ate. Ask what they ate. I'd wager the second is by far the bigger contributor to the disease. If HFCS was a banned substance, I would
      • Yeah, well, what I think you're forgetting is that American sugar farmers don't like competition from overseas sugar growers, and American corn farmers really want higher prices for their corn. I mean, they could switch to other crops, but that's just a pain, you know? You might spend 100 hours a year adapting to keep your job skills relevant, but it's WAY too much to ask of American farmers that they grow a different fucking crop or sell their land and do something useful.

        So, I understand your point, bu
      • by dfghjk (711126)
        High Fructose Corn Syrup is used because it is cheap. If it were banned or more expensive, then other forms of sugar would be used instead. Those sugars would be equally damaging just as wheat flour is equally damaging. The problem isn't what the carb is or how it's sourced but rather how much of it is used and how fast it is absorbed and metabolized. A Coke made with HFCS may be gold standard of unhealthiness, but a Coke made with cane sugar is just as bad, and as it turns out, a rice cake is even wors
    • by Temkin (112574) on Wednesday October 18, 2006 @09:48AM (#16484057)
      I've often wondered the same thing. I suspect there's a lot of misinformation floating around out there with regards to type 2 diabetes. Cause and effect are really not easy to tease apart with this disease, and the finger pointing may give some people a sense of vindication for their own lifestyle choices, and/or a bit of schadenfreude. It's easy to sit at a computer and type trash when you consider yourself immune because you play ultimate frisbee everyday at lunch. But it's a false sense of security. I became type 2 while doing outdoor science research, hiking all day, 6 days a week.

      A1C - 5.5% on a modified Atkins diet. Drives my flaming idealist vegetarian sister-in-law nuts... I tell her "Get over it... biochemically, I'm a carnivore". :-)

    • Oh, if only I could give you mod points...

      I was diagnosed with Type 2 diabetes about 5 years ago. No-one in the family (either side) has diabetes and there is no family history of it either. I am not overweight for my height (6ft 2in), my diet is reasonably balanced and healthy (I reckon I visit KFC/McDs/Burger King etc. about 5 times a year) and the doctors think I became diabetic as a result of a viral infection.

      I don't get annoyed at people who post 'diabetes = fat people' messages 'cos there's no point,
    • Why are so many slashdrones so terribly hostile toward diabetics?

      It's not about you. It's about them. They're better than you -- that's their point. They're "the good people". How would you know how much better they are if they didn't tell you how bad you are in comparison? More importantly, how would they know?

      Similar people drive a Prius, only buy organic food, support smoking bans in taverns, and "only watch PBS on TV".
    • by ishark (245915)
      Cheap psychology answer: the same reason why a lot of people like to think that if you're ill then it's your lifestyle/choice/fault/whatever.
      They reassure themselves by thinking that if they don't do [something], then they won't be ill. This is easier to handle than thinking that you could wake up tomorrow and find you have cancer because you just had bad luck.
    • Because people are afraid of it. Going blind, end-stage kidney disease, nerve damage, amputation. It is the modern day leprosy. (amputation subconsiously makes the connection stronger in people's minds). Yeah, it's not transmissable, but we are having an epidemic. People want to think only the "bad" people get it, but wonder if their lifestyle makes them on of it. There are probably a whole lot of subconsious reasons. Look up "diabetophobia" - it is a recognized fear.
  • by LGagnon (762015) on Wednesday October 18, 2006 @08:29AM (#16483131)
    Instead of making America take more drugs and waste more money, how about they just ban high fructose corn syrup? We might not have the big diabetes epidemic we have right now if we stopped filling all our food with such a dangerous sweetener. But of course, our government is more concerned with the "rights" of big business than the well-being of the people that it supposedly serves. And those pharmacutical companies that "donate" to our politicians stand to make a larger killing off of this than they would with an actual good plan.
    • Re: (Score:3, Interesting)

      by mrjb (547783)
      Instead of making America take more drugs and waste more money, how about they just ban high fructose corn syrup?
      Wikipedia says "A more recent study found a link exists between obesity and high HFCS consumption, especially from soft drinks.".

      So instead of banning HFCS, how about cutting down on the fizzy drinks, for example by reducing the serving size at your local golden arcs? The bucketloads of soda-pop served as a single serving in the States are beyond ridiculous. An average restaurant in Europe w
      • by k_187 (61692)
        because its blaitantly obvious when a gun is being misused. HFCS is much more subtle.
      • by boingo82 (932244)
        Just FYI, European soft drinks aren't usually made with HFCS. It's mostly used in the US thanks to our own sugar tariffs and corn subsidies. [thundercloud.net] US sweetener consumption by year. [answers.com]
        • Re: (Score:3, Interesting)

          Once E85 becomes more popular here, there will be less corn syrup, since ethanol production (corn liquor in the gas sounds funny, but it will help our energy dependence) will be using up the corn supply. The top priorities for corn will be eating it directly and car fuel, corn syrup will become less economical.
      • by dfghjk (711126)
        HFCS itself isn't the issue. A soft drink sweetened with cane sugar would be just as bad. Fruit juices aren't as bad a soft drinks but they are very good either. There is a hysteria over HFCS, and there should be because it's terrible, but eliminating it won't solve the problem. There are other products just as bad.

        "My point is, instead of telling the government to 'ban HFCS instead of making the people spend more money', what about educating the people and letting them take some responsibility for thei
        • Re: (Score:3, Interesting)

          by Apotsy (84148)
          A soft drink sweetened with cane sugar would be just as bad.

          No, it would not be "just as bad", because cane sugar and HFCS affect the body very differently. Go read some of the links in this thread and you'll see. They are not equivalent. That is the whole point. The "hysteria" you point to is actually quite justified. HFCS is a dangerous ingredient, regardless of people's eating habits.

      • by ilsie (227381)
        My point is, instead of telling the government to 'ban HFCS instead of making the people spend more money', what about educating the people and letting them take some responsibility for their actions?

        In the above statement, replace "HFCS" with "nicotine" or "crack." Why does anyone do anything when they know it's bad for them?
    • Instead of making America take more drugs and waste more money, how about they just ban high fructose corn syrup? We might not have the big diabetes epidemic we have right now if we stopped filling all our food with such a dangerous sweetener.

      While I agree with you that there is entirely too much high fructose corn syrup in the foods that are commonly available, I don't think banning it is an appropriate fix. Corn syrup, in and of itself, isn't deadly, so there's no need to ban it. People who cannot grasp

    • by Spokehedz (599285)

      High-Fructose Corn Syrup (HFCS) is dangerous stuff indeed. But first, to really understand how dangerous it is you have to understand how the body processes sugar. (information taken from the book 'Good Carb, Better Carb Cookbook' which you can find here http://tinyurl.com/ycuvmx [tinyurl.com])

      Glucose, fructose and galactose can all be absorbed directly by the body--no breaking down at all. They are monosaccharides (one sugar) and they are 'simple sugar'. Glucose is also called 'blood sugar' and it is this that diabetics
    • by Kohath (38547)
      We have high fructose corn syrup because of the tarrifs on foreign cane sugar imports going back about a hundred years. The tarrifs are to protect (artificially enrich) US farmers. So sugar is expensive and corn sweeteners are cheaper.

      On the other hand, your plan to ban high fructose corn syrup is, of course, stupid totalitarian nanny-state nonsense. People should be allowed to choose what they eat, not be forced to eat what you think is "the good food".
  • I assume it was a 17 patent on it.
  • Someday, one of these announcements will actually help those of us with Juvenile Diabetes (Type 1), who have to take multiple shots a day and not just pop a pill.

    Genetics sucks.
  • No statement I can see about how much this treatment will cost. Many new-gen drugs are so expensive that only the super-rich can afford them. So, while nice to know of, they are effectively useless for 99 per cent of humanity. The irony is that the super-rich are much less likely to need such treatments, since they can afford to eat well. No corn-syrup-soaked breakfast cereal for them, no breads mostly containing only fats and air with a few corner-sweepings of wheat thrown in, no vegetables pumped full of
  • Cost Benefit? (Score:4, Insightful)

    by q2k (67077) on Wednesday October 18, 2006 @08:59AM (#16483497) Homepage
    My wife is Type 1 diabetic, and her take on this is that $5 a pill is a lot of money for something that doesn't really work any better than the existing therapies available at 50 cents a pill. Getting A1C readings down to 7 is nothing to crow about. 7 is still too high. To minimize the long term complications of uncontrolled blood sugars, you really want your A1C down around 6.
    • by Andy Dodd (701)
      Add to that the fact that this pill will do nothing to help Type 1 diabetics such as your wife and myself.

      In fact, in our case such a pill could be dangerous, as injections of glucagon (which this inhibits) are the "last resort" treatment for severe hypoglycemia (low blood sugar, caused by either an overdose of insulin, a smaller than normal meal combined with a normal insulin dose, or exercise without accompanying food or reduced insulin.)

      Others have hinted at this, but the basics of diabetes, Type I and T
      • by q2k (67077)
        She got some marketing propaganda on the new Mimimed CGMS system recently. Her initial reaction was "Great, now I'll need two infusion sets in me at all times, and at double the cost." And apparently the CGMS infusion set is electronically controlled to shut down after 3 days. No stretching an extra day or two out of an infusion set, like she does with the insulin sets.

        But it is Gen 1 product, it'll get better. She beta tested the Gen 1 blood meters back in the day. It was the size of a textbook, had to be
  • by Monkelectric (546685) <slashdot@@@monkelectric...com> on Wednesday October 18, 2006 @10:00AM (#16484203)
    I'd like to say to all the diabetics out there (I am a t2) that Cinnamon of all things has helped my diabetes tremendously. ome studies have shown that Cinnamon can lower blood sugar levels quite a bit and help with cholesterol [newscientist.com]. It appears as if certain types of cinnamon contain molecules wich are chemically similar to insulin -- and as such can activate insulin receptors.

    I have been doing this for the last few months and it has really turned the tide for me, before I really felt like I was loosing the battle against diabetes. The only trick is finding the right *kind* of cinnamon can be difficult. There are hundreds of types of cinnamon and the kind you want is commonly called "cassia" or "cinnamonium aromium" (sp?) or sometimes "cinnamonium romulus" (generally the chinese name). It is grown in indonesia and china. Problem being that most cinnamons sold in the US are blends of Saigon Cinnamon which does not seem to have the same properties. A number of nutrition stores sell cinnamon pills (vitamin shoppe, gnc) that have the correct cinnamon in them. Currently the best price i've found is at GNC -- if you buy their GNC card ($15/year) it knocks a bottle of 200 pills down to about $12. Before you say "thats expensive for cinammon" as yourself -- what are you spending on medication right now? On your glucophage, on your metformin, on your zocor, on your benazepril, on your insulin?

    For me the cinnamon does not have the horrible side effects of things like metformin and glucophage. The side effects (sudden intense hunger, increased appetite) make me eat more, gain weight, and thus require more medication. I am not suggesting you replace your medications for cinnamon, but if you are having trouble controlling your blood sugar, try adding cinnamon to your diet. If you are not having trouble, try replacing some of your medication with cinnamon.

    I am planning on starting a website soon about this to try and get the word out. How many times in life is there something simple and safe that can improve your health?

  • http://www.nerf-herders-anonymous.net/images/Wilfo rdBrimley.jpg [nerf-herde...nymous.net] Unavailable for comment.
  • The FDA and USPTO are what enable the profits of big pharma. You can't patent a vitamin.

    If you're at risk for diabetes, control your diet, exercise, and take chromium [bioactivenutrients.com]. Chromium for diabetes is not new. It's three or four decades old.

    The link to the vendor I provided listed only the positive studies. There are some negative studies as well. Because chromium opens up the cell gateway for fat, my personal unscientific opinion is that it accelerates fat loss or gain, depending on diet. That's been my experienc

  • I would not want to take this. It's tricking your beta cells to produce more insulin. Beta cells die off after so many tries at insulin production. beta cells are not regenerative. Everyone has thier x number of beta cells. it sounds like you get the same
    results if you take metformin and avandia together..which I will not do. Beta cell depletion will just lead to type I symtoms and you will need to be on insulin. Here's what I do. I take 100mg of metformin a day along with 1000mg of chromium picolin

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