References
Hyperinsulinaemia

Abstract
George Winter discusses the need to evaluate the respective roles of diet, lifestyle, and pharmaceuticals in relation to improving glycaemic and insulin control in type 2 diabetes
The idea of type 2 diabetes (T2D) being a progressive illness is almost redundant, with increasing evidence even confirming how T2D remission is possible. For example, Cucuzzella et al (2023: 146) note that therapeutic carbohydrate restriction is an effective option in T2D management, improving the condition, reducing medication burden and achieving weight loss.
Accordingly, there has been a move away from medical practice that concentrates ‘almost exclusively on prescribing and intensifying medical therapy as chronic disease progresses’ and towards ‘safely de-prescribing medications’ (Cucuzzella et al, 2023).
As Johnson (2021) observes, T2D ‘is much more reversible than was once thought’ and since ‘[m]ost drugs are designed to combat hyperglycaemia, counteract the deficiency in glucose-stimulated insulin secretion, and increase insulin sensitivity in the context of frank diabetes’, it is arguable that substantial pathology has occurred before deranged glucose concentrations are detected, and that some drug-related approaches ‘may be double-edged swords.’
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