"Eumetabolic"
therapies of diabetes are defined as those which promote and potentiate a normal physiological pattern of
insulin activity--in contrast to the less subtle effects of exogenous
insulin or sulfonylureas. Effective eumetabolic
therapy would provide better metabolic control and reduce the risk of secondary complications, would be more convenient to administer, and would be especially appropriate for preventive use in the early stages of diabetes. Possible components of a eumetabolic
therapy include:
aspirin, as a potentiator of
glucose-stimulated insulin secretion; GTF, to directly enhance the efficacy of
insulin;
weight loss, exercise, and fasting, to help reduce tissue resistance to
insulin; mitochondrial "metavitamins", to optimize the oxidative disposal of excess substrate; a high-fiber,
low-fat diet, which appears superior to traditional
diabetic diets as a promoter of
glucose tolerance. Following a prolonged fast, obese diabetics show substantial improvement in most parameters of
insulin function--an effect which is to some degree independent of
weight loss; long-term remission of diabetes may be possible if the benefits of therapeutic fasting are conserved by appropriate eumetabolic measures.