When a patient newly diagnosed with type 2 diabetes mellitus asks the nurse why she has to take a pill instead of insulin, the nurse replies that in type 2 diabetes mellitus, the body makes insulin but:

• A. overweight and under active people cannot simply use the insulin produced.
• B. Metabolism is slowed in some people so they have to take a pill to speed up their metabolism.
• C. Sometimes the autoimmune system works against the action of the insulin.
• D. The cells become resistant to the action of insulin. Pills are given to increase the sensitivity.

Answer: (D)

In type 2 diabetes the problem is insulin resistance: the body's cells—especially muscle, fat, and liver cells—don’t respond well to insulin, so glucose isn’t taken up efficiently even though insulin is present. Because of this, treatment often uses oral medications that improve how sensitive the tissues are to insulin and that reduce glucose production by the liver. That’s why the statement that pills are given to increase insulin sensitivity is the best fit: it reflects the core issue in many patients with type 2 diabetes and why oral agents can be effective early in the disease. Autoimmune destruction of beta cells describes type 1 diabetes, not type 2; and the option about metabolism speed or “overweight and underactive” users not fitting the primary mechanism of resistance.