Maturity-onset diabetes mellitus--toward a physiological appropriate management

"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.