David - great discussion. If my post-dinner BG is 250 and it takes 12 hours to get me back to 110, my pancreas has been working all night chugging like the little engine that could, working overtime never getting back to the fasting state. In a non-diabetic my spike never goes over 130 and I am back to about 83 two hours later and I am back in fasting state, slowly pulsing. Those are just the numbers and how it is. With early insulin intervention we can get the PWD back to the fasting state and resting period and that is why they often see beta cell improvement.
But it gets worse because as a PWD my A1c says 7 and my FB is 110 and my doctor says I am doing great. Mean while I was incurring hours and hours of MVD and my beta cells never got a resting period so over time things get progressively worse.
As far as metformin being safe. Thats the great debate emerging. MRIs show increased brain plaque of metformin users which is leading to dementia. There are a number of good research papers on why. Recently there was a study done to show metformin was safe. Here is the summary - medscape.com/viewarticle/880249#vp_2 I have seen some numbers quoting 50% of metfromin users are now developing dementia. I can't confirm if thats correct but the MRIs don't lie.
Is it safer than avandia and orinase, it clearly appears to be. Is it safer than Victoza, Trulicity and the rest of the T2 meds? It sure seems to be as long term most of them appear very toxic. Is the question safe or less damaging or time?
Now, believe what you want and again its a risk/reward proposition. However, when a group is paid to prove metfromin is safe and then did not provide the MRI scans to prove it, it makes you wonder. I would have thought the first thing which would have been done on each PWD is to take the baseline MRI, just saying. Moreover what are those scans going to show at the 20yr mark?
What we do know is in 70%+ of T2s its a failure at hitting a 7.0 A1c which is and average BG of 154. We know a couple hours at 140 cause MVD. How many metformin users are failing to meet an A1c of 5.5, maybe 90%+? Not good.