My guess is that his blood sugar is not well controlled. Contrary to popular belief, diabetes is a wasting disease. Most people think that it makes you fat (the other way around...a classic diabetic is extremely thin). It is the fat, that continues to throw the body messengers further and further out of whack until diabetes sets in. Untreated it causes wasting of lean body mass and eventually death by literal starvation in the midst of excess food in the blood in the form of glucose. Glucose is the primary fuel every cell on the planet runs on. Ketone bodies are an alternative fuel supply the body produces from a direct combustion process of fat which is why diabetics develop ketosis since they can't use their glucose. This process is similar to how the Atkin's diet works. The excess glucose changes the body chemistry and cause all kinds of negative changes. Serum glucose in excess of 200 ng/dl exceeds the ability of the kidneys to reabsorb the glucose to hang on to it during the exchange process when the urine is being made up. As a result, the glucose spills into the urine and is readily measurable by lab tests. This is the basis of the glucose challenge test (one of the tests used to diagnose diabetes).
It is also likely that he is low on testosterone, based on age. Many studies have shown that testosterone and also some anabolic steroids actually improve insulin sensitivity. In fact, the package insert to Axiron, a topically applied testosterone gel discusses this. The question is does he have insulin insensitivity (very likely since his type 2 diabetes progressed to insulin dependent diabetes.). Since his diabetes has progressed to insulin dependence, the situation is no longer reversible as it is with non insulin dependent diabetes where the insulin resistance is being caused by the excess fat. It is likely that he is both insulin resistant AND insulin dependent. Lean mass tends to have a positive effect on insulin resistance and fat has a negative effect. This needs to be determined by a medical professional although the patient that is an astute observer can pretty well figure it out for themselves by the amount of insulin they need based on ingested carbs. So if they titrate their insulin by 1 IU to 10 grams of carbs ingested, they probably aren't resistant. If they are doing 5 IUs to 10 grams of carbs, then there is serious insulin resistance. If they need to titrate the long acting NPH insulin at high doses, say 50 or 60 units or more at night, then they have serious insulin resistance. Insulin dependent diabetics normally have to use both long acting NPH insulin once per day and a short acting insulin 15 minutes before meals.
So the level of insulin resistance needs to be determined and the dose of metformin needs to be adjusted to help reduce this. The titration of the insulin will also have to be adjusted as metformin will affect the insulin resistance. Also the cause of resistance needs to be determined, so if a medication is causing the resistance, which is common among many HIV medications as well as other prescription medications, then alternatives may need to be looked at because if a person gets serious insulin resistance that is pharmacologically driven by the HIV or other meds, it is possible that it may not be able to be adequately controlled by methods other than changing out the offending cause (HIV or other med).
So yes, testosterone can help as can the desired effect of less fat mass and increased lean mass. I would go to a specialist (endocrinologist) that is amenable to testosterone replacement therapy so you will likely have to doctor shop to find one. Most endocrinologists are completely brainwashed against male hormone replacement therapy for any reason and don't care about quality of life issues. At least that has been my life time observation.
I would also consider anyone that claims that they can heal your diabetes by magnesium treatments or by alkaline water when you are insulin dependent to be quacks. You simply can not change your serum pH by diet. You CAN change the pH of your urine but since this is contained in the bladder it has no real affect on the rest of the body. Serum pH is naturally alkaline and is controlled in a very tight range between pH of 7.37 to 7.47--anything outside of this range is lethal since all the biochemical reactions that need to take place will not all go in the right direction if the pH is outside of this range (some may go in reverse). The serum pH is tightly controlled by the kidneys and the lungs. For example, if there is some excess acidity in the blood, the respiration rate may slightly increase (without you realizing it) to blow off excess CO2 to reduce acidity. This is because H2CO3 (carbonic acid) levels in the serum is broken down to CO2 which is expelled through the lungs and the remaining H2O is removed by the kidneys as water in the urine. There are many ways that the kidneys control excess alkalinity or acidity through ion exchange to the urine. Of course, this is very basic biochemistry for those that have had it in college.
Diabetes can be very complicated but I hope this sheds some light on it and hopefully this helps.
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