What happens when people get old....is that if they have insulin resistance , the body tells the pancreas to put out more and more insulin (even when no drugs are given), and eventually the Islet cells can't do this anymore and die. So yes, even without drugs the cells die or burn out.

Doctors can monitor this by taking fasting INSULIN levels, to show how much is going up this way. The theory is that insulin somehow fails at the cell membrane to help glucose enter the target cells of the body that need it, signals are sent and a hormone stimulates the pancreas to make more and more insulin and eventually the pancreas burns out.

Type II diabetes starts this way. It is just that many doctors don't do the fasting INSULIN level... some don't even know how to interpret it. Those who become diabetic earlier as type II just have a faster decline than older people. I think genetics drives most of this.

In fact some doctors today don't like the oral meds much except for metformin (which has other actions that are desirable too) because they CAUSE a form of insulin resistance and therefore weight gain.(which becomes a vicious cycle)