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Latest Insulin Articles
Physicians who treat people with type 2 diabetes face difficult choices when selecting the best medical therapy for each patient. The decision process is further complicated by the fact that because type 2 diabetes is a progressive disease, therapeutic agents that were initially successful may fail five or ten years later.
As recently as 1994, there were only two options for patients with type 2 diabetes: insulin and the sulfonylureas (such as glyburide and glipizide). The good news is that today, seven totally different classes of medications are available, as well as much better insulins. The bad news is that many physicians are more confused than ever, especially when faced with the option of combining two, three, or even more drugs at one time.
In addition, the past several years have seen the advent of six combination drugs (such as Glucovance, Avandamet, and Janumet), with more on the way. Faced with this explosion of therapeutic options, many physicians are reluctant to start insulin therapy even when it is clearly indicated.
Insulin Resistance and Deficiency in Type 2 Diabetes
Most patients with type 2 diabetes suffer from two major defects: insulin resistance and beta cell "burnout." Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes. Patients with insulin resistance are often diagnosed with the metabolic syndrome, which predisposes them to both type 2 diabetes and cardiovascular disease.
When food is ingested, insulin is secreted by the beta cells into the bloodstream. The insulin travels to the liver or muscles, where it attaches to receptors on the surface of the cells like a key in a lock. In non-diabetic people, this process allows individual glucose molecules to enter the cells of muscles, liver, and other organs. However, the cells of people with insulin resistance are "turned off" to the insulin key, so much of the glucose cannot enter the cells. The mother is calling, so to speak, but the children are not listening.
The pancreatic beta cells respond to this resistance by making extra insulin, which for a time keeps glucose in the normal range. If people with insulin resistance do not lose weight, exercise, and/or take certain medications, however, their beta cells may lose the ability to produce enough extra insulin to overcome their insulin resistance. That is the second defect in type 2 diabetes: a relative deficiency of insulin.
When the pancreatic beta cells can no longer overcome the insulin resistance, blood sugars begin to rise. Initially, only the post-meal glucose values are elevated, but in time the fasting glucose levels also increase. When fasting glucose tops 125 mg/dl, a patient is considered to have diabetes. It has been shown that when persons are first diagnosed with type 2 diabetes, they have already lost over fifty percent of their beta cell function.
Medications for Type 2 Diabetes
Fortunately, patients with type 2 diabetes often respond to dietary interventions, increased exercise, and weight loss. When more help is needed, oral diabetes medications such as metformin (Glucophage) or a thiazolidinedione drug (Actos or Avandia) can improve glucose levels by overcoming insulin resistance in the liver or muscle. Sulfonylurea drugs such as glipizide or Amaryl and their cousins (Starlix and Prandin) lower glucose levels by stimulating the remaining beta cells to make more insulin.
It is now known that people with type 2 diabetes are deficient in the intestinal hormones called incretins. Incretins are messenger molecules that travel to the pancreas to help beta cells make extra insulin during meals. The new drugs Byetta, Symlin, and Januvia are incretin substitutes. They not only raise insulin levels with meals, but also make that insulin more effective by slowing stomach emptying and reducing the harmful effects of glucagon (another pancreatic hormone that increases glucose).
Byetta and Symlin, both injected medicines, are unique because they produce satiety (a feeling of fullness) that often leads to significant weight loss. Januvia, an oral medication similar to Byetta in function, does not affect satiety or gastric emptying. Consequently, it does not help patients lose weight. On the other hand, it does not cause the nausea that commonly occurs in patients taking higher doses of Byetta.
In animals, these incretin - like drugs seem to prevent the destruction of the beta cells. Although there is no long-term evidence in humans that Byetta, Symlin, or Januvia preserve beta cells, we do know that, unlike the commonly used sulfonylureas, these newer drugs do not cause "burnout" of the beta cells.
(Refer to our Charts page for a complete list of type 2 medications).
When Medications Fail
Some patients can control their diabetes for years with a good diet and exercise routine plus one, two, or even three different medications. However, there are many conditions that may render these drugs either ineffective or no longer safe for the patient. These include:
Unfortunately, many people with type 2 diabetes experience progressive loss of beta cell function. Their overworked beta cells seem to burn out, and drugs that were once effective can no longer hold their A1c's below 7%. (For more information on A1c's, see "What Is A1C And What Does It Measure?" and "Perfect Control".)
Starting Insulin
The overwhelming majority of type 2s eventually require insulin to obtain or preserve satisfactory glucose control and an A1c of 7% or less. Research clearly shows that achieving good control early on prevents diabetic complications, including nerve, kidney, eye and heart disease, up to twenty years later.
Deciding exactly when to begin insulin therapy is problematic for physicians who treat type 2 diabetes. Patients' misguided fears about needles, hypoglycemia, and weight gain often lead to reluctance and physician inertia. A recent survey found that fewer than half of all physicians made any change in diabetes therapy even for patients with A1c's of over 9%.
A similar study at Johns Hopkins found that it took an average of 240 days before doctors added insulin or another drug for patients who could not achieve good control. By the time they finally took action, two-thirds of their patients had A1c levels approaching 10%.
Table 1 lists the relative and absolute indications for initiating insulin therapy in patients with diabetes. Even when initiation of insulin is clearly indicated, however, both patients and their physicians are often reluctant to do it. Some patients are needle-phobic, not realizing that modern insulin syringes and insulin pens are virtually painless.
Patients may also be worried about hypoglycemia and weight gain, although both of these concerns can be minimized. In cases where a doctor remains unwilling to start insulin for a patient whose glucose control is not improving even on two or three drugs, the patient should request consultation with an endocrinologist. Table 2 lists common concerns or barriers to initiation of insulin and some proven ways to overcome these obstacles.
In summary, most patients with type 2 diabetes will eventually need insulin to keep their diabetes in control. In general, the sooner insulin is started, the better off the patient will be in terms of preventing complications. Today's modern insulins and treatment regimens (basal-bolus programs) make insulin a user-friendly therapy. Starting insulin early is the key to improved control and a longer and healthier life for all patients with type 2 diabetes.
Table 1: Indications for Starting Insulin
| Absolute | Relative |
|---|---|
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Table 2: How to Overcome Barriers to Starting Insulin
| Weight Gain | Needle Phobia |
|---|---|
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| Hypoglycemia | Insulin resistance |
|
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For other articles from this month's special Insulin issue, see:
"Diabetes Is Not A Disease Of Blood Sugar"
"In My Opinion: There is No 24-Hour Basal Insulin"
"Why Smaller Shots of Insulin Get Absorbed Faster, Peak Sooner, and Are Out of Your System Quicker"
"Why Basal-Bolus Insulin Therapy May Be The Best Choice for Type 2 Diabetes"
1304 comments - 26 Apr 2007
147 comments - 29 Nov 2007
124 comments - 2 Apr 2008
120 comments - 13 Mar 2007
117 comments - 25 Dec 2008
Comments
I live in England and earlier this year my gp recommended me for insulin since the metformin wasn't working as well. I had taken myself off the avandia when I gained over 5 pounds in a week when it was doubled by the diabetes nurse from the diabetes clinic.
The diabetes nurse said no to insulin and that's when she doubled the metformin to 2000mg a day and the avandia to 8mg a day.
Well, now I am anemic which seems to be raising my bs and my gp has raised my dose of metformin to the highest dose.
Last week I saw my gp and asked for Byetta. She can't give it to me because I have to have approval from the diabetes clinic.
My gp seems to want to help me but the local diabetes clinic doesn't care. In fact, my last appointment there had been canceled without them telling me. Why was it canceled??They are only seeing insulin users.
What do I have to do to get on insulin? I am constantly running close to 180, which isn't good.
I'm a type-2 who recently started once-a-day insulin, using the Pen. My prior (and unfounded) insulin phobia were related to concerns about injection risks (not pain) and and calculating insulin dosing. I thought that injections had to go into particular places because vaccines go into muscle and some drugs go into veins. That made me wonder if I could be careful enough to inject myself into the right tissue and hit or avoid blood vessles and not inject air, causing an embolism? The answer I found was that the needle on the pen is short enough to avoid the wrong tissue and my injection site solves the other issues. The tummy for example, doesn't seem to have as many nerve endings as some other places, so combined with the thin needle it almost can't be felt. As to dosing, one can start with a base dosage of slow-acting and up it or lower it based on BG reading.
The one issue I'm still working on is matching my dose to my BG reading and "getting my number down". ;-)
I'd recommend to all doctors that when they first tell a patient that they have diabetes, they should immediately expose them to BG meters and Insulin injections by making the patient use both tools for themselves (with 31/33 guage lancets and needles), even if they may be able to avoid insulin or testing. They will lose their concerns and get a glimpse of one treatment they can work to avoid or postpone.
HUH?
Allie. What are you trying to say? That, a controled diet & excersize ALONE will do the job. . .for EVERYONE?
I wish this were true in my case.
I tried that route years ago, counting every single carb, putting myself on, what my dietician said, was a "starvation diet" of 1500 cal. daily and excersizing in addition to the physical labor required of my profession.
For four months I did this when diagnosed and my BG meter sometimes could not display a number becouse it was so high! {But, I did loose alot of fatty weight and thined up which, isn't a bad thing for a "husky" diabetic guy.}
Only with the addition of oral meds and a normal diet, did my numbers come down to normal ranges and a few months ago, when they started an upward swing again, I started taking a long acting insulin which is working great.
So much for your big bad drug companies and their "pushed" medications theory. Not every diabetic responds the same way to ANY form of treatment(s).
I will, at least, check out your sites you've posted. Perhaps there is something I could learn within them.
Nick.
Ahhhhhh. Yeah.
Good article. I was diagnosed type 2 in March 07. I'm 36, 5'11" and weight 205 lbs.
Learning that my beta cells are already half-dead is sobering and depressing.
I'd like to avoid insulin as much as possible. My last A1C was 6%. Hopefully in "15 years" better treatments will be available so I can remain off of insulin.
Why are you still pushing Avandia. It is a high risk drug
Hi Nicholas,
Can you elaborate on your statement about insulin resistance? "In the continued absence of any such reference it it reasonable to suppose that every type 2 Diabetic 'complication' arises as a result of the treatment of the 'insulin resistance' that was actually keeping type 2 Diabetics healthy in the first place."
This is the first time I have heard that insulin resistance can keep a person healthy. I've only heard that insulin resistance is bad.
The latest research shows that type 2 diabetes is caused by inflammation and not obesity. Exercise and fish oil reduce inflammation. What else can be done to reduce inflammation so that diabetes can be reversed. Why continue to treat the "symptoms" of diabetes with drugs instead of getting to the root cause. What causes inflammation?
Regarding insulin resistance:
I had a GTT test 30 years ago when I was in my 20's because I complained of hypoglycemia. My blood sugar went from 80 at fasting to 200 and then dropped to 40. The doctor told me that when I got older I would gain weight and develop diabetes, which is exactly what happened. I was lean and fit, and now I am fat and diabetic. I control my diabetes with low carbs and exercise, but my body will not lose weight. I have always been insulin resistant, even when I was a lean athlete. I had problems with hypoglycemia, so it makes sense that insulin resistance is a protective mechanism for hypoglycemia.
A question for Nick:
If insulin resistance protects against hypoglycemia, and therefore drugs that increase insulin sensitivity are defeating the protective purpose of insulin resistance, as you stated, "Diabetics are more protected from sudden HYPOgycemia c/o more glucose / insulin resistance ie leaving more glucose in a Diabetic's blood circulation [for feeding brain / optic / nerve cells] rather than glucose being too rapidly shunted-off [eg by GM insulin] into fat / liver / muscle cells ..." Then is exercise counterproductive? When I exercise, my blood sugar plunges, sometimes down to 50. I am type 2 diabetic and control my blood sugar by diet and exercise alone. Apparently, I am under the misunderstanding that low blood sugar is better than high, and since I do not take any insulin or medication, I don't worry about hypoglycemia. Should I worry? Should I increase my carbs to treat/prevent hypoglycemia during exercise? If, as you say, there is zero requirements for carbs, how do I prevent hypoglycemia without eating more carbs?
In this article, Dr. Tanenberg correctly states that oral medications fail in those people in whom antibodies destroy beta cells (in people with type 1, misdiagnosed as type 2). But then the author incorrectly states that, “many people with type 2 diabetes experience progressive loss of beta cell function.” The studies that show progressive loss of beta cell function did not exclude those people who have slow onset Type 1 but have been misdiagnosed as having Type 2 diabetes. When slow onset Type 1’s are excluded from studies looking at beta cell function in Type 2 diabetes, no loss of beta cell function is seen. According to the American Diabetes Association’s own peer-reviewed scientific journal Diabetes (Borg et al. “A 12-Year Prospective Study of the Relationship Between Islet Antibodies and Beta Cell Function At and After the Diagnosis in Patients With Adult-Onset Diabetes,” Diabetes 51 (6): 1754. (2002)) “None of the patients who were islet antibody–negative at diagnosis developed complete beta cell failure during the 12-year period. Indeed, 12 years after diagnosis, fasting P-C-peptide levels in islet antibody–negative patients were not significantly different compared with the levels at diagnosis.” In other words, if you remove the antibody positive patients (people with autoimmune diabetes who have been misdiagnosed as having Type 2 diabetes) from a study of beta cell failure in Type 2 diabetics, no beta cell failure occurs in the true Type 2 diabetics (i.e., those who do not have immune-mediated destruction of the beta cells).
Hi Dr. Tanenberg,
You said, "Insulin resistance typically precedes outright diabetes by several years, appearing in adults and children who are overweight, sedentary, and have a genetic predisposition to diabetes."
However, some people who are sedentary and obese never develop diabetes and others who are lean and physically active do develop diabetes. There must be a reason for "insulin resistance" if so many people have it. Taking drugs to make the body more insulin sensitive, and adding more insulin to someone who already has too much, seems to be assaulting our bodies, like force feeding someone who is already full and is screaming, "No more!" Why is there a diabetes epidemic anyway? Why won't anyone get to the root cause?
Hi Dr. Tenenberg,
Regarding your statement, "When the pancreatic beta cells can no longer overcome the insulin resistance, blood sugars begin to rise. Initially, only the post-meal glucose values are elevated, but in time the fasting glucose levels also increase. When fasting glucose tops 125 mg/dl, a patient is considered to have diabetes."
That is exactly what happened to me. I was insulin resistant at age 23, my postpranial glucose at a diabetic level, even though I was very lean and physically fit. Later I developed gestational diabetes but returned to normal after delivery. Years later, my fasting blood sugar went to 150 and my Aic was 7.6%. I am no longer diabetic. My A1c is down to 5.9%. This mornning, my fasting BS was 84. I am improving, not getting progressively worse. When I get lots of sleep, exercise, and eat low carbs, my diabetes disappears. Sleep seems to be the main factor, because when I am sleep deprived, my fasting blood sugar continues to rise regardless of exercise and diet. I wonder if the diabetes epidemic is caused by people being stressed by overwork and sleep deprivation.
Thanks Nick!
Perhaps many people with diabetes get progressively worse because they work too hard at trying to control their blood sugar (by way of starvation diets and strenuous exercise) rather than getting adequate sleep and relaxation. I feel much better after a relaxing walk and a good night's sleep. I can even eat more carbs if I take a 20 minute walk after meals.
I was Diagnosed Type 2 since 1984, my A1c is at 7 since last year 2006. I found by my own "common sense" 2 Years ago that "Exercise" AFTER meals for 20-30 minutes "LOWERED" my sugar back to 80-100 range! For "YEARS" I WASNOT Exercising AFTER meals: just taking oral meds plus Metformin LIKE MOST Diabetics I have met in my life! Now that my A1c is at 7; I will start some type of insulin because by my own reading diabetic news articles over the years I DIDN'T KNOW I WOULD SOMEDAY HAVE TO START INSULIN! My Doctors "NEVER" mentioned that possibility to me! How MANY other type2's in the world are living like this who "won't admit" they "WILL NEED TO START INSULIN" one day or get COMPLICATIONS as they get older and simply shrug thier shoulders and say quiely: it's my "Diabetes" getting worse!
Good article, but I worry about prolonged hyperinsulinemia and its effects on blood vessel disease, macro and micro. Also it causes weight gain as people snack and eat more to cope with a constant fear of hypoglycemia with barely concious feelings of sugar dropping too low triggering adrenalin and other alarms in the brain. Weight gain causes abdominal obesity increasing destructive hormone levels of hunger hormones, etc making many paradoxically more hungery for carbs and fat after they start a meal. Clearly exercise and insulin sensitizers like actos and glucophage help the resistance part but this alone cannot counteract the weight gain caused by the insulin. Gastroparesis would seem a problem for taking incretins. Is simply going on a strict carbohydrate weight loss diet a few days a month a better approach as I always feel incredibly better physically even though hungry and shaky when I do it in a way the medicines never come close. But as soon as I start to eat fully again, even with the meds, I begin feeling sluggish and gaining weight again. Also omega 3 and 6, vit e, c, and b's,(artificial and fish, veggie, fruit sources) and aspirin should in theory help blood vessel disease along with activity, but does it really?
Dear Nick (and anyone else reading this),
In answer to your question, I don't know how many people use diet and exercise alone (without drugs) to control diabetes. I think that when diet and exercise become too frustrating in keeping blood sugars in the normal range, some people resort to drugs because their doctors scare them into believing that they will have a stroke or heart attack. (My doctor scares me so much that it gives me high blood pressure whenever I visit him. I told him that if I were going to have a stroke, it would be in his office and he would be the cause of it.) In addition, I know of people who use drugs as an easy way out, so that they can eat whatever they want.
Yes, it is my opinion that proper rest between meals does help to control blood sugar. Most of us eat on the run and don't take time to relax. We go to bed too late and are jolted out of bed in the morning by alarm clocks, which in itself is distressing. (On weekends, when I sleep in, my blood sugars are normal.)
It makes perfect sense to me that the real disease is hypoglycemia. Basic biology teaches kids about homeostasis, so why can't doctors accept the fact that the human body is able to keep everything in equilibrium? I believe that if we take proper care of our bodies, our bodies will heal themselves.
I agree with your statement, "Any 'WORK' at trying to reduce a blood glucose concentration ... which is raised, by that body, as an adaptative mechanism [to PROTECT that body] is DISTRESSFUL."
You could probably say the same thing about using drugs to control blood pressure and cholesterol.
Here's question for you: If Alzheimer's disease is being called type 3 diabetes because of insulin resistance in the brain, what protective mechanism is at work here? Why would the brain, which depends on glucose, and which makes its own insulin, want to keep out glucose?
Nicholas,
Thanks for all the excellent information and links. I've just finished reading most of the studies you referred to and am very excited about it. I'm going to try eating less often and see how I do. My father recently died of Alzheimers at the age of 90. I want to prevent it from happening to me!
Nicholas Dynes Gracey,
I've very curious in your comments. I notice that you keep asking for evidence of the scientific postulates used by doctors in their treatments and yet you seem to keep using references from a BLOG. Indeed very scientific, yes, very evidence based. I hope those credentials you use serve you well, because your concepts on diabetes seem to be a throw-back to the days when the treatment for type 1 diabetes was starvation (qouting your comment: "UNdrugTREATED type 2 Diabetics and other healthy People should test daily with ChemStrips and pause from eating, and drink just water, until their urine is glucose free. The less carbohydrate eaten ... the less time between meals. That is how to CURE type 1 & type 2 Diabetes."
I recall a very interesting outcome of those patients...THEY ALL DIED!!!!!!
To bird54,
Your comments are very well founded, although there are a few other theories to explain insulin resistance...As you indicated glucotoxicity (too much glucose at the level of the cells - note that this is significantly different from "eating too much carbohydrate") is one of the theories. Another one is the concept of lipotoxicity (too much lipid or fat) in which the breakdown products called free fatty acids change the way that the cells respond to the insulin. A third idea (and one that parallels the gluco and lipo-toxicity theories on a molecular level) is that of inflammation, which is in itself a very difficult entity to describe (although we all seem to know what it is...). Some of the chemicals that are increased in the setting of inflammation are cytokines which can also be increased directly by the presence of high glucoses (so I'm not sure why Nick implied earlier that hyperglycemia is safe since these cytokines are very harmful to the body). The bottom line is that the chemical structures that float around in the blood come in contact with the cells of our body and some of these chemicals (be it glucose, free fatty acids, cytokines, something scientists have yet to identify, or some combination thereof) enter the cells and interact with the proteins that are in our cells. These interactions include changing the physical structure of the protein making it so it is unable to do its job (think of it like putting a big wad of gum on a bicycle chain and then trying to go for a ride) - for those who want the science behind this, I encourage you to read about tyrosine phosphorylation of both the insulin receptor and the insulin receptor substrate type 1 (IRS-1) and then compare it the serine phosphorylation which is caused by the free fatty acids and cytokines. The unfortunate reality is that our bodies are very complex organ with lots of things there to try and protect itself from anything that it perceives is "not normal". Indeed that will include both hypoglycemia and hyperglycemia. Perhaps the best question to be asking is what does the body (or more specifically our own body) consider to be "normal"???
To Nick and Anonymous,
Nick, Did you read the comments made by "anonymous" dated Dec. 5? I would like your opinion on it.
Anonymous, You said, "The unfortunate reality is that our bodies are very complex organ with lots of things there to try and protect itself from anything that it perceives is 'not normal'. Indeed that will include both hypoglycemia and hyperglycemia. Perhaps the best question to be asking is what does the body (or more specifically our own body) consider to be "normal"???
It would seem that our bodies already know what is "normal" and that is why I think medications can be dangerous. Our bodies have a wisdom of their own and are so complex that researchers have only seen the tip of the iceberg. Every time researchers discover some new enzyme or hormone in the body, they try to find a new drug to counteract it, or mimic it, (or whatever they do)and by interferring in one area, they create a problem in another area, because scientists do not know how the whole organism works. It is like the analogy you used of the "wad of gum in the bicycle chain," except that I am using that analogy to explain how medications gum up the workings of the human body.
The body is always trying to find balance (homeostasis), so my quesion is, "Why does the body get out of whack?" The human race has survived a long time on this earth without the need for medications. Of course, some died, but most adapted and thrived, otherwise we would not be here today. So my opinion is that we have deviated from nature and have consumed far too many calories, eaten too many refined junk foods, been exposed to toxins, and by so doing we have thrown our bodies out of balance. So diabetes and hypoglycemia are reactions to an unnatural lifestyle.
In the mice study, the mice who were fed the "normal" diet had average blood gluoses of 150. The mice that were fed a restricted calorie diet, and the mice that were fed on alternate days, both had blood glucoses of 100. So what is normal? It depends on their diet. Normality changes depending on what one eats. When I fast all day, my blood sugars range from 60 to 80. Is that normal? Yes, it seems so for my body, because that is how my body reacts to fasting. When I eat, my blood sugar rises according to what I eat, and how much I eat. Is that normal? It seems so. Blood sugar fluctuations are a normal response to eating and fasting. So the real question is, "What is healthy?" The results of the mice study show that eating less and eating less often both result in healthier mice.
However, I think type 1 diabetes has a different cause. It is caused by inflammation which causes the body to stop producing insulin. Without insulin, people die. The Toronto study showed that it was inflammation that caused the pancreas to stop producing insulin, and that when the inflammation was reversed, so was the diabetes. If type 1 is solely an autoimmune disease which destroys the beta cells, then how can dead beta cells produce insulin again AFTER the inflammation is gone? That tells me that the beta cells are not destroyed, but just inflammed, which makes them unable to produce insulin. So the cure to type 1 diabetes is to find a cure to inflammation.
Nick, You say that hypoglycemia is the real disease but that diabetes is the body's preferred state as a protective mechanism against hypoglycemia. Could you define "hypoglycemia"? By that, I mean, how low is low? Most of my hypoglycemic symptoms are from rapid dropping of blood sugar and not from being low. For example, while fasting, my blood sugar can be in the 60's with no symptoms. Yet, if I eat a high carb meal, my blood sugar will spike and then drop suddenly, resulting in shaking, sweating, irritability, at 70. It is the rapid drop that gives me my symptoms. I also get symptoms when my blood sugar is rising. Once after exercising, I was surprised to find my blood sugar at 50. I ate some glucose tablets and then the shaking started, as my blood sugar rose quickly to 90.
Does this mean that I am NOT insulin-resistant?
To Nick and Anonymous,
Diabetes is a normal response to an abnormal lifestyle.
To Anonymous,
I got so caught up in thinking about "what is normal" that I forgot to say "thank you" for your response regarding all the theories on insulin resistance. I will certainly look into "tyrosine phosphorylation" compared to "serine phosphorylation". I have no idea what that means, but I am curious to find out!
To Nick,
You said, "PLEASE really do this ... have each & every One of your Doctors identify ANY Peer-reviewed scientific reference, with an UNdrugTREATED control [ie comparing a Diabetic Group entirely UNdrugTREATED], ever been produced, that has ever evidenced that type 2 Diabetics are less healthy UNdrugTREATED ?"
I will ask, however, I don't believe that anyone will ever compare UNdrugTREATED diabetics, because most of the research is funded by drug companies, and all they care about is making money by treating the chronic diseases they invent (like diabetes). If they can label it, then they can treat it.
Nick,
How do you define eating "too often"? In the mice study, they fed the animals on alternate days. In your opinion, how often and how much should a person eat? In the mice study, the mice consumed twice as much food on the days they ate, thereby making up the lost calories for the previous day in which they had fasted. For a person with relative hypoglycemia, eating too much can result in huge blood sugar swings. In that case, wouldn't the standard treatment of six small meals be more beneficial in order to stabilize blood sugar? In other words, fast one day, and then graze the next day?
In the human study involving fasting diabetics, they discontinued the fast for those with either hyper or hypoglycemia. Again, HOW low is too low?
There's a book by titled, Adrenal Fatigue, by James L. Wilson. He states, "We have known for almost a century that people who suffer from low blood sugar frequently suffer from adrenal fatigue." Wilson's solution (among other things) is to get eat more often.
In your opinion, was I better off two years ago when my fasting blood sugars and A1c were higher? I thought that by improving my blood sugars I was "reversing" my diabetes, but have I in fact made my disease worse by increasing my episodes of relative hypoglycemia? I have to say honestly that I felt better when my blood sugar was higher than I do now, but as I mentioned earlier, my doctors scared the crap out of me when they diagnosed me with diabetes. It was like a death sentence, so my reaction has been to starve myself and overexercise in order to save my own life.
To Nick and others,
If diabetes is caused by relative hypoglycemia, and hypoglycemia is caused by eating too often, then food is the cause of disease. Therefore, eating less often is the cure because it gives the body time to detox.
The question is: Is "food" the cause of this disease, or is food "intolerances"? It is known that many type 1 diabetics also have other autoimmune diseases, namely Celiac Disease (intolerance to the gluten in wheat, barley, and rye.) Studies have also suggested that casein (from milk) may trigger type 1 diabetes. Certain adenoviruses may trigger diabetes. The body mistakes these proteins and viruses with its own organs, triggering an autoimmune response.
In addition, many people react to the proteins in other foods such as eggs, soy, seafood, and corn. People with food allergies/sensitivities also suffer from adrenal fatigue/exhaustion. Food allergies cause relative hypoglycemia. That is one reason why they tell diabetics to test their blood sugar after meals. Some diabetics can tolerate some foods, while others can't. Food sensitivities cause rapid rises in blood sugar followed by rapid falls, resulting in hypoglycemia. Food intolerances also cause inflammation. Inflammation is the cause of all diseases, including cancer, arthritis, and diabetes.
Therefore, eating less often reduces inflammation, thereby curing these diseases.
rDNA insulin CAUSES more inflammatioon throughout the body. Why would you CONSIDER introducing MORE inflammation to *reduce* blood sugar -- when in Type 2 diabetes -- it is INFLAMMATION that caused it in the first place?
Nowadays, a doctor is expected to prescribe a *fix* for his or her patient and send them on their way. However, taking into consideration NO INSULIN will HELP a TYPE 2 recover -- but rather IMPAIR a person with Type 2 diabetes -- why are people immune to understanding this?
The fact that we look upon insulin treatment for a person with Type 2 diabetes as an *OPTION* completely defies the HIPPOCRATIC OATH -- which states: "To please no one will I prescribe a deadly drug nor give advice which may cause his death."
Folks, even though what Nick says is very complex in wording -- it makes sense!!
The human body is the most miraculous machine on Earth! Allow it to heal itself and you will be gifted with the health He intended you to enjoy.
To AllieB2,
You are right. Nick's writing is very complex. I am still trying to comprehend it.
Hi Nick,
I'm still reading and thinking about all of this information, so I'll get back to you. In the meantime, I have another question. You said, "PLEASE really do this ... have each & every One of your Doctors identify ANY Peer-reviewed scientific reference, with an UNdrugTREATED control [ie comparing a Diabetic Group entirely UNdrugTREATED], ever been produced, that has ever evidenced that type 2 Diabetics are less healthy UNdrugTREATED ?"
I understand and agree that there is no evidence that un-drug-treated diabetics are less healthy than drug-treated diabetics. My question: Is there evidence that un-drug-treated diabetics are less healthy than non-diabetics? Is there any evidence that hyperglycemia actually causes complications? If hyperglycemia is the cure to hypoglycemia, does there need to be a cure for hyperglycemia? If you were to list the types of diabetes on a spectrum, what order would you put them and what would come BEFORE type 0 diabetes?
Dr Aulakh here.a diabetes specialist from india
I have seen many patients where HbA1C is more than 10,but everytime there FBS comes below 180 mg/dl {capillary}for last 2-3 months.WILL HbA1C be the absolue indication in all these cases for starting insulin therpay.
Hi NIck,
WOW! Impressive!
You have convinced me. I've read the links you listed, but I'm not done analyzing them yet, so I may have more question later. As the saying goes ..."inquisitive minds want to know..."
I've been fasting all day (just drinking water) and eating in the evening when I get home from work, Last week I lost 5 pounds. I feel fine--more relaxed and less irritable, probably due to less blood sugar swings.
Hi Nick,
I will definitely share this information with others. I have already shared it my friends and coworkers. Keep it up!
Hi Nick,
Have you thought about writing a book explaining your theory and cure for diabetes?
Hi Nick,
You said, "What (?) would my writing a book add to what Dr Bernarr is already offering RIGHT NOW ... ie a 100% bona-fide cure for type 1 & type 2 diabetes."
I think that a book, explaining all the research to back the claims would seem more credible to anyone who would want the scientific basis for the cure to diabetes.
You said, "How is your understanding of my work different from your understanding of Dr Bernarr's work?"
Dr. Bernarr's website says, "Fast only when you are symptomatic, i.e., when you have symptoms. Eat only when you are genuinely hungry....When you fast, drink only water, lie down and close your eyes. Keep your eyes closed every moment of the 24 hours, every day that you water fast. During a water fast, you must have total physiological rest."
That seems a lot different than eating less OFTEN, as you propose. You imply that a person should eat only one meal a day, to give time for complete digestion, and to allow time for the urine to become glucose-free, before consuming another meal. If, as Dr. Bernarr suggests, a person should rest completely with the eyes closed, that could only be accomplished when one is not working. I have been fasting all day while working, and eating when I get home. I have been ignoring my hunger pangs during the day. I never have glucose in my urine, even after a meal, so what would be the benefit for me to fast, except to cleanse my body, reduce the inflammation, and lose excess body fat?
Dr. Bernarr suggests fasting as a cure to all diseases, not just diabetes. The Bible says, "WHEN you fast", not IF you fast, so it was common practice 2000 years ago for people to fast, whereas nowadays health care practitioners say, "Eat small meals more often, and make sure you eat a nutritious breakfast..."
Dr. Bernarr also suggest strenuous anaeorbic exercises to build muscle because glucose in stored in muscle.
I think that Dr. Bernarr's cure for diabetes is very simple and straighforward. However, I think that many people want more scientific basis for a cure.
How much more simple can "eat right and exercise" be? Yet, people refuse to do it. They would rather take drugs. Sad, huh?
Nick said,
"Please summarize, in 5 short paragraphs, the most important issue raised in each of the 5 'diabetes breakthrough' references 2000-2007 [listed immediately above]."
1. Rats that fasted for 72 hr had a reduced plasma insulin level. However, insulin levels in the brain were elevated after a 72 hour fasting period.
2. In mice, hyperglycemia was induced after 48 hours of fasting, but not after 24 hours. Serum insulin levels were low. However, after refeeding for 12 hours, the mice were hyperinsulinimic, insulin resistant and had impaired impaired glucose tolerance. (What is this suggesting--that one should fast no longer than 24 hours?)
3. Intermittent fasting resulted in reduced serum glucose and insulin levels and may protect the brain from disorders such as epilepsy, strokes, Alzheimer's and Parkinson's diseases. Intermittent feeding can enhance health even if the fasting period is followed by a period of overeating.
4. Glucose restriction extends life span of (worms?).
5. Prolonged fasting is safe for type 1 diabetics as long as they reduce their insulin dosage. They had lower insulin levels but higher A1c's (I thought the goal was a lower A1c)
To answer Nick's questions:
1. I was diagnosed with type 2 diabetes in 2005. My fbs was 150 and my A1c was 7.6%
2. I was never given a C-peptide test.
3. My physician told me that I had worn out my beta glands but never did any kind of test to determine the condition of my beta glands.
4. I never had glucose in my urine.
5. Upon diagnosis, I immediately went on a low-carb diet, against my physician's advice, and lowered my A1c to 5.9%, so I was never prescribed any diabetic drugs.
However, in 1990, I had gestational diabetes. They put me on a high carb, low fat diet, which made my diabetes worse. Then I was put on insulin, without a C-peptide test to determine that I needed insulin. I had a bad reaction to insulin. It made my heart race and I felt horrible. When I exercised, I got hypoglycemia. The diabetic nurse told me that my reactions were worse than her "brittle diabetics." They had to keep lowering my dose until I was down to 2 units. Then the physician told me that at that dose, I really didn't need it. When I went into labor, the nurse tried to give me my morning shot of insulin, without even checking my blood sugar, but I refused. I knew that on an empty stomach, and with all that exercise (contractions of labor), I would have gone into insulin shock. I can't believe how ignorant they were. As it was, my baby got stressed, was born with hypoglycemia, and had to be put into ICU for a day.
I don't trust the medical profession any more. They could not prevent my diabetes, even though they knew I was at risk. In fact, one physician told me, "You cannot prevent diabetes. You will get it no matter what you do." Doctors have not given me any good advice about how to treat it. Everything I know about diabetes, I have learned on my own. Whenever I have a check-up, they want to put me on statin drugs and ACE inhibitors. I have more faith in my own body's ability to regulate itself than I do in physicians and prescription drugs.
Dr. Tenanburg,
Why do you recommend insulin during pregnancy? On your chart, you listed:
"Indications for Starting Insulin"
"Absolute"
"During pregnancy"
My grandmother had three, fat, healthy babies, all 10 and 12 pounders, with no complications or defects.
My second baby, born in 1993, was a HEALTHY 10 pounds 10 ounces. He was born at 42 weeks. During labor, he showed no signs of distress. His heart rate did not drop during contractions. The nurses kept commenting how much endurance he had. His delivery was natural with no drugs and no epidural. The doctor was surprised to find that he did not have hypoglycemia or a broken collar bone. He was so strong that he could hold his head up. They commented, "This is no newborn--This is a three-month-old!
I'm glad I did not take insulin. My OBGYN did not give me insulin, even though I had glucose in my urine. I just ate healthy foods and exercised.
To Nick and anyone else,
Nick's "I-eat-less-OFTEN-I-fast-more-OFTEN" method really does work.
I lost 10 pounds in 2 weeks!
They all say, "Lose weight (if you can) and your diabetes will go away." Easier said than done. I tried low carbs and exercise, but it didn't take off the pounds like "eating-less-often-fasting-more-often."
Merry Christmas Nick and Anyone Else!
I've been reading back on all the comments, and wow! There is a lot of information to absorb.
The research supporting “eating less often, fasting more often” is astounding. I think that if one looks at a meal as a "rew