July 3, 2007

Should you Avoid Injected Insulin when Natural Insulin Levels are High?

If you are a Type 2 who is having a tough time getting normal blood sugars using oral drugs, your doctor may tell you that injecting supplemental insulin would be a bad idea as you already are producing high natural levels of insulin.

This sounds like a compelling argument--except if you also, despite those high levels of natural insulin--are experiencing consistently high blood sugars.

That is because the higher your blood sugar, the more insulin resistant your cells will become. This nasty effect appears to kick in as blood sugars go over 180 mg/dl (10 mmol/L). So if you you are routinely walking around all day with blood sugars of 250 mg/dl (14 mmol/L) or more, no matter how much insulin your body is pumping out, your cells will have a tough time using it, which means your blood sugar will tend to go even higher. Even worse, these blood sugar levels are high enough to poison your remaining beta cells, making your diabetes permanently worse.

Some people can reverse this vicious cycle by cutting carbohydrates out of their diet to the point where the post-meal blood sugars no longer go high enough to increase insulin resistance. If you can do this, it is a very good way to deal with the problem. But this approach, though it often works, is one that few doctors currently recommend, since their orientation is to prescribe heavily marketed pharmaceutical drugs and they may be influenced by outdated nutritional research and not know that current research backs the safety of cutting carbohydrates to control diabetic blood sugars.

But if this approach doesn't work for you, and if, despite taking two or even three oral drugs and making a trial of Byetta, your A1c is higher than the 7% level that even the ADA admits cause the dreaded complications of diabetes, then insulin is the only drug that can bring your blood sugar back to safer level.

That is because, no matter how insulin resistant you may be, with enough supplemental insulin, properly dosed, your blood sugars will come down. And if you can get your blood sugars under the level at which insulin resistance increases, your response to insulin, including your own homemade insulin, will improve. Most importantly, by using insulin to get your blood sugar down to a safer level, you will cut way down on your likelihood of developing life-ruining complications.

It is tough to understand why so many doctors take a lackadaisical approach to doing something about the over 7% A1cs of their Type 2 patients, but sadly, many do, standing by while patients experience year after year of blood sugars that are continually in the very high range guaranteed to cause complications.

This lackadaisical attitude is even harder to justify when you realize that science has found that as long as your blood sugars are very high glucose molecules are continually flooding into your nerves and retinas which is a major explanation of what causes the damaging complications of diabetes. It turns out that these key tissues--the nerves and the retinas--do not require functioning insulin in order to take in glucose. If glucose levels are high in the blood stream, glucose is drawn into these tissues and over time it destroys the nerves and causes the changes in the blood vessels in the retina that lead to blindness.

Your doctor may argue that exposure to very high insulin levels for a prolonged period of time may not be good for you. This may be true, since insulin is a growth hormone and there is concern that very high levels of it may cause some tissues to grow at unhealthy rates--though the evidence on this is mixed. But whatever the longer term effect of exposure to extra insulin there is no dispute in the scientific community that long-term exposure to extremely high blood sugars results in outcomes that are a lot worse.

So if you have tried cutting way back on your carbohydrates and taking drugs that are supposed to lower insulin resistance or lower blood sugar itself, and you still have an A1c over 7%, or if your post-meal blood sugars are routinely over 180 mg/dl despite taking a variety of drugs, and your doctor hasn't suggested that you supplement insulin, you should demand that your doctor explain to you why he or she is withholding the only drug that can normalize blood sugars and allowing those high blood sugars to ravage your body.

The answer better be a good one.

Note: One last point that is often missed is that doctors may conclude you are making high levels of insulin based on faulty interpretation of lab data. The C-Peptide test, for example, only shows whether you are making insulin at all. The measurement of C-peptide does not correlate well with how much insulin you are making.

Though many type 2s are insulin resistant, after years of being exposed to very high blood sugars their beta cells may have been destroyed or have lost the ability to respond properly to high blood sugars, so their insulin production, while enough to register on a C-peptide test, may actually be much less than they need to control their blood sugar. In that case insulin supplementation will be the only treatment that can normalize that blood sugar.


BetterCell said...

Using supplemental insulin in TRD(aka Type 2 Diabetes) is a bad idea.
The use of exogenous insulin will create antibodies within your body to it later on. Since you actually have available insulin, the real focus is a complete Lifestyle change that incorporates the following:
1. Self-Respect.
2. Healthy Food Intake with an abundance of "fresh" vegetables, fruits, and lean protein sources.
3. limitation of Carbohydrates.
4. DAILY exercise.
5. Meditation
6. Responsibility for your own care.
7. Nutraceuticles.
8. Learning everything about IRD
9. Not giving up your Autonomy.
All the above requires work. but an improved Life is worth it.
You are your own best Doctor.

Jenny said...

The argument that injected insulin "Causes antibodies" and should be injected, when blood sugar is very high, is nonsense.

Type 2s are put on insulin by good doctors at the time at diagnosis if they are running very high, and they go off it later when their blood sugar has dropped to the level where it isn't worsening insulin resistance.

Any antibodies will fade out pretty quickly. I've started and stopped insulin without seening any effect of antibodies after 2 weeks.

Neutraceuticals are an expensive way to delude yourself. None of them will lower a severely high blood sugars, using them, besides draining the wallet, just postpones getting better control.

If you had read the post, you'd have seen that I do recommend cutting carbs, but there are many of us who still have higher than normal blood sugars no matter how few carbs we eat. We have defective or dead beta cells, not just insulin resistance.

I'm glad your approach works for you and if you are getting normal blood sugars doing what you describe you don't need insulin, but one of the biggest problems in the community of people with diabetes is assuming that what works for your own metabolic problem will work for others who may have a completely different cause for their diabetes.

Type 2 Diabetes--high blood sugar--is a symptom with many causes, not one physiological disorder.

Jenny said...

Correction, in previous comment
The argument that injected insulin "causes antibodies" and should NOT be injected . . . .

tina said...

You mentioned that "current research backs the safety of cutting carbohydrates to control diabetic blood sugars." Are there any links you could post that I could show my CDE, to show her that research? I have been doing very well for two months (since my diagnosis in April, with an A1C of 12) on about 30-50 carbs a day, but I saw her last week and she freaked! She insists that I must have a minimum of 150 a day or risk brain damage, organ damage, malnutrition, and all kinds of other problems. Following her recommendation my post-meal BG#s have shot way up again (168, 202, 156, etc., compared to 135, 140ish before), so I'm going back to a lower carb count, but I'm meeting with her again next week and would love to be able to point her to some research supporting my position. Plus, I hate to think how many other diabetics she is telling to INCREASE their carbs, just because she doesn't know that it's okay to eat less! Thanks for any info -- your blog is one of my favorite resources.

Anonymous said...

I know this isn't a dialog forum, but I couldn't resist a comment in response to Tina's problem with her CDE "freaking out" about low carbing.

To idiots like that CDE, I tell them I kept my BG well controlled with a prescribed "very strict" low carb diet during pregnancy with BG target numbers far lower than ADA recommendations, yet delivered a healthy, normal weight baby. How "dangerous" can it be if it is prescribed durign pregnancy? I ate far healthier food on the low carb diet after I was diagnosed during pregnancy and my only regret is that it wasn't recognized for what it probably was then, the early stages of "real" diabetes, not "temporary" gestational diabetes.

Nine years later (& doing very well back on the low carb, minimal "packaged" food diet for several years) I have learned that the science is clearly showing that lower carb intake is closer to our evolutionary roots and a better foundation for good health, but much of the medical profession is lagging behind in recognizing this.
Be very, very careful which experts you listen to. Some are "certifiable". :-)