Questions about The Lantus/Cancer Association

UPDATE: August 17, 2009: A safety review of an ongoing study of Lantus,sponsored by Sanofi-Adventus, the drug company who produces Lantus, but where the drug company supposedly has no access to the findings, found no evidence that people taking Lantus in that study were seeing a higher rate of cancer.

Science Daily: Research Team Responds To Concerns About International Insulin Drug Trial
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ORIGINAL POST

By now you've probably heard the disturbing news about the epidemiological studies that connected Lantus to a higher incidence of cancer.

It says something about our health system that this news was reported by the business press long before the health press noticed it. And the business press coverage was concerned entirely with the impact this news would have on share prices of Sanofi-Adventis-not on the health of the people taking the drug. That's how capitalism works, folks, and it is the reason for a lot of unnecessary drug-related morbidity. Companies will hide and suppress bad news about a drug as long as possible in the hopes of supporting their share price.

You can find the news and the actual full texts of the studies connecting Lantus and Cancer here:

Diabetologia - Cancer & Lantus

I don't have the time right now to do a detailed analysis of these four studies. But here are my initial thoughts. We know that high glucose levels promote the growth of cancers. We also know the demographic of who is prescribed Lantus: Type 2s who have been out of control for more than a decade. This is because most doctors are reluctant to prescribe insulin until patients have taken every oral drug available for years, even if their A1cs continue to climb. The typical A1c of a patient who starts Lantus is 10% and their fasting blood sugar is usually near 200 mg/dl.

NOTE (added 7/2): The editor of the "PRESENT DIABETES Newsletter" mailed 7/2/09, "If you look at the actual study data, you see that it's not real world: 2/3 of the patients were excluded, because they were on a combination regimen, e.g. basal-bolus insulin. Moreover, the glargine patients were on quite different regimens and used more oral medications. [Emphasis mine]"

When doctors put out-of-control Type 2s on "insulin" it tends to only be basal insulin. This is because most Type 2s get their diabetes care from family practitioners, instead of endocrinologists, and family doctors don't have the resources to provide the detailed education patients need to use fast acting insulin with meals effectively and without causing themselves hypos.

Dr. Tamler's note confirms my suspicions, the patients found to have higher rates of cancer were Type 2s on inferior basal-only regimens and high carb diets which ensure
the high blood sugars that promote cancer.

Basal insulins like Lantus cannot counter the blood sugar spikes caused by the high carbohydrate meals most doctors still recommend, meals filled with so-called "healthy whole grains" and bananas. So even when people with Type 2 inject huge doses of Lantus--100 units is a typical Type 2 dose--most long-term Type 2s "on insulin" still experience post-meal blood sugars that spike into the 200s. That is why the A1c of all too many Type 2s "on insulin" (i.e. Lantus) are almost always considerably higher than the ADA's anemic 7% target.

This means that these people, despite injecting Lantus regularly experience blood sugars are high enough to a) turn off their immune system allowing cancerous cells to begin to grow and b) feed those cancerous cells.

Besides that, patients "on Lantus" have been on cocktails of powerful oral drugs for years before starting Lantus. So one would want to know if some these patients who contracted cancer were taking Januvia, the single most promoted new diabetes drug for Type 2s. There is significant evidence that Januvia turns off a tumor suppressor gene. We also do not know the impact on cancer of the TZD drugs, Actos and Avandia.

So the valid study comparison that would tell us whether Lantus is in fact promotion cancer would be a comparison between two groups of people with Type 2 diabetes who have been matched for the length of time since their diabetes diagnosis, who have the identical A1cs and oral drug consumption histories, where the ONLY difference between the groups is whether or not they are taking Lantus.

If that comparison shows a higher incidence of cancer in the Lantus group, then Lantus is, in fact, a very dangerous drug.

But comparing Type 2s taking Lantus, Avandia, Actos, Metformin and Januvia with Type 1s using R insulin or for that matter, Type 2s taking only Sulfonylureas and NPH (a common European protocol), may mean that you are comparing two different populations with different blood sugar histories and drug exposures. If that is the case, the cancer incidence in the two groups may not stem from the Lantus, but from the other factors applying to the group prescribed Lantus.

This latest alarm, as scary as it is to people who have been taking Lantus, is probably GOOD news, because it will trigger some serious research into the cancer profile of all the analog insulins and perhaps, even, of the oral diabetic drugs.

If you have been using Lantus and are still running damagingly high blood sugars capable of suppressing your immune system--sugars higher than 140 mg/dl after meals--the first thing to do is drop those blood sugar levels. Give your body the help it needs to nip cancer in the bud. Each of us develops a few cancerous cells every year, but a healthy immune systems kills them off before they can proliferate. Remember that cancer cells require a lot of glucose to grow (and don't need to be insulin sensitive to use that glucose). If you are taking Januvia, stop. It has definitely been connected with a mechanism that promotes cancer in a way that is well-understood.

If Lantus does promote cancer independent of its inability to tightly control the blood sugars of people with Type 2 diabetes who eat high carb diets, it would be helpful to know what exactly it is about Lantus that promotes cancers so we could know if the other analog basal insulin, Levemir, and the fast acting analog insulins, Novolog, Humalog, and Apidra, also cause cancer.

NOTE (Added 7/2): Dr. Tamler also states this: "However, use of the insulin-sensitizing agent metformin has been associated with decreased cancer risk."

I think the doctors commenting on the Lantus news did have it right this time: we don't think we have the evidence yet to understand this disturbing finding. Whether we will get that evidence or be handed a bunch of spin and persiflage from the drug manufacturers designed to prop up their share price at the cost of human lives, is another question.