Less insulin better health?

[johnboy326]

My dietician made a comment that the less insulin you take its better for your health, apart from increasing your weight are there any other reasons?

 

[therower]

What necessitates the need for insulin?

My insulin requirements are based solely on food and lifestyle.

Hence food and lifestyle are the leading factors regarding health.

 

[Art Of Flowers]

Dr Bernstein advocates a low carb/low insulin regime for type 1 diabetes ( ‘law of small numbers’ ) ... See https://www.diabetes.co.uk/diet/low-carb-and-type1-diabetes.html

For type 2 sufferers the less medication you need to take the better and having a HbA1C below 42 with no medication is ideal.

For type 1 diabetics and type 2 diabetics who use insulin there is a correlation of all cause mortality an HbA1C with both high and low HbA1C levels having higher risk - this is known as a "J" risk curve. High levels of blood glucose and high levels of insulin increase the risk of heart disease. See also ... https://gpnotebook.co.uk/simplepage.cfm?ID=x20061014083325853220

 

[ickihun]

My dietician made a comment that the less insulin you take its better for your health, apart from increasing your weight are there any other reasons?

An older post in diabetes news stated research found harshly controlled bgs with insulin is a higher risk to death. So too much insulin can get perfect bgs but higher risk of hypos and mental health problems.

Obviously type2s are better on lower insulin as they constantly have higher output.
Insulin taking type2s have to be risk assessed for what is best.

 

[ringi]

A very high BG will kill you.
A long-term high BG will make you go blind.
High levels of insulin in your blood increase the risk of strokes and heart attacks.

The ACCORD study shows that for Type2, there is no benefit in using insulin or any drug that makes our body produce more insulin to get a low A1C, but that insulin should be used to prevent a high A1C.

 

[tim2000s]

The ACCORD study shows that for Type2, there is no benefit in using insulin or any drug that makes our body produce more insulin to get a low A1C, but that insulin should be used to prevent a high A1C.

How did you draw that conclusion? The ACCORD study showed that those who had lower Hba1Cs in the intensive therapy group had lower mortality than those in the non-intensive group when normalised for the use of Avandia (which 95% of the intensive group were on). Avandia discredits the initial findings of the study as it has since been withdrawn in most regions due to increased risk of Myocardial Infarction when taking it, and in light of this, subsequent review of the data has reversed the original conclusions.

 

[Art Of Flowers]

If you check the link from my post above you will see the UK GP advice from NICE is as follows ...

For diabetics:

• HbA1c levels of between 6.5% and 7.5% are recommended by NICE (1)
  • a MeREC review (2) states that "..If appropriate and achievable in an individual, reducing blood glucose to HbA1c levels of around 7.5% would seem optimal based on current evidence. Lower levels may be appropriate for individuals with early disease..."

• NICE note that for type 2 diabetes (1):
  • for adults with type 2 diabetes managed either by lifestyle and diet, or by lifestyle and diet combined with a single drug not associated with hypoglycaemia, support the person to aim for an HbA1c level of 48 mmol/mol (6.5%)
    • for adults on a drug associated with hypoglycaemia, support the person to aim for an HbA1c level of 53mmol/mol (7.0%)
      
  • in adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher:
    • reinforce advice about diet, lifestyle and adherence to drug treatment and
    • support the person to aim for an HbA1c level of 53mmol/mol (7.0%)
    • and intensify drug treatment

 

[johnboy326]

Thanks for that I am currently 6% my endo wants 7% so if I aim for 6.5% about 47.5 hba1c then that's a compromise and we will see what happens to my spikes. If I could cut out bread completely that would help but that's one food I'm not willing to cut completely! Have a dietician on board so that will help

 

[Art Of Flowers]

What you eat and what medication you take will have a huge impact on your health. The QRISK3 calculator suggest that type 2 people will live about 8 years less than average and type 1 13 years less. The most common cause of death for diabetes is heart disease and strokes.

Heart disease is affected by inflammation in the arteries which can be caused by glucose spikes and high concentrations of insulin. Spikes in blood glucose also can lead to kidney, liver disease and some cancers as well as raising the risk of Alzheimers.

It is possible to have a low average blood glucose levels but have lots of short duration hyper/hypo events. These high/low events will shorten your life expectancy as well as leading to mental issues such as mood swings. So HbA1C is not the only metric to be worried about.

You can eat what you like, but it is better to avoid glucose spikes and hypos, so if you want to eat high carb foods like bread or rice then make sure you don't suffer spikes and hypos. CGMs devices like Dexcom and Libre can give confidence that you are within normal glucose levels e.g. 4-8.5 mmol/l. If some foods are causing spikes then stop eating it.

 

[librarising]

My dietician made a comment that the less insulin you take its better for your health, apart from increasing your weight are there any other reasons?

I've noticed how increasingly, as the old lipid hypothesis is discredited (which claimed high cholesterol led to heart disease), that modern health commentators cite two main causes of heart disease : inflammation and hyperinsulinemia/insulin resistance.
Here's Ivor Cummins on insulin resistance (from 22.45)

Here's a short video on the problems that can stem from too high insulin :

Geoff

Edited to replace Cummins link. Now to YT video and not his blog.

 

[johnboy326]

What you eat and what medication you take will have a huge impact on your health. The QRISK3 calculator suggest that type 2 people will live about 8 years less than average and type 1 13 years less. The most common cause of death for diabetes is heart disease and strokes.

Heart disease is affected by inflammation in the arteries which can be caused by glucose spikes and high concentrations of insulin. Spikes in blood glucose also can lead to kidney, liver disease and some cancers as well as raising the risk of Alzheimers.

It is possible to have a low average blood glucose levels but have lots of short duration hyper/hypo events. These high/low events will shorten your life expectancy as well as leading to mental issues such as mood swings. So HbA1C is not the only metric to be worried about.

You can eat what you like, but it is better to avoid glucose spikes and hypos, so if you want to eat high carb foods like bread or rice then make sure you don't suffer spikes and hypos. CGMs devices like Dexcom and Libre can give confidence that you are within normal glucose levels e.g. 4-8.5 mmol/l. If some foods are causing spikes then stop eating it.

Agreed all makes perfect sense

 

[Bluetit1802]

Also, too much circulating insulin will most likely trigger insulin resistance. In turn, insulin resistance means even more insulin is needed to do the same job, so there is even more insulin circulating, and worsening insulin resistance. Vicious circle.

 

[johnboy326]

Also, too much circulating insulin will most likely trigger insulin resistance. In turn, insulin resistance means even more insulin is needed to do the same job, so there is even more insulin circulating, and worsening insulin resistance. Vicious circle.

So the only option to try to counter this is reduce carbs towards no carbs hence less insulin. Also note changing injection sites namely basal in buttocks thigh and bolus best around skin on stomach as absorbed quickest here

 

[Bluetit1802]

So the only option to try to counter this is reduce carbs towards no carbs hence less insulin. Also note changing injection sites namely basal in buttocks thigh and bolus best around skin on stomach as absorbed quickest here

Yes to the low carb bit. Have no idea about insulin injection sites! (I am medication free.)

 

[Lamont D]

Just to throw my weirdness into the information that has already been given.
We can't live without insulin, but too much is very dangerous and a risk to your health and well being, as well as mental health. (Don't I know it!)
However, I get a very weak insulin response initially to any carby meal, but because of the very quick glucose spike, that is the trigger for a secondary insulin response, an overshoot it is called.
Over time, excess circulating insulin creates insulin resistance, which causes high blood glucose levels, which in turn means more of the viscous circle of glucose and insulin.
There are two ways to stop this overshoot, one is not to create the glucose, that means no spike, no spike, no overshoot. The need for a secondary response is unnecessary.
The second is to take a dpp4 inhibitor. The Gliptin will increase the initial insulin response. So the second insulin response is not needed.
However, I would still hypo if I ate anything that I am intolerant to, but using insulin to counter excess insulin is a bit of thinking out of the box moment that my endocrinologist made, and it works.
For some diabetics increasing the initial response will effect the spike down and be useful for lowering hba1c and fasting blood glucose levels.

 

[ringi]

http://www.sign.ac.uk/assets/sign154.pdf lists a lot of the studies that have gone into the Scotland guidelines for HbA1C standards. My view is that the NICE targets are about right and unless only diet and/or Metformin is in use, I would rather have fewer drugs/insulin then get below them.

(There are newer drugs than Metformin that reduce BG without increasing insulin, these may be worthwhile to push HbA1C below the NICE targets, but these drugs don't yet have a long history of usage.)