DIABETES 2 INSULIN QUESTION

[ickihun]

I know the medical profession appears to recognise more than two types of diabetes and that seems logical to me. The problem I have is diagnosing on a symptom that can be caused by more than one "condition". To me if the pancreas is no longer able to produce enough insulin then that condition is nearer to what we currently refer to as T1 diabetes.

Having read Jason Fung's two "code" books recently I am more than a little concerned about too much insulin in my body. I haven't had an insulin level test but will discuss this with my GP when I get back to Australia in July. I would like to know what the current medical profession thinking is on Hyperinsulinaemia.

Diabetes is way to complex and illogical for me. In my logical mind if I have too much insulin in my system it seems wrong to increase that amount. (Like giving alcohol to an alcoholic as a treatment.) It seems to make sense that increased insulin only serves to force more glucose into fat cells and make losing weight harder. I'm not a medical professional and the number of variations with this dreadful condition sometimes blow logic out of the window.

There does not appear to be one size fits all, but I'd like the medical profession to get away completely from the term diabetes as a catch all and start to focus on identifying and treating the causes of high blood sugar.

Up until the last few years I have been type2 on metformin and very very well but overweight.
Since trying to address my weight I have had a burn out, ended up on insulin and had various ailments; mechanically and physically. Mentally on occasion. No food cravings or emotional eating thou.

If I wasn't overweight I would have been happy to have just continue on metformin, if my body had been happy to.
My body stopped getting any help from any med but insulin.

 

[kokhongw]

The short answer is that the overriding concern for mainstream T2D management is glucose control and risk avoidance. It has been deemed to be safer to have higher glucose level than to have near normal glucose levels. For decades it has been drummed into medical professionals that near normal glucose levels means increased risks of accidental deaths due to hypoglycemic events.

The treatment goals are never about truly normalizing glucose levels or glucose response.

 

[ickihun]

Personally, I don't think any type 2's should be prescribed insulin without having a c-peptide result that indicates loss of endogenous insulin production. No way would a GP be able to convince me to start insulin without such a test. Insulin therapy is known to increase the risk of CVD and other complications in Type 2 diabetics. Just one recent study:

https://www.ncbi.nlm.nih.gov/m/pubmed/28958751/

Some people don't have a choice.
Even insulin produced diabetes don't deserve to suffer a life of rotting flesh and organs due to an anti-fat society, surely?

 

[Guzzler]

I agree generally with your comments. In your example of a T2 insulin user who has been misled about dietary advice and hasn't reduced their carb intake, who then finds this forum, what's to stop them informing their HCP about reducing their carbs, then responding to reduced BGs by gradually reducing their insulin dosing eventually to zero?

It is the luck of the draw if those with Diabetes find this site. I would definitely not have found it if I hadn't typed dotUK instead of dotORG because the other site was first on the ggogle list and was my first foray into garnering more information. And, we must be honest here, how many people still put their health and all the decisions about their treatments into the hands of their HCPs and look no further? It shouldn't be a case of luck or of having an enquiring mind. The system is flawed.

 

[Jenny15]

Some people don't have a choice.
Even insulin produced diabetes don't deserve to suffer a life of rotting flesh and organs due to an anti-fat society, surely?

Come now, you're being a bit too logical there, aren't you? (Joke)

 

[ickihun]

The short answer is that the overriding concern for mainstream T2D management is glucose control and risk avoidance. It has been deemed to be safer to have higher glucose level than to have near normal glucose levels. For decades it has been drummed into medical professionals that near normal glucose levels means increased risks of accidental deaths due to hypoglycemic events.

The treatment goals are never about truly normalizing glucose levels or glucose response.

Thats because the medical world use an average (hba1c). So based on a hypo is an average of a good hba1c then hyper must occur too. And vice versa. A hyper on a meter with a good hba1c concludes missing hypos. Right?

 

[Jenny15]

It is the luck of the draw if those with Diabetes find this site. I would definitely not have found it if I hadn't typed dotUK instead of dotORG because the other site was first on the ggogle list and was my first foray into garnering more information. And, we must be honest here, how many people still put their health and all the decisions about their treatments into the hands of their HCPs and look no further? It shouldn't be a case of luck or of having an enquiring mind. The system is flawed.

True, but can a person in the example stop their insulin? It seems to me that's the important issue here.

 

[Guzzler]

True, but can a person in the example stop their insulin? It seems to me that's the important issue here.

Given the right information they can at least make an informed choice.

 

[ickihun]

True, but can a person in the example stop their insulin? It seems to me that's the important issue here.

Some can and some can't.
Just like bariatric surgery type2s or prediabetics. Some reverse and some don't.

 

[ickihun]

Given the right information they can at least make an informed choice.

Choice to try and reduce or lose. Some still cannot stay healthy without it. Especially long term.

 

[Jenny15]

Given the right information they can at least make an informed choice.

There are also examples of people starting on insulin because of severe life threatening emergencies like having a heart attack and 4 stents put in, and having an HbA1c of 113, so the medical team rightly uses insulin to get them out of the danger zone as fast as possible, then 6 weeks later they've lost weight and reduced their carbs, and can come off insulin.

There's an endless number of scenarios where insulin is used at least short term (say 3-12 months) then no longer needed. The hypothesis that regardless of BG levels a (suspected or confirmed) T2 should avoid insulin unless they have a blood test result proving low insulin is an interesting one to study and it applies to some people. It doesn't apply to everyone, though.

 

[Guzzler]

There are also examples of people starting on insulin because of severe life threatening emergencies like having a heart attack and 4 stents put in, and having an HbA1c of 113, so the medical team rightly uses insulin to get them out of the danger zone as fast as possible, then 6 weeks later they've lost weight and reduced their carbs, and can come off insulin.

There's an endless number of scenarios where insulin is used at least short term (say 3-12 months) then no longer needed. The hypothesis that regardless of BG levels a (suspected or confirmed) T2 should avoid insulin unless they have a blood test result proving low insulin is an interesting one to study and it applies to some people. It doesn't apply to everyone, though.

The need for insulin is not in question here. The use of insulin that is used by a patient and prescribed by a physician who are both unaware of possible hyperinsulinaemia is.

 

[kokhongw]

Thats because the medical world use an average (hba1c). So based on a hypo is an average of a good hba1c then hyper must occur too. And vice versa. A hyper on a meter with a good hba1c concludes missing hypos. Right?

Yes. That is the common assumption. It is only with the availability of CGM and CGM-like tools that provides more convincing data that flatline glucose is achievable safely with low carb.

 

[kokhongw]

For example

 

[Jenny15]

The need for insulin is not in question here. The use of insulin that is used by a patient and prescribed by a physician who are both unaware of possible hyperinsulinaemia is.

I think others in this thread are questioning the need for insulin in some T2s, whether directly or with subtlety. If the physician is aware of possible hyperinsulinaemia and judges the benefits of insulin therapy for the particular patient to outweigh that risk, would that change your view of the hypothetical decision to offer it to a given patient?

 

[Guzzler]

Choice to try and reduce or lose. Some still cannot stay healthy without it. Especially long term.

My point is that if you do not have the right information in front of you then how can you make any decision? If you are told not to test your bg at home because "It is not necessary and will just make you worry and by the way come back in six months" as many a members report being told how can you see what possible harm you might be doing? You are told to take this pill ( I'm thinking Metformin here) and dismissed out of hand and you might think that the pill will treat the Diabetes and no further action need be taken, again, as many a member has reported, you may then see a need for further medications and ....

Of course insulin is needed by T1s and some T2s and those who are diagnosed with LADA but in the case of people with high or rising insulin resistance then imo there are other options.

 

[Guzzler]

I think others in this thread are questioning the need for insulin in some T2s, whether directly or with subtlety. If the physician is aware of possible hyperinsulinaemia and judges the benefits of insulin therapy for the particular patient to outweigh that risk, would that change your view of the hypothetical decision to offer it to a given patient?

So this doctor would be weighing up the 'possibility' of hyperinsulinaemia against the benefit of insulin therapy. My point is that the 'possibility' element of that scenario could be eliminated by the use of further testing. Of course, in the interim, insulin would be the best treatment and especially in emergency situations.

 

[Jenny15]

Yes. That is the common assumption. It is only with the availability of CGM and CGM-like tools that provides more convincing data that flatline glucose is achievable safely with low carb.

I think those tools are essential for research purposes and for certain people who need or want them. IMO it is possible without CGM for a person to find out that normalised glucose levels is achievable safely with low carb.

I did just that, starting 9 years ago. I proved to myself that low carb works for me. I forget what my BG levels were but by HbA1cs were in the low 30s for several years. Good times.

Unfortunately my medical picture is now different and I made the informed decision in partnership with my doctors to trial insulin with the hope I *might* be able to come off it at some stage, but accepting that if I need it to optimise my quality of life and indeed save it, I will happily continue.

My doctors have always used an individualised approach that starts with dietary changes, so I've never been at risk of an inappropriate rush to using insulin without trying other things first. It's a shame others aren't so lucky.

 

[Jenny15]

Let me give you an example not using insulin. If you should have a high calcium level in blood or urine, this does not indicate that you are fine and dandy with your bones. It means you are possibly leaching calcium from your bones and are osteoporotic. Or, it could b part of a more complex diagnosis. However, having a lot of something and your body being able to use that something are two separate but related things

You hit the nail on the head here, IMO.

 

[ickihun]

My point is that if you do not have the right information in front of you then how can you make any decision? If you are told not to test your bg at home because "It is not necessary and will just make you worry and by the way come back in six months" as many a members report being told how can you see what possible harm you might be doing? You are told to take this pill ( I'm thinking Metformin here) and dismissed out of hand and you might think that the pill will treat the Diabetes and no further action need be taken, again, as many a member has reported, you may then see a need for further medications and ....

Of course insulin is needed by T1s and some T2s and those who are diagnosed with LADA but in the case of people with high or rising insulin resistance then imo there are other options.

Definitely.
It is heart wrenching that so much is in the dark because the truth costs more money.... from the nhs.
I know for sure my notes are filled with notes I'm not aware of.
I'm not ready to read my current health risks but need to focus on the future. Luckily I have one.