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Dr Sebastian Rushworth

Probably better to stick to the science rather than resorting to ad hominen attacks and claims about Donald Trump, covid conspiracy theories or whatever else is popularly being used to disagree with people these days.
 
I think you're missing the point rather.
This chap is a small voice in a huge world influenced and dominated by mainstream media and incredibly wealthy organisations with vested interests. Like big pharma and food producers.
People believe what they are told on television and in MSM. They believe things because they think what they are told is definitive. But it's not necessarily.
Things change, opinions change. The people who recognize and bring about those changes are initially deemed to be cranks or conspiracists.
Smoking was perfectly acceptable 50 years ago - until it wasn't. That didn't stop the cigarette manufacturers fighting tooth and nail for years. Did the delay in recognizing the dangers lead to my mother's early death?
Heart attack victims were initially instructed to remain immobile for weeks. It was subsequently discovered that immobility is the worst thing you could do, but the person who first to recognize and try and implement an alternative way (moving about) was called a heretic.
We are still taking statins by the billion dollars.
Regarding the initial blog about T2 diabetes, that is certainly open for debate. I would think that anyone debating how to manage their T2 would not suddenly go and change course because of one article. But it can be added to the debate to allow us to choose.

One problem these days is that, in many areas, there is 'only one way'. Anyone with an alternate opinion or who wishes to add to the debate must do so through more obscure channels, thereby opening themselves up to being called a minority crank, before being dismissed, or banned from Facebook or Twitter.

One final point regarding Dr Rushworth is that he isn't a lone voice on the topics he covers, many experts agree with him, in fact, that is where some of his ideas come from. He hasn't just thought to himself, 'OK, saturated fats are OK, I'll say that.' He researched it and in many cases, it appears that the way to reach an honest conclusion is to actively ignore MSM.
 
bulkbiker said:
They do unless mis-diagnosed...
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Agree except to add that many late stage T2 will have reached the point of insulin deficiency. But - and it’s a big but - the pathology caused by hyperinsulinemia remains. Once they’re solely reliant on exogenous injections, they will typically be using huge quantities.

People claim that not all T2 are insulin resistant, but this is demonstrably and objectively false. T2 is insulin resistance, or rather, a symptom of it. Anything else is a misdiagnosis.
 
Insulin makes you fat according to Dr Rushworth. Really? The UKPDS did note an increase in weight in all the intervention groups, but I bet there are insulin users here that do not see this effect. Again, intensive treatment may be force feeding since a target control point of 6 mmol/l is quite low. Certainly when I was in hospital recently they set my control point at 12, and a T1D collegue has his set at 11 for his pump.
I am on a sulfonylurea drug, but i am not putting on weight and my bgl is running at around 6.5 mmol/l

Is insulin a life saver for T2D - yes, for some. Does NICE go straight to insulin therapy in the guidelines? NO! it is a defined route that covers all bases. Some GP's do seem to jump straight to insulin, but they are not following the guidelines.

We have evidence here in the forum of T2D on insulin coming off that treatment after making lifestyle changes so it is not inevitable. For some mainly elderly or infirm patients then insulin may be easier to manage. It is an institutional instrument, but not in my local hospital.

Lastly, can we interpret UKPDS which was an extreme control regime with what actually happens in the real world? Maybe when we get closed loop pump systems and CGM monitoring for all then tighter control may be introduced. At the moment it is horses for courses. Remember tht UKPDS concluded in 1998, and was at least 10 years duration, so diabetes treatment was very different to where we are now.
SMBG was not available, the insulin used was very different.

Not sure what the point of the OP is making. As pointed out the intervention was extreme, and involved different therapies. but he is banging the drum about insulin . He also points out that the fact that it was drug company funded which seems to be significant, and which i think is probab;ly the driving force behind the article. The article itself does not add to our understanding and the UKPDS study has already shown the main outcomes.
 
Oldvatr said:
Thats a very sweeping statement. Remember that most T2D are elderly when diagnosed and may well have failing pancreas issues.
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Then they aren't T2.. as I said just misdiagnosed.

I subscribe to the "T2 is hyperinsulinaemia" school.
 
Oldvatr said:
Insulin makes you fat according to Dr Rushworth. Really?
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It's perhaps a sweeping statement to claim that insulin makes "you" fat, but it's not entirely unfounded. Insulin is essential in the process of making fat from glucose. In that sense, it literally makes fat.
 
bulkbiker said:
I subscribe to the "T2 is hyperinsulinaemia" school.
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Yes, I do too. I feel T2 is used as a catch-all group when the medics simply don't know what group to put a patient in and that skews the picture. And yes, too much insulin has made me fat (because I ate carbs) and n=1 is all I really care about.

I do feel it's a shame that the dr is claiming that all of the intensive treatment was with insulin whereas it was either with a sulphonylurea or with insulin as @Dark Horse points out, but don't sulphonylureas promote an increase in natural insulin production, so that is in effect the same as administering exogenous insulin? The result will surely be the same, lower BG levels at the cost of higher insulin levels?
 
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Jim Lahey said:
It's perhaps a sweeping statement to claim that insulin makes "you" fat, but it's not entirely unfounded. Insulin is essential in the process of making fat from glucose. In that sense, it literally makes fat.
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Polite cough from the back of the class...

It helps build muscle tissue too. Doesn't it?
 
Jaylee said:
Polite cough from the back of the class...

It helps build muscle tissue too. Doesn't it?
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Yes I believe insulin is anabolic and essential for maintaining lean mass. I certainly haven’t ever seen anything said to the contrary.
 
Jaylee said:
Polite cough from the back of the class...

It helps build muscle tissue too. Doesn't it?
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So are you suggesting that injecting obese T2s with insulin will turn the fat to muscle?
 
zand said:
So are you suggesting that injecting obese T2s with insulin will turn the fat to muscle?
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In all seriousness, I feel I would be nice to hear some feedback on this artical from T2 insulin prescribed?
 
Jim Lahey said:
It's perhaps a sweeping statement to claim that insulin makes "you" fat, but it's not entirely unfounded. Insulin is essential in the process of making fat from glucose. In that sense, it literally makes fat.
Click to expand...
Technically it is Glucagon that triggers fat production, and insulin allows the fat to be used or stored. Glucagon is the antithesis of insulin. Insulin is merely the bouncer on the door into the cells.

In the OP the comment is in the section discussing weight gain, so implying the gain is due to fat and ignores the possibility of weight gain through muscle buildup so it is a sweeping statement. Note that UKPDS did not assign any special diet restrictions so weight loss is not an expected outcome anyway.

As i said in a previous post, intensive therapy is like force feeding in that the glucose in the blood has to go somewhere so forcing it into the cell storage will lead to weight gain if not accompanied by increased exercise. This is the old model of diabetes, which uses insulin as a sledgehammer and this treatment IMHO does nothing to address the problem of ~insulin resistance except by brute force. So many T2D would not benefit from insulin treatment compared to modern alterntives. My own experience supports my POV in that the occassions I was on insulin infusions in A&E and post op support were not very impressive.
 
Glucagon signals the release of glucose. Insulin is required in order to make fat from that glucose. So insulin can definitely make you fat. Although it may not in all cases.
 
  • Stimulating the liver to break down glycogen to be released into the blood as glucose
  • Activating gluconeogenesis, the conversion of amino acids into glucose
  • Breaking down stored fat (triglycerides) into fatty acids for use as fuel by cells.
  • From this website - I hope this clarifies the role of glucagon!
 

Good stuff. Bullet point three is interesting. I wonder how this interplays with hyperinsulinemia. Since we already know insulin blocks the breaking down of fat, I assume this part doesn’t work. But then I also wonder how much glucagon would ever be sloshing about when the liver is already trying to deflate glucose into the bloodstream anyway.

ETA: come to think of it I’m guessing in the setting of hyperinsulinemia there’s definitely very little glucagon about.
 
I don;t dispute that. Insulin is the storage hormone, and lipogenesis is creating lipids from carbohydrates and proteins ( fatty acid creation) which normally go into storage - then insulin being involved is not a surprise.

What was a surprise was the paper which showed that lipolysis ( unpacking trigs into fatty acids for burning) is inhibited by insulin. it raises a query in my mind as to whether T1D should be using a keto diet. or doing prolonged fasting. It also feeds into my original comment about fat shaming. Does insulin reduce the ability to lose excess fat? Or compete in high intensity long duration exercise where glucose energy must be supplemented by lipid energy. Or does the adrenaline rush override the insulin (as per Citric Cycle) is this why athletes have to hype themselves up before the starting gun? Or is the research wrong? it's late, and my head hurts, and my nightcap is kicking in.

Night Night all
 
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