Pancreas producing insulin again?

[catapillar]

Just as a thought experiment here - what function do you know of insulin performing other than to facilitate the uptake of glucose by cells in the body? (I'm not being facetious here, I genuinely don't know the answer to this and you may have an answer)

Let's just suppose that somebody follows a zero carb diet and exercises regularly. We know that GLUT4 receptors (the transporters in cells enabling the uptake of glucose) within muscles translocate and proliferate in number in response to muscle contraction (exercise) just as they respond to insulin (in the absence of exercise). Consequently, the body is able to overcome the need for insulin in this regard. The body can take up glucose into cells (certainly into muscle cells) in the absence of insulin.
We also know that the body can fuel itself effectively on fats (ketones) alone and isn't dependant on carbs in the diet. Even a potential blood glucose rise from proteins and some carbs can be exercised away.
In the absence of insulin I could foresee a potential issue of blood glucose rise through intensive exercise or any bodily stress response, where without insulin suppressing the glucagon release from the pancreas there may be an unchecked glucose rise. If muscles are regularly depleted of their glycogen stores through exercise however, then surely the blood glucose level would gradually fall?

Of course I am not advocating that anyone with type 1 diabetes stops taking insulin but sometimes it's good to challenge the things that we think we know.

I'm sorry, but your thought experiment is unhelpful nonsense that seems to have a fundamental misunderstanding of what type 1 diabetes is and how it can be managed - type 1 cannot be managed by diet and exercise alone.

A type 1 diabetic who eats zero carbs and exercises regularly will still need to take insulin.

Throughout the day and night your liver will release glucose to keep you going, even eating no carbs you body will turn protein into glucose and store this in your liver for release. No carbs does not mean no insulin is required. Your body prioritises storing glucose in your live because it know this energy source is vital.

GLUT4 pathways can not be established in the absence of insulin. Someone making no insulin and taking no insulin will not make use of GLUT4, insulin is required to stimulate production of the pathway.

Even if GLUT4 pathways are in existence the pathways are not sufficient alone to allow glucose to be transported into cells and provide sufficient energy to keep you alive. Your body in the lack of energy will think you are starving and will breakdown fats and other tissue causing acidosis and death.

So yes, the only thing insulin does is allow glucose into the cells. It is required to keep you alive. All the exercise and all the no carbs diets in the world doesn't change the fact that insulin is required to keep you alive.

Either you are producing insulin (a cpeptide test can tell you that) or you are injecting insulin or you are dying/dead. Those are the limited options.

 

[EllsKBells]

@Bebo321 Biochemistry student here, insulin DEFINITELY has roles beyond glucose uptake. Throughout the body it is involved in growth and development pathways, and is important in several signalling pathways. Even though the brain doesn't take up glucose in the same way, insulin signalling pathways are also present in the brain, and where they go wrong bad things happen - it isn't entirely clear what they are doing, but an example of how important they are is that insulin signalling can be seen to be going wrong in Alzheimer's Disease - if you want references look up Garwood et al 2015, or Yarchoan et al 2014, or Konrad et al 2012. Insulin is ESSENTIAL for survival - it is the way glucose gets into cells, and no glucose means no respiration, which means no cellular activity, which means death. As @catapillar has said, a T1 not eating any carbs will still need insulin, because of gluconeogenesis, where the liver can make more glucose from proteins etc.

No insulin = Death.

 

[Bebo321]

@Bebo321 That 'thought experiment' is done by many newly diagnosed Type 1s and parents of Type 1 children. It does not work. Insulin is crucial to life and without it you die.

Before insulin was discovered, Type 1 was a terminal illness - every single sufferer died. No carbs, exercise, starvation diets cured Type 1 - they only delayed the inevitable.

Moreover, in the final stages before diagnosis, I strughled to walk up the road to my house let alone take vigorous exercise. I was extremely I'll but didn't realise it.

So many desperate people clutch at straws after a Type 1 diagnosis, and I consider it unkind at best, dangerous at worst to suggest that there's an easy answer out there that we can find if we think hard enough. The evidence speaks for itself.

Hi @azure, you're absolutely right that insulin is the right treatment for T1 diabetes. Trying to live without insulin without at least knowing that you have some pancreas function would be downright dangerous. @Robin Ah-Sing is a unique case and may not be a clear cut T1 diagnosis.
I can't imagine that anyone diagnosed with type 1 diabetes would consider that having to follow a severely restricted diet and strict exercise regime would be a satisfactory 'cure' for their condition (especially because we know it would only be moderately effective and insulin would be a requirement at some level anyway)
This case did make me think though about the function of insulin, as in reality the body does only need a minimal amount to function. Knowing what we now know about ketogenic diets and exercise (glucose transporters), it makes me wonder what else (if anything) insulin does within the body.
All those years ago, when diet and exercise was the only available treatment for type 1 diabetes, I wonder, were people dying because of the poor quality/lack of understanding about the diet or the lack of understanding about the importance of exercise, or was there a fundamental bodily function lacking without those beta cells.
It is understandable that anyone who makes a claim to have 'cured' their diabetes (especially T1D) will get criticised on the forum. It is after all (sadly) impossible. I figured I would just jump in to challenge the obvious though.
Anyway, apparently there's due to be a cure in the next ten years

 

[azure]

@Bebo321 Thank you for your considered reply Yes, it seems likely Robin is LADA or possibly a Type 2.

Before insulin, Type 1s died no matter what they did or didn't do diet and exercise-wise. It wasn't a question of not trying the 'right thing'. Starvation diets were tried, very low carb diets were tried (eg boiled cabbage), keto diets were tried. They simply prolonged the inevitable. The human body cannot survive without insulin. The blood sugar will rise to very, very high levels, ketones will appear, DKA will follow, then coma and death.

The body might need a minimal amount of insulin but without that the person will die, so it is absolutely crucial.

A quick Google Image of Type 1 diabetics before insulin will show you what happens in the absence of exogenous insulin when the body's own insulin production fails below critical levels. The pictures are distressing, especially of the children. They died a painful death despite the best efforts of their doctors and desperate parents.

No diet, no exercise will replace insulin when it's required. There is no cure for Type 1 - but there is a life saving medication and I'm extremely grateful to have it. Raising an imaginary glass in celebration of insulin

 

[Bebo321]

@Bebo321 Biochemistry student here, insulin DEFINITELY has roles beyond glucose uptake. Throughout the body it is involved in growth and development pathways, and is important in several signalling pathways. Even though the brain doesn't take up glucose in the same way, insulin signalling pathways are also present in the brain, and where they go wrong bad things happen - it isn't entirely clear what they are doing, but an example of how important they are is that insulin signalling can be seen to be going wrong in Alzheimer's Disease - if you want references look up Garwood et al 2015, or Yarchoan et al 2014, or Konrad et al 2012. Insulin is ESSENTIAL for survival - it is the way glucose gets into cells, and no glucose means no respiration, which means no cellular activity, which means death. As @catapillar has said, a T1 not eating any carbs will still need insulin, because of gluconeogenesis, where the liver can make more glucose from proteins etc.

No insulin = Death.

Hey there,
Thanks for that. I was aware of insulin signalling pathways in the brain and dysfunction being linked with Alzheimer's. I wonder how much of that is linked to the fact that our diet is carb loaded? The brain does function satisfactorily on ketones which negates the need for insulin though surely?
Growth and development pathways, I have no knowledge of, so I will do some reading around that subject.
I would challenge your statement that 'insulin is essential for survival' in reference to glucose uptake. I would be interested know what cells are unable to take up glucose without insulin. Certainly muscles can.
With reference to gluconeogenesis, on a ketogenic diet the body adapts to utilising fat as a source of fuel. Gluconeogenesis (and glycogenolysis for that matter) may be an issue in times of stress, but at all other times why would the liver keep supplying a fuel that it isn't using (or is limiting its use of).
I throw the gauntlet down in your general direction.

 

[azure]

@Bebo321 I don't have the biological knowledge to,refute your claim scientifically but insulin IS necessary even in the absence of food/carbs.

Without insulin, a person dies - no matter what they're eating.

Here's a tragic recent news story where the parents decided their Type 1 son didn't need insulin:

http://www.diabetes.co.uk/news/2017...ype-1-diabetes-starved-to-death-93669392.html

.

 

[EllsKBells]

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.960.9032&rep=rep1&type=pdf
@Bebo321 this paper actually puts it quite nicely, even though it is quite old. If you do the maths, even though about 70% of glucose transport is insulin independent, about 90% of that is accounted for by the brain, which is sometimes referred to as being 'insulin resistant' (even though that's wrong, and will make any neuroscientist very cross!) The brain is unusual in that insulin isn't really used by it for glucose uptake, as far as is known at the moment anway. In *most* organs (this isn't my area, and I don't have enough hours in the day to do an extensive literature review well enough to answer your question properly) GLUT1, GLUT2, and GLUT3 pathways are responsible for a very small percentage of glucose uptake. GLUT4 is the major glucose transporter and it is insulin dependent.

As for why we would keep making glucose, we still need it! It is the major compound used by cells to produce ATP in respiration, ATP is the major source of energy for all active processes in the body - not just things like moving and breathing, but things like kidney function and liver function, keeping ionic balance correct. For nerve impulses to be transmitted, the sodium balance needs to be correct, and that involves actively pumping sodium out, which requires ATP, which requires glucose to be manufactured. We keep making glucose because we still need it! Glucose gets put into glycolysis, generating a series of intermediates that then go into the Link reaction before entering the Krebs Cycle and the electron transport chain, where ATP mostly gets produced.

I hope I've answered the question that you actually asked. I really shouldn't try to do three things at once, I'm not good at it!

 

[Bebo321]

I'm sorry, but your thought experiment is unhelpful nonsense that seems to have a fundamental misunderstanding of what type 1 diabetes is and how it can be managed - type 1 cannot be managed by diet and exercise alone.

A type 1 diabetic who eats zero carbs and exercises regularly will still need to take insulin.

Throughout the day and night your liver will release glucose to keep you going, even eating no carbs you body will turn protein into glucose and store this in your liver for release. No carbs does not mean no insulin is required. Your body prioritises storing glucose in your live because it know this energy source is vital.

GLUT4 pathways can not be established in the absence of insulin. Someone making no insulin and taking no insulin will not make use of GLUT4, insulin is required to stimulate production of the pathway.

Even if GLUT4 pathways are in existence the pathways are not sufficient alone to allow glucose to be transported into cells and provide sufficient energy to keep you alive. Your body in the lack of energy will think you are starving and will breakdown fats and other tissue causing acidosis and death.

So yes, the only thing insulin does is allow glucose into the cells. It is required to keep you alive. All the exercise and all the no carbs diets in the world doesn't change the fact that insulin is required to keep you alive.

Either you are producing insulin (a cpeptide test can tell you that) or you are injecting insulin or you are dying/dead. Those are the limited options.

@catapillar, I need to correct you on some misinformation there. You are absolutely correct that GLUT4 transporters are mobilised by the action of insulin. Indeed for people with type 2 diabetes it is the interruption and ineffectiveness of this process that contributes to insulin resistance.
Where you are wrong is in saying that GLUT4 transporters only respond to insulin. In fact they proliferate in number and mobilise through the action of muscle contraction. This is why exercise is a particularly effective way of improving insulin resistance for those with T2D, as this mode of mobilisation does not diminish with diabetes. It is also the reason you become more sensitive to insulin after you do some exercise - you have already mobilised transporters that are facilitating the uptake of glucose into muscle cells. Adding insulin to the mix just acts as a doubly whammy.
With regards to liver function, you're correct of course when it comes to a 'standard' diet, but I'm not sure that the same is true when in ketosis. It wouldn't seem logical that the body would release glucose into the bloodstream unchecked when it is not a preferred source of fuel. Though I personally don't know the answer, I would challenge that as an assumption unless it's been proven in a study.

 

[Bebo321]

@Bebo321 I don't have the biological knowledge to,refute your claim scientifically but insulin IS necessary even in the absence of food/carbs.

Without insulin, a person dies - no matter what they're eating.

Here's a tragic recent news story where the parents decided their Type 1 son didn't need insulin:

http://www.diabetes.co.uk/news/2017...ype-1-diabetes-starved-to-death-93669392.html

.

I don't disagree with you @azure. There is plenty of evidence to demonstrate that insulin is essential to life. If it wasn't, then when the only treatment was diet and exercise people would have lived on indefinitely. I just wonder why and where the insulin lack causes the problem, because it seems to me that diet and exercise can overcome some of the biggest hurdles.
Such a great shame that anyone should lose their life over a condition that can be managed with insulin.

 

[Bebo321]

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.960.9032&rep=rep1&type=pdf
@Bebo321 this paper actually puts it quite nicely, even though it is quite old. If you do the maths, even though about 70% of glucose transport is insulin independent, about 90% of that is accounted for by the brain, which is sometimes referred to as being 'insulin resistant' (even though that's wrong, and will make any neuroscientist very cross!) The brain is unusual in that insulin isn't really used by it for glucose uptake, as far as is known at the moment anway. In *most* organs (this isn't my area, and I don't have enough hours in the day to do an extensive literature review well enough to answer your question properly) GLUT1, GLUT2, and GLUT3 pathways are responsible for a very small percentage of glucose uptake. GLUT4 is the major glucose transporter and it is insulin dependent.

As for why we would keep making glucose, we still need it! It is the major compound used by cells to produce ATP in respiration, ATP is the major source of energy for all active processes in the body - not just things like moving and breathing, but things like kidney function and liver function, keeping ionic balance correct. For nerve impulses to be transmitted, the sodium balance needs to be correct, and that involves actively pumping sodium out, which requires ATP, which requires glucose to be manufactured. We keep making glucose because we still need it! Glucose gets put into glycolysis, generating a series of intermediates that then go into the Link reaction before entering the Krebs Cycle and the electron transport chain, where ATP mostly gets produced.

I hope I've answered the question that you actually asked. I really shouldn't try to do three things at once, I'm not good at it!

Great answer!
Thanks for the link - I've not taken it in yet, but I will. Thank you.
Just a note, I mentioned elsewhere that although you are correct in stating that GLUT4s are stimulated by insulin, it is not their only mode of proliferation/stimulation. They also respond to muscle contraction - which is why insulin is not required during exercise. Indeed, for anybody (with or without diabetes) the pancreas shuts off production of insulin once an activity begins.

Oooo! I wonder if anybody has assessed the metabolic pathway to determine the body's use of energy by source - on a 'standard' foodplate, vs a 'ketogenic' foodplate. You're right of course that the body needs glucose, and thank you for the explanation (I bow to your greater knowledge) but I wonder if there is a discernible 'shift' - a change to the balance of source substrates when body becomes ketotic. Interesting!

 

[azure]

I don't disagree with you @azure. There is plenty of evidence to demonstrate that insulin is essential to life. If it wasn't, then when the only treatment was diet and exercise people would have lived on indefinitely. I just wonder why and where the insulin lack causes the problem, because it seems to me that diet and exercise can overcome some of the biggest hurdles.
Such a great shame that anyone should lose their life over a condition that can be managed with insulin.

I think @EllsKBells has explained well above. The body needs insulin - that's the way the human body works. Outside factors may affect the amounts required, but insulin is always needed else death will ensue. Insulin is a basic requirement of every body.

 

[cz_dave]

@catapillar

I'm LADA and having reduced and stopped my own BI and QA insulin over a 4 month period I'd say it CAN be done. I too achieved this with LCHF, and did so having informed my DSN I was doing it - and whilst they were unable to endorse it as it goes against their current guidelines, they have been amazed by the results and continue to keep a close eye on me and now support me with how I am managing my D.

There is a time and place for taking insulin - I wouldn't be here now posting if I hadn't been put on it within 3 hours of diagnosis, however once my hba1c had been reduced to 'normal' levels, and my pancreas had been given a rest, it is now able to fully support me whilst following LCHF; which in itself has given me the energy and zest for life I haven't seen in decades.

Honeymoon? - possible (the longest one I know of was 7 years)

Cure? - I think it's a little early, rather that it's successful management of a challenging condition.

How many carbs per day do you eat?

 

[Shadow_83uk]

My D team told me to continue with insulin, even if it's only a couple of units with meals etc and take a couple of units at night and stay on a pretty strict diet. I did this for a couple of weeks then decided why not enjoy and I did, I got about a 6 week honeymoon. I enjoyed food like I never had before or after. I'm not saying I don't occasionally misbehave, but I feel as guilty as when wolfing down a muffin or cake and if I over indulge do I cop it. Trust me you will know when to stop partying, but you are being offered a few weeks / months of freedom. Their theory is that the D team have managed to get you to comply with one hell of fright (diagnosis) and the risk is that it maybe much harder to get you compliant a second time which was exactly my problem. You will however learn. I go past a great ice cream and Milkshake place. It took me a number of attempts to learn that one of their milkshakes is so good, but I feel so sick afterwards I'm now to scared to go in there as I know a few minutes of pleasure is followed by hours of misery. The official line everywhere is do as the Drs tell you. Just remember, they know the theory but have never practice it. They must be seen to do the right thing or risk being sued or up on malpractice charges. Would I do anything different if I got a second honeymoon, you bet - I would be into the bad food straight away. The choice is yours, but you are only going to get one go at this.

I'm not sure why you need to cut out the milkshakes if your on rapid insulins and carb count for the milkshakes you can what some would call a completely normal diet (like anyone we all gain weight ) but if your type 1 for all the down sides one upside is you can eat normally if your good at carb counting and adjusting your dose on occasion usually a day at the weekend IL eat terribly take away cake chocolate etc yet my levels stay in range

 

[Robin Ah-Sing]

I don't think encouraging type 1 diabetics to believe they can stop taking insulin without medical supervision is helpful to anyone. Either you are honeymooning and making endogenous insulin, or you're not. If you're not, stopping insulin will kill you. And if you are, stopping insulin should only be done with careful medical guidance.

I'm glad you are getting on well, but that is what works for you, with what appears to be LADA or type 1.5 in the honeymoon. It won't work for someone with type 1. No matter what they eat, they will need to keep taking insulin.

How many carbs per day do you eat?

Hi.I am not encouraging anyone to stop taking insulin. I have just posted my experience. I dropped 12 kg and ride 300km per week. I have cut out all carbs. I check my sugar levels before and 2 hours after every meal and my levels range between 6.5 and 9.1 making my average 7.2. Will look up the honeymoon phase you talk about and see if this is my situation. I appreciate your input and will let you know how it goes in the future.Thanx...Robin

 

[Robin Ah-Sing]

Some people with LADA can stop insulin temporarily but this should only be done with the support of a medical team.

This is an extremely old thread but the advice hasn't changed: do NOT stop your insulin without medical support. It can be immediately dangerous, with the risk of DKA, and also risky long term as higher than desired sugars can cause insidious damage to the body, eg retinopathy.

Before the discovery of insulin, Type 1s were put on a diet of black coffee and whisky - ie they ate basically nothing - and every single one of them died, some very quickly (usually the younger ones), some more slowly (usually those who developed Type 1 as an adult).

Keep testing @Robin Ah-Sing and watch for your honeymoon ending and your sugars creeping up. Insulin will prolong the life of your remaining beta cells then, so take action sooner rather than later.

Best wishes and enjoy this respite from insulin.

I don't think encouraging type 1 diabetics to believe they can stop taking insulin without medical supervision is helpful to anyone. Either you are honeymooning and making endogenous insulin, or you're not. If you're not, stopping insulin will kill you. And if you are, stopping insulin should only be done with careful medical guidance.

I'm glad you are getting on well, but that is what works for you, with what appears to be LADA or type 1.5 in the honeymoon. It won't work for someone with type 1. No matter what they eat, they will need to keep taking insulin.

Thanx for clearing up the honeymoon phase.I am in africa and this is the first I have heard of it.I cant explain why my levels have come down suddenly.I thought it was the diet and exercise...but as you all clearly know...that is imposible. I check levels before I eat and 2hours after...I cant take any isulin as I go low very fast...this is the reason I stopped the insulin after speaking to my doc. Will continue with the cycling and diet and enjoy....what you refer to as the honeymoon period.thanx for the info.

 

[Robin Ah-Sing]

Hi @azure, you're absolutely right that insulin is the right treatment for T1 diabetes. Trying to live without insulin without at least knowing that you have some pancreas function would be downright dangerous. @Robin Ah-Sing is a unique case and may not be a clear cut T1 diagnosis.
I can't imagine that anyone diagnosed with type 1 diabetes would consider that having to follow a severely restricted diet and strict exercise regime would be a satisfactory 'cure' for their condition (especially because we know it would only be moderately effective and insulin would be a requirement at some level anyway)
This case did make me think though about the function of insulin, as in reality the body does only need a minimal amount to function. Knowing what we now know about ketogenic diets and exercise (glucose transporters), it makes me wonder what else (if anything) insulin does within the body.
All those years ago, when diet and exercise was the only available treatment for type 1 diabetes, I wonder, were people dying because of the poor quality/lack of understanding about the diet or the lack of understanding about the importance of exercise, or was there a fundamental bodily function lacking without those beta cells.
It is understandable that anyone who makes a claim to have 'cured' their diabetes (especially T1D) will get criticised on the forum. It is after all (sadly) impossible. I figured I would just jump in to challenge the obvious though.
Anyway, apparently there's due to be a cure in the next ten years

Thanx for clearing up so much.I understand the honeymoon phase now after reaching. I am looking into my type 1 diagnosis. At age 32 I was diagnosed type 2 diabetes. At age 36 I was put on insulin.at 40 insulin dosis was increased to 3 times a day (30 units apidra) and(30units lantus at night).could it be that my diet was so bad and my lack of exercise...could make for a false type 1 diadnosis?

 

[azure]

Thanx for clearing up so much.I understand the honeymoon phase now after reaching. I am looking into my type 1 diagnosis. At age 32 I was diagnosed type 2 diabetes. At age 36 I was put on insulin.at 40 insulin dosis was increased to 3 times a day (30 units apidra) and(30units lantus at night).could it be that my diet was so bad and my lack of exercise...could make for a false type 1 diadnosis?

Type 1 is an auto immune condition so it can usually be diagnosed by blood tests that look for the antibodies that destroy the beta cells in the pancreas. It's a different condition from Type 2.

Tests aren't very accurate if it's been too long after diagnosis, but a doctor may be able to make deductions about your type by looking at your history, and the fact you're now able to stop insulin.

 

[tim2000s]

Just as a thought experiment here - what function do you know of insulin performing other than to facilitate the uptake of glucose by cells in the body? (I'm not being facetious here, I genuinely don't know the answer to this and you may have an answer)

The key point here is that Insulin also plays a part in regulating the release of free fatty acids in the body from Adipocyte cells. The reason that T1Ds go into DKA (and the majority of T2s don't) is that insulin stops the body releasing free fatty acids and producing ketones. With very little insulin, you cannot regulate that release, and as the concentration increases, as does the acidity of blood as the body attempts to fuel from Fat when it can't use the glucose (which the insulin is also required for).

Insulin is also involved in the uptake of amino acids for cellular rejuvenation. When levels are low, degeneration takes place and this is seen in undiagnosed type 1 diabetes as well.

So while insulin & glucose are tightly linked, there are additional things that Insulin is important for.

 

[Robin Ah-Sing]

How many carbs per day do you eat?

Wow...I am experiancing this and was amazed at how I feel. I do mountain bike racing as you have seen...I cut carbs out completely...I dont follow a high fat diet though.the forum has explained that I could be in a honeymoon phase.I am exploring this now. I am in a third world country ...so its hard to get the latest info. Thanx for your positive response

 

[catapillar]

Thanx for clearing up so much.I understand the honeymoon phase now after reaching. I am looking into my type 1 diagnosis. At age 32 I was diagnosed type 2 diabetes. At age 36 I was put on insulin.at 40 insulin dosis was increased to 3 times a day (30 units apidra) and(30units lantus at night).could it be that my diet was so bad and my lack of exercise...could make for a false type 1 diadnosis?

That sounds like you're type 2. Nowhere in that brief history of you diabetes is it suggested your initial diagnosis with type 2 at age 32 was ever questioned. Was there ever a suggestion that the initial diagnosis with type 2 was wrong? Being put on insulin doesn't make you type 1, it makes you a type 2 diabetic treated with insulin. Now you are treated with diet, something that is not an option for someone with type 1.