recent insulin study

My take on this would be that Type 2's on insulin tend to be people who have been through the raft of other medications and still failed to control their blood sugar levels due to a failing pancreas or insufficient dietary carb control. They would have had higher blood sugar levels in the intervening years which would have exposed them to a higher likelihood of complications. Maybe the researchers have got their conclusions wrong?

 

I agree, majority of T2's do not go straight onto insulin. It is a long progression of struggling BG levels generally before having to inject.

 

Yes but if there's no history of complications prior to going on insulin why would mortality rate increase

 

Well, I am only guessing but I think for most, certainly not all T2's, insulin is a slow progression from steadily rising BG levels. However, I'm certainly no scientist !


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I haven't read the study so these are just my thoughts as to what might cause the death rates:

1. Insulin is final treatment for poorly controlled Type 2s

2. Insulin resistance is a big factor in Type 2 so injected insulin will be at high doses which can increase weight and make insulin resistance worse.

3. Those with insulin resistance have high levels of insulin as well as high levels of glucose in their blood. Adding more insulin can surely only add to risk factors.

Just my thoughts and not based on any evidence!

Smidge

 

The authors may well have controlled HbA1C but the fact remains that the majority of T2's do not use insulin. It's generally those who have erratic control or have struggled with diabetes for a long time who end up insulin dependant. There will always be exceptions but I think because of this the results are hardly surprising.


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I did find this paper which suggested that non compliant insulin users ,Type 2, were more at risk.
http://care.diabetesjournals.org/content/35/6/1279.full

 

Do you have a link to the study academicdiabetic?

 

having been in the system for a long time, (as a T1) I am aware that insulin is best minimised. When first diagnosed I ate a restricted carbohydrate diet as instructed in order to keep my sugar levels low. These days I eat a restricted carbohydrate diet to keep my required insulin levels lower.

 

Well, I don't believe that any medication is a magic bullet. All drugs, however beneficial will have unwanted side effects. Insulin is no exception.

One of the things I do know about injected insulin is that it travels through many area of the body that natural insulin does not go into. Natural insulin is contained within only a few area of the body and doesn't leak into places it is not required. We know this is believed to be one of the reasons insulin users have a tendency to put weight on. Maybe insulin being where it shouldn't be is one of the risk factors to mortality in using insulin?

We also know that insulin should not accumulate in the blood - for normal functioning humans, it is produced and used relatively quickly because of the body's amazing balancing act in producing insulin and glucose to keep BG within VERY tight limits. This would tend to suggest that insulin accumulating in the blood isn't very good for you.

Insulin is an amazing drug and it saved my life - and continues to do so every day - but it isn't the correct treatment for everybody and even where it is the correct treatment, I believe that it is a sensible precaution to use it wisely and not abuse it by eating junk and jabbing to cover it.

Smidge

 

Absolutely agree with Smidge, the main reason I went for the exercise and diet regime is to put off having to take insulin, which one of my doctors assured me I will need before too long.


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This is the report http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612791/

It makes interesting reading, not taking into account their final analysis about insulin, but that the overall average HbA1c of all people in the study was 8.7% (it wasn't a small study ether). No wonder my GP thinks I'm unusual with one of 5.4%.

So what is behind such terrible HbA1c's for the population of the UK Type 2 diabetics?

1. Head in the sand and not changing their diet
2. Poor dietary advice from HCP
3. People who think meds are going to do all the work
4. Sweetie eating old people
5. Being told by their GP that a HbA1c of 7% is fine
6. Non-compliance
7. Not getting informed by joining forums such as this

The NICE pathway has medication recommendations for HbA1c of over 6.5% http://pathways.nice.org.uk/pathway...therapy-for-type-2-diabetes.xml&content=close are they not being taken any notice of?

According to the State of the Nation 2013 Diabetes UK report http://www.diabetes.org.uk/Documents/About Us/What we say/0160b-state-nation-2013-england-1213.pdf only 65.9% of Type 2 diabetics have a HbA1c of 7.5% or under, goodness only knows what the rest have.

 

Does it say what the weight of the people were? Obesity results in higher mortality rates whether someone is diabetic or not, with the added complication of being diabetic I would imagine that would just make it even more likely.... The result may not have been solely to do with insulin.....I haven't read the study though so I'm just coming up with ideas here nothing more


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

I'll try to find the reference. It was a reference posted a few months ago either on this forum by Phoenix or another forum I use by Catza, so I'll have a look and see if I can dig it out.

Talking of the differences between natural and injected insulin, the obvious difference is that there is no c-peptide molecule attached to injected insulin - so those of us who do not produce enough insulin also do not produce c-peptide I guess. The researchers are only just starting to uncover the purpose of c-peptide in the human body, but it must have a purpose. And presumably, insulin resistant Type 2s have an excess of this too. So a very big difference there between Type 2s and Type 1s/1.5s maybe?

Smidge

 

Have read a bit on the differences. Main one of topic is the c~peptide thingy produced as smidge said. I believe it is possible to have that injected also but, as they are undecided exactly its function, probably due to cost and uncertainty not usual practice.
Injected insulin goes directly into fatty tissue so, injected areas are more prone to weight gain as it does something to the fat cells and also has a longer action period than if naturally produced . The other thing I remember is that the body fails to recognise the drop in sugar levels from injected insulin which is why diabetics are at risk of hypos, because the body does not react to the drop In sugar levels till at crisis point.
Those are a few things I remember reading about, sorry no studies.

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