recent insulin study

academicdiabetic said:

Does anyone know what the issues are with measuring insulin production and/or has anyone had a test for insulin production done under the NHS?

Click to expand...

I had a C-peptide test done which concluded my insulin production was low.

fatbird said:

Paul said

“I'm genuinely interested in this and have a question...If for example,a type 2 with less than perfect control,has an insulin resistance problem BUT tests reveal that they have plenty of their own insulin being produced-how does injecting synthetic insulin help that individual in any way if the insulin resistance is the issue?”

More insulin will only increase insulin resistance. It’s a well known vicious circle.


FB

Click to expand...

Thanks FB-I thought the same too,ie,more insulin=more potential weight gain=more insulin resistance=more insulin injected=more weight gain etc,etc

As insulin is considered a magic bullet by some HCP's despite the above problems regarding insulin resistant patients with plenty of naturally produced insulin of their own on board I was interested if there was something fundamental I'd missed somewhere as it seems so counter productive.

Paul

Patch said:

I been "advised to start an insulin regime - Basal & Bolus insulin.

But my C-Peptide results came in at 18'ish - so I AM producing LOTS OF insulin... I don't like th eidea of taking MORE insulin, especially with reports like this turning up...

Click to expand...

Dear Patch,

Even reports can be spun so I would advise in response to your extremely high triglycerides that you mentioned on another thread, that you ask to see an Endocrinologist before you start insulin and let him/her explain to you why you are being offered insulin and how long you can expect to be on it. It may be that once your triglycerides start to lower to an acceptable range that you can come off, it much the same as Typ2s with steroid induced diabetes.
There are no experts here, nobody here knows your medical history and this debate is meaningless to you. It is a debate by lay people producing papers.

It seems to me that everyone here is trying to say that they know more about this than the next poster and it really doesn't help anyone other than to scare Type2s who are being prescribed insulin.

I am sure there are plenty of Type2 that do well on insulin.

This is worth a read which explains about how results are spun.
http://www.nhs.uk/news/2012/09September/Pages/Half-of-all-medical-reporting-is-subject-to-spin.aspx

Get your GP to sort out an appointment for you as soon as possible as the unnecessary worry that is being created here for you will do nothing for your blood sugars.

Insulin measurement:
It's not easy to measure insulin because of it's short half life in the blood. Cpeptide and Insulin are produced in equal amounts but C peptide has a longer half life. This is why it tends to be C peptide that is measured.
Testing for insulin levels is problematic
Natural insulin and c peptide are also a function of blood glucose levels ie they will be higher when glucose levels are higher and vice versa hence they are variable
Insulin declines in T2 but the rate of decline and the starting point are extremely variable . It has also been observed observed that C-peptide may fall but then return to higher levels in the same person.

The urinary c pep/creatine ratio test that Patch has is useful for distinguishing between T2, T1, and MODY . His values were right in the middle of those for people with T2 (not on insulin) but note how they don't really differ from the levels of non diabetic controls (the difference is presumably that there is not enough insulin to overcome resistance).
Note also that the ratio goes down when the T2 takes insulin. I assume this is because natural insulin is suppressed. Compare this to the levels for people in the early years with T1 (ie similar)

http://www.diabetesgenes.org/content/urine-c-peptide-creatinine-ratio

Academic,
I don't think that the study that you referred to tells us much. I do know that we have 90 years experience with injected insulin and it has prolonged lives, not only in T1. Until the 1950s this was the only treatment available to those who were probably T2s (not actually defined then so some may have had LADA) . As soon as insulin was introduced these peoples life expectancy increased. (Joslin quotes an average life expectancy of 8years for a person diagnosed aged 40-59 in the Allen (starvation diet) era and 15.6 years in the post insulin period from 1944-49) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2037674/pdf/brmedj03598-0003.pdf
I've no doubt that you will find that some people using injected insulin will develop some problems and indeed it may be discovered that excess insulin may play a part in causing cellular damage . However, these people and that includes me would have more severe problems caused by raised glucose levels
Is there a better alternative available?
(and I agree that reducing insulin resistance is an important aim for some but this will only be a possibility in some cases (weight loss certainly helps but this doesn't help someone who is insulin resistant for other reasons ? genetic )
I also think that good education into the effective use of insulin is lacking, especially in T2 (how often do we read of T2s and even T1s being put on insulin with no real help) It's not much use using insulin if it's not used effectively.

academicdiabetic said:

MID: Exactly - why not measure insulin, it seems obvious really. I can only assume that its more difficult to measure than blood glucose. I know that there are lab tests which can be done, so its not impossible. The consultant I see seems to have given me every test under the sun at his own instigation but whenever I've asked to have the amount of insulin I'm producing measured (which is understood to be the key problem for a T1 after all!) he has refused.

Does anyone know what the issues are with measuring insulin production and/or has anyone had a test for insulin production done under the NHS?

Click to expand...

Like some others that have been contributing on this thread, I was initially misdiagnosed as a Type 2 and eventually went onto insulin still not sure whether I was LADA or Type 2. I requested an insulin test several times but was always told 'no'. I read everything I could about insulin tests at the time and from memory I think the issues were around cost, reliability and the inability to differentiate natural insulin from injected insulin.

Apparently insulin lives in the blood stream for a very limited time and the amount of it in the blood stream is rapidly-changing, so two tests taken very close together could give very different results. C-peptide is much cheaper and easier to test for as it lives in the blood stream significantly longer. As it is always and only ever formed as part of an insulin molecule (not sure that's the right word!), measuring it is seen as a really good indicator of the amount of insulin being produced. There is also disagreement as to whether fasting insulin or random insulin is the significant test because someone with insulin resistance will probably have very low fasting insulin levels until the condition is pretty advanced as insulin production is triggered mostly after food, but people without insulin resistance will also have a higher level after food. Finally, if you are already injecting insulin, there is no way of differentiating natural from injected insulin, so once someone has gone onto insulin therapy, the insulin test is not appropriate. C-peptide is not injected as part of insulin, so the presence of c-peptide can differentiate natural insulin levels from injected levels. Anyway, the upshot is that insulin levels are rarely tested.

The c-peptide test should be a good alternative, but again this test is often withheld on the grounds of cost. In my case, when I eventually got the GAD tests agreed and they came back positive, I was rediagnosed as Type 1/1.5, so the consultant decided the c-peptide test was not necessary as we could see I was still producing some insulin (as I wasn't dead having managed my diabetes on diet and exercise for nearly a year while misdiagnosed as Type 2!) and as a result of the GAD tests we knew I had an autoimmune type of diabetes. So I still don't really know whether I have any insulin resistance in conjunction with the LADA, and as LADA shares some of the metabolic issues of Type 2, I think that is important to know.

Smidge

paul-1976 said:

I'm genuinely interested in this and have a question...If for example,a type 2 with less than perfect control,has an insulin resistance problem BUT tests reveal that they have plenty of their own insulin being produced-how does injecting synthetic insulin help that individual in any way if the insulin resistance is the issue?

Click to expand...

I think it is about the balance of risk, Paul. If you believe BG is the only (or at least the crucial) factor in the outcome of diabetes, then you accept the other risks and reduce the BG in the most effective way you can - and if you don't believe in low-carb diets, insulin is going to be the most effective way - even if it requires large doses and adds to the excess that is already in the blood. If you believe that insulin is in itself a crucial factor to the outcome of diabetes, then you might well take a different approach. That's why i think this particular topic is so important - it is fundamental to how you manage those risks and treat diabetes.

Smidge

[removed rude comment]

Very interesting though smidge - ref all that stuff about "normals" having their insulin contained to certain areas.

Thread closed. This isn't the place to be scaremongering and dishing out potentially dangerous information.