You asked…Can I go insulin-free as someone with type 1 diabetes?

By Kurt Wood
10th November 2015
In Depth
 
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In this feature, we’ll be asking questions posted by members of the Diabetes Forum. This week, the question is: “Can I go insulin-free as someone with type 1 diabetes?

The short answer is no. But this article isn’t the short answer. So let’s take a look at what would happen if you tried to go insulin-free with type 1 diabetes, and why it’s a bad idea.

We’ll start with the basics. When we eat, food is broken down into glucose. The glucose goes into our blood. When the cells need energy, glucose in transported from the blood to the cells. The hormone responsible for transporting the glucose is called insulin. So when a person without type 1 diabetes has high blood glucose levels, the body produces more insulin to keep blood glucose levels at an even keel.

Type 1 diabetes occurs when the immune system attacks the cells in the pancreas that are responsible for producing insulin. Thinking that the insulin-producing cells are foreign invaders, the trigger-happy immune system destroys them. As a result, people with type 1 diabetes have to inject insulin.

We need insulin. If you don’t have it, your blood glucose levels will spiral out of control. Every time you eat, they will get higher and higher. Out of control blood glucose levels can make you feel tired, thirsty, hungry, make you need to wee all the time and give you blurred vision.

High blood glucose levels are responsible for complications, both short and long term. If you regularly have high blood glucose levels, they will cause damage to various parts of your body – from the eyes to the heart to the kidneys to the brain.

If you have really high blood glucose levels, you might be exposed to short-term complications. There are two major ones: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, which we will refer to as HHNS. DKA is the one that commonly affects people with type 1 diabetes.

We’ve already established that a lack of insulin means high blood glucose levels, but it also means that glucose isn’t going to cells. You’re eating, but the energy isn’t going where it needs to go. It’s just sitting there.

insulin vials

So how do we get energy, if there’s no glucose going to the blood? The body burns fat reserves. This is why people usually lose a lot of weight before being diagnosed with type 1 diabetes. The process of burning fat produces an acidic substance called ketones. A small amount of ketones is no big deal. Most of us burn some fat overnight, and the ketones create the phenomenon of “morning breath.” But a lot of ketones is a bad thing. The ketones get into your blood, causing a state called ketoacidosis. That’s the unpleasant truth of it: not having any insulin turns your blood into acid, and it’s this condition that we called diabetic ketoacidosis (DKA).

Symptoms of DKA include vomiting, dehydration, a weird fruity smell on your breath, rapid heartbeat and confusion. If left untreated, it can lead to coma and even death.

Many cases of type 1 diabetes go unnoticed until DKA kicks in, especially when it occurs in children. The kids obviously don’t know the symptoms of type 1, and their parents might not either, so the child’s blood glucose levels go up and up, unidentified as type 1 diabetes until things get serious.

So that’s why people with type 1 diabetes cannot go “insulin free” no matter how carefully controlled their diet. But it’s not a stupid question. Before the discovery of insulin, the only treatment for type 1 diabetes was the “starvation diet” which consisted of an extremely low-calorie diet and regular exercise. It extended the lives of diabetes patients, but not by much, and they didn’t live particularly nice lives. So be grateful for the fact that we have insulin injections, and keep injecting.

 

What do you think?

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Why were "starvation diets" promoted for diabetes during the pre-insulin period?

In the decade before the discovery of insulin, the prominent American physicians Frederick Allen and Elliott Joslin advocated severe fasting and undernutrition to prolong the lives of diabetic patients.