For the last 10 years or so, medical authorities have been advocating starting people with Type 2 diabetes on insulin earlier rather than later. The idea is to prevent complications by keeping blood glucose down. Lower blood glucose might also help beta cells recover. (I have to admit that I sometimes jumped on this bandwagon too.)
Now a recent report by Roger Unger, MD, of the UT Southwestern Medical Center, says giving insulin is one of the worst things you can do for overweight people with Type 2. Insulin is needed to get glucose into cells for use as fuel, but it also causes the body to create more fat for energy storage. According to Dr. Unger, studies show that high levels of insulin lead to high levels of fat, which then causes insulin resistance.
I am not convinced that it’s the mere presence of fat that creates insulin resistance. Studies disagree on this. I think it may be that not enough exercise, too many calories, and too much stress are the causes. However, does it make sense to give more insulin when the body is trying to resist it? Maybe not. For the same reason, taking sulfonylurea drugs (which raise insulin levels) may do more harm than good.
“Giving more insulin to an insulin-resistant patient is akin to raising the blood pressure of a patient with high blood pressure to overcome resistance to blood flow. Instead, you would try to reduce the resistance,” Dr. Unger said.
The Fate of Beta Cells
As you should know, insulin resistance builds up for many years before blood glucose levels start to rise. For a long time, the beta cells compensate for insulin resistance by pumping out more insulin. When the beta cells can’t keep up, diabetes starts.
But why can’t they keep up? Most experts think the beta cells “wear out,” or “burn out,” from years of overproducing. Others believe the cells are damaged by high blood sugar and stopped working. Either way, giving insulin should help preserve these vital insulin-producing cells.
But the work of researchers such as Dr. Unger brings up a different concept. It seems that fat in the blood also wears out beta cells. The beta cells may “turn off” as a defense against fat. Without insulin, fat cells can’t take in more outside fat, and they will actually release fat to be used as energy. So injecting insulin might go against what the body is trying to do for itself.
Of course, when insulin production “turns off,” blood sugar levels will go way up if food intake and exercise don’t change. So it’s a tough problem of what to do.
Bottom Line: ??
I’m not sure what to think about all this. It is certainly true that insulin often causes weight gain, which can’t be good. But most of the insulin-resistance-lowering drugs have serious side effects too. I think Dr. Unger and I would agree that self-management approaches like exercise, calorie cutting, and stress reduction (which he doesn’t mention, but should) are the best way.
What’s your take on insulin? If you have Type 2 and you’ve tried it, how has it affected you? Please leave us a comment to let us know.
Weight Stories Wanted
Well, I’m going ahead with my weight control book, “From Weight to Wellness.” I would really like to hear from readers who have stories to tell about struggles with weight, successful or less-successful. If you’re willing to tell me about them, e-mail me at firstname.lastname@example.org, or visit my web site www.art-of-getting-well.com.
New Diabetes Newsletter
I’m getting a lot of information from a newsletter called “Diabetes Alerts,” put out by Marc Onigman, a man who has Type 2 and has two children with Type 1. You can subscribe to “Diabetes Alerts” by mailing here.