It’s time diabetics stop seeing insulin as a knight in shining armour

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Insulin is not the knight in shining armor for type 2 diabetic

SUGAR is the enemy and INSULIN is the saviour. The “success” of bariatric surgery, as a treatment for type 2 diabetes, is forcing a re-think of the story.

You’re battling prediabetes or type 2 diabetes…..

YOU’RE MOTIVATED !

You’ve seen the horror pictures…………..

Amputated feet
Blindness
Heart attacks and heart failure etc.

You’re convinced SUGAR is the enemy and you see INSULIN as the saviour.

But is it ?

The “success” of bariatric surgery, as a treatment for type 2 diabetes, is forcing a re-think of the story.

Surgery to cure type 2 diabetes

Meta-analysis studies, show 80 % of people with type 2 diabetes, that undergo bariatric surgery, experience a sustained reversal of type 2 diabetes. Significant weight loss is not a pre-requisite. Diabetic patients undergoing bariatric surgery are “FIXED” within a week of the surgery, when very little weight loss has occurred.

Researchers from East Carolina University have tried to piece together how bariatric surgery “fixes” type 2 diabetes…….

And their conclusion paints INSULIN, more as the villain, and less as a saviour.

Thinness through bariatric surgery

The team enrolled 27 white ladies, into their study….

9 ladies were severely obese (BMI = 37.4) but non-diabetic
9 ladies were severely obese (BMI = 44.8) and diabetic
9 ladies were healthy skinny bean poles (BMI = 22.9)

Only the obese ladies underwent bariatric surgery, the skinny bean poles were included in the study, to get an idea of what NORMAL should be.

Glucose and insulin levels were probed, three times in each obese lady and once in the lean ladies

a week before surgery,
a week after surgery and
3 months after the surgery

Fat people have higher insulin

When they’re NOT eating. In medical speak, this is referred to as fasting hyperinsulinemia.

The folks who were fat and diabetic, didn’t just have high insulin levels, they also had high fasting sugar levels…………….. not a big surprise, this is DIABETES.

The surprise……………

ONE WEEK after bariatric surgery, the insulin levels were NORMAL.

Yah ! But, type 2 diabetes is a sugar issue, so were the sugar levels NORMAL ?

Normalized sugar levels

Kinda.

The ladies with type 2 diabetes, showed significant improvements in their fasting sugar levels a week after surgery, they weren’t perfect, but they were much better.

And when these ladies tucked into a “meal”, which included sugar, their sugar levels spiked, a little higher than in the non-diabetic and skinny bean poles, but it returned to “normal”.

Effectively, the acute response to glucose was “NORMAL”

i.e. they had been “CURED” of type 2 diabetes.

But………….. they were still insulin resistant.

Insulin sensitivity not normal

When the team crunched the numbers, they found the “cured” type 2 diabetics showed some improvement in insulin sensitivity, but they were still profoundly insulin resistant.

Mmmm………..

Fasting insulin levels were NORMAL
Response to glucose was NORMAL
Insulin sensitivity was NOT NORMAL
Weight was NOT NORMAL either

Insulin resistance and obesity are NOT the cause

But the consequence of too much insulin, especially too much insulin, in the “middle of the night”.

The pancreas is …………………..”giving it’s all”.

It is pumping out copious amounts of insulin, day in and day out. Unfortunately, when you’re running at full capacity, it’s impossible to give more.

So, when a sugar dump happens, courtesy of dinner, more insulin cannot be produced.

Resulting in a SUGAR SPIKE of gargantuan proportions, which leads to all sorts of trouble. Including a diagnosis of TYPE 2 DIABETES.

Stop the fasting hyperinsulinemia

Why is the pancreas pumping out insulin ALL NIGHT ? Who knows ?

What we do know, is “something” that is changed by the rewiring procedure in bariatric surgery, must be the trigger. But what ?

Bariatric surgery is a radical procedure……………… LOTS OF THINGS CHANGE

The size of the stomach is reduced
The gut is re-arranged so the flow of nutrients and bile flow is changed
The gut nervous system is altered
The gut hormones are changed
The gut residents are impacted

Hopefully, scientists will figure out, what it is and devise strategies to stop the pancreas running full throttle 24/7, until then…………

The battle is not just against sugar, it is also against insulin, especially insulin at night.

Roux-en-Y Gastric Bypass Corrects Hyperinsulinemia – implications for the Remission of Type 2 Diabetes. J Clin Endocrinol Metab (2011) 96(8):2525–2531. Melissa A. Reed, Walter J. Pories, William Chapman, John Pender, Rita Bowden, Hisham Barakat, Timothy P. Gavin, Tom Green, Ed Tapscott, Donghai Zheng, Nigel Shankley, Lynn Yieh, David Polidori, Steven P. Piccoli, Leona Brenner-Gati and G. Lynis Dohm.