Know the potential risks involving early insulin treatment for type 2 diabetes
Physicians generally encourage early insulin treatment for type 2 diabetes. However, a study shows this practice may cause more harm than good. Insulin therapy controls your blood sugar temporarily and daily, but it does not help you to promote self-regulation of sugar levels or insulin production.
Insulin therapy requires increasingly higher doses and constant switching of different kinds of insulin. It does not prevent β-cells from becoming dysfunctional. Better clinical outcomes in early diabetes have been seen with antihyperglycemic oral regimens such as Metformin and Glipizide.
Other risk factors are episodes of severe hypoglycemia, increased cardiovascular mortality, weight gain, and the potential increased risk for specific cancers. In rare cases, excess insulin in the blood can also lead to mitogenic activity, a condition found in individuals with pseudo acromegaly, a disorder in which acromegalic features develop. The complications of insulin injection are exacerbated by insulin resistance itself. For more information, please read Early Insulin Therapy for Type 2 Diabetic Patients: More Cost Than Benefit.
Excess insulin in the system
In normal physiology or persons without diabetes, β-cell insulin secretion is rapid because insulin’s half-life (how fast a drug is eliminated from the system) is ~5 min. The glucose regulatory system has a slight lag time, so insulin does not stay in the bloodstream longer.
When insulin is injected, the usual rapid assimilation found in normal individuals is canceled since subcutaneous injections are absorbed slower and without natural metabolic control. It is dependent on the type of subcutaneous injection site and other factors.
This, in turn, creates hyperinsulinemia, which means “too much insulin in the system at one given time. " Hyperinsulinemia is associated with tumor growth and other cell growth conditions throughout the body.
Effect of insulin injections on cells
Insulin action on cells has two signaling pathways, one of which regulates metabolic activity, such as the absorption and use of sugars, and the other regulates cell growth, growth hormones, and other growth-related functions. In a normal cell, these pathways are balanced. When the cell is insulin resistant and external insulin by injections is used to overcome insulin resistance, growth activity will be overstimulated, and the pathways become out of balance. Evidence suggesting this relationship comes from studies in patients with pseudoacromegaly. This disorder develops acromegalic features in markedly insulin-resistant individuals.
Hypoglycemia and increased mortality
Until recently, it was thought that the prevalence of hypoglycemia associated with insulin therapy was low; recent long-term clinical trials with patients treated with intensive insulin regimens have shown the contrary.
A recent long-term clinical trial named Action to Control Cardiovascular Risk in Diabetes (ACCORD) showed a 15.9% increase for intensive glycemic control to 5.0% for standard glycemic control.
In another study, Veterans Affairs Diabetes Trials (VADT) had a 21.1% for intensive insulin to 9.7% for the moderate control group. Cardiovascular mortality was also greater in studies where subjects were treated with prandial insulin (insulin given before meals).
Weight gain
Weight gain accompanies early insulin treatment for type 2 diabetes. These factors influence the magnitude of the weight gain.
Level of the initial glycemic control
Glycemic control achieved
Duration of insulin therapy
Type of insulin regimen used
Oral agents used
In a study focused on normalizing A1c levels for six months of intensive multiple doses of insulin therapy, the mean weight gain was 8.7 kg. A 1.4% decrease in A1c and only 6.4 kg of weight were observed when oral agents were added. The mechanism responsible for the weight gain in insulin-treated patients is complex and can result partly from the decrease in glycosuria. Other forms of treatment, like Metformin, have been shown to promote weight loss. The increase in weight is associated with a striking increase in waist circumference.
Risk of cancer
Recently, there has been a growing concern about the association between an increase in the incidence of specific cancers and the type of therapy for type II diabetes. It has been well established that pancreatic, hepatobiliary, colon, and breast cancers occur in higher incidence in patients with type 2 diabetes than in control populations. The reasons for these associations may be multiple, including obesity, hyperglycemia, insulin resistance, and antihyperglycemic therapy. Chronic intense insulin treatment might facilitate cancerous growth.
EInsulin therapy should start late in the diabetes treatment and only when no other resources to lower blood glucose levels are available. Type II diabetes is characterized by a progressive decrease in both β-cell mass and secretory function. In most individuals, absolute insulin deficiency occurs in the late stages of the disease, hence the delay in treatment.
Our insulin production has a unique metabolic process; the insulin we inject has a different action with its own problems. These should be considered carefully, weighing the benefits against their adverse effects.
Diet is a better alternative ( a case study)
As a nurse, I care for type 2 diabetic patients in a nursing facility, and for the past 12 years, I've seen all kinds of diabetics with very different average glucose readings. My experience has shown me that high glucose numbers, in many cases, can be easily controlled with diet changes.
Not long ago, there was a young woman who was admitted after having a mild stroke. She was overweight, and her sugars were through the roof. Her average readings were 300 - 400. So, doctors prescribed massive doses of insulin. She had two types of insulin: long and quick-acting.
I usually talk to these patients, especially if they feel receptive to my advice. And I usually tell the same story: " You have to stop eating starchy foods and sugar." Most often, these patients are not able to follow any of my advice, and to make matters worse, the food provided in these facilities is all starch-based, with plenty of bread, pasta, rice, and fruit, even though it is labeled a "carb control diet" according to state guidelines.
Doctors seldom or never address diet changes, and the nutritionists in these facilities follow state guidelines. So, I can't help but advise them directly in hopes of creating some benefit for these patients.
But Brenda (fictitious name) was determined to change, and she followed my advice and took it to heart. I told her to start with baby steps, to cut all sugars, to drastically reduce bread and pasta, and, of course, no cookies. No sugar-free juices and, of course, no juice because they have a lot of sugar.
Baby steps on what not to eat
No sugars or no foods that contain any sugar. No sugar-free anything
No bread or anything made of wheat flour, including pasta. No starchy foods
Reduce rice drastically
Baby steps on what to eat
Eat more dense and nutrient-rich foods. Eggs, nuts, butter, meats, healthy oils like olive oil
Don't snack between meals.
Perform intermittent fasting
Brenda not only followed my advice, but she took it to the next level. She engaged in long fastings and lost weight rapidly. Her sugars went down to 90 -100 in just a few days. It was surprising how easy it was to change her high blood sugar completely.
I've seen similar situations and patients with the same diagnosis. Still, unfortunately, the majority of these patients did not see any improvement and needed insulin shots before every meal and had to be poked every time before insulin shots.
The solution is simple and a few days away. Try it for yourself and see the results. Please let me know in the comment window below if you have any questions.
Watch the video below for much more information on helpful diet tips
References
Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial: Design and Methods
Intensive insulin therapy in the medical ICU — not so sweet?
Intensive insulin therapy and mortality among critically ill
Intensified insulin therapy and the risk of severe hypoglycaemia
Early Insulin Therapy for Type 2 Diabetic Patients: More Cost Than Benefit
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