In an interesting paper the question is asked what if the history of the development of our understanding of diabetes has it wrong? The paper (J. Denis McGarry. What If Minkowski Had Been Ageusic? An Alternative Angle on Diabetes. Science, Vol. 258, No. 5083 (Oct. 30, 1992), pp. 766-770).
Despite decades of intensive investigation, the basic pathophysiological mechanisms responsible for the metabolic derangements associated with diabetes mellitus have remained elusive. Explored here is the possibility that traditional concepts in this area might have carried the wrong emphasis. It is suggested that the phenomena of insulin resistance
and hyperglycemia might be more readily understood if viewed in the context of underlying abnormalities of lipid metabolism.
Some powerful food for thought in the paper. Another paper (Arius, Energy Metabolism
) summarizes the argument as:
The author considers the possibility that the hyperinsulinemia of early non-insulin—dependent diabetes is coincident with hyperamylinemia, since insulin and amylin are cosecreted. Amylin would cause an increase in plasma lactate (Cori cycle); and lactate, a better precursor than glucose for fatty acid synthesis, would indirectly promote the production of very-low-density lipoproteins (VLDL). There would follow an increased flux of triglycerides from liver to muscle (and adipose tissue) and, as proposed and elaborated on, an increase in insulin resistance and production of many of the metabolic disturbances occurring in diabetes.
The Randle cycle is a biochemical mechanism involving the competition between glucose and fatty acids for their oxidation and uptake in muscle
and adipose tissue
. The cycle controls fuel selection and adapts the substrate supply and demand in normal tissues. This cycle adds a nutrient-mediated fine tuning on top of the more coarse hormonal control on fuel metabolism. This adaptation to nutrient availability applies to the interaction between adipose tissue and muscle. Hormones that control adipose tissue lipolysis affect circulating concentrations of fatty acids, these in turn control the fuel selection in muscle. Mechanisms involved in the Randle Cycle include allosteric control, reversible phosphorylation and the expression of key enzymes. The energy balance from meals composed of differing macronutrient composition is identical, but the glucose and fat balances that contribute to the overall energy balance change reciprocally with meal composition.
Fatty acids may act directly upon the pancreatic β-cell to regulate glucose-stimulated insulin secretion. This effect is biphasic. Initially fatty acids potentiate the effects of glucose. After prolonged exposure to high fatty acid concentrations this changes to an inhibition. Randle suggested that the term fatty acid syndrome would be appropriate to apply to the biochemical syndrome resulting from the high concentration of fatty acids and the relationship to abnormalities of carbohydrate metabolism, including starvation, diabetes and Cushing’s syndrome.
My own weight had been in the 280 range for a long time. In the months before I was diagnosed as Type 2 Diabetic my weight dropped 50 lbs without any lifestyle changes. After I went on Metformin my weight was relatively lower for a while. When I eventually went on Insulin my weight went up 40+ lbs fairly quickly. It is well known that Insulin adds weight.
My own thought is that the Insulin is both the lock and the key. Increased levels of Insulin pushes glucose or fat into cells and decreased levels of Insulin allows fat to come out of cells. That’s why Intermittent Fasting is such a great bullet for Type 2 diabetics. It allows our fasting Insulin levels to drop. Add to that Low Carbohydrate diets and the perfect recipe for controlling Diabetes comes into play.
The problem never really was Insufficient Insulin. The problem was too much Insulin. And clearly it is a fat related problem.
I’ve got a reason to celebrate today. Three months – no Insulin. So obviously I am not dead but what happened with my daily blood sugar numbers? My meter only goes to one month on the average but I downloaded the data and here’s what it looks like (averaged over three months):
All of the daily averages are in the 80-120 range. My overall average is 101.5. That works out to a HbA1C value around 5.2. I haven’t had it tested yet but would expect my value to be somewhere around that number. That is pretty great.
I also went below the 50 lb scale drop on the work scale this past week so the weight loss is going really well also.
Clothes don’t fit all that well anymore though. I need a better belt and some new pants. I’ve been wearing XL tee shirts this past week too.
Things are going well. Weight loss has slowed but my Blood Glucose numbers have been great. Here’s my before/after numbers on a chart:
I started eating LCHF and IF about 8/1/16.
Interesting study (Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials). The study reviewed:
A systematic literature review (Pubmed, Embase, Cochrane Library) including all randomised clinical trials (RCT) analysing insulin vs. hypoglycaemic drugs or diet/placebo, published between 1950 and 2013, was performed.
Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed:
The study looked at:
We included all RCTs reporting effects on all-cause mortality, cardiovascular mortality, death by cancer, cardiovascular morbidity, microvascular complications and hypoglycaemia in adults ≥ 18 years with T2D.
The conclusion was:
There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia.
I was eating a lot of chicken wings thinking they are Low Carb. And when it comes to carbs, they are. Well, sorta. Here is the nutritional information for chicken wings. Note they took away the skin which has fat.
A wing without skin has 43 calories where 24 of the calories come from Protein. 15 Calories come from Fat. That’s only 35% of calories from fat. Not LCHF at all. That’s LCHP, not the goal for a diabetic.
What happens with the Protein? Suppose you have 6 wings. That’s 36 grams of Protein. But half of that gets converted to Glucose. That’s 18 grams of carbs (equivalent).
Leaving the skin on helps quite a bit. It is the best part after all. Here’s the wing with the skin.
Fat is 5.4*9=48.6 calories from fat = 60%
Protein is 29.8 calories from protein = 37%
A half dozen whole wings is 44 grams of protein with the glucose equivalent of 22 grams of carbs. No wonder I used to need to pump under such a protein load. It wasn’t spread out like my carb load was. It would last around twice as long. But it still had a load for Insulin response.
One good thing about the pump is that it logs a lot of data. One of the things it logs is use of carbohydrates. I decided to dig back though my pump data and see how many grams of carbs I was eating per day before switching to LCHF+IF. I thought I was eating relatively low carb. Turns out I was way wrong. Here’s the chart.
Average was 200 grams of carbohydrates a day. Below the recommended daily amount.
The Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of your total daily calories. So, if you get 2,000 calories a day, between 900 and 1,300 calories should be from carbohydrates. That translates to between 225 and 325 grams of carbohydrates a day.
So my own highest day was below the recommended range and my lowest days were less than half the recommended value. So, on the Recommended Daily Guidelines I should have been eating more carbohydrates. Something like 75 more grams a day.
Yes, folks, we are letting the nutritionists in our government keep us fat, dumb and happy. And sick. Very sick.
Things are going really well on LCHF+IF. Here’s my Insulin use.
Here is my Blood Glucose levels:
My Blood Glucose level continues to fall since getting off Insulin completely. It is averaging around 100 every day which seems like a decent number for where I am at (just 4 weeks in).
I am eating LCHF and doing IF. I didn’t weigh myself at the start, but I am down more than 20 lbs now.
Decide today I would cut my Metformin to 1x with my dinner meal. Eliminated my statin earlier this week as well as my Niacin tablet.
Saw an unbelievable sight when I woke up at 5 AM. My blood glucose reading was 100. I can’t remember ever seeing 100 when I was pumping Insulin.
Weight is down a couple of lbs in the past couple of days. Wish I had started tracking from the start. I am down 16 lbs from Aug 5th. My rough guess is about 20 lbs so far since I started IF on July 31.
My blood sugar readings average in the past 3 days has been 115. That’s down from my previous 7 day average of 125. Also, I did switch to the Bayer Contour Next and it reads a bit higher than the OneTouch UltraLink I was using before.
So, all of the trends are good. I’ve been trying hard on the diet to eat higher fat and lower protein. Seems to be paying off. Combining LCHF with IF looks to me to be the cure-all for Type 2 Diabetes. At least in me. Your mileage, as they say, may vary.
Still taking Metformin 2x, 625 mg. Stopped taking Avorstatin. Considering stop taking Niacin since it is listed as raising blood sugar when taken in combination with Metformin.
I’ve been off Insulin for a full week now.
So why am I still alive? After all, I needed 100 units a day on the average just one month ago. But here I am. Still Alive!
So did I just decide to ignore my Blood Glucose levels and am I on the edge of dying? Hardly. I’m still checking multiple times a day – mostly now in disbelief at how well my blood sugar is being regulated by my body. My high today was 124 and my low so far today is 109. I never got numbers like that before day after day on Insulin.
For dinner last night I took the kids out to Five Guys Burgers and Fries. I skipped the fries. I ate a bunch of peanuts and more importantly had my burger “bunless”. The choice to replace the bun with lettuce was a good one since it took away about 40 grams of carbs and left about 1 gram. The fat ratio was good and the jalapenos, etc didn’t add much to the carb count but they did add to the flavor.
All of that made my Blood Sugar at 103 around bedtime.
Addendum : Still taking Metformin. Not out of the T2D woods yet.
I shut off my Insulin Pump 36 hours ago.
My Blood Glucose numbers have been great.
This will be my last Insulin dosage chart since I am no longer on Insulin. I am still on Metformin.
I will probably post numbers like these:
7 day average – 123
14 day average – 124
30 day average – 137
The LC-HF plus IF dieting has been going great. Easy to do. I don’t get hungry until after 2 PM which is when my blood sugar goes down to around 104 or so.