Diabetes Basics Part 1

There’s a ton of info on the internet about diabetes, and I ran into a very long article today by diabetes educator David Hite, and I thought that this would be a great article to have a look at in depth for you, to go over the material covered here and provide some comments.

This provides us with a good look at how conventional thinking approaches diabetes management, and we can particularly look to discuss what the rationale may be behind Dr. Hite’s thinking, although generally speaking he doesn’t really provide a whole lot, although this article is not short on advice and is targeted toward diabetics with very little knowledge who are presumably expected to just take the advice and follow it without a whole lot of questioning.

However, we’ll not be doing that, and in fact the goal here is to question this as much as we can and see which parts make sense and which do not, and perhaps try to figure out why he and so many others share a certain viewpoint.

There’s quite a bit of material here so as I’m writing this I’m not sure how many segments this will take, and as usual I will break it down to digestible pieces for you so I expect that it will take several for us to do all this justice.

As we begin to read through this, it’s obvious that the treatment goal here is blood sugar management, and you might be thinking, well what else would diabetes management consist of, but we do want to be careful here, very careful in fact, to focus on the right things.  Now ultimately, blood sugar management does matter, if you have an A1C over 10 for instance, especially if this is over a long period of time, this is going to be something that is going to be a concern, as we know that this increases the risk of damage from high blood sugar rather significantly.

So yes, that matters, but there’s something else we want to pay attention to, at least as much if not more, and that’s our insulin levels.  Since we don’t usually measure our insulin levels, we really have no idea where we’re at here, and very likely we have no idea why this even would matter, but as it turns out, our insulin levels being too high is even more of a concern than our blood sugar being too high, as high insulin damages us in multiple and significant ways, not the least of which is causing and worsening high blood sugar over time.

If we don’t manage our insulin levels properly, our diabetes will get worse, including seeing our blood sugar get harder and harder to manage over time, no matter what else we do.  There is no antidote to this, other than to look to seek healthier insulin levels.  This is why our management of diabetes is so unsuccessful, and they even tell you to expect that you will get worse over time.

We don’t have a meter to check our insulin levels like we do a glucometer to check our blood sugar, and it’s too bad we don’t because that would be very useful, but we can and should get our insulin levels tested periodically, to see how we’re doing with that, both our fasting insulin and our insulin levels under load, after a high carbohydrate meal or a glucose challenge.

The glucose challenge is actually best because it involves a fixed dosage of glucose, called an oral glucose tolerance test, and while we don’t normally measure insulin levels during this test, it’s important that we do, because our blood sugar will only tell one side of the story and the insulin side is a very important tale as well.

There’s no question in fact that insulin levels under load is much more important to know than blood sugar levels, and we already monitor blood sugar levels intensively, but we don’t measure our insulin levels at all other than with lab work such as this.

It’s also important to measure our fasting insulin levels as well, and given that we are typically told to fast for blood work, this provides an opportune time to run this test.  While we do want to make sure that we don’t have an insulin deficiency, it is very uncommon for type 2’s to run low, and our insulin levels generally run very high, and it’s not hard to figure out why.

Dr. Hite does mention that our pancreas does work overtime with high blood sugar, with diabetes basically, and it does secrete insulin in response to high blood sugar, and diabetics have high blood sugar, so we would expect that type 2 diabetics secrete more insulin than non diabetics, and this is true and has been well proven to be the case as well.

So when we have excess glucose secreted into our blood, this is going to cause an increase, and a marked increase in our insulin levels, to toxic levels actually.  The body is designed to function at certain levels of certain hormones, too much or too little is unhealthy, and much too much is much too unhealthy, and this is what type 2 diabetics tend to have, at least uncontrolled type 2 diabetics where uncontrolled here means uncontrolled insulin levels, or worse, levels that we purposely worsen with medication or a poor diet.

So our fasting insulin is easy to interpret, and somewhere around 5 is considered to be optimal, you want to make sure this is not down to zero or a very low number like 1, but you also want to make sure it’s not very high either, 10 is about the upper range where this does not become a real concern medically.

Most non diabetics have insulin higher than 10 though and this is why metabolic disease is so rampant, especially being overweight and obese, and I’m not even saying this is one of the reasons why, it’s the reason, period, it’s that significant.

In our state, being diabetic, we’ve gone well past this stage though and this excess insulin has caused the alpha cells in our pancreas to become too active and a hormone called glucagon to be secreted in great excess as well, and glucagon is the main reason why our blood sugar is high.

Without high glucagon, you don’t even get high blood sugar, period.  It instructs the liver to produce excess glucose from non glucose sources, called gluconeogenesis, and Dr. Hite is right in that our pancreas as diabetics is too active, and far too active, but it produces both hormones, insulin and glucagon, in excess, and the result is a real mess metabolically.

I’ll pick this up in part 2.

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