Diabetes Basics Part 2

David Hite, in his article Diabetes Basics, starts out by mentioning what he feels is the goal in managing diabetes, which is avoiding complications.  This might not seem noteworthy but I do want to point out that what is meant by that is avoiding what we call microvascular complications.

The ones most often mentioned here is damage to the nerves called neuropathy, damage to the kidneys called nephropathy, and damage to the eyes called retinopathy.  Now these are indeed things we want to avoid, but it’s actually a bit disturbing to just have this as a goal, and here’s why.

There is another class of damage called macrovascular complications, and we generally refer to damage to the cardiovascular system here.  Microvascular damage is generally caused by high blood sugar over time, and macrovascular complications are generally caused by high insulin levels over time.

So there’s two threats but when we just focus on the stuff from high blood sugar, we ignore the other threat, and this is not a meaningless one as this one is even more deadly.  Like the microvascular damage, this one does manifest itself by degree, as cardiovascular disease does generally, but the end stage of it is heart attacks and strokes, which are certainly no fun, and of course a lot of people die from this stuff.

Macrovascular risk from diabetes isn’t completely ignored, but we can say that it is virtually ignored, and this is a huge mistake.  You don’t even have to have high blood sugar to have significant risk here, as this is caused by hyperinsulinemia, and a lot of people have hyperinsulinemia, it’s a much bigger epidemic than high blood sugar actually.

These days, the majority of the population has insulin levels that are too high.  High insulin causes a lot of things we don’t want, type 2 diabetes for instance, but several other prominent disorders as well, obesity, various cardiovascular conditions, and more.

If you are a type 2 diabetic though, you either still have high insulin, or your insulin levels will not be high, which is the exception, but if that’s the case this means that your body has simply been ravaged by the damage high insulin has caused over a period of decades and has lost its capacity to secrete excess insulin.

Now this might be seen as preferable, and in some ways it is, but this means that insulin resistance is very high, and insulin resistance in itself causes a lot of problems, with high blood sugar just being one of them.  Insulin resistance itself contributes to cardiovascular risk significantly.

In spite of our describing type 2 diabetes widely as insulin resistance, that’s usually the last time we mention it, our disease is insulin resistance, specifically, high blood sugar caused by insulin resistance, but that’s the last time we think about this connection, and we then ignore the insulin resistance connection and look to lower blood sugar in a temporary fashion that tends to worsen insulin resistance.

For instance, what happens to a type 2 diabetic that we use insulin therapy with?  Well higher than normal levels of insulin causes insulin resistance, as sure as the sun rises, this is much more than just a theory, it not only makes sense but we can easily show that this happens through experiments and have done so.

So guess what happens when we not only start ignoring this but make insulin resistance worse on purpose by looking to temporarily lower blood sugar with excessive amounts of insulin, either injecting it or giving someone medication to increase insulin secretion?  They get worse of course, and more and more insulin or medication is needed to produce the same short sighted temporary reduction.

As we do this, we keep increasing our risk for macrovascular complications, and in the end, we also increase our microvascular risk, as this is ultimately caused by insulin resistance, and we’re making it worse all the time.

Just talking about microvascular complications also tends to keep us just focused on blood sugar levels and not focused on controlling our insulin levels, and this is made worse by our defining control in the short term, what our blood sugar is now, what our blood sugar has averaged over a short period of time, or what our A1C may be.

As I mentioned in the first segment though, we need to define control as striving to normalize both blood sugar and insulin levels, at the very least, and there’s some other hormones that we need to strive to normalize, glucagon in particular.  We also need to pay attention to other hormones that influence this like amylin for instance, as well as leptin and cortisol, three other hormones that play a fairly big role in the diabetic condition.

First and foremost though, if we suffer from the disease of insulin resistance, we need to monitor and improve that.  Insulin resistance is measured by looking at how much glucose is in your blood and how much insulin is in it, and we know for instance that normal blood sugar has a certain amount of glucose in it and also a certain amount of insulin, the amount required to keep it stable in a healthy individual.

So we’ll say that’s an insulin level of 10 and normal blood sugar, and the more insulin you need to maintain a certain blood sugar level, the more insulin resistant you are.  Of course this requires our measuring both blood sugar and insulin levels, but we rarely ever measure insulin, so admit that we suffer from insulin resistance, and that it tends to get worse and worse over time with us, but we don’t even care to measure this, let alone focus on treating and trying to improve it.

Over time, this short sighted and actually pretty idiotic approach to managing diabetes not only ignores macrovascular risk, it actually only effectively manages microvascular risk in the short run, and fails in the long run, and its the long run that is the timeframe which both of these types of damage occur.

There isn’t a single prescription anti diabetic that provides durable benefits, that is, it works long term, they all fail to work long term.  Still though, they do clinical trials and show they work in the short run, and that’s more than enough, the lineup forms and everyone is treated and who really cares how this story goes, but we can ill afford to not bother to read it, because it’s a sad story indeed.

This brings us to our next topic in looking at this article where our friend sees the proper management of diabetes as putting yourself under the exclusive care of a medical doctor, which I’ll certainly have some things to say about in Part 3 of this series.

 

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