Hyperinsulinema vs. Hypoinsulinemia

hypoinsulinemia and hyperinsulinemia






I got the idea of this title from a search that I noticed I got today, and I do pay a little attention at least to what people are searching for in order to get a feel for what people are wanting to see.  By the way if anyone is reading this and has a topic in mind they are welcome to post their suggestions in the comments.

It’s no surprise that I get people searching for hyperinsulinemia being directed here as there may not be another website that discuss this topic more in depth than I have already on here, and I’m far from finished.  Maybe Dr. Jason Fung’s site, his site has been up longer than mine and he’s also a champion of this topic, but most of his stuff is on diet and as strong as his views are on high insulin I don’t think he’s got as many articles on this particular topic.

There’s some people on a diabetic forum that I hang out from time to time on that actually think that the idea that high insulin is dangerous and plays such a big role in modern diseases like diabetes is somehow my idea, but this is of course nonsense and this goes back all the way to the 1950’s, and more and more people are becoming aware of this colossal health problem all the time, but if someone isn’t aware of what the hell is going on with diabetes and just go to their doctor and fills prescriptions, and go to a few popular diabetes sites, well you just aren’t going to learn much.

In this article I want to discuss both forms of insulin imbalance, and I don’t talk about the condition of hypoinsulinemia, abnormally low insulin levels, anywhere near as much as I speak about hyperinsulinemia, the condition of abnormally high insulin levels.

When we speak of abnormal here, we just don’t mean marginally higher or lower, we mean high enough or low enough to represent a real medical condition, with known negative health consequences.

Untreated type 1 diabetes presents with hypoinsulinemia, due to the immune system attacking the body such that this produces beta cell dysfunction.  It’s not that it attacks the beta cells directly, it interferes with the conversion of glutamate to GABA, and GABA levels decline enough that beta cells don’t work anymore.

This is why we’ve looked into the use of GABA supplementation in looking to improve type 1, and this has been successful in rats, although we haven’t studied it much in humans, for whatever reason, and the only real question is whether a meaningful improvement can be found with the dosages that we would use in people.

Anyway, this is what goes wrong with type 1.5 diabetics as well, and raising GABA isn’t the only strategy here to treat this naturally, an even bigger issue is the autoimmune response itself, and we know quite a bit about what causes this, leaky gut syndrome in particular, which allows our bloodstream to be overrun with all sorts of things that should have been not allowed to enter, undigested food in particular, and this really wreaks havoc on our immune system and causes autoimmunity among other things.

So what a concept, look to discover what is behind a disease and then look to fix it.  That would certainly be a novel idea within the conventional medical community, and if we think on what conditions they actually even attempt to treat, not treating just the symptoms but the actual causes, well I can’t think of any actually.

This is the difference between conventional and functional medicine, as functional medicine does seek to treat conditions, not just symptoms, and therefore we should be calling the other kind dysfunctional medicine, and that would be a perfect term actually.

The problem with hypoinsulinemia isn’t that we don’t get glucose into our cells, which is a widely held myth actually, even though Roger Unger proved this to be false many years ago when he destroyed the beta cells of rats, and in spite of having no insulin at all, they maintained normal blood sugar, and all he had to do is to suppress glucagon.

So the cells took in a normal amount of glucose, without insulin, and the idea that we need a certain amount of it for this is just false.  Now insulin does increase glucose uptake in cells, when there’s too much glucose in the blood, to store it, and when it’s high it puts too much glucose into cells actually, and this is one of the problems with diabetes, too much glucose in the cells, that’s what they call glucotoxicity.

So if you have too much glucose in your blood, a normal amount of insulin will store it, and that part isn’t too bad, but when you have too much in your blood and way too much insulin as well, well this just doesn’t end well.

Somehow people have reasoned that too much glucose in the blood is the worry here, so they use excess insulin to shunt it into the cells and then say, no worries now about glucotoxicity, blood sugar is normal or it’s lower, the cells become poisoned, and that’s what glucotoxicity is, and they get poisoned more by too much fat too, lipotoxicity, which is even worse.

This is all just pure stupidity in action actually, but that’s a condition that is very evident in our thinking about diabetes generally.

The issue with low insulin is that when it is low, this affects the insulin to glucagon ratio that the liver uses to decide whether we need more glucose, and when insulin is too low, a normal amount of glucagon will produce too much glucose secretion by the liver.  If it is very low, like we see in type 1’s, then the ratio is extreme and we see massive glucose secretion, and this is what does them in.

While we may be able to take in normal amounts of glucose without insulin, we cannot take in massive amounts, the massive amounts you get when your insulin to glucagon ratio is so low.  So we give them insulin and this at least corrects the insulin to glucagon ratio somewhat, although we need to induce the condition of hyperinsulinemia to accomplish this.

With type 2, we see high levels of insulin, and even higher levels of glucagon, so the insulin to glucagon ratio is out of whack here as well, and this is what causes high blood sugar period, it’s not the cells not taking in enough.  So we end up with too much glucose in our blood in all forms of diabetes, and there just isn’t a good place for this to go, because there’s just too much glucose flowing around period.

The hyperinsulinemia that we see in type 2 causes a number of problems that takes us on the way to diabetes, but the primary dysfunction and the one that does us in here is its poisoning our glucagon secreting alpha cells in our pancreas by way of both glucotoxicity and lipotoxicity, such that our alpha cells lose their sensitivity to react to glucose and think we are low when we are high, and secrete glucagon to put us up, because they think we are in a hypoglycemic state.

Even though type 2 diabetics lose beta cell mass, and see their beta cell function reduce, when you’re secreting abnormally high amounts of insulin, this is not low insulin, this is not lack of beta cell function, this is the opposite, but many people mistakenly believe this and focus on restoring beta cells just as if we had the opposite condition, hypoinsulinemia.

Of the people with diabetes, only about 1 in 10 have hypoinsulinemia, and this is very easy to diagnose, you just test their insulin levels, instead of just making ignorant assumptions about it, as we love to do.  This is especially important since the cases of hypoinsulinemia may all be related to autoimmunity, type 1 or type 1.5, and if that’s the case, we need to be treating the immune system, and if it’s hyperinsulinemia, we certainly don’t want to be making this condition worse by raising insulin further.

Joseph Kraft is right as far as his calling people with either hypoinsulinemia or hyperinsulinemia diabetics, because diabetes isn’t just high blood sugar, it’s the disease of dysfunctional glucose metabolism.  So based upon his work, 9 out of 10 people are diabetic.  It may be worse than that now actually since his data is now somewhat dated, and this has all gotten worse not better, and we don’t have to look any further than the trends in weight management to see that.

It’s not just people having higher and higher insulin levels and getting fatter and fatter either.  Autoimmune diseases have exploded as well, in step with our rapidly declining gastrointestinal health, and we probably will see a lot more hypoinsulinemia in the future as well on account of this, more type 1.5 in particular, which often results from a type 2 having an autoimmune attack on their beta cells, which is what type 1.5 is, both type 2 and type 1 at the same time, double diabetes they call it.

Our management of diabetes has been pretty pathetic thus far in human history, sure we can keep type 1’s alive now with insulin therapy but that’s about the only thing we have to be proud of and we pulled this off 100 years ago.  Things have gone more and more downhill ever since, and without a proper understanding of what the hell is going on here, or even caring to look, nothing will ever change.

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12 Comments on “Hyperinsulinema vs. Hypoinsulinemia

  1. I am a type 1 experimenting with higher dose GABA supplementation. Any supplements / treatments you recommend for autoimmunity?

    1. Avoiding grains is a big deal with a lot of people, possibly dairy as well if you have a problem with that, eliminating then adding them in is a good way to tell. As far as supplements, there’s a lot of things that can help this, things that repair leaky gut for sure like probiotics and glutamine, vitamin D and magnesium, adaptogens like ginseng, cordiceps, rhodiola, and ashwaghanda can help balance immunity, moducare for immune balance for sure, anti-inflammatories like MSM, astaxanthin, and pycnogenol, omega 3, and n-acetyl cysteine to raise glutathione. Type 1 is very difficult to treat and I congratulate you for making the effort, these are some of the things I’d be considering, plus a few more but that’s enough for this post for sure. The most important thing is carb control though and this is actually a bigger deal with type 1 than type 2, all type 1’s should read Bernstein’s book, it really is all about the law of small numbers with T1, the less insulin you need to use the better for sure, and he doesn’t mention this but you basically have to overdose yourself on insulin to bring your insulin to glucagon ratio up enough for reasonable control, so when you eat more carbs you need more and it’s not just a matter of more easily managing your blood sugar like Bernstein believes, it’s more about reducing the toxic load of hyperinsulinemia. Good luck!

      1. Hi Ken, Thanks a lot for the suggestions! I deeply appreciate them. I already have Bernstein’s book and am on a ketogenic diet. Is there a way, like a blood test, to measure immune system balance? I worry that if I take too many immune modulating supplements that my immune system will get out of wack in a different way. What is the specific type 1 reason to focus on glutathione?

        1. Immune modulating stuff modulates the immune system, in a pretty mild way actually compared to what is going on in autoimmune disease, otherwise someone could just take a bunch of Moducare and cure oneself. Autoimmunity is necessary to some degree because otherwise if you turn it down too much you will weaken it. The main problem here is the pathogens, the stuff that gets into your blood from leaky gut for instance. That’s the biggest deal here by far I’d say. So that’s what I’d be focusing on the most. With glutathione, people’s levels are low generally from all the oxidative stress we encounter but diabetics are especially low, and type 1’s as well, see https://www.ncbi.nlm.nih.gov/pubmed/17957916

          1. Hi Ken. Again in the context of low insulin / type 1 diabetes, are there specific benefits of ginseng, cordiceps, rhodiola, and ashwaghanda as anti-inflammatories over alternatives such as aspirin and curcumin? Should all knowledgeable type 1s be taking anti-infllammatorie or should you test specific blood markers of inflammation and take anti-inflammatories only if the markers are high? Is there a way to test for leaky gut?

          2. Good questions. Type 1’s have a higher need for anti inflammatories than non diabetics due to the need to induce hyperinsulinemia. I don’t know about aspirin, curcumin is definitely good though. The idea behind adaptogens is to get your body to adapt and I would say those can help, MSM might be the best thing to take actually. None of these things are toxic at all at the dosages people take, I wouldn’t bother testing myself, if you are breathing, that’s a good test 🙂 With leaky gut, people can get tested for antibodies but type 2’s already know they have them, at least GAD anyway, who the hell knows what other conditions.
            Leaky gut does present with symptoms but most people have them these days. There’s lots for all of us to work on. There’s a lot of things that type 1’s can do for themselves as well, I’m glad that you are this interested in helping yourself. Good luck!

  2. I wanted to leave a separate comment on why type 1’s need to worry about managing high insulin. Don’t they have the disease of low insulin? Well low secreted insulin, and while it’s believed that most type 1’s secrete at least some, it’s not enough. So they need to inject insulin, but as it turns out, that’s a very inefficient way to control blood sugar. You can’t really control blood sugar effectively with exogenous insulin, because in order to do that you need certain concentrations in the pancreas and liver, otherwise your body will think you are hypoglycemic and secrete large amounts of glucose into the blood. So in other words glucagon is high in type 1’s and in spite of injecting it, the insulin/glucagon ratio in the liver is too low. Now the level in the blood must therefore be kept considerably higher than normal, which does help somewhat to bring up the insulin/glucagon level but mostly what it does to lower blood sugar is to increase peripheral glucose uptake. This is why so many type 1’s are overweight, it doesn’t have much to do with what they eat and in fact if they stop the insulin they can eat all they want and they will die of emaciation. This is actually the best example of how central insulin is to weight management. You can manage your blood sugar levels but it’s more a matter of the liver dumping too much glucose into your blood and then this peripheral insulin dumping this extra glucose into the periphery, and neither is a good thing, it’s just that we don’t have another safe way to treat this disease right now. Ideally we’d find a way to lower glucagon safely so that we wouldn’t need to use so much insulin, but in the mean time, we need to protect ourselves from all this. So high levels of insulin in the blood are inflammatory, but you need the insulin, this is the biggest reason why low carb is so good for type 1’s, to reduce the amount of insulin people need to use. Anyway, both excess insulin and excess glucose create excess oxidation, which is what causes inflammation, so anytime your insulin levels are too high, which includes just about everyone these days, you have to try to manage this with anti oxidants. People don’t pay much attention to this and this is why both type 1 and 2’s have a reduced life expectancy. All that extra insulin and glucose does you in, especially insulin and the way it damages the vascular system, something we know a lot about but few people know about.

  3. One more comment on this subject. So many people are ignorant about hyperinsulinemia it’s not even funny. They worship the three monkey gods, hear no evil, see no evil, speak no evil. If you do open your eyes though we know that type 1’s have about twice as high insulin levels as non diabetics, and non diabetics themselves have too high insulin levels for that matter. So here’s an abstract from a study on this: Abstract
    Insulin is lipogenic and may invoke inflammation. We wished to determine if well controlled human and mice with type 1 diabetes had iatrogenic hyperinsulinemia as an explanation for the increased rate of coronary artery disease (CAD) in type 1 diabetes.
    Type 1 diabetic subjects with HbA1C less than 7.0% had plasma insulin measured before and one hour after a Boost® challenge and a dose of subcutaneously administered insulin. These levels were compared with non-diabetic humans. Plasma insulin levels in well controlled NOD mice with type 1 diabetes were measured 3 h and 17 h after their usual dose of insulin. Hepatic cholesterol-relevant CAD and inflammation markers were measured in the NOD mice.
    Marked iatrogenic hyperinsulinemia was observed in patients at levels of approximately two times higher than in non-diabetic controls. Similar findings were present in the NOD mice. Hepatic CAD risk markers were increased by insulin, but did not exceed normal expression levels in non-diabetic mice with lower insulin. In contrast, insulin-mediated stimulation of pro-inflammatory mediators TNF-α and IL-1β remained significantly higher in hyperinsulinemic NOD than non-diabetic mice.
    Optimal insulin therapy in mice and humans with type 1 diabetes causes iatrogenic hyperinsulinemia and subsequently promotes pro-inflammatory macrophage response independent of hepatic cholesterol-relevant CAD markers. The tight glycemic control in type 1 diabetes may thus increase the risk for atherogenesis via inflammation.

  4. Hi Ken, Thanks a lot for your very helpful comments. I ordered Moducare and was already taking ashwaghanda. I will look into each of the other supplements. As I eat a lot of eggs, which contain sulfur, do I need to look into MSM or does the supplement do more than just increase sulfur intake?

    I have a bigger question. One of the issues I experience with low insulin is muscle wasting. Do you have any supplements that might specifically substitute for insulin injections in preventing muscle wasting? Thanks!

    1. MSM is a specific form of sulphur that is particularly helpful with inflammation. Do a search for MSM benefits, this is something that everyone can benefit from. I’m not sure why you are saying your insulin is low, you’d have to be an uncontrolled type 1 for that. What does happen with diabetes in general is muscle wasting due to excess gluconeogenesis, which some call liver dumping, and the reason this can be a problem with type 1 is that injected insulin does not suppress liver dumping like your own insulin does, because your own reaches the liver in higher concentrations than injected insulin does. If we could control this we could treat the diabetes a lot better, but this is where the challenge lies with T1, you have to put up with high glucagon and then look to increase peripheral uptake to compensate for this, but this results in too much glucose being put into the blood and that has to come from somewhere. So in other words injected insulin does not suppress glucagon in the pancreas enough, then glucagon levels in the liver are too high, and insulin levels in the liver are of a below normal concentration as well, and the resulting low insulin to glucagon ratio causes the liver to spew out glucose, even when your blood sugar may be high. Liver dumping is a huge problem in type 2 and our insulin is too high, at the pancreas and liver too, but both become too deaf to it so to speak. In the end, the body is set up to get the extra glucose that the liver requires to elevate our blood sugar too much from anywhere it has to, including our muscles, and this is where the muscle wasting can occur. Leptin seems to be a big deal here actually and more so than we tend to think, so when it’s low, or more often, when we are leptin resistant, our hypothalamus thinks we’re starving and will signal the pancreas to secrete more glucagon. The tendency tends to be toward leptin resistance with both types and if someone has excess adiposity then that’s pretty reliable, low leptin results in a condition called partial lypodystrophy and you can have abdominal fat but are otherwise thin. , and often this is mostly visceral fat and there is a deficiency of fat cells overall, and fat cells secrete leptin. There’s not a lot of things that help here, if someone is leptin resistant things like CLA, African Mango, and carnitine can reduce this. To make up for the excess liver dumping if it ends up causing muscle wasting, increasing your protein intake can help, and I had to increase mine a lot, to 150 grams a day, to help with what I went through when I first went on a low carb diet, which took me from a normal weight to skin and bones and what I lost was mostly muscle, but I’m fine now.

  5. Ken, I recently completed a Boston Heart series of tests and had a high GSP of 279. My FBG was 106 and A1C was 5.3. I decided to look deeper and ran a Kraft Insulin test and was classified as a Pattern 5 (Hypoinsulinemia) but with normal glucose numbers. I just ran the antibody tests for LADA and waiting on the results. I suspect I will be diagnosed with LADA. I really liked your description of liver dumping and that role that glucagon has on glucose levels when hypoinsulinemia is present. Your article gives me hope that I may not need to use insulin. Can you point me to other references or books on how to manage hypoinsulinemia with using Insulin. I too have noticed that when I increase my protein intake my glucose control improves. Can you explain how protein helps prevents liver dumping? Thanks!

    1. Thanks for the comment Brian, this is certainly very interesting. Definitely a good idea to check for antibodies but the thing is with pattern 5 is that it comes with the high blood sugar, not normal blood sugar. It’s not possible to have diabetes of any sort with low insulin and normal blood sugar, that’s the opposite of diabetes actually. Dr. Kraft’s diabetes in situ is characterized by high insulin levels regardless of blood sugar, the traditional definition is high blood sugar, you just don’t fit in here. This is probably just great readings, although what you want to do is look at your postprandial insulin levels and if they are flat then you do have some issues with insulin secretion. When this is the case though, blood sugar goes up, they do in the chart for pattern 5 and with LADA they don’t go up much if at all, this is really what characterizes the disease. Those numbers are a tad higher than normal so perhaps this is the very early stages of LADA and if so you sure caught it early on. The only way it makes sense to manage hypoinsulinemia using insulin is to look to replace it, although that’s not what we do. If you overshoot this, as they all pretty much do, then what will happen is that you will build more and more insulin resistance since you are using too much. I don’t know of anyone who uses a sensible protocol because all people look at is blood sugar control and that’s the wrong way to go about this. There’s no easy way to replace natural insulin secretion by the way, you do have to use too much, elevate serum insulin too much, but the plan should be to do so no more than needed, to minimize this. It takes time to resolve blood sugar issues but they just want to smack it down, that’s the biggest problem. Protein helps me as well and the main reason is that when you consume more protein you consume less carbs, there are other reasons as well, protein helps balance IGF for instance, it also contains a good amount of carnotine, etc. The rule of thumb is if something helps you, go with it, if it doesn’t, consider alternatives. It’s great that you’re taking such an interest in this though! I wouldn’t get too bent out of shape about all this at this point but with slightly elevated readings the time to start thinking about this is now not when you really get messed up. Good luck!

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