I talk a lot about the disease of hyperinsulinemia on here, and with good reason, as this is the cause of a lot of conditions, type 2 diabetes included. In spite of the fact that we’ve been studying this for decades, there’s a lot misinformation about this in both the general public and much of the scientific community as well.
People think that if someone is a scientist and has studied a condition then they must know what they are talking about, although that statement should produce a big grin among those who realize that we see a lot of divergent views on things of various qualities.
In terms of type 2 diabetes, you often see papers opening up with such nonsense as type 2 diabetes is either caused by insulin deficiency or insulin resistance, which is completely asinine and shows that they have no idea at all about any of this. They no doubt read some other papers who made the same claim, and think that because they read this here or there it therefore must be true or even have some sort of validity.
I’m not sure where the notion that type 2 diabetes is caused by insulin deficiency comes from, it neither makes any sense nor is found in practice. This is a lot like saying alcoholism is caused by either not drinking enough alcohol or drinking too much, where do we get the idea it might be from not drinking enough?
The best guess might be that some people thought, well their blood sugar is high, type 1’s don’t make enough insulin and their blood sugar is too high, maybe it’s the same thing? However that’s where the conversation tends to stop as people don’t bother measuring insulin levels that often to see just where it is at, although when we do, we see that it’s not too low at all, and this should matter.
The other side, the insulin resistance causing type 2 diabetes, is even more foolish actually. While it’s true that type 2’s do have insulin resistance, what causes hormonal resistance? Well everyone knows or should know that it’s caused by hormonal excess, so you can’t have this without too much of a hormone, in this case insulin, hyperinsulinemia.
Now hyperinsulinemia isn’t just higher than normal insulin levels, it’s pathologically high levels, the kind that would indeed produce insulin resistance. The cells resist hormones, insulin and all other hormones it resists, as a protective mechanism, to mitigate toxic exposure. This is not something that is disputable, it’s very basic stuff.
So what this comes down to is the statement that type 2 is either caused by hypoinsulinemia, low insulin, or hyperinsulinemia, high insulin, and when we measure our insulin levels, we see that it’s not hypo, we make plenty of insulin and too much in fact. So the cause therefore is hyperinsulinemia.
I’ve read papers where it’s asserted that hyperinsulinemia is an extremely rare condition caused by a tumor in the pancreas, this shows just how you don’t have to be familiar at all with the truth to publish a paper. In actual fact, the majority of the population, diabetics and non diabetics alike, have been found to have insulin levels high enough for a diagnosis of hyperinsulinemia.
So with this preface in place, let’s look at the Wiki article. There’s so much nonsense written about this that I didn’t have very high hopes that it would be all that representative of what we actually know. A lot of the discussion about hyperinsulinemia actually tends to be pointed toward insulin resistance, and it’s thought that the two are interchangeable, but in actual fact no more than blaming a headache for a hangover the morning after a binge.
The insulin resistance is a symptom of hyperinsulinemia, one of many, and we never want to replace our understanding of diseases with symptoms. A lot of the things you read in these papers are right, it’s just that they call the condition insulin resistance, but the resistance is actually the body’s attempt to fight off the disease, as is often the case with symptoms generally.
The article starts off by defining hyperinsulinemia as a high level of insulin relative to glucose. That’s not quite correct, because after all this is a disease, and it’s persistently high insulin levels relative to normal, glucose has nothing to do with the diagnosis actually.
So the way to measure this is to measure the area under the curve for insulin, not just take a reading and say well with this much glucose in your blood or this much ingested it should be this, this is something that we need to measure over time, just like any hormone.
The definition they provide is used to measure not hyperinsulinemia but HOMA, a calculation used to measure degrees of insulin resistance, not to measure hyperinsulinemia. To measure insulin levels you simply measure the insulin levels. So to decide whether or not we have excess insulin levels we compare the levels to that of a healthy person and then say something like yours is two or three times higher or whatever.
Of course you can also diagnose hyperinsulinemia somewhat from a HOMA test, because you are measuring insulin levels with this test, and if they are too high, well this is a lot like taking a random blood sugar test. It can suggest a diagnosis of diabetes if it is high enough, as normal people don’t get very high blood sugar typically, but it’s better to confirm this with more than just a one off test.
There is a protocol established for this, although to really measure this we should measure insulin levels hourly for a period of 24 hours, to see the daily area under the curve, although Dr. Joseph Kraft’s protocol of the 4 hour test works well enough, as we see both the baseline levels in addition to the response to a glucose challenge.
Thankfully Dr. Kraft devoted his career to this as to date this is the only large scale test of people’s insulin levels, we generally don’t even care enough to do this, and when we do it’s with a limited number of subjects. Dr. Kraft’s data involved thousands of subjects, not just diabetics but all people, it was a real eye opener, although only if you bother to look at his data.
Dr. Kraft showed that 9 out of 10 people with hyperglycemia have hyperinsulinemia, and the other 10% are the type 1’s or type 1.5’s actually, where the immune system destroys the insulin secreting ability of the beta cells in the pancreas. It turns out that there are more type 1.5’s, adult onset type 1 basically, then a lot of people believe, and many 1.5’s get misdiagnosed as type 2’s, because we don’t bother to measure their insulin levels.
What characterizes the difference here is easily measured, as with type 1 or type 1.5 you don’t get much of an insulin response, if any, to glucose. So this is close to flatline, and this does require the GTIR test that Dr. Kraft uses, a four hour test, and we don’t generally bother.
Type 1 is usually more obvious as this manifests itself as extreme insulin deficiency, where with type 1.5, fasting insulin levels are usually close enough to normal to be considered perfect actually, it’s actually after we eat that the thing goes wrong, the beta cells fail to increase their secretion.
So what do we measure when we do bother to test insulin levels? Fasting insulin actually, so you can see how this gets missed. There’s another test for this, a GAD antibody test, but we do that test less often in trying to decide what type of diabetes one has, which is usually no more than testing blood sugar and slapping a type 2 sticky note on their foreheads if they are adults with diabetic hyperglycemia.
He also showed that 8 out of 10 people have hyperinsulinemia, whether they have diabetes or not, and this is pretty alarming, if we cared to notice.
We’ve only gotten to one line of the Wiki article so this is going to take at least one more part.