It’s The Insulin, Stupid, Part 7

 

 

 

 

 

 

This week I had the privilege of listening to a new talk with Dr. Joseph Kraft, who was featured in this year’s Diabetes Summit, and even though I’m plenty familiar with the work and views of Dr. Kraft, any time you can watch an article with such a legend in the field of diabetes it’s pretty exciting.

We’ve been talking about Dr. Kraft’s work in this series of course, and he is to clinical practice what Dr. Roger Unger is to diabetes research, and they are both truly icons in our field.  They are both of very advanced ages and we’re not sure how much longer we’ll have the pleasure of their company so I sure was glad that we’ve got fairly recent interviews from both of them to enjoy.

Dr. Kraft has come to the rare realization that the problems of type 2 diabetes are all related to damage from excess insulin, and elevated blood sugar is just one of many, one complication so to speak, but all of the complications are due to hyperinsulinemia.  Insulin damages both major blood vessels and the smallest ones, including those of the eyes, the kidneys, and the nerves, the so called microvascular complications.

It does this mostly from its role as a promoter of inflammation, and Dr. Kraft explained how it does it, how it injures the epithelial tissue which lines the walls of our blood vessels, and it does not discriminate.  Insulin causes a lot of other damage but this particular thing is a big deal and is what we fear the most, and for good reason, because things like amputations, kidney failure, going blind, or dying of a heart attack are not pleasant outcomes.

While high blood sugar does contribute to the incidence of this, nothing contributes to this risk as much as high insulin levels do, and when we lull ourselves into a false sense of security by thinking that just managing our blood sugar will protect us from this, we are truly being deceived.

Given that high blood sugar in type 2 diabetes is ultimately caused by high insulin levels, we would be wise to focus not just some of our efforts, not just most of our efforts, but in fact all of our efforts in looking to normalize our insulin levels, not our blood sugar levels.

This is why I tell people that I’m not really concerned about blood sugar per se and they tend to get real confused and even view me as a madman, but the only madness I see is when we ignore our underlying disease and instead look to simply treat one of its symptoms, which very often does not usually end well.

So this is not even about ultimately achieving good glycemic control as an end in itself, it is really about achieving healthy insulin levels, and when you do that, better glycemic control will follow in time, but it’s actually much more important to control the high insulin then the high blood sugar.

So going back to Amy Berger’s series, which we are looking at here, called It’s The Insulin Stupid, we left off talking about insulin resistance being a huge issue and looked at some remarks from Dr. Tim Noakes which she shared.

Insulin resistance isn’t that well understood though from a pathological perspective though, and a lot of the false assumptions that we make about diabetes in general spills over to this as well, thinking that for instance the problem with T2 is reduced peripheral glucose uptake.  So this is the view that our blood sugar is too high because our cells aren’t taking in enough, which is purely ridiculous when we actually look at the science here.

So somehow, peripheral insulin resistance itself is seen as the culprit, and you see all sorts of nasty things that are supposed to flow from this.  As we’ve discussed in other articles, peripheral insulin resistance is actually protective, not pathological, and protects us from the damage of both high blood sugar and high insulin levels, to a degree anyway, although we’re still harmed by both even with insulin resistance.

So in a previous article I mentioned that this is why TZDs are so harmful, not from the side effects, but actually from the drugs’ main effects, overcoming peripheral insulin resistance, and all this ends up doing is exposing us to even more damage than we would otherwise see if the insulin resistance was not reduced.

The problem with insulin resistance isn’t the resistance, it’s what’s being resisted, the insulin, far too much insulin, so much that the cells fight back.  They just don’t want any more insulin, they just don’t want any more glucose, they just don’t want any more fat, because they are getting way more than they can handle of all this stuff.

So Amy does seem to get this somewhat anyway, by saying she wouldn’t call this a medical condition, and I agree at least somewhat.  I do think it’s a medical condition as it’s preferable to not have insulin resistance, but it’s not a condition in itself to be sure, it’s the insulin, stupid, that is behind it and that’s what we must address, and that bears repeating, that’s what we absolutely must address if we are going to help ourselves at all.

Even the insulin resistance we see in the liver and in the pancreas is protective, and even with the alpha cells this protects them from being damaged even further and spewing out even more excess glucagon, and causing our blood sugar to rise even further as a result.

So we do need to look to fix insulin resistance, by removing the reason why cells need to resist it, and that’s because there’s just too much insulin, unhealthy levels of it to very unhealthy levels of it.

Getting back to Dr. Kraft’s work, if you look at his pattern 1, which he calls normal, you will see that the average post prandial insulin levels are well above what’s considered to be healthy, which is actually 15 to 20.  His chart shows these levels going up 3 to 4 times higher than this.  That’s hyperinsulinemia actually.  At the rate we’re heading, a healthy insulin response is going the way of the dodo bird, there’s so many people who have high insulin, to the point where it’s actually a disease state.

By the way, they had Amy Berger give a presentation on ketogenic diets at the summit this year, although it’s too bad she didn’t have the opportunity to speak about high insulin more, but we did have Dr. Kraft cover that.  I suppose that Amy, being a nutritionist, may not have been seen as having the qualifications to speak on a medical topic such as the condition of hyperinsulinism, but she is well qualified as far as I am concerned.

I also got to watch a very good presentation on LADA by Dr. Ritamarie Loscalzo, and it was so refreshing to see someone look to treat LADA not just by looking to elevate insulin levels but to look to address the cause.

There were a few things in her talk that I found issue with though, and one of them was her idea that people who start getting elevated fasting blood sugar, but not enough to be classified as pre diabetic, should have their blood sugar watched, and she calls these people pre-insulin resistant, but we know that insulin resistance precedes hyperglycemia by as much as a decade or more, so she needs to be checking people’s insulin levels, not their blood sugar, if she really wants to screen people for insulin resistance.

Next time we’ll move on to Amy talking about the various things that high insulin worsens, and there’s a lot to talk about there.

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