So to sum up what we’ve looked at so far in our attempt to clarify the main mechanisms behind diabetes, we’ve kept too little insulin and too much insulin resistance. The insulin resistance is uncontroversial, and at least some type 2 diabetics don’t make enough insulin, in other words have an insulin deficiency, and we’ve added too much insulin and too much glucagon to the list.
By the way, it’s worth mentioning that the too little insulin is often referenced as what we could call a relative insulin deficiency, in other words, with high blood sugar, we could say that whatever amount of insulin we are making isn’t enough to normalize blood sugar.
While this is true, the actual problem here is insulin resistance, not lack of insulin secretion, and it’s truer to say that in cases where insulin levels are elevated, and blood sugar is high, it is high in spite of high levels of insulin.
This is actually a more important distinction than you may realize, given that the main thrust of diabetes medication management is to further increase insulin levels, which can be problematic to say the least, but even more notably, it does not address the problem here at all, because the problem in this case is insulin resistance, not insulin deficiency.
The reason we become resistant to hormones by the way, and this is true of all hormones, not just insulin, is due to elevated levels of them over time where the cells resist these levels. So not surprisingly, looking to maintain or even increase insulin levels when they are already above normal doesn’t just not fix the problem overall, it makes it worse, as this is the biggest cause of insulin resistance, too high insulin levels, and too high here means above normal levels, just like too high blood sugar means above normal levels of that.
Anyway, there are other hormones besides glucagon that increase blood sugar, and we need to add the adrenal hormones corisol and adrenaline to this as well, in addition to excess growth hormone levels.
Hardly anyone talks about the effects of growth hormone on blood sugar but it does definitely have an effect, and when this is too high, and when another hormone that keeps it in check, somatostatin, isn’t high enough, this will also cause the liver to secrete too much glucose, if you are a type 2 diabetic.
I”m just looking to mention these at this point and a further discussion of growth hormone and somatostatin will be reserved for a more advanced section of these articles, I am looking to get into more detail later for those interested, but for now it will suffice just to mention them.
We’re not sure how big of a player growth hormone, and its opposing hormone, somatostatin, is with type 2 diabetes other than they do have an effect on excess liver glucose secretion, which is otherwise known as liver dumping, because it involves a dumping of glucose into the blood beyond, and often far beyond what is needed to maintain normal blood sugar.
We need liver glucose production to survive actually, and the things that act upon it to produce this are given priority, and need to be, but what happens when these hormones are in excess is that things can really run amok.
Adrenaline and cortisol both raise blood sugar by way of increasing liver glucose secretion, adrenaline also breaks down fat, known as lipolysis, which in itself tends to raise blood sugar while this is going on, and cortisol also has the additional feature of increasing insulin resistance. Both also suppress insulin secretion, so if you are thinking, well this is a real recipe for high blood sugar, well we need it to be able to exert powerful effects in order to keep us alive, but when these hormones are chronically elevated and we are diabetic, then that leads to chronically high blood sugar all by itself.
So when blood sugar is higher, from this extra glucose from the liver, we are of course going to need extra insulin to combat this, and extra insulin causes insulin resistance and the need for even greater amounts over time, and insulin resistance also affects the liver which causes it to increase its excess glucose production even more, so you can see we have a real vicious circle going on here.