While the role of glucagon in diabetes is very well known at this point, most still cling to the idea that insulin, and in particular, our lack of insulin is what drives type 2 diabetes. This idea doesn't even make sense though when we even dare to peek at what's really going on with us.
If we get this wrong, if insulin is actually the culprit, if it's too much insulin that made us sick and continues to make us sick, and we decide to keep increasing insulin levels over time, well that's going to be a nightmare, and that's exactly what conventional type 2 diabetes treatment is.
If we look at short term results, like people's A1C being reduced over a short period of time, and we put up a big curtain beyond that, then this strategy can even look good, wow we just reduced your A1C by a whole percentage point, our plan is working!
What they don't tell you though is what happens later. We don't even have to look beyond what happens to blood sugar actually. So in short order this strategy ends up failing and people end up worse off than they started. This isn't surprising because what actually happens is that these medication strategies indeed worsen our disease, the disease of excess glucagon secretion, which is what type 2 diabetes is, and is actually what type 1 diabetes is as well, as Dr. Unger has shown.
So he does spend a lot of time in the lecture that we're looking at establishing the role of glucagon in type 1, but that's important for type 2's as well because it shows clearly that, even in type 1 patients, glucagon is the sole force driving hyperglycemia. If not for excess glucagon, we would not go hyperglycemic in fact.
So now when we stop to think what's wrong with us when our blood sugar is too high, well we tend to think, well we're eating too many carbs for instance, but that's not the case at all. Eating any amount of carbs does not cause high blood sugar. Excess glucagon causes it.
To be clear, this is not a matter of excess carbs causing part of it and high glucagon causing the other part. It is all high glucagon. Where we can get confused is from the fact that eating a lot of carbs will raise our blood sugar further, and even dramatically, but this happens because our glucose metabolism is already taken up by dealing with all that extra glucagon, and all that extra blood sugar, and there's little or even no capacity left to deal with any amount of extra glucose.
When your blood sugar is elevated during fasting, as is generally the case with us, this means that the body's capacity to regulate blood sugar has already been exceeded and often well exceeded, without eating. So what do you think will happen when you eat? There is no capability to deal with this, it's like a bucket of water that is already overflowing, more water will all overflow as well.
So now back to Dr. Unger's lecture to look further into the nuts and bolts of this. By the way, this is an epic lecture and well worthy of all the time we're spending on it, I'm not sure how many more segments will be needed at the time of writing this but we want to make sure we give it its due.
Dr. Unger next asks, is glucagon elevated in every form of diabetes? The answer is, yes, with every form and across every species. This includes diabetes from total removal of the pancreas, glucagon is still high with this type as well.
So this caused some skeptics of Dr. Unger's to question the role of glucagon in diabetes, since with the pancreas removed, glucagon would be shut down, presumably, because it's the alpha cells of the pancreas that secrete it, right?
Well Dr. Unger found that these subjects still had high glucagon levels, and that was a breakthrough, showing that glucagon isn't just secreted by the alpha cells, although insulin is only secreted by the beta cells, so now we have the same situation essentially as we see with type 1 diabetics, an insulin deficiency and a glucagon excess.
All the way back in the 1970's, Dr. Unger studied dogs whose pancreas was removed and found glucagon levels in them to be very high, the pancreatectomy did remove all insulin producing capacity but it did not remove glucagon secreting capacity.
This is a much bigger deal by the way than just showing the fact that it's glucagon that drives diabetes, as if the pancreas isn't the only place that glucagon is secreted, in other words if there are alpha cells or other cells elsewhere in the body, and they can by themselves cause diabetes, well that's a pretty big discovery indeed.
So next, Dr. Unger set out to find out where this other glucagon was coming from, and he discovered that it comes from the stomach, by measuring glucagon levels in the gastric vein and other parts of the body and finding that it was extremely high in the gastric vein coming from the stomach and not elsewhere.
So now we not only know that glucagon is fundamental to diabetes but so is the stomach. I don't think we've scratched the surface of this yet, mostly because in spite of Dr. Unger having discovered this phenomenon 4 decades ago, no one really paid much attention, or we at least haven't really paid much attention at all to it and far less than this deserves.
So years later they find that gastric bypass can virtually cure diabetes and many are scratching their heads wondering what the mechanisms behind this are, speculating that it could be GLP-1 for instance, even though GLP-1 is secreted lower down the gastrointestinal tract and has nothing at all to do with the stomach, glucagon secretion sure does though, that would certainly explain the reversal that we see with diabetic patients who undergo these procedures.
This is so buried though that it wasn't until I saw this lecture that I became familiar with the idea that the stomach secretes glucagon, and I read a lot of material on diabetes. It is amazing that we haven't taken this and run with it, and in particular, looking at the pathology of excess gastric glucagon secretion.
We can speculate though that gastric health may indeed play a big role in diabetes and I've found my own diabetes to respond to certain things that tend to improve this, for instance things that improve my digestion definitely help my diabetes and this isn't something that's been explored much either, actually I'm not aware of it being looked at at all.
We'll continue on in Part 6.