There's a fairly popular website out there by a blogger called Blood Sugar 101 which is a particular favorite among a lot of low carbers, and there's a banner at the top of all of the pages which announces "What They Didn't Tell You About Diabetes."
This is an interesting site for sure and one I'll be referencing more than a few times I expect, and I want to reference one of the articles on it now to help show one of the things they really didn't tell you about diabetes, and this site isn't telling you either, and hardly anyone tells you, although there is a fair bit of info on this stuff if you care to look for it.
Anyway, here's the article from Jenny:
So if you read through this, and you don't have to but feel free, this really sums up well one of the things that's truly wrong with our standard way of thinking about type 2 diabetes. We tend to characterize the disease as not enough insulin. That's actually quite ridiculous.
So there's a discussion of how insulin is supposed to work which is pretty basic other than it just looks at one thing, insulin, and insulin is but one factor here. So moving on to how this all goes wrong, the section is called "Why Insulin Release Fails."
So already we know that this is the focus and it is actually true that insulin secretion does fall over time as type 2 diabetes "progresses." A lot of that has to do with the way we manage it but hyperglycemia itself will cause this to some extent.
Oddly enough, the first thing she mentions about why insulin release fails is insulin resistance, insulin resistance is a problem of course but it's a completely separate one from not releasing enough insulin, and in fact this makes you release more insulin.
There is a mention here about glucotoxicity and some other info, but what stands out is that failing insulin production is held to blame for all of this, which is absurd. What really happens here is that the body attempts to secrete insulin to keep up with the ever increasing demand for it due to increasing insulin resistance, so insulin resistance is indeed a huge factor here but it's not the pancreas' inability to secrete normal amounts that gets us in trouble, it's its diminished ability to secrete the huge amounts that are required to overcome insulin resistance.
So yeah, beta cell function does decline over time, but it's only in very advanced cases that it even declines to the point where it actually can't secrete normal amounts. We know this because we test some very uncontrolled diabetics with double digit A1C's, who are in pretty advanced stages of the disease, and we don't see below normal insulin production, we see insulin levels way above normal.
So you can't say that lack of insulin is the problem here, and although some diabetics do reach the stage where they become more like a type 1 and actually do have an insulin deficiency, we can't just throw us all in that category because we actually have the opposite of this going on, too much insulin.
When we look at the overall picture, diabetes does tend to progress and loss of beta cell function is part of that, but that tends to be the only part we look at, and a much bigger issue driving this is the increased levels of insulin resistance that occur over time.
So if we are interested in slowing down or stopping the progression, we need to look at the real problems here, and a big one is insulin resistance. There are others as well but this is definitely the big one as it's really what's behind our disease.
So the article concludes that we need to consider using injected insulin to take the stress off our beta cells, but there's actually no reason to suspect that they are being stressed this way, what hurts them is actually glucotoxicity, poisoning by glucose, and lipotoxicity, poisoning by fat, and secreting a lot of insulin isn't even on this list.
One thing that we do know though is that we need to pay attention to the things that increase insulin resistance, and the number one factor is actually, guess what, too much insulin in the blood, regardless of what source it's from.
So we certainly can't treat diabetes by just worrying about the beta cells, and worrying about something that doesn't even matter, overactive beta cells, and not worrying at all about what matters most, insulin resistance , and we especially want to avoid ways that worsen it instead of improving it.