Is high blood glucose or high insulin the problem?

nvmomketo

On Jason Fung's IDM blog the other week he discussed whether high BG or high insulin is the problem causer. It could be the excessive insulin is the larger problem, which makes treating T2D with insulin, sulphonylureas or thiazolidinediones potentially problematic.

Metformin seems to be beneficial as it reduces how much glucose the liver makes (gluconeogenesis) which subsequently lowers insulin.

https://intensivedietarymanagement.com/not-treat-diabetes-t2d-38/

I found it interesting so I thought I'd share.

RalfLott

Thanks - intetesting read!

'Metformin reduced diabetes-related death by a jaw-dropping 42% decrease and the risk of heart attack by a whopping 39%. Metformin performed far superior to the insulin/ SU group despite the weaker blood glucose effect. Something was protecting the organs, but it had nothing to do with the blood glucose lowering effect. The specific type of diabetic medication used made a huge difference. Metformin could save lives, where SUs and insulin could not."

Whew!

rheddmobile

It's my understanding that the study quoted was a bad study which has led to bad conclusions. The excess cardio deaths are explained by the specific sulphonylurea they were using, which causes heart problems. Also, "tight control" was defined by the ATTEMPT to control blood sugar tightly, not by how successful the attempt was in individual cases. People were divided into the tight control group or the looser control group based on the medications they were given, not on their A1c or glucose readings.

The tight control group was also having multiple episodes of hypoglycemia per week, which is more damaging than hyperglycemia.

Due to this seriously flawed study, my doctor actually won't allow me to have an A1c in the normal range, because the myth that a normal A1c is dangerous has become pervasive in the medical profession.

RalfLott

@rheddmobile, thanks for the heads-up.

I haven't ever had my insulin level tested, as every doc has pronounced it unnecessary. But I've only been asking since the concept of insulin resistance got onto my radar, which was long after I had discovered my T2D and had reduced my carb intake as low as I could tolerate.

My PCP completely missed my increasing BG at the prediabetic stage (as did I..), but I wonder at what point a glucose tolerance test with insulin assay might have caught the developing IR - perhaps years before the diabetic BG appeared.

There have been reports of small-sample studies showing possible downsides to Metformin use (such as http://www.diabetesincontrol.com/new-study-raises-questions-about-metformin-and-risk-of-dementia-and-parkinsons).

Regardless, it does seem pretty clear that some combination of very low-carb, calorie-controlled eating and intermittent fasting can be very effective for a great many T2Ds.

rheddmobile

RalfLott wrote: »

@rheddmobile, thanks for the heads-up.

I haven't ever had my insulin level tested, as every doc has pronounced it unnecessary. But I've only been asking since the concept of insulin resistance got onto my radar, which was long after I had discovered my T2D and had reduced my carb intake as low as I could tolerate.

My PCP completely missed my increasing BG at the prediabetic stage (as did I..), but I wonder at what point a glucose tolerance test with insulin assay might have caught the developing IR - perhaps years before the diabetic BG appeared.

There have been reports of small-sample studies showing possible downsides to Metformin use (such as http://www.diabetesincontrol.com/new-study-raises-questions-about-metformin-and-risk-of-dementia-and-parkinsons).

Regardless, it does seem pretty clear that some combination of very low-carb, calorie-controlled eating and intermittent fasting can be very effective for a great many T2Ds.

I can see an immediate flaw in the study you linked - the cohort was chosen based on whether or not they were already taking metformin at the time the study began, and compared to those who were diabetic but had not been prescribed metformin. Since metformin is pretty much a standard treatment, in other words, the ones who got dementia were sicker to begin with.

I definitely agree that controlling carbs is key to glucose control - however, I think eating to the meter and controlling exercise are as useful as low-carb, for those who are able to tolerate it.

RalfLott

I agree.

I tested 10x daily for a year, figuring that I'd have all my responses pretty well nailed in that time. Nope, I'm still regularly surprised by readings, and my ability to predict within 10 points how my BG is running has not improved to the point where I'd stop frequent testing. Too many variables; eating and exercising to the meter appears necessary for good control.

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sarahtrust

metformin caused diarrhoea and stomach cramps though I have been\n on it for years, just didn't connect the symptoms with metformin until I learned that I had very low B12 ( and low iron) due to this being leached out of my system by metformin B12 injections for a year), , also other nutrients lost so OFF METFORMIN Haven't Noticed ANY DIFFERENCE IN BG LEVELS