Is Insulin Shot Necessary in Type 2 Diabetes Care?
“It is better to discuss how far you have walked, then how little you have eaten” Dr. Elliott Proctor Joslin
When it comes to non communicable chronic diseases we always seem to defy logic and quick to medicate diseases that have origin from modern lifestyle of excessive food consumption and insufficient physical activity. A case in point is type 2 diabetes which is conventionally described as “when the body cannot produce enough insulin to regulate blood sugar levels.” American Diabetes Association says type 2 diabetes is when “your body does not use insulin properly.” Well, International Diabetes Federation described insulin as “a hormone…that…let glucose from the food we eat pass from the blood stream into the cells in the body…”. A study published in November 2018 predicted that in twelve years (i.e. 2030), about 40 million people who need insulin would not have access to it. The question is why is insulin being pushed as a long-term necessity in controlling blood glucose?
Lack of clarity about definition of type 2 diabetes implies that the use of insulin is inevitable especially after the failure of oral anti-diabetes agents. I have been a physical therapist for just over 30 years, and I know a lot of pharmacists, both as friends and colleagues, and they would often explain the function or “mechanism of action” of a particular drug based on its “target cell or organ”. This clarity is not demonstrated to the general public as far as type 2 diabetes is concerned. Again, if all you know about type 2 diabetes is the confusing information about the “… body does not use insulin properly” or insulin helps to drive glucose “…into the cells in the body to produce energy”. The question is, which cells do the insulin act on? Or which main organ in the body does insulin exert the most effect? In other words, what is the target organ of insulin action instead of the words like “cells” or “body”?
Skeletal Muscle: The Ignored Organ in Type 2 Diabetes
You might be shocked to know that the misery “cells” or the so called “body” is the skeletal muscle which is the biggest organ in the body. Skeletal muscle is the principal site where glucose is burnt to make chemical energy called ATP. Therefore, insulin acts on skeletal muscle cells where it is burnt to make useful energy. Here is another shocker, the liver which stores glucose as glycogen does not need insulin to pick up glucose from the blood stream.
In fact, medical evidence shows that skeletal muscle contributes 70–80% of total glucose clearance from the blood stream with help of insulin during and following feeding. Better still, skeletal muscle has ability to pick up glucose without assistance of insulin during physical activity through muscular contractions. Therefore, the skeletal muscle is the “target organ” when it comes to insulin and major glucose clearance from the blood stream. More importantly the effectiveness of insulin on skeletal muscle depends on the level of physical activity of an individual.
The” Road” to Diabetes Starts with Insufficient Muscular Contractions
With chronic physical inactivity and excessive feeding, the muscle cells have inherent ability to “resist” the action of insulin and shut off glucose entrance leaving excessive amount of both insulin and glucose blood stream, a condition called insulin resistance. So, the road to diabetes starts with the muscle’s refusal to pick up glucose in the blood stream leaving dangerous levels of glucose in the blood stream. Over time, high levels of blood glucose may cause damage to the eyes even before the diagnosis of diabetes. Hence diabetes is a disease of physical inactivity, dietary disease or if you will, disease of civilization. This explains why diabetes is rarely found in hunting and gathering societies or among the indigenous populations all over the world.
Prolong high levels of blood glucose put undue burden on the pancreas to secrete excess insulin into the blood stream (hyperinsulinemia). Though the liver does not need insulin to remove blood glucose, but it is especially sensitive to excess insulin for formation of fat from excess glucose which is then export to the fatty tissue where it is properly stored. Now if the fat depot is full, the excess fat can be sent to anywhere in the body including the pancreas where, over time, it blocks the production and secretion of insulin, a condition called pancreatic failure. Pancreatic failure is the usual “medical justification” for insulin shot after years of body’s inability to handle high levels of glucose and fat.
Put simply, at the time someone needs insulin, the insulin resistance is well established in the skeletal muscle and the main target organ for glucose removal has shifted to the liver which converts this excess glucose to fat for storage. Therefore, insulin is often referred to as storage and hunger hormone as majority of people on insulin often stay hungry with tendency for weight gain.
More Insulin is not Better
Exposure of skeletal muscle to high levels of insulin increases its resistance causing the liver to make more fats. As noted by Jason Fung, a Canadian doctor, no doctor would continue to treat a known infection that is resistant to certain antibiotics with the same old antibiotics, and no alcoholic would be advised to consume more drinks to get sober. Yet most anti-diabetic drugs act to stimulate pancreas (insulin secretagogues) to secrete more insulin or act temporarily to improve insulin resistance (insulin sensitizers) until the pancreas is unable to secrete any more insulin. This explains why 50% of patients with diabetes on aggressive glucose lowering drugs would need insulin injection within 10 years as noted per medical literature.
Diabetes is Reversible
Studies have clearly demonstrated that that obese people with diabetes who underwent bariatric surgery purposely for weight loss had their blood sugar normalized within a week because of forced drastic change in consumption. There have also been studies that showed that individuals with diabetes normalized their blood sugar with keto or low carbohydrate high fat diet because fat consumption hardly provoke insulin secretion during feeding. In addition, intermittent fasting and regular exercise under medical supervision allow the body to deplete excess glucose and fats and thus reduces insulin levels with the added advantage of weight loss.
As they say, when you are in the hole stop digging. Long term insulin shots worsen insulin resistance in the skeletal muscle and cause the liver to make more fats. The anticipated worsening access of insulin in 2030 should be embraced as a welcome opportunity to focus on lifestyle interventions that reverse diabetes and not controlling it. Lifestyle treatment would not only reduce the demand for insulin, it would improve access for people with type 1 diabetes who actually need it. As stated by Dr. Sarah Hallberg, a US endocrinologist who advocates keto diet for diabetes, “you don’t treat food disease with medicine.”