Weight loss more effective than intensive insulin therapy for type 2 diabetics

The National Heart, Lung, and Blood Institute of the National Institutes of Health recently halted part of an ongoing clinical trial on diabetes and heart disease after more than 250 people died while receiving intense treatment to drive their blood glucose levels below current clinical guidelines.

The evidence is compelling that when insulin levels are high, certain tissues are overloaded with fatty molecules, which leads to insulin resistance. And yet, the high blood glucose levels of many obese patients with insulin-resistant type 2 diabetes are being treated with increasing amounts of insulin in an attempt to overpower that resistance. While high doses of insulin may lower glucose levels, it will also increase the fatty molecules and may cause organ damage.

In a commentary in the March 12 issue of The Journal of the American Medical Association, Dr. Roger Unger, professor of internal medicine, wrote about the recent findings of his own and other labs that link insulin resistance to excess accumulation of fatty molecules in liver and muscle.

Dr. Unger, who has investigated diabetes, obesity and insulin resistance for more than 50 years said intensive insulin therapy is contraindicated for obese patients with insulin-resistant type 2 diabetes because it increases the fatty acids that cause diabetes. Instead, the most rational therapy eliminates excess calories, thereby reducing the amount of insulin in the blood and the synthesis of the fatty acids stimulated by the high insulin. Giving more insulin simply increases body fat.

“Evolution was unprepared for the change in the American diet to processed fast food and drive-through lanes,” he said. “There’s no way that our genes could evolve to gird themselves against the superabundance of very, very high-calorie foods that have flooded the U.S.”

Before the discovery of insulin, starvation was the only treatment for diabetes, said Dr. Unger, who is a member of the National Academy of Sciences.

“Today there are many treatment options, including bariatric surgery, if necessary, to lower the fat content in the body before you start giving insulin,” he said. “The fat is causing insulin resistance and killing the insulin-producing beta cells in the pancreas – that is what is causing type 2 diabetes.”

Giving more insulin simply channels the glucose into fat production. There is now a spectrum of therapies that improve diabetes by correcting the insulin resistance by reducing the body fat. Insulin treatment would be indicated only if all these fail.

Dr. Unger said insulin should be given to patients with insulin deficiency, but not if the insulin levels are already very high but ineffective. “Giving more insulin to an insulin-resistant patient is akin to raising the blood pressure of a patient with high blood pressure to overcome resistance to blood flow. Instead, you would try to reduce the resistance,” he said.

In the commentary, Dr. Unger said the increase in the number of patients with insulin-resistant type 2 diabetes can be traced to the epidemic of obesity that began in the U.S. after World War II, when food preparation was moved from the family kitchen to factories and companies that produce high-fat, calorie-dense foods, leading both men and women to consume substantially more calories on a daily basis. In addition, technological advancements such as televisions, computers and automobiles reduced the number of calories burned per day.

Type 2 diabetes occurs when the body is unable to make enough of the hormone insulin to compensate for insulin resistance. The condition affects between 18 million and 20 million people in the U.S.

Factors that increase the risk of type 2 diabetes include obesity, age and lack of exercise. Over a period of years, high blood sugar damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness and kidney disease.

Source: UT Southwestern Medical Center

Can diet alone control type 2 diabetes? No evidence yet
Despite strong evidence that type 2 diabetes can be prevented or at least delayed by a combination of lifestyle changes and good dietary advice, a team of Cochrane Researchers found that there is no indication whether dietary advice alone can prevent the disease.
Insulin Suppresses Receptors that Cause Cascade of Inflammation, Study Shows
(PhysOrg.com) -- Researchers at the University at Buffalo -- the first to identify the anti-inflammatory and cardioprotective properties of insulin -- now have discovered one pathway through which the hormone produces this effect.
Liver protein associated with type 2 diabetes in older adults
The presence of a protein expressed by the liver which inhibits insulin action may identify individuals more likely to develop type 2 diabetes, according to a new study led by a researcher from the UCSD School of Medicine, to be published July 9 in the Journal of the American Medical Association (JAMA.)
Overweight, insulin resistant women at greater risk of advanced breast cancer diagnosis, says study
Women who have risk factors commonly associated with Type 2 diabetes also have much greater odds of being diagnosed with an advanced breast cancer, according to research to be presented today.
Boosting survival of insulin-cell transplants for Type 1 Diabetes
Researchers in Japan are reporting a discovery that could improve the effectiveness and expand the use of transplants of insulin-producing cells to treat diabetes. Their study is scheduled for the July 16 issue of ACS' Bioconjugate Chemistry. Insulin-dependent, or Type 1, diabetes affects about 800,000 people in the United States.
New discovery a step towards better diabetes treatment
In today's issue of the prestigious journal Cell Metabolism Uppsala scientists are presenting new findings that shed light on the processes that determine the release of the blood sugar-lowering hormone insulin. The discovery is based on the development of image analysis methods that make possible the detailed study of events immediately inside the plasma membrane of the insulin-secreting cells.
Eating junk while pregnant can harm your baby
We all know that smoking and drinking when pregnant can harm the baby, but new research published in The Journal of Physiology suggests that poor diet may also cause long-lasting, irreversible damage in offspring from heart disease to diabetes.
UK and US guidelines on kids' physical activity levels need rethinking
UK and US guidelines on how much physical activity children need to boost their health and stave off obesity need to be revised, conclude researchers in a study published ahead of print in the Archives of Disease in Childhood.

Weight loss more effective than intensive insulin therapy for type 2 diabetics

Related stories:

News discussion: