Nigeria: 100 years of insulin, but type 2 diabetes persists

When it comes to treating type 2 diabetes, more insulin isn’t better!

Type 2 diabetes is a disease of civilization and would continue to increase in the face of polypharmacy if we do not return to a circadian cycle of eating and fasting that helps prevent fuel overload to maintain a normal metabolic state. Pushing glucose out of the bloodstream with intensive insulin therapy to maintain normal blood sugar levels does not resolve insulin resistance. It only facilitates the production of endogenous fat, leading to increased body weight and constantly overloading metabolic tissues.

Since ancient times, diabetes has always been an enigmatic metabolic disease. Its prevalence spanned the entire medical age: ancient Hindu writings called the sweetness of diabetic urine “honey urine” and a follower of Hippocrates, Aretaeus, coined the word “diabetes”, which means “siphon”, to explain the disease. excessive urination associated with the disease. In what appeared to be a helpless observation of the combination of excessive urination and uncontrolled weight loss, Aretaeus went on to describe diabetes as “… a wonderful condition, not very common in men, being a melting of flesh and limbs into urine. ”The description of the direct supernatural medical age was noted by Thomas Willis in 1674, who called diabetes“ evil tracking ”but the sugar symptom did not escape him, for he also observed that the urine was “wonderfully sweet, as if it were impregnated with honey or sugar”.

Diabetes was a rare fatal disease before the discovery of insulin 100 years ago by Frederick Banting and Charles Best at the University of Toronto in 1921. According to the International Diabetes Federation, “the only treatments available at the time were fasting and low calorie diets. but nothing was really effective in maintaining adequate blood sugar levels and keeping people with severe form of diabetes (now called type 1 diabetes) alive for more than a few months. “Recounting her prior clinical experience. in the age of insulin, Dr. Elliott P. Joslin, one of America’s leading diabetologists at the turn of the 20th century, said in a 1943 speech that “diabetic coma took away all the children,” adding that ” life was not a joy … not fun to starve a child to let it live. “

Since 1921, thanks to the discovery of insulin, diabetes was no longer a fatal disease and the cause and control of “honey urine” that had remained elusive since Antiquity was finally resolved. However, there was no distinction between type 1 diabetes and type 2 diabetes when insulin was first discovered. In 1936, Harrod Percival Himsworth, in what he described as his tentative opinions, classified diabetes into 2 groups: insulin insensitive and insulin sensitive. About fifteen years later, Robert Daniel Lawrence, a diabetic doctor, also categorized diabetes in two: “The first begins in young people who are often underweight; it is severe in that the patient is dependent on the administration of insulin. The second is mild and characteristic occurs in middle-aged patients who are often obese and rarely need insulin “.

… despite all these drugs and insulin therapy, diabetes is still a mystery. In 2000, diabetes was expected to increase worldwide from 171 million to 366 million by 2030. In 2019, the global prevalence was already estimated at 463 million people, and now with a staggering projection to climb to 578 million by 2030. The flawed projection was also noted in the United States, where the prevalence of diabetes increased from 11 million in 2000 to 34.2 million in 2018 …

The first and second categories, as described by Dr. Lawrence, were first referred to as type 1 and type 2 diabetes, respectively by Philip Hugh-Jones in 1955. Type 1 diabetes is a disease autoimmune which occurs when the body’s immune system attacks and destroys insulin-producing cells in the pancreas. Removal of the pancreas in dogs induced diabetes, which mimicked the symptoms of diabetes seen in humans and ultimately led to the discovery and successful purification of insulin by Banting and Best. On the other hand, according to the International Diabetes Federation, type 2 diabetes is characterized by insulin resistance, where the body does not fully respond to the insulin produced by the pancreas, causing high levels of sugar in the pancreas. persistent blood.

The insulin extracts from the pancreas of cows and pigs, which were initially used, have been replaced by biosynthetic human insulin produced using recombinant technology that harvests human insulin from microorganisms. Insulin is inactively produced and stored in the body as a group of six insulin molecules called a hexamer. This hexamer is disintegrated to release free active insulin molecules or monomers into the bloodstream. Since 1996, we have taken advantage of this cluster property of insulin to control its action over time by transforming the amino acid sequence to make human insulin analog, often called insulin analogues, causing a rapid or delayed disintegration of the inactive insulin cluster to produce fast-acting, short-acting, intermediate-acting and long-acting insulins. Besides insulin, which is considered a biologic drug made from living cells, there are over 50 diabetes drugs of different classes targeting different tissues.

However, despite all these drugs and insulin therapy, diabetes is still a mystery. In 2000, diabetes was expected to increase worldwide from 171 million to 366 million by 2030. In 2019, the global prevalence was already estimated at 463 million people, and now with a staggering projection to climb to 578 million by 2030. The flawed projection was also noted in the United States, where the prevalence of diabetes increased from 11 million in 2000 to 34.2 million in 2018, compared to 29 million projected by 2050. Adjusted for dollar inflation. Today, the United States spent an estimated $ 342 billion in World War II which lasted about four years, according to Parramatta History and Heritage. As we speak, on its shores, the United States spends $ 237 billion annually in direct medical costs of diabetes and an additional $ 90 billion wasted in reduced productivity.

Type 2 diabetes … violates the diet and fasting cycle with a persistent, toxic mix of high blood glucose and insulin levels called insulin resistance. The opposite of insulin resistance is insulin sensitivity and this can be effectively induced by reducing blood sugar levels through dietary fat, exercise, fasting, and a combination of exercise / fasting under the supervision of a health professional.

May I repeat the enigmatic story of diabetes even in the 21st century, in which the medical community seems to emphasize evidence-based care while applying the same intervention to two causes of a disease, the loss of pancreas (type 1) and ineffectiveness of insulin (type 2), as both lead to high blood sugar. There is no doubt that type 1 diabetes, which accounts for about 10% of the incidence of all diabetes, is fatal without lifelong external insulin replacement, but should we continue to induce insulin resistance? in type 2 diabetes with more insulin, to the point of rewarding an alcoholic with more alcohol?

Before the insulin era, fasting and calorie restriction were the only treatment options for type 1 and 2 diabetes, but we have reversed therapy in this insulin era by properly treating type 1 diabetes. 1 with insulin and frequently, and I dare say it wrong, doing the same for type 2 diabetes. Just as water follows salt, insulin is secreted due to the presence of glucose in the body. blood. It should be noted that dietary glucose is the only macronutrient that breaks the fasting state and, therefore, high blood glucose levels are metabolically a state of eating or absorption. Type 2 diabetes, an abnormal state of persistently high blood sugar, therefore violates the diet and fasting cycle with a persistent and toxic mixture of high blood sugar levels and insulin called insulin resistance. The opposite of insulin resistance is insulin sensitivity and this can be effectively induced by reducing blood sugar levels through dietary fat, exercise, fasting, and a combination of exercise / fasting under the supervision of a health professional.

While Dr. Joslin described the unbelievable sadness of starvation diets in children in the 1943 speech, he added, however, that “… adults fared better on a restrictive diet of carbohydrates and fats.” All healthcare professionals have seen anecdotal cases where some patients with type 2 diabetes have lost weight with normal blood sugar restored, either because they lost their appetite or because they did not. liked the food served in the establishments where they were admitted, even for ailments other than diabetes. . And to quote Dr Lawrence again, he described type 2 diabetes in the early 1951s as “… mild and characteristic occurring in middle-aged patients who are often obese and rarely need insulin. “. Type 2 diabetes is a disease of civilization and would continue to increase in the face of polypharmacy if we do not return to a circadian cycle of eating and fasting that helps prevent fuel overload to maintain a normal metabolic state. Pushing glucose out of the bloodstream with intensive insulin therapy to maintain normal blood sugar levels does not resolve insulin resistance. It only facilitates the production of endogenous fat, leading to increased body weight and constantly overloading metabolic tissues.

When it comes to treating type 2 diabetes, more insulin isn’t better!

Mukaila Kareem, Physiotherapy Doctor and Physical Activity Advocate, writes from the US and can be contacted via [email protected]

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