Brief look at diabetes standards of care

The low hanging fruit, if you will (pardon the carb joke), is to look at diabetes care.  By presenting the body with moderate to high quantities of carbohydrates and high glycemic foods (those that raise blood sugar in a pronounced way), insulin is called upon in increasing amounts to remove excess glucose from the bloodstream. While this may seem useful, and it certainly is to a degree, there are many downstream complications long term that can result.

Insulin does not simply remove the blood sugar and recede.  At the cellular level, insulin signals the adipose tissue (fat cells), to get into storage mode.  The adipose tissue is either in accumulation mode or in burn mode.  As long as insulin is elevated, fat cells will be signaled to grow in size and number.  It isn’t just the bikini/speedo presentation this has an impact on; fat cells (white adipose tissue, or WAT, in particular) kick out inflammatory signals by way of cytokines that stoke up the inflammatory fire throughout the body.

Insulin also changes the cholesterol type and amounts found in the bloodstream.  One impact insulin impacts is by way of increasing the MHG-CoA reductase enzyme activity, which increases cholesterol synthesis.  The what?  Sorry, that alphabet soup abbreviation is precisely the same system that the popular statin drugs block.

Can we pause here and ask a simple question?  In these few paragraphs have we seen enough to question the dogma of the standard care for diabetics?

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This coupled with most of the standard to initiate insulin or really any agent that causes an increase in insulin.

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both images from http://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf

Increased dietary carbohydrates cause an increase in blood sugar, which causes increased insulin in circulation, which causes resistance to that insulin over time, requiring more insulin be produced by the pancreas, and that insulin also causes an increase in cholesterol in the blood. The standard of care solutions offered are to introduce even more insulin in the system and give statins to decrease the amount of cholesterol production in the body which is caused by the increased insulin.  Got that logic?

Next, let’s look throwing in one more factor funny looking factor here called HbA1c.  It is the lab measured often to get an approximate 3 month average of your blood sugar.  Sounds pretty cool right?  The abbreviation HbA1c refers to glycated hemoglobin. This develops in everyone when hemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming glycated.

Quick pause again.  This may clue us in as to why insulin works so hard to get glucose out of the bloodstream.  It physically attaches to proteins, which is not an aw-shucks type of event.  This glycation leads to Advanced Glycation End Products (AGEs) that are involved in many inflammatory and high oxidative stress conditions.  This is why diabetes can be looked at as an inflammatory condition.  These AGEs wreak havoc throughout the entire body.   We see here that HbA1c is far more than a simple average.

If we can’t have too much sugar because it harms proteins in the body and getting the sugar out of the bloodstream into our cells is problematic by the mechanisms of insulin, might we reduce the need for either of these events to take place by reducing carbohydrate consumption?


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