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Weight Loss, Lifestyle Changes May Be More Important Than Intensive Insulin Treatment For Patients With Type II Diabetes
| Author: Tony Cappasso |
| Article Date: 5/4/2008 |
Patients with Type II diabetes might benefit more from dropping pounds and making other lifestyle changes than from intensive treatment with insulin, according to a scientist at the University of Texas Southwestern Medical Center in Dallas, Texas.
In a commentary in the March 12 issue of The Journal of the American Medical Association, Dr. Roger Unger, professor of internal medicine, writes about the recent findings of his own and other labs that link insulin resistance to excess accumulation of fatty molecules in liver and muscle.
Unger, who has investigated diabetes, obesity and insulin resistance for more than 50 years, says intensive insulin therapy is contraindicated for obese patients with insulin-resistant Type II diabetes because it increases the fatty acids that cause diabetes.
Unger pointed out that 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, he writes, 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 II 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.
Instead, Unger asserts, 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 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.
Unger says 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 says.
Type II 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 II 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: Univ. of Texas Southwestern Medical Center, Mar. 11, 2008.
In a commentary in the March 12 issue of The Journal of the American Medical Association, Dr. Roger Unger, professor of internal medicine, writes about the recent findings of his own and other labs that link insulin resistance to excess accumulation of fatty molecules in liver and muscle.
Unger, who has investigated diabetes, obesity and insulin resistance for more than 50 years, says intensive insulin therapy is contraindicated for obese patients with insulin-resistant Type II diabetes because it increases the fatty acids that cause diabetes.
Unger pointed out that 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, he writes, 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 II 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.
Instead, Unger asserts, 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 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.
Unger says 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 says.
Type II 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 II 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: Univ. of Texas Southwestern Medical Center, Mar. 11, 2008.