Weight Loss More Effective Than Intensive Insulin Therapy For Type 2 Diabetics

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Weight Loss More Effective Than Intensive Insulin Therapy For Type 2 Diabeticshttp://www.medicalnewstoday.com/articles/100298.phpWeight-loss and major lifestyle changes may be more effective than

intensive insulin therapy for overweight patients with poorly

controlled, insulin-resistant type 2 diabetes, according to a diabetes

researcher at UT Southwestern Medical Center.

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. 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.

Dr. Unger's research is supported by grants from the National Institute

of Diabetes and Digestive and Kidney Diseases, the Department of

Veterans Affairs, and the Juvenile Diabetes Research Foundation.

Visit http://www.utsouthwestern.edu/edocrinology to learn more about UT Southwestern's clinical services in endocrinology.

UT Southwestern Medical Center

5323 Harry Hines Blvd.

Dallas, TX 75390-9060

United States

http://www.utsouthwestern.edu