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

[Guest guest]

Colleagues, the following is FYI and does not necessarily reflect my own

opinion. I have no further knowledge of the topic. If you do not wish to

receive these posts, set your email filter to filter out any messages

coming from @nutritionucanlivewith.com and the program will remove

anything coming from me.

---------------------------------------------------------

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

diabetics, , according to UT Southwestern expert

Media Contact: Holland Shear

kristen.hollandshear@...

DALLAS – March 11, 2008 – Weight-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.

###

This news release is available on our World Wide Web home page at

http://www.utsouthwestern.edu/home/news/index.html

--

ne Holden, MS, RD

" Ask the Parkinson Dietitian " http://www.parkinson.org/

" Eat well, stay well with Parkinson's disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

http://www.nutritionucanlivewith.com/