Insulin, Chapter 3
This site has an insulin and blood sugar simulator. It illustrates the relationship between eating, rising blood sugar and insulin levels (and of course their subsequent drop). But why is insulin in the picture at all?
Simple: Pancreatic hormone that signals cells to absorb glucose from the blood. Central regulatory hormone of energy metabolism. is a hormone with many roles and effects in the body, and in each chapter I look at a few of them.
Today’s topic is Type 2 diabetes (T2D) in detail - the undisputed celebrity of insulin-related conditions. Almost everyone has heard of it, but hardly anyone understands how quietly it sneaks up on you in clear sight.
Diagnosis
Interestingly, there are two quite different ways to look at this:
Standard Diagnosis
T2D is usually diagnosed via blood sugar. The markers are: fasting blood sugar above the threshold, and HbA1c (the average blood sugar level over roughly the last 3 months) too high. Since I explain principles here rather than give diagnoses, I’ll keep it at “too high” and leave out the actual numbers.
In many cases, a T2D diagnosis is preceded by “prediabetes”. The same values are elevated, but haven’t yet reached the threshold for T2D. Generally a gradual transition - but the diagnosis depends on crossing a specific limit: healthy on Monday, over the line on Tuesday and sick (1) .
Two alternative, more useful diagnoses
As is the custom on butterbei.de, let’s turn the whole thing inside out and look at where the problem actually starts: not with the sugar, but with insulin.
It is more informative and more useful not to describe T2D as “high blood sugar” but to view it as insulin resistance: normally the body lowers blood sugar by releasing insulin. In T2D, however, the body’s cells have become resistant to insulin, so the body has to release more and more of it to get the signal through.
Insulin resistance can be diagnosed significantly earlier than elevated blood sugar, because the body can keep blood sugar in check for years by releasing more insulin.
The second perspective alongside insulin resistance is carbohydrate intolerance, which describes the personally controllable cause much more accurately: carbohydrates raise blood sugar, which the body can no longer properly process.
Cause(s) and the Risk Factors
So the cause is insulin resistance - meaning: a significantly elevated insulin level over a long period of time. (And the cause of the cause is elevated blood sugar, which in turn comes down to a carbohydrate-heavy diet.)
There are plenty of “risk factors” commonly linked to T2D, including obesity, high blood pressure, and lack of exercise.
As in many other articles here: it helps to look at cause and effect differently. Forget the classic idea that obesity or high blood pressure are causes of T2D. A cough isn’t a cause of a cold either - it comes with it:
Insulin levels shoot through the roof years before blood sugar does. And with them, a key feature of insulin: it drives fat into the fat cells and throws away the key. The fat is locked in, energy stops reaching the muscles. The result: you gain weight because your hormones are forcing fat storage, and you feel sluggish because the fuel isn’t getting through. Lack of exercise is not a character flaw - it’s the logical consequence of a metabolism that has been blocked for a long time already.
High blood pressure is commonly treated - alongside medication - by reducing salt intake. But salt is not the only cause here either; elevated insulin plays a role too, by causing the kidneys to excrete less salt.
I’d therefore like to invite you to see the “risk factors” as the first effects of T2D announcing itself. These symptoms are not independent related problems of the body, but early consequences of elevated insulin, usually unfolding over years or decades.
Standard Treatment
T2D is usually treated with Metformin and insulin injections. (I’ll skip other options for now - as with everything on this site, this is not medical information but principles and guidance for building a useful mental model.)
Metformin produces an artificial lowering of blood sugar (I’ll spare the details for now - the real problem lies elsewhere). Exogenous insulin amplifies the signal that the body’s own insulin is trying to send, but which the body no longer hears.
And here is the problem: the body is insulin resistant - it can no longer pick up the insulin signal, and is already producing so much of it that it can’t increase production any further. At the same time, the very high insulin level drives the storage of more energy, and ensures the fat cells are firmly locked. And this insulin level is then raised even further by medication.
Not to forget: with this artificially elevated insulin level, patients are advised to lose weight. Which is impossible with a high insulin level.
Setting up for failure
Chronic, Progressive? Remission?
T2D is widely considered chronic and progressive. However, there are now studies and many documented case reports that have achieved complete remission within a very short time (months). The approach? Low-carb or even ketogenic eating - cutting out carbohydrates.
How does that work?
By cutting out carbohydrates, blood sugar doesn’t rise in the first place, so no insulin needs to be released to bring it down. Over time, the elevated insulin level also falls, and the body switches its energy supply to fat within days.
As can be seen here, it is possible that doctors - even those with a background in nutrition - either don’t know about this approach or don’t like it. My view: it is perfectly possible and legitimate to inform a doctor about your plans and ask them to support you.
Worth knowing:
The hearing loss metaphor only holds as long as the lifestyle is maintained and carbohydrates continue to be eaten in large quantities. Unlike ears, the body can - after a period of “metaphorical quiet” (meaning: low blood sugar) - bring insulin back down to a normal level without difficulty.
T2D is only chronic and progressive if the lifestyle doesn’t change. Equally, medication is only necessary long-term if the lifestyle remains unchanged (3).
For doctors, the effort involved in low-carb education is not manageable; the medical system is not set up for dietary change.
For patients, however, it is possible to inform themselves and discuss this approach with their doctors. Patients have the choice - if they know it exists. This article may be a start.
TL;DR
- T2D is the visible tip of an iceberg whose submerged parts are called insulin resistance and carbohydrate intolerance
- Early detection is possible - and considerably more pleasant than the complications (4)
- Diet is the most powerful tool available to the individual
- If medication is being taken, medical supervision is absolutely necessary (5)
