[HN Gopher] Insulin at 100
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Insulin at 100
Author : crapvoter
Score : 62 points
Date : 2021-07-19 23:54 UTC (23 hours ago)
(HTM) web link (diatribe.org)
(TXT) w3m dump (diatribe.org)
| mnw21cam wrote:
| So, I have a couple of issues with the text.
|
| 1. The article describes the reduction in use of insulin in type
| 2 diabetes as a bad thing. No. It is a good thing. Type 2
| diabetes is caused by having too much blood glucose, the body
| producing more insulin to lower it, fat cells absorbing the
| glucose, and then this cycle continuing until there is so much
| energy stored in fat tissue that the amount of insulin required
| to keep it there is really high, and eventually the body can't
| produce that much insulin any more. Injecting more insulin
| stabilises the blood glucose level yes, but it does it by
| cramming more energy into fat cells that are already full. Diet,
| exercise, and other glucose-lowering drugs are a much better
| treatment. Taking insulin just makes you dependent on insulin and
| potentially even less healthy. Removing the stored energy by some
| other method (for instance SGLT2-inhibitors make you pee out
| glucose in your urine[0]) can make you more healthy. If you're up
| for it and dedicated enough, fasting can often completely reverse
| type 2 diabetes. The record for the longest fast is 382 days [1]
|
| 2. The article says that "what no one predicted was that GLP-1
| agonists and SGLT-2 inhibitors have been shown to reduce the risk
| of both heart and kidney disease". This should be the least
| surprising thing in the entire world. Most of the management of
| diabetes these days is to try and get blood glucose levels
| stable, specifically because of the consequent benefits in
| reducing the risk of various diseases, including heart and kidney
| disease. If you have diabetes, your doctor will be trying to
| reduce these risks, because they are what people with diabetes
| tend to die from in the long term. That includes giving heart
| medication. You can live with blood glucose levels out of whack
| for a long time without noticing anything particularly untoward,
| but it will be constantly causing damage. So, was anyone
| surprised that drugs that lower blood glucose can reduce cases of
| diseases caused by high blood glucose levels? No, they were not -
| it was obvious.
|
| [0] https://www.fda.gov/drugs/postmarket-drug-safety-
| information... [1]
| https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast
| rdedev wrote:
| Do we know why the blood glucose gets too high? From what I
| understand our cells reduce the number of insulin receptors
| which leads them to absorb less glucose and hence lead to
| increased blood glucose. But the reason for this insulin
| resistance is still sort of up for debate. Atleast this is what
| I understood.
| mnw21cam wrote:
| There are a few theories out there, and the truth is probably
| a mixture of them along with some we don't know about.
|
| However, firstly, type 2 diabetes starts out with no
| significant increase in blood glucose. The reason for this is
| that the body is very good at self-regulating (homeostasis),
| so it just produces a bit more insulin to keep glucose levels
| about right. This happens in the pre-diabetes stage. The
| insulin tells the fat cells to convert glucose into fat and
| store it, which causes people to put on weight. Type 2
| diabetes should be viewed as a disease of too much insulin
| required, rather than too much glucose present. Yes, there
| ends up being too much glucose, but the primary problem is
| that you are giving the body too much energy to store, and it
| needs to produce too much insulin in order to do that.
|
| This leads into one reason for insulin resistance - the fat
| cells that are already full need a higher and higher level of
| insulin to persuade them to keep that energy stored there.
| Adding more insulin gets them to cram more in, but there is a
| limit to how much they can.
|
| Another possible reason for insulin resistance is constant
| high levels of insulin in the blood. Like a drug which you
| become resistant to if you are constantly taking it, your
| cells probably get resistant to the insulin. Insulin is
| secreted in response to high blood glucose and food intake.
| So there are two things that can cause a constant high level
| of insulin. The first is if fat cells are full, and they need
| a high insulin level to stop them dumping the stored energy
| back into the blood in the form of glucose. The second is if
| you're constantly snacking. For that reason, it is a real
| benefit to have a decent long stretch of the day when you
| don't eat anything. It used to be quite normal to have an
| evening meal at 6:30pm, and then not eat anything until
| breakfast the next morning, which gives the body a nice
| 12-ish-hour session each day of low insulin levels that allow
| resistance to recover. It's one reason why the 5-2 diet
| (where you eat normally for five days and then fast or
| severely diet for two days, every week) is successful.
| bpizzi wrote:
| I second that. Looks to me that the author is more
| knowledgeable in T1 than T2, and is almost categorizing the
| latter as a subspecies of the former, for example:
|
| > Some type 2 patients wrongly associate insulin with personal
| failure surrounding diet or exercise
|
| Well, I don't want to be that person, but to me the association
| is tangible.
| mnw21cam wrote:
| There is a tipping point beyond which type 2 diabetes gets a
| positive feedback loop, which can make it extremely hard to
| treat with diet/exercise/drugs. Also, the beta cells in your
| body that produce insulin can wear out through exhaustion at
| having to produce so much insulin. Once that has happened,
| then injecting insulin is necessary.
|
| Some people falsely think this means that your type 2
| diabetes has progressed to type 1, but that's not true - it
| is still type 2, just more severe. Type 1 is a completely
| different disease, but with some similar symptoms.
|
| I quite understand the "personal failure" part of this. You
| inject insulin if the diet/exercise/drugs weren't good enough
| to stop the disease progressing.
|
| However it should also be noted that a decent number of
| people do actually develop type 1 diabetes late in life.
| Typically they will be misdiagnosed with type 2 diabetes,
| because doctors tend to assume that diabetes late in life
| must be type 2. If this happens, a progression on to insulin
| injections is nigh-inevitable, regardless of how much
| diet/exercise/drugs they have. There are a few tests that can
| help distinguish these patients - firstly they tend to be
| thin, but secondly the auto-antibodies that caused the
| destruction of the beta cells can often be detected in their
| blood.
| bpizzi wrote:
| > but secondly the auto-antibodies that caused the
| destruction of the beta cells can often be detected in
| their blood.
|
| That's actually really interesting, I still have got much
| to learn (and you seems to know that stuff pretty well,
| thanks for sharing!).
| refurb wrote:
| Although the article mentions Eli Lilly as the first
| manufacturers of human insulin made through genetic engineering,
| that technology actually came from Genentech located in South San
| Francisco.
|
| Since Genentech was a small biotech company without a lot of
| money or manufacturing capability they outsourced it to Eli Lilly
| who was already a leader in the insulin market.
|
| https://www.gene.com/stories/cloning-insulin
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(page generated 2021-07-20 23:03 UTC)