STUDY: Intensive conventional insulin therapy for type II diabetes. Metabolic effects during a 6-mo outpatient trial


(Richard Morris) #1

This study to see the result of tightly controlled glucose in 14 type 2 diabetics who were all just starting to be unable to get glucose into pre-diabetic ranges with medication other than insulin. The study itself is not that interesting, but the narrative about how to treat diabetics in the early 90s is interesting.

But something that popped out at me when looking at the data was the increase in insulin over the 6 months to try to keep their glucose in a tight range and fighting insulin resistance by adding more insulin. Of course that sounds crazy, but you can see the numbers. The further they went, the more insulin resistant they became, the more insulin they needed to do the same job … and these people were getting 100 units of insulin a day by the end. So look at what else changes as they pile on the insulin - body weight, In 6 months they pit on 8.7 ± 1.9 kgs. That is a lot in 6 months just to move their mean plasma glucose from 17.5 ± 0.9 to 7.7±0.7 mmol/l.

Did you notice the other change … how many calories they were eating. They started at 2023±138 kCal. After a month of hard core insulin therapy they’d put on 3.7±1.0 kgs and they were eating 1937±122 kCal. By the 3 month followup they needed 6 units more insulin every day to achive the same glucose control and they had packed on 7.0±1.5 kgs from baseline … and they were eating even less 1918±121 kCal. At the final followup at 6 months to keep up their glucose control they were now injecting an additional 8 units every day, and now they were 8.7±1.9 kgs above the baseline weight … and now they are eating 1711±119 kCal a day.

Anyone still think you can reduce calories and lose weight and insulin doesn’t matter?


Inconsistent success on omad lchf
(Solomom A) #2

The question I am interested in is why are they consuming lower calories? Can this be answered scientifically? A conscious effort to fight the increasing weight? An unsuccessful hormonal regulation to reduce the weight?


(Richard Morris) #3

Indeed. With extra insulin vacuuming up energy they should have been hungrier, you would expect them to eat more. But in 24 hr food recall surveys and twice weekly meetings with dietitians their food diaries indicated they had reduced their caloric intake.

I guess if you put on 7±1.5 kgs in 3 months, you might take it upon yourself to try to shave 200 kCal from your daily fare. It’s a shame they didn’t ask that question of their subjects.


(Mel Soule) #4

A textbook case for insulin toxicity and how to create insulin resistance for sure. This is a poster child paper for Jason Fung’s video of insulin toxicity.

Once again the “day-long serum insulin level” shines through as the villian. This sentence from the abstract reminds me of sage advice from an old cell biology prof. “Remember statistics are like a bikini: What you see is interesting,what you don’t is valuable.”

Thanks for sharing.


(VLC.MD) #5

cool stuff.


(VLC.MD) #6

genius.