"Insulin causes blindness"

Type 2
21

Yes, insulin involves a definite learning curve if you’re going to do it both safely and effectively, no question. But many things in life work that way (driving, for example).

As you rightly observe, knowing about something in the third person is not the same as living with it. There are numerous clichés that express the basic idea (“walk a mile in my shoes”, “every job is easy for the person who doesn’t have to do it”, etc.). That, actually, is one of the most precious things about a community such as this one: the ability to learn from the experience of thousands of others.

Irrelevant aside: at the moment I am sucking on a small piece of candy because my last carefully computed bolus wasn’t quite perfect. Sigh. :neutral_face: One of the biggest shocks for people who work at this conscientiously is that it isn’t an exact science and never can be. Each apple contains a different amount of sugar; some match the published tables perfectly, others don’t. Etc.

22

This is why I think Stephen Ponder’s Sugar Surfing thesis is so important. Diabetes is dynamic, not static. Blood glucose control with insulin works best when the person closely observes and acts in the moment to counteract developing trends. The idea that there is a perfect insulin meal dose or basal profile is a myth. Things change, we respond.

The piece of candy you enjoyed made your carefully calculated bolus work … perfectly.

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23

Actually, the basic thrust of Sugar Surfing is what I’ve been doing since I started insulin. Maybe it’s my engineer mindset, I dunno. It just seemed like the obvious, correct way to proceed. As you know, one of my heroes is Bernstein, who was also an engineer before he changed careers to become an endo.

24

I believe numeracy is a critical diabetes/insulin skillset.

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25

I’m very glad to learn of this resource, Dr Bernstein’s book. Thank you.

26

Just a note, but important: this particular forum tends to have a lot of well-educated diabetics who practice (and achieve) very strict control. I daresay we (by which I mean those of us who are diabetic) don’t match very well with “the general diabetic public.” One of the things you often hear here is “your diabetes may vary.” And, on that note, please note the flairs: you are conversing not only with Type 2, but also with Type 1 diabetics.

When you make statements like “the diet we are consuming - with undeniably higher and higher rates of sugar consumption - is what is driving metabolic diseases,” you’re being very much over-specific, especially for disease(s) as varied in presentation, cause, and effect as those we lump together as “diabetes.” There is no question that varying diet is something that many diabetics find to be useful in treating diabetes. There is no question that some cases of diabetes have poor diet as a contributing factor. There is no scientific evidence that I know of showing that poor diet (and other lifestyle choices) causes any kind of diabetes. I’m a scientist, so I pay attention to the peer reviewed literature on this subject, and note the disparity between the science and the “popular science” on the issue. And this extends to the medical establishment, at least in the U.S.

I, like many other diabetics, was diagnosed as Type 2 at age 41 because of the combination of mild symptoms, my age, and the fact that my BMI indicated I was “overweight.” My G.P. didn’t bother to assess my lifestyle, my bodyfat %, or other indicators of general fitness. If he had, he might have questioned his assumption: middle-aged men with BMI over 25 are Type 2. Statistically speaking (which is how epidemiology works), that’s likely a good assumption. From an individual treatment perspective, it was a terrible assumption (because, as it turns out, I’m T1 LADA). While insulin is an unquestionably powerful tool that can also be dangerous, so is well-intentioned but poor medical advice. Recent statistics indicate that more than 20% of adults diagnosed with Type 2 are actually Type 1 (because they have auto-antibodies). Another significantly large portion of Type 2s (in that they aren’t MODY, MIDD, and don’t test positive for antibodies) don’t respond to oral medications.

My point being that “diet, Metformin, and walk after supper,” which is standard issue RX for both American and British adults diagnosed with diabetes, is necessarily a very poor prescription for many of those same adults. Anyways, it’s complicated. We need better education about diabetes, about diet, and about insulin. But we need that with doctors, patients, the general public, and CDEs (as well as the British equivalent). My CDE’s dietary plan for me initially made my BGs and A1c worse, because she didn’t understand that some diabetics don’t respond well to increasing their carbohydrate consumption. Her advice may have been great for some people, but it wasn’t for me. She needs education on the subject more than I do, since I was at least able to find communities like this to learn from.

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27

“the diet we are consuming - with undeniably higher and higher rates of sugar consumption - is what is driving metabolic diseases,"

I did not mean the diet diabetics consume, I meant the typical American one with its unrelenting focus on sugar.

“She needs education on the subject more than I do, since I was at least able to find communities like this to learn from.”

I would have hoped from my posts, that it is evident that I am open to learning from patients (I am always asking people “tell me what you did!”), and that no one knows as much about my body as I do. But perhaps not.

“There is no scientific evidence that I know of showing that poor diet (and other lifestyle choices) causes any kind of diabetes.” I won’t argue, but I do believe that increasing consumption of processed carbohydrates drives insulin resistance. I can’t site the studies, though I bet Gary Taubes can.

28

There are medical professionals with open minds who really listen to their patients. My GP is one of them. At our very first meeting, he volunteered (unprompted) the comment, “I don’t know everything.” And we do indeed work as a team, listening to each other and discussing options. I don’t follow his advice on every single issue, and I tell him why not. This works for us.

What I fear—and what is corroborated by almost every scrap of anecdotal evidence I can find—is that for every one like him there are 4 or 5 of the other kind. You can certainly debate whether that ratio is accurate or not, but @David49 is absolutely correct: in the U.S. at least, very substantial numbers of Type 1s are misdiagnosed as Type 2 through the automatic application of rule-of-thumb profiles, without doing any tests. One of our members, @Melitta, has written extensively about this, both here and elsewhere.

29

I have no difficulty believing that, at all. I too get frustrated that docs don’t do the tests I sometimes think they should.

30

I don’t think we are really in any serious disagreement, although I question absolute statements such as those you make about diet. Even if they’re largely true, that’s not really good enough in medicine. We must strive for a much higher standard. Anyhow, I’ve got a few more thoughts below, but I am glad that you’re asking questions here. And I think it’s great that you acknowledge that learning something about a disease is entirely different than learning from living with a disease. One of the first things I learned about diabetes from living with diabetes was that medical diagnoses based on statistics are not to be trusted in individual cases, and that CDEs can be well-intentioned but poorly educated. I don’t think that is a personal fault. I had to find more competent medical providers, and fortunately I was capable of doing that. Many people, unfortunately, are not.

Misdiagnosis is a very real problem in the diabetes community. Heavy, middle-aged men are not necessarily Type 2.

I’ve read Gary Taubes, and although he makes a good case for sugar being a “not terribly great thing for many people to eat,” he doesn’t provide (or cite) any evidence indicating that consumption of sugar or processed carbohydrate causes diabetes. As a scientist, I don’t think you can possibly provide evidence that consuming processed carbs “drives insulin resistance.” What it is perfectly reasonable to say is something like this:

“In those predisposed to Type 2 diabetes by genetics, high carbohydrate consumption and insulin resistance are correlated.”

The scientific question, which is genuinely unanswered, is: which came first, elevated carb consumption or insulin resistance? And I’m not arguing to be pedantic or for some kind of cause. I’m not Type 2, I eat a radically low-carb diet at the moment (25g digestible carbohydrate or less per day), and am an athlete (formerly competitive, now amateur but still pretty competitive). I think a good place to start questioning the assumptions about diet and lifestyle and “causing” Type 2 lies in meta-population studies. Two things on that front are interesting: obesity in the West and all types of diabetes (1 & 2) are both increasing, but they aren’t linearly related (i.e., the rate of obesity is rising faster than the rate of diabetes, over the last fifty years).

What all of us want here (and I’m including you in “us”) is better learning, better treatment, and better outcomes for diabetics. One of the things that is absolutely critical in learning is questioning and testing assumptions. There is a serious assumption being made in the medical community that is not, so far, borne out in the scientific literature on diabetes: namely, that poor diet causes Type 2 diabetes. Are they correlated? Certainly. Is correlation the same as causation? No. What should not be up for discussion, at this point, is that carbohydrate restriction is very useful in treating many diabetics (probably most or all Type 2s and many Type 1s). I’m a Type 1 who has immensely benefited from serious carb restriction, and I don’t question at all the idea that processed carbs (or any carbs) make life difficult for diabetics.

Anyhow, we see here quite often new (Type 2s especially, but sometimes others) diabetics beating themselves up because they genuinely believed they “did this to themselves.” I’m a Type 1 and my doctor told me I did it to myself. And then my CDE tried to get me to increase my carb intake, because it was “unhealthy” to eat less than ~180g of digestible carbs per day, according to her… That was her training (to ADA standards), not a personal failing. The training needs to change.

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31

I don’t think you can possibly provide evidence that consuming processed carbs “drives insulin resistance.”

That is a categorical statement, I suppose!

One at any rate, I’m not going to accept just yet. The reason I said that was that in the presence of insulin, calories are stored as fat as opposed to being burned for energy and carbohydrates trigger insulin release.

Triggered by carbohydrates, insulin is released and drives blood sugar into cells for their energy. But insulin also keeps fatty acids inside cells, accumulating, instead of being put to use for energy. In other words, if there’s insulin, there’s no fatty acids being used for energy. Conversely, when there is less circulating insulin, there are more fatty acids being used.

This is my own interpretation of Taubes. In my own personal experience, I have lost weight when I have given up eating sweets (drinks; jellies; desserts). Not every middle aged, overweight person is at equal risk of developing metabolic disease or autoimmune disease; of course only an idiot would not understand that. But if you look at patterns and stats (sorry), you might think that it’s a matter of time.

The clients I see and the two or three people on this discussion are vastly different, primarily vastly different in terms of time, motivation, access, and education. Also culturally I’m guessing.

32

Also I am unaware that “the medical community” believes poor diet (what is even meant by “poor diet” anyway?) causes diabetes. As far as I know, they are taught about risk factors, and diet is a risk factor, as are age, race, overweight, genetics, and so on.

ETA: What Taubes says over and over is: sugar is to diabetes as tobacco is to lung cancer. (ETA Part 2) - and he’s talking about Type II.

33

wow you guy’s are much smarter than me. maybe my case was genetic maybe it was life style and diet.
but I stand with what I said I should not have drank as much soda . I ran and biked a lot and had a very
physical job. am 5’10 weighed 218 at dx. put on about 2lbs. a year after age 30. weigh 187 today with diet
changes still bike but can’t run much. and off work with injury. am worried about the med’s I am taking but
feel I have no choice . good luck with your work senator.

34

I think we’re having two different conversations here. I’m a scientist: causation is not the same as correlation. You’re talking, a lot, about correlation (sugar and Type 2 go together!). I’m not suggesting that they’re entirely disconnected. The research indicates that there are too many unknowns to state what is happening with Type 2. Some scientific studies show that eating excessive fat and protein are correlated with insulin resistance. Others show that eating excessive “processed” carbohydrates are correlated with insulin resistance. There is endless speculation that some level of obesity itself causes hormonal cascades leading to insulin resistance. And then their are those studies which demonstrate insulin resistance in fit people with body fat under 18%. What the hell is going on there?

The problem is when people use the term “diabetes” to refer to whatever is going on with all people that have been diagnosed with some version of diabetes. Except Type 1, diabetes is diagnosed by symptoms rather than a direct biochemical marker (Type 1 is now diagnosed by the detection of one or more of five auto-antibodies). I myself was around 16% bodyfat when diagnosed, but because I was 40 and “overweight” by BMI (as a weightlifter, that happens…), my doctor knew I was Type 2. He knew wrongly, as it turned out. Even though his “knowledge” would have been right about 80% of the time, it wasn’t right in my case.

I’m not suggesting that carbohydrate restriction isn’t a tool to be used in treating diabetes. I believe that it is appropriate in most Type 2s and many Type 1s (not sure about the strictly genetic versions like MIDD, MODY, etc., but probably relevant there as well). Low-carb and exercise can often produce seemingly miraculous “reversals” in early intervention in Type 2s. Are they actually cured or reversed? Of course not. All anyone ever diagnosed as any type of diabetic needs to do to test whether their disease has been “reversed” or cured is to stop their treatment and “eat like a normal person.” In Type 1s, this would likely kill most of us in pretty quick order. In Type 2s (and MODY), hyperglycemia and associated complications are almost certain to return, although for many it will be a slower return than for a Type 1 (with seriously impaired insulin production).

SO my issue isn’t about carb-restriction. It is about “sugar” being bad: honestly, potatoes are just as deadly to me as the equivalent amount of sucrose. Same goes for beets, maize, and wheat. Some are quicker than others, but digestible carbs are digestible carbs as far as my metabolic disorder goes. And I didn’t eat my way into it (and I don’t believe even Type 2s do). It’s also about the idea that all diabetics (or all Type 2s) can be lumped together under a single “cause” and a single “treatment.” Anyone with any experience knows this isn’t the case.

I’m sure you know this isn’t the case as well, since you’re a professional. It’s important that our language reflects the reality: I don’t speak in generalities about a group of disorders that is remarkably varied in cause, presentation, treatment, and outcome.

2 Likes
35

Hmm. I wonder about that. Unless I’m wrong (certainly wouldn’t be the first time), starch is pretty much metabolized by being converted to glucose. Sucrose on the other hand is about 50% glucose and 50% fructose. (HFCS is about 55/45.) And sucrose and glucose do not affect the body the same way. Fructose is mostly trapped by the liver and converted to fat there. I refuse to believe that it’s mere coincidence that high-fructose diets correlate with increased incidence of NAFLD. That’s a different sort of deadly than high BG. They’re both bad, but not in quite the same way.

36

It’s my personal “bugaboo” to refer to insulin as a drug. It is an essential hormone and introducing it to your body is much more natural than taking a drug.

Just my two cents.

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37

I think in “less” educated societies any story about negative experiences - especially with western drugs - is preserved very well by telling the story to others. In this case the people have obviously experienced that people got blind after the use of insulin. Here the problem is the wrong assumption that the insulin caused the blindness - although the real driver was uncontrolled diabetes.

However the problem is more complex than this. High levels of glucose will reduce the capability to repair damage to the retina. By rapidly normalizing the blood glucose levels with insulin the risk is that the eye will start to act on these damages again. Now these repair effords can induce the uncontrolled growth of new blood vessels in the retina. In developed societies this would be immediatly treated with lasers. Since this option is often not available in poorly developed countries the negative side effect of getting blind might be the potential outcome. Again the blindness was caused by the damage done to the retina by uncontrolled diabetes in the months and years before diagnosis.

Developed countries will use a protocol that will reduce the glucose levels of new patients gradually. In combination with eye exams this critical transition phase to normalized glucose levels will be managed effectively. Perhaps it would help to educate them more about this.

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38

Funny – doctors don’t have similar reluctance to prescribe other medications - usually oral - for such reasons. If they did, I wouldn’t be having the lengthy ‘argument’ I’ve been having with my doctors over my reluctance (refusal?) to take statins to lower my otherwise normal blood cholesterol levels to the recently revised “stricter” levels they want for people with diabetes. And my reluctance is not based on myth and rumor, but on personal observation based on the hard experience from BOTH of my parents!

Hm…

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39

I saw Dr Robert Lustig speak live recently, he is a pediatric endocrinologist and works with obese children.

He mentioned that the normal curve for insulin has shifted dramatically to the right in the last 30 years, which is directly related to massively increased sugar and processed foods consumption.

Plus that fructose consumption (in processed foods) is driving NAFL, as well as excess glucose. He sees children with NAFL and other metabolic diseases. He is able to reverse these by cutting all added sugars (and in more resistant cases, adopting low carb eating).

He explained it scientifically (his audience were all doctors), using metabolic pathways of sugar metabolism. All the issues start with abnormally high insulin levels… and a cascade of health implications follow… affected by genetics, and other susceptibilities.

I do believe that type 2 diabetes is greatly influenced by diet. Dr. Lustig said: “Everything we have been taught about healthy diet for the past 40 years has been wrong”. Then he went on to explain why.

This doesn’t make it the person with Diabetes fault. They have been taught the wrong things. The foods that people can access and are cheap are a result of corporate interests / lobbying. But we are now facing a health crisis of catastrophic proportions. And access to health care is going to become more and more limited, simply because the demand will far outstrip any reasonable supply.

I am in a local support group here in Philippines. We have built up to 600+ members over the past 6 months. We have people with type 2 diabetes and hba1c of frighteningly high numbers, having their levels reduce to close to normal by changing to very low carb / Ketogenic diet. Losing heaps of weight. Getting off BP meds, gout meds, diabetes meds, hyperacidity meds.

This view may be controversial. But I am personally sure, that diet is largely to blame for most of the modern day health issues we see (pollution, endocrine disrupting chemicals including glycophosphate, vaccines, lack of sleep - are also part of the problem too). Diabetes, Heart and other cardiovascular diseases, cancer, dementia may all well be part of the same condition.

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40

I agree with the statins there not that effective stopped mine was ruining body. have heard many stories
about people losing lots of muscle on them. it’s your body your call.