I put this on my blog but I need feedback and you folks are great at that, so here goes.
By sheer luck, I fell across a method of reactivating my 1st phase insulin response. You basically have two responses that come from your pancreas, basal and 1st phase. The basal is the constant but low flow of insulin that occurs all the time in your body. The 1st phase is a modifier of this basic level of insulin to account for changes in the amount of blood sugar that occurs with things like eating, exercise and stress. I use to think of it as a big wave of insulin that suddenly flowed in to your blood stream to counter act potentially high blood sugars caused by something like eating a fast acting carbohydrate. It can and will do this but mostly it’s active like a computerized glucose monitoring system counter acting small spikes in the system due to the actions of other things going on in the body.
It should be noted that I’m talking about spikes not drops in blood sugar. Drops aren’t the problem usually. (There is reactive hypoglycemia but I view it more as part of a failed mechanism.) Your body is set up to strongly defend against hypoglycemia. This can kill you in a day while hyperglycemia make take years. There are a series of systems and hormones that interact to assure that the body has enough glucose. The one which is counter to those is insulin.
At any rate, I’ve found a way to get that first phase back and conversely, I’ve found how to lose this 1st phase. In the last month, I’ve gotten to the point where I have been able to more or less switch it off and on and notice when it is working. I’ve even dropped all medications. My typical blood sugar profile kept me at about 110 with spikes of 40 to 50 points higher after meals. This is even with eating a largely low carb diet. Now my typical profile keeps me in the 90’s with spikes never above 130 and generally about 20 points above my basal rate. It should be noted this is without insulin, exercise or supplements. (I’m trying to keep down the confounding variables. Ned Kock is big on this!)
One thing this has shown me is that the beta cells are there. They aren’t dying off or sick. I’ll have a 1st phase for a few days, make an adjustment and then I won’t have a 1st phase. I’m thinking that this is very much an abrupt type 2 onset thing.
Type 2 is traditionally thought of as slow onset with continually rising blood sugars over many years. With us, insulin failure occurs quickly but on the converse side insulin recovery occurs quickly as well. I’ve read where various methods were used to assess beta cell function or mass and it was found to be intact.
I produce insulin but not a 1st phase so my constant dribble of insulin is not enough to keep down my blood sugars without additional insulin. Guess where my blood sugar average is usually, without medications? 134. This is about an A1c of 6.3 which is pretty standard for a Ketosis Prone type 2 diabetic. This A1c and its implications were discussed in a few posts back. http://ketosisprone.blogspot.com/2010/10/a1c-glycation-problems-and-dka.html
All this and more lead me to believe that this isn’t a problem of beta cells desensitizing but of a failure of a control loop that the beta cells respond to by releasing 1st phase insulin. By saying “control loop”, I am talking about a circuit. Think of it as a lightbulb and switch. If this switch is controlled by a sensor for certain amount of darkness then when it gets too dark, the switch is activated and the light comes on. There might be a sensor for lack of movement in area where the light is. If no motion is detected, the switch is deactivated and the light goes off. There is nothing wrong with the light, it’s fine. Its behavior, however, is being controlled through the sensors that activate or deactivate the switch.
What my intuition is telling me, that at least in those with “abrupt type 2 diabetes onset”, the circuit isn’t working and what breaks it down are hyperglycemic episodes which effect one or more components which are part of the loop that operates in the 1st phase circuit. These components could be anywhere. They could function as an aggregate or there could be just one component which is effected by hyperglycemia. What seems clear is that the message isn’t getting through.
I bring up hyperglycemia because all I have to do to shut down the 1st phase is to initiate a high glycemic environment which is too high for my 1st phase to cover, typically for me, this is a tub of popcorn at my local cinema. (If you’re going to do something bad, you should at least enjoy it.) My blood sugars will stay below 160 then they will soar above 200 and stay there for 4 or five hours. After that, no more 1st phase and higher blood sugars till I make the adjustment.
You are probably wonder what this adjustment is. I should say it is relatively safe but there are potential side effects and frankly I don’t want people starting to take stuff with little or no understanding what they’re undertaking. I’m going to keep this under wraps for a while.
What I’d love to know is what chemicals or hormones or whatever breaks down in a high glucose environment? Some where, at least for us, that is where the answer lies I believe.
I put this on my blog but I need feedback and you folks are great at that, so here goes.
That is an interesting observation, Michael. Japanese scientists revealed that the hormone Orexin is emitted when high carbohydrate intake is about to happen. Amongst other things this hormone orders the muscles to consume glucose and this compensates for the slower response of the insulin producing cells (this is the finding of the study). Here the body has invented a mechanism to manage the fact that the insulin is coming slower as needed and this will reduce the spike. Maybe higher levels of glucose for longer periods of time will disable the Orexin emission somehow (for the specific diabetes subgroup you are refering to). Of course this is highly speculative but something that came to my mind while reading your blog.
Thanks Holger. I had never heard of Orexin. I’ve since read up on it and it sounds interesting. What I can’t fathom is how an anti inflammatory would effect it.
Can you please share your method of reactivating 1st phase insulin response. I would like to see if I can do the same.
This post is nearly four years old. Michael also has a specific type of diabetes, so his experience may not generalize.
The Phase I insulin response is a release of stored insulin when you eat, it is quick and strong. For many of us, our insulin production declines and we no longer produce enough insulin to generate a Phase I response, instead when we eat our pancreas kicks into production for a Phase II response. The Phase II response is slow and sluggish and although it may eventually catch up it often leaves us higher than we should be.
If you are still early in your diabetic career you may find that "resting up" and using a low carb diet can give your body a chance to restore a Phase I response. Resting up means just that, giving your body a break from the high carb diet. Sometimes your poor pooped out pancreas is just overwhelmed and once rested up it can restore some level of reasonable function. The second item is to just eat a low carb diet, lower carbs means less demand for insulin and with that a potential for store some level of insulin for a phase I response.
You phase I response will determine how well you handle immediate blood sugar surges and your blood sugar at about 1 hour.
thanks. appreciate the explanation
The best studied and documented way for a T2 to restore insulin response is dramatic weight loss - how much you eat (total calories) is far more important than what you eat (carb, protein, fat, whatever). Accompanying with increased exercise is even better. See this thread for a discussion: T2 Reversal
This starvation diet isn't well studied and I've got concerns about it's safety. As far as I can tell it reduced the patient's fatty livers and reduced insulin resistance but didn't do anything to restore insulin response.
There have actually been several studies, of which this is one LINK HERE. In this study, it states that dramatic decrease in food intake and subsequent weight loss for T2 subjects did restore both basal and phase 1 insulin response: "After 1 week of restricted energy intake, fasting plasma glucose normalised in the diabetic group (from 9.2 ± 0.4 to 5.9 ± 0.4 mmol/l; p = 0.003) ... The first-phase insulin response increased during the study period (0.19 ± 0.02 to 0.46 ± 0.07 nmol min−1 m−2; p < 0.001) and approached control values (0.62 ± 0.15 nmol min−1 m−2; p = 0.42)."
I agree with you this study of 11 people showed improvement. But I think we need to be prudent about suggesting the best studied way to improve insulin response is a starvation diet. I think we might point to some other directions as having much more substantial bodies of evidence and probably being safer for the average member to attempt.
Well of course there are larger studies which show similar results. I think this is again a case where each person needs to weigh the costs and benefits for themselves.
I wouldn't recommend any radical diet change without doctor's supervision. And that includes the ultra low-carb diet you often promote (which often requires supplements and laxatives), of which Bernstein himself writes it should be tried "under your doctor’s supervision".