Chapter 15
If diet and exercise are not enough to bring blood sugar under control, the next step in the fight will be the use of oral antidiabetic drugs (OPS).
There are three categories of such drugs: those that increase insulin sensitivity, those whose action is similar to that of insulin, and those that stimulate the pancreas to produce more insulin - sulfonylurea drugs. The second type of drugs acts like insulin, but does not lead to obesity. I recommend the first two types of drugs, the reasons for this I will explain a little later (some companies combine the first and third types of drugs in one product, I am completely against this action). 69
For those who still produce their own insulin, insulin sensitivity medications may be helpful. Some patients whose bodies do not produce their own insulin or produce little of it may benefit from a combination of type 1 and type 2 drugs.
There are three types of drugs on the market at the moment, and at the time of writing I am prescribing all three: metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos). Rosiglitazone and pioglitazone have the same effect on blood sugar, so it makes no sense to use both at the same time.
Note: because drugs may have different names in different countries, throughout this chapter I will use only the common name of the drugs. In my experience, not all forms of metformin are as effective as Glucophage.
Some of the SPPs on the market do not increase insulin sensitivity and are not insulin-like drugs. They increase the production of insulin by the pancreas. For several reasons, this is a less suitable method than taking medication to improve insulin sensitivity. First, pancreatic stimulant medications can cause hypoglycemia if used incorrectly or by skipping meals. Moreover, stimulating an already overloaded pancreas eventually leads to beta-cell burnout. These foods also cause destruction of beta cells due to increased levels of a toxic substance called amyloid. Finally, as has been repeatedly shown in experiments, and I myself have observed this among my patients, control of diabetes by normalizing blood sugar helps restore depleted and destroyed beta cells. There is absolutely no point in prescribing drugs that only increase the destruction of beta cells. Conclusion: Pancreatic stimulants are counterproductive and have no place in the treatment of diabetes.
In the following, I leave out such drugs (even those that may be created in the future) and will only discuss insulin-like drugs and drugs that increase insulin sensitivity. Later, at the end of the chapter, I will give an overview of possible new treatments in three special cases.
Drugs that increase insulin sensitivity.
The big advantage of these drugs is that they help lower blood sugar by making body tissues more receptive to insulin, either self or injected. This is a benefit that should not be underestimated. Not only is this a boon for those who are trying to keep their blood sugar under control, it is also a boon for those who are obese and in doing so seek to reduce their weight. By helping to lower the amount of insulin in the blood at any given time, these medications can also help reduce the fat-forming properties of insulin. I have non-diabetic patients who come to me for help with obesity.
A significant disadvantage of these drugs is that they are slow acting. For example, they will not be able to prevent high blood sugar after a meal if taken an hour before a meal, unlike some drugs that stimulate pancreatic beta cells. As you will learn later, this problem can be worked around.
Some diabetic patients come to me with the fact that they are forced to inject very large doses of insulin, because. their extra weight makes them very insulin resistant. Large doses of insulin lead to the formation of fat, which makes weight loss extremely difficult. Taking drugs that increase sensitivity to inulin helps to solve this problem. I have one patient who was injecting 27 units of insulin at night even though he was on our low carbohydrate diet. After the start of metformin, the dose decreased to 20 units. This is still a lot, but the use of metformin stimulated its reduction.
The use of insulin sensitivity drugs has also been shown to improve a number of factors that affect the risk of heart disease, including blood clotting, lipid profile, lipoprotein (a), blood fibrinogen, blood pressure, C-reactive protein levels, and even thickening of the heart muscle. In addition, metformin has been shown to slow down the destructive binding of glucose to body proteins, regardless of its effect on blood sugar. Metformin has also been shown to reduce the absorption of glucose from food, improve blood circulation, reduce oxidative stress, reduce the loss of blood vessels in the eyes and kidneys, and reduce the formation of new fragile vessels in the eyes. In addition, the use of the product has been shown to increase the feeling of satiety in women close to menopause. Thiazolidinediones such as rosiglitazone and pioglitazone may slow the progression of diabetic kidney disease, regardless of their effect on blood sugar levels. These drugs have also been found to slow or prevent the development of diabetes in some people at high risk for the disease.
Insulin-like drugs.
In addition to insulin sensitivity drugs, there are drugs sold in the US that also help control blood sugar, but work in a different way. Many studies in Germany have shown the effectiveness of R-alpha lipoic acid (ALA). A 2001 study showed that it works in muscle and fat cells by mobilizing and activating glucose transporters, in other words, it acts like insulin, i.e. is an insulin-like drug. Also, German studies have shown that the effectiveness of this drug is greatly increased if used in conjunction with a certain amount of evening primrose oil. This drug can reduce the amount of biotin in the body 70 , so it should be taken with drugs containing biotin (although regular alpha-lipoic acid is much more common, R-alpha lipoic acid is more effective). However, it should be noted that ALA and evening primrose oil are not a substitute for administered insulin, but their combined effect is nevertheless significant. In addition, ALA is arguably the most effective antioxidant currently on the market, and has some cardiovascular benefits similar to those of fish oil. Many cardiologists who previously recommended vitamin E for its antioxidant properties have recommended ALA in recent years. I myself have been taking it for almost 8 years. Once I started using it, I found that I needed to lower my insulin doses by about a third. ALA and evening primrose oil don't seem to mimic one property of insulin - they don't help create fat cells. Both drugs are available without a prescription from pharmacies and grocery stores 71 . These drugs have the potential to cause hypoglycaemia in diabetics if they do not appropriately reduce insulin doses, and I am not aware of any cases of hypoglycaemia when used without insulin administration.
Other German studies have shown tremendous improvements in diabetic neuropathy (nerve damage) when ALA is administered intravenously at high doses over several weeks. Given its antioxidant and excellent anti-inflammatory properties, this is not surprising. But it falls under the "Don't try this at home" category.
Alpha-lipoic acid, as well as high doses of vitamin E (in a form called gamma-tocopherol) and metformin, can interfere with glycation and glycosylation of proteins that cause many diabetic complications of high blood sugar. I usually recommend 2 x 100mg tablets every 8 hours or so, plus 1 x 500mg evening primrose oil capsule at the same time. If an insulin resistant patient is already taking insulin, I start with a half dose and monitor the sugar profile by decreasing the insulin dose and increasing the evening primrose oil ALA dose. This is a trial and error path, you need to look individually in each case.
Who is a likely candidate for insulin-like or insulin-sensitizing drugs?
Generally speaking, these drugs are the default choice for type II diabetics who cannot lose weight or return their blood sugar to normal despite a low-carbohydrate diet. An increase in blood sugar can occur only at a certain point in time, such as at night, or it can occur little by little throughout the day. I base my recommendations on the sugar profile of the individual patient. If, even with our diet, blood sugar at some point exceeds 16 mmol/l, I immediately prescribe insulin and do not even attempt to use these drugs, except for attempts to reduce the doses of insulin administered. If your sugar levels are higher when you wake up than before bed, I will prescribe you a drug in a sustained-release form of Metformin at night. If your blood sugar rises after a particular meal, I will prescribe a relatively fast-acting insulin sensitivity drug (Rosiglitazone) 2 hours before that meal. Because food enhances the absorption of thiazolidinediones, they should be taken with food. If blood sugar is slightly elevated throughout the day, I will prescribe an alpha lipoic acid and evening primrose oil intake upon waking, after lunch and after dinner. However, it should be noted that drugs that increase insulin sensitivity are much more effective than insulin-like drugs in lowering blood sugar.
Where to start: a few typical scenarios.
Let's imagine that you are a Type II diabetic who, through weight loss, exercise, and diet, keeps your blood sugar largely within the desired range. However, the sugar profile shows daily increases in the morning after a low-carb breakfast, likely due to the dawn phenomenon.
Of all the drugs I have described above, the fastest acting is rosiglitazone, which, although it reaches its peak about an hour after ingestion, probably has its full effect at about two hours. You can take the first 4 mg dose of this medication on waking and then eat breakfast 1 to 2 hours later. If this helps only partially, the dose can be increased to 8 mg (maximum recommended daily dose). If there is some benefit, but blood sugar is high 2 hours after eating, you can add a dose of extended-release metformin at night before bed. This type of metformin reaches its peak of action 7 hours after administration. It is better to start with a 500 mg tablet at night. If this dose does not help normalize sugar, then the dose can be increased step by step, by 1 tablet at night per week, and so on, until you reach the maximum dose of 4 tablets at night or sugar does not normalize. I always recommend starting with the lowest dose possible, partly because of the law of small numbers and partly to reduce possible side effects. When using metformin, gradually increasing the dose slowly reduces the likelihood of gastrointestinal discomfort, which occurred in about a third of patients when using the earlier, faster version.
In some cases, blood sugar rises overnight or within the first two hours of waking up, most likely due to the dawn effect. In both cases, the situation can be corrected with extended release metformin (Glucophage XR in the USA) with or without ALA along with evening primrose oil, all taken at night, the doses are described above. If needed, you can also add pioglitazone at night. The maximum dose of pioglitazone is 45 mg per day.
Another situation in which the use of this type of medication is justified is if blood sugar levels rise after lunch or dinner. Potentially, this problem can be solved by taking rosiglitazone 1-2 hours before meals.
A drug
Action type
Maximum (effective dose)
Metformin
Metofarmine long acting
Increases insulin sensitivity
Rosiglitazone
Increases insulin sensitivity
pioglitazone
Increases insulin sensitivity
R-alpha lipoic acid with biotin
insulin-like
evening primrose oil
Enhancer of action of insulin-like drugs, used for every 300 mg of ALA
Do these drugs cause hypoglycemia?
Sulfonylureas and the newer glitazone can lead to dangerously low blood sugars, which is one reason I never prescribe them. However, this is only likely to a very small extent with the insulin sensitizers and insulin-like drugs described above. None of them affect the pancreas, which can still produce its own insulin. If your sugar drops too low, your body will most likely simply stop producing its own insulin. Sulfonylureas and the like, on the other hand, stimulate insulin production, whether needed or not, which can cause hypoglycemia.
Although the manufacturer and specialist literature unanimously report that metformin does not cause hypoglycemia, I had a patient in whom this condition occurred. She was very obese but very mildly diabetic and I put her on metformin to reduce her insulin resistance in order to lose weight. When using metformin, her blood sugar decreased, but not to dangerous levels (up to about 3.4 mmol / l).
Thus, there is a small risk of hypoglycemia with the use of insulin-like drugs and drugs that increase insulin sensitivity, but it is not comparable with the risk with sulfonylurea drugs and the like. One important note: your body will not be able to "turn off" exogenous insulin, so if you are taking insulin along with the aforementioned medications, hypoglycemia is quite possible.
What to do. if these drugs do not normalize blood sugar?
If the use of these drugs does not bring blood sugar back to normal, then most likely something is wrong with the diet or exercise plan. The most likely cause of persistently high blood sugar is the insufficiently controlled carbohydrate content of your diet. So your first step is to check again if this is the root of the problem. For many of my patients, the main problem is carbohydrate cravings. If this is also the case for you, I recommend that you reread Chapter 13 and consider applying one of the techniques described there. If diet is not the cause, then the next step, no matter how obese or unprepared for exercise, is to try to start intense exercise. If this does not help, then you should definitely start using insulin.
Also, be aware that infections and other diseases can seriously undermine your efforts to normalize blood sugar. If your blood sugar is still abnormal even with insulin, you should check with your healthcare provider for hidden infections, especially in the mouth.
Disadvantages of insulin-like drugs and drugs that increase insulin sensitivity.
Although the above drugs are among the best means to maintain normal blood sugar, they also have disadvantages.
The use of ALA reduces the body's stores of biotin, a substance that helps in the absorption of protein and a number of other nutrients. Thus, unless you are taking ALA with biotin (US brand name Insulow), you should take biotin alone. Theoretically, the dose of biotin should be 15 times the dose of ALA, i.e. 1800 mg of ALA should take 18 mg of biotin. Most of my patients do not take more than 15mg per day, and they do not see any visible negative effects from this.
Metformin has very mild side effects, with the exception of the effect on the gastrointestinal tract - nausea, vomiting, diarrhea, mild stomach pain in about a third of people who used regular metformin, and not prolonged action. Most patients, however, notice that the side effects are greatly reduced when the drug becomes habituated. Very few patients do not tolerate this medication at all (some patients, especially obese patients who are trying to lose weight and where metformin helps, ignore any initial gastrointestinal distress metformin causes and use antacids such as Pepcid and Tagamet for relief. Other patients , whose symptoms are relatively mild, prefer to endure the acclimatization period just so as not to stop treatment). In very rare cases, it happens that diarrhea continues for a long time after the start of the drug. It goes away after the drug is discontinued. I have not observed gastrointestinal side effects from the use of thiazolidinediones or long-acting metformin.
Metformin's predecessor, phenformin, was associated in the 1950s with a potentially life-threatening condition called lactic acidosis. It has occurred in a small number of patients who were already suffering from heart failure or severe kidney or liver dysfunction. Although I have seen only a few cases of lactic acidosis associated with metformin in the literature, the FDA warns against its use in patients with such diseases. Metformin has also been found to decrease the amount of vitamin B12 in the body in about a third of patients. This effect can be compensated by the use of calcium supplements.
There are currently 2 types of thiazolidinediones available in the US that may cause minor problems. Pioglitazone is removed from the bloodstream by the liver using the same enzyme that is used to remove many other drugs. Competition for this enzyme can result in potentially dangerously high concentrations of these drugs. If you are taking these medications, such as antidepressants, antifungals, certain antibiotics, you should probably not use pioglitazone. You need to carefully study the instructions for using the drugs, as well as consult with your doctor.
Rosiglitazone, and especially pioglitazone, can cause slight fluid retention in the body. The consequence of this is a decrease in the number of red blood cells and slight swelling in the legs. There may also be some slight weight gain due to accumulated fluid, not fat. Fluid retention has been linked to several cases of heart failure in people taking one of these drugs with insulin. Based on this, the FDA recommends that doses of these drugs should not exceed 4 mg and 30 mg per day, respectively, for people taking insulin. I have had many patients taking these drugs along with insulin, in some cases I have observed slight swelling of the legs. In these cases, I immediately canceled the drugs. Also extremely rare, but there have been cases of reversible liver damage with rosiglitazone or pioglitazone 72 . A study published in the Journal of Practical Endocrinology in 2001 showed that those who use rosiglitazone have significantly increased triglyceride levels in the blood, which is not observed in those who use pioglitazone. On the other hand, pioglitazone has been shown to improve lipid profiles (DLL, HDL and triglycerides), while rosiglitazone may cause slight visual impairment.
Due to possible fluid retention in the body, none of these drugs should be falsely used in patients with serious heart, lung, kidney or heart failure conditions.
I usually start with rosiglitazone to avoid the potential problem of the liver removing other drugs from the blood that may be prescribed by other doctors in the future.
The use of several drugs at once.
Metformin works primarily by reducing insulin resistance in the liver. It also somewhat impairs the absorption of carbohydrates in the intestines. Thiazolidinediones affect muscle and fat, and to a lesser extent the liver. Thus, if metformin does not completely normalize sugar, it makes sense to add one of the thiazolidinediones and vice versa. Because Since both rosiglitazone and pioglitazone have the same mechanism of action, it does not make sense to use both drugs at the same time. The FDA recommends not exceeding a dose of 30 mg pioglitazone per day when taken with metformin.
Because ALA and evening primrose oil are insulin-like drugs, and it is obviously advisable to use them in any combination with other agents.
Other considerations.
Thiazolidinediones do not have a hypoglycemic effect immediately after the start of administration. Pioglitazone fully begins to act within a few weeks after the start of taking rosiglitazone, it may take up to 12 weeks for this.
When blood sugar much higher I have set targets, the combined use of metformin and thiazolidinediones can cause the pancreas to produce more insulin in response to glucose. Because blood sugar is usually lower, this effect can be neglected.
Vitamin A has been shown to reduce insulin resistance (as well as vitamin E 73) at doses greater than 25,000 IU per day. Because even a small increase in vitamin A doses potentially very is toxic, and doses of 5000 IU can leach calcium out of the bones, I recommend using small doses of its precursor, non-toxic beta-carotene.
Studies have found that a lack of magnesium in the body can lead to insulin resistance. Therefore, it may be useful for physicians to check magnesium levels in red blood cells (rather than serum) in Type II diabetics. If this level is low, then the use of external sources of magnesium is necessary. Excessive doses of magnesium can cause diarrhea. Since erythrocyte magnesium (in red blood cells) is not an accurate measure of blood magnesium in general, and for people with healthy kidneys, magnesium does not cause problems (with the exception of diarrhea), it is advisable to use magnesium supplements for testing to see if sugar drops cut. For adults, the usual dose is 700 mg per day.
Similarly, zinc deficiency in the body can lead to decreased production of leptin, a hormone that prevents overeating and weight gain. Zinc deficiency can also lead to thyroid disorders. Therefore, type II diabetics are advised to ask their physicians to prescribe a serum zinc test and prescribe zinc supplements if necessary. Further tests must be repeated at regular intervals to ensure that normal levels are not exceeded.
Vanadium compounds have been shown to reduce insulin resistance, reduce appetite, and possibly act as insulin-like substances as well. They are a very powerful means of lowering blood sugar, but there is one problem. Vanadium compounds work by inhibiting the enzyme tyrosine phosphatase, which is essential for many vital biochemical processes in the body. It is highly likely that this inhibition could be devastating. Because clinical trials in humans did not exceed three weeks, so far there is no certainty that there are no long-term side effects. Some patients experience gastrointestinal irritation when using vanadium preparations.
Although vanadium sulfate is available in pharmacies and health supply stores as a dietary supplement and has been used for many years without any reported problems in medical journals, I would tentatively recommend that it not be used until further notice. more will become known.
Acarbose: For people whose carbohydrate cravings are uncontrollable.
At least in theory, there are people who are not helped by any of the measures suggested in Chapter 13 for controlling carbohydrate cravings and overeating. A drug called acarbose (precose) may help a little for such people. Acarbose is available in 25, 50, and 100 mg tablets. Its action is based on slowing down the action of enzymes that break down starch and table sugar, thereby slowing down and reducing the effect of products from the “Categorical NO” list on blood sugar. It is interesting to note that the ADA recommends eating starch and acarbose at the same time to prevent its digestion. The maximum daily dose is 300 mg. It is usually used with meals along with carbohydrates. The main side effect (in about 75% of patients) is flatulence (which is predictable), so it makes sense to adjust the dose gradually. It should not be used by those patients who have any gastrointestinal diseases (for example, gastroparesis). I never had the need to prescribe it.
Bleed: Last choice, but may work in some cases.
Commercial airline pilots with diabetes in the US are now facing regulations that threaten them with loss of license (and livelihood) if they inject insulin. Of course, these people should first try all of the oral medications recommended above, as well as a low-carbohydrate diet and exercise. They should also try vanadium sulfate, magnesium, and other drugs mentioned in the "Other Considerations" section above.
But there is another potentially powerful tool for reducing insulin resistance. In people whose iron content places them in the top 20% of normal for non-anemic people, insulin resistance has been shown to be higher than in the bottom 20%. Moreover, insulin resistance is greatly reduced if they donate blood every 2 months and move into the lower 20% of normal. I have seen it work for some of my patients myself. A good indicator of iron content in the body is a test for ferritin. Because some blood transfusion stations do not accept blood from diabetics, it may be necessary to visit a hematologist every two months and drain blood from a vein. Women are much less likely to have elevated ferritin levels (within the normal range).
And one more option.
The recent introduction of DPP-4 inhibitors provides another opportunity for those strongly opposed to injections. The new product sitagliptin (Januvia) is sold in the form of tablets of 25, 50 and 100 mg. The maximum dose for adults without kidney disease is 100 mg once daily. It significantly reduces the effect of glucagon on blood sugar during and after meals (Chinese restaurant effect). May be used in conjunction with metformin and thiazolidinedione.
Energy is needed for the processes in the tissues of the body. Insulin sensitivity determines the possible sources of a plastic substrate for the cell. For some tissues, this may be only glucose, for others it can also be fatty acids, ketone bodies, and more. It is thanks to the successive stages of all types of exchange that are controlled.
Norm of measurements
Normally, 1 unit of insulin reduces the value of glycemia within 2-3 mmol.
The insulin sensitivity factor helps to calculate how much and how quickly the plasma glucose concentration decreases in response to the administration of 1 unit of insulin. A known coefficient contributes to the correct calculation of the dose. A good response allows you to replenish the energy supply of the muscles, and not deposit the excess in adipose tissue. On an empty stomach, the amount of the hormone in the blood ranges from 3 to 28 mcU / ml.
There are 3 types of susceptibility:
- Peripheral is determined by the ability of peripheral tissues to absorb glucose independently and during insulin stimulation.
- The hepatic type is measured by fluctuations in the activity of gluconeogenesis, that is, the processes of glucose production.
- The pancreatic type shows the number of working beta cells. With their decrease or damage, the concentration of the hormone in plasma falls.
Differences in insulin sensitivity of different tissues
Nervous tissue cells are independent of insulin. Insulin-dependent tissues such as muscle, fat and liver are completely dependent on the concentration of the hormone in the blood and are sensitive to fluctuations in its density. Glucose, and therefore energy, enters the cells only when interacting with insulin. The hormone stimulates the production of specific transporter hormones. In the case of its deficiency, tissues become completely immune to sugars and glucose is deposited in the plasma. Cells of the nervous tissue, vascular endotheliocytes and the lens are insulin-independent tissues, that is, glucose enters by simple diffusion, following a concentration gradient.
Why is there a low susceptibility?
Low insulin sensitivity, in other words, resistance, leads to the inability to deliver an adequate amount of glucose into the cell. Therefore, the concentration of insulin in plasma increases. The action of the hormone provokes a violation of not only carbohydrate, but also protein and fat metabolism. A decrease in the susceptibility of cell receptors to the hormone is due to both genetic predisposition and an unhealthy lifestyle. As a result, impaired susceptibility to glucose and insulin leads to the development of type 2 diabetes mellitus and its complications.
Resistance symptoms
Reduced sensitivity of the body to insulin is manifested by such key features: abdominal type of obesity (that is, deposits of adipose tissue at the waist) and an increase in the level of systolic, less often diastolic, pressure. Sometimes only laboratory manifestations are possible: changes in the lipogram towards an increase in total cholesterol, triglyceride levels, low and very low density lipoproteins. In addition, there are changes in the general analysis of urine - protein appears. At first it will be microalbuminuria, later - proteinuria.
An increase in insulin levels in the blood is a sign of reduced cell sensitivity to the hormone.
High sensitivity
With hypersensitivity to insulin, physical activity can cause a severe decrease in blood sugar. In general, high insulin sensitivity is considered a sign of good health. However, sometimes there are cases when increased susceptibility provokes a number of complications. So for patients suffering from type 1 diabetes, such an outcome increases the risk of developing hypoglycemic conditions and coma. Sometimes during physical activity, excessive receptor responsiveness can lead to a critical decrease in blood glucose concentration. The level of insulin sensitivity is affected not only by gender and age, but also by weight, general health, level of physical fitness and muscle severity, season, diet and much more. The more the same level of carbohydrates in a person during the day and the closer it is to normal levels, the higher the tissue tolerance to insulin. Any disease, including obesity, leads to a decrease in tolerance. And also frequent hypoglycemia provokes an increase in the susceptibility of cells to the hormone.
Synonyms: Insulin
General information
Insulin is a pancreatic hormone that regulates carbohydrate metabolism, maintains the concentration of glucose in the blood at an optimal level and is involved in the metabolism of fats. Insulin deficiency leads to an increase in blood sugar and energy starvation of cells, which negatively affects internal processes and causes various endocrine pathologies.
An insulin blood test allows you to determine a metabolic disorder (metabolic syndrome), the degree of insulin sensitivity (insulin resistance) and diagnose serious diseases such as diabetes mellitus and insulinoma (a hormone-secreting tumor of pancreatic beta cells).
Insulin is a specific protein that is secreted from proinsulin in the beta cells of the pancreas. Then it is released into the bloodstream, where it performs its main function - the regulation of carbohydrate metabolism and the maintenance of a physiologically necessary level of glucose in the blood serum.
In case of insufficient production of the hormone, the patient develops diabetes mellitus, which is characterized by the accelerated breakdown of glycogen (complex carbohydrate) in muscle and liver tissue. Also, against the background of the disease, the rate of glucose oxidation decreases, the metabolism of lipids and proteins slows down, a negative nitrogen balance appears, and the concentration of harmful cholesterol in the blood increases.
There are 2 types of diabetes.
- In the first type, no insulin is produced at all. In this case, hormone replacement therapy is necessary, and patients are classified as insulin-dependent.
- In the second type, the pancreas secretes a hormone, but it cannot fully regulate glucose levels. There is also an intermediate condition (early stage) in which the typical symptoms of diabetes mellitus do not yet develop, but there are already problems with the production of insulin.
Important! Diabetes mellitus is a dangerous disease that significantly reduces the quality of life, leads to severe complications and can cause diabetic coma (often fatal). Therefore, the timely diagnosis of diabetes mellitus by analyzing the level of insulin in the blood is of great medical importance.
Indications for analysis
- Diagnosis and control of the course of diabetes mellitus of the first and second type;
- Examination of patients with a hereditary predisposition to diabetes mellitus;
- Diagnosis of gestational diabetes in pregnant women;
- Determination of the body's resistance to insulin;
- Establishing the causes of hypoglycemia (decrease in blood glucose);
- Suspicion of insulinoma;
- Prescribing insulin preparations and dosage selection;
- Comprehensive examination of patients with metabolic disorders;
- Examination of patients with polycystic ovary syndrome (ovarian dysfunction with menstrual irregularities);
- Diagnosis of endocrine disorders;
- Monitoring the condition of patients after islet cell transplantation (beta cells of the islets of Langerhans).
Symptoms in the presence of which an insulin test is prescribed
- Irritability, depression, chronic fatigue;
- memory impairment;
- A sharp change in body weight while maintaining the usual diet and level of physical activity;
- Constant feeling of thirst and hunger, excessive fluid intake;
- Dry skin and mucous membranes (dry mouth);
- Increased sweating, weakness;
- Tachycardia and a history of heart attacks;
- Clouding of consciousness, double vision, dizziness;
- Prolonged healing of wounds on the skin, etc.
A comprehensive examination and appointment of this study is carried out by an endocrinologist, surgeon, therapist or family doctor. In the case of gestational diabetes, a consultation with a gynecologist is necessary. When diagnosing insulinoma or other formations of the pancreas, the oncologist deciphers the test results.
Decryption
Common units of measurement: mcU/ml or mU/l.
Alternative unit: pmol/liter (µU * 0.138 µU/mL).
The normal amount of insulin in the blood is
- 2.7 - 10.4 mcU/ml.
Factors influencing the result
The result of the study may be affected by the use of drugs:
- levodopa;
- hormones (including oral contraceptives);
- corticosteroids;
- insulin;
- albuterol;
- chlorpropamide;
- glucagon;
- glucose;
- sucrose;
- fructose;
- niacin;
- pancreozymin;
- quinidine;
- spironolcton;
- prednisol;
- tolbutamide, etc.
high insulin
- Diabetes mellitus of the second type (the patient does not depend on insulin preparations);
- Hormone-secreting tumors of the pancreas, such as insulinoma;
- Acromegaly (dysfunction of the anterior pituitary gland);
- Pathology of the liver;
- Myotonic dystrophy (genetic muscle damage);
- Cushing's syndrome (hypersecretion of adrenal hormones);
- Hereditary intolerance to sugars (glucose, fructose, lactose, etc.);
- All stages of obesity.
low insulin
- Heart failure, tachycardia;
- Hypopituitarism (decreased activity of the endocrine glands);
- Diabetes mellitus of the first type (insulin-dependent).
Preparation for analysis
To determine insulin, it is necessary to donate venous blood on an empty stomach. The fasting period is about 8-10 hours, on the day of the analysis you can drink only plain water without salts and gas.
For several days, you should stop taking alcoholic and energy drinks, avoid any mental and physical stress. It is also undesirable to smoke on the day of blood sampling.
30 minutes before the examination, it is necessary to take a sitting position and completely relax. Any physical or emotional stress at this moment is strictly prohibited, since stress can trigger the release of insulin, which will distort the test results.
On a note: in order to avoid obtaining incorrect results, the analysis is prescribed before the start of a conservative course of treatment and medical diagnostic procedures (ultrasound, x-ray, rectal examination, CT, MRI, physiotherapy, etc.) or 1-2 weeks after them.
You may also have been assigned.
Building muscle, losing fat, improving overall health - it all depends on one important hormone. Insulin is your body's most important peptide hormone released by the pancreas that can dictate the course of your physique and overall well-being.
So what is insulin sensitivity?
Insulin sensitivity refers to how your body responds to the hormone insulin and is directly related to how efficiently it processes the carbohydrates you consume. High sensitivity (fast response) has better blood sugar regulation, which allows the body to store glucose in muscle tissue rather than subcutaneous fat.
On the other hand, poor insulin sensitivity can lead to an overproduction of insulin, causing the body to play catch-up to control rising blood sugar levels and storing glucose as body fat.
Chronically poor insulin sensitivity can lead to a number of diseases such as type 2 diabetes and cardiovascular disease, so it's important to keep your insulin responsive body strong and prosperous!
Once released in the pancreas due to rising blood sugar levels, insulin normally binds to receptors on body cells. Where they activate cells by opening portals on the surface of the cell so that glucose can enter it. Once in the cell, glucose can be converted into bodily energy. This function of insulin works quite smoothly if the cells remain "sensitive" to insulin, that is, they easily respond to an attempt by insulin when the cell's portals open. If cells become "resistant" to insulin, they end up starving the cell of energy while higher levels of glucose build up in the blood. If blood glucose levels remain consistently high due to insulin resistance, type 2 diabetes can develop. Of course, there are different levels of insulin resistance. Diagnosis of type 2 diabetes is the extreme stage of this negative condition. Now it becomes clear why it is necessary to improve insulin sensitivity.
When we learn how to improve insulin sensitivity, it means that our bodies need less insulin to convert glucose into energy. This results in a decrease in total daily insulin levels. This is a good thing. Since insulin is basically an energy storage hormone that requires the least amount and is a sign that our body uses carbohydrates and fats most efficiently, converting them into the required energy. This can lead to higher bodily energy and a reduced tendency to store fat. It can also decrease the chances of our cells becoming insulin resistant, and developing the cascading negative effects of these conditions.
So, you want to improve your own insulin sensitivity. This is necessary if you want to build muscle mass with a minimum amount of fat.
If you stick to proper nutrition, you will feel much better, with fewer energy ups and downs, and you will be able to maintain proper muscle glycogen levels. The following tips will help you significantly improve your insulin sensitivity.
Remove simple carbohydrates from your diet
By removing simple carbohydrates from the diet, this is crucial. One of the main reasons why people develop diabetes for a long time is their excessive consumption of refined carbohydrates, the use of sugar in their diet, which causes the pancreas to constantly produce more and more insulin.
The higher the amount of refined carbs you consume, the more likely your cells will become insulin resistant, resulting in low insulin sensitivity.
Gourmet carbs include lots of sweeteners, white flour, snacks, and soda.
Use Some Healthy Fats
Another way to increase your insulin sensitivity by optimizing the rate at which your body processes carbohydrates and sends them to muscle tissue is to eat plenty of healthy fats.
A diet that is loaded with trans fats tends to contribute to worse insulin sensitivity, while the opposite is true for those who consume a lot of monounsaturated and omega fats. The best sources of healthy fats are olive oil, flaxseed oil, avocado, nuts, nut butter, and oily fish or fish oil.
If you can consume small amounts of these fats each day without overdoing it, you will be one step closer to promoting iron, the link between your body and its insulin.
Using more fiber
Eat more fiber, it's good for digestion. Fiber-rich meals also slow down the release of carbohydrates into the bloodstream, which allows insulin to be used more efficiently.
Many fiber-rich foods such as fruits and vegetables also provide numerous vitamins and minerals to further improve your health and prevent disease.
Remember that fiber is also very beneficial for burning fat, as its ability to release unwanted components from the body, rather than allowing them to be stored as fat!
Physical exercise
Training is very important for the body, physical activity will increase the rate of glucose delivery to muscle cells, this will deplete glycogen stores. By depleting your muscle glycogen levels, you will create a large "cesspool" in which glucose can move. When you are in a depleted state of glycogen, your body will instantly suck up sugar to put it into your muscles, staying away from your fat cells.
Don't do exhaustion workouts every time you're in the gym, as this can seriously interfere with your workout. But this is useful because it is necessary to stress the muscles in order to constantly progress.
Protein use
Getting protein is another important way to improve insulin sensitivity. It is also extremely important for getting lean muscle mass. The main reason is that they can send more of those extra calories to muscle cells, where they provide energy for muscle building and growth, rather than being stored as fat.
People who follow a healthy diet and do not consume a lot of refined carbohydrates, sugars, get optimal insulin sensitivity. This means that your body will work faster and your insulin and body will be the strongest.
Activity during the day
The final step to improve your insulin sensitivity is to try to engage in some sort of physical activity periodically throughout the day.
A balance is needed between physical activity and consumed carbohydrates. You should eat less food throughout the day and also try to do light physical activity such as walking or cycling in a coffee shop at work.
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Despite the fact that Berardi spoke in detail about everything related to insulin, the text turned out to be not complicated, but very informative. And towards the end, practical recommendations for insulin control are given.
Well, let's talk about insulin. What is it and why do athletes, fitness enthusiasts or just healthy lifestyle advocates need to know about it?
There is a lot of effort in the health and fitness environment right now to control insulin. But few people truly understand this difficult hormone. You see, insulin is an anabolic giant. It is the hormone with the highest anabolic (anabolic = muscle-building) potential, as it is he who delivers nutrients such as amino acids and carbohydrates to muscle cells and stimulates their growth. But, although it sounds very cool, its excess leads to such unpleasant consequences as obesity. Let's cover the basics first:
Insulin is a hormone that is released into the bloodstream by an organ such as the pancreas. Insulin is responsible for the storage of energy reserves (read - fat) and the growth of muscle mass. I will say more, insulin is called the most anabolic hormone. After insulin enters the bloodstream, its main task is to deliver glucose (carbohydrates), amino acids, and blood fats to cells. “Which cells?” you ask. Well, first of all - in muscle and fat cells. If nutrients go mainly to the muscles, the muscles respond with growth, and we do not add fat. If most of the nutrients go to fat cells, muscle mass does not change, but fat becomes more.
Obviously, if we find a way to send nutrients to the muscles and not to the fat cells, then we will have more muscle and less fat. This is the main goal of the programs and diets I recommend - to increase the flow of nutrients into muscle cells. I think this is the main goal of all involved in sports, whether they realize it or not.
Ok, how can you control this hormone to stimulate muscle growth and fat burning?
Well, this is where the trouble starts. Because insulin is responsible for storing stores, most people believe that it should be avoided, otherwise more fat will appear. There are several reasons why I think this is a mistake. First, there is no way to avoid insulin in your blood. If you eat, insulin is released.
Secondly, if you do manage to get rid of insulin, you will also lose all of its anabolic functions and its ability to store nutrients in the muscles. In fact, type 1 diabetics do not produce insulin, resulting in death if they are not treated.
But praying for insulin is also not worth it. If the level of insulin in the blood is constantly at a high level, problems arise. High insulin levels lead to the accumulation of huge amounts of fat, increased risk of cardiovascular disease and type 2 diabetes. This type of diabetes is characterized by obesity, cardiovascular disease, and a weakened muscle's ability to store nutrients, leading to muscle loss and more fat accumulation. This is called insulin resistance.
So my position is this: you need to learn how to control insulin so that you can balance between muscle nutrition and fat accumulation. Make it work so that your muscles grow and fat is burned. This is achieved in two ways. First, it is necessary to increase the sensitivity to insulin in the muscles and lower it in the fat cells. And secondly, to control the release of insulin at certain times of the day.
Please explain the difference between insulin resistance and insulin sensitivity.
Simply put, insulin resistance is bad. This means that your cells - especially muscle cells - do not respond to the anabolic effect of insulin, i.e. they are resistant (resist) to the action of insulin. In this case, the body begins to secrete even more insulin, trying to overcome this barrier in the cells and force them to store nutrients. Well, a high level of insulin in the blood, as you already know, is very bad and leads to type 2 diabetes.
Insulin sensitivity, on the other hand, is a very good thing. In this case, your cells - especially muscle cells - respond perfectly to even a small release of insulin. And, accordingly, you need very little insulin to put them into an anabolic state. So high insulin sensitivity is what we're looking for.
Here's a better way to remember the difference. If you are dating someone who is very sensitive to your advances, then that person is sensual. It will symbolize insulin sensitivity. He just needs a little attention to get the payoff. On the other hand, we will have a person on whom all your efforts do not make any impression and you spend a lot of effort to get his attention. This is an example of insulin resistance. To achieve the location of such a person, you will have to spend a lot of effort.
Can insulin sensitivity be changed somehow?
Insulin sensitivity is different for everyone, but the good news is that it can be controlled through diet, exercise, and various supplements. Actually, this is what I do with my clients, completely changing their figure and body composition.
Both aerobic and strength training help to greatly increase insulin sensitivity through a number of mechanisms in our bodies. In addition, substances such as omega-3 fats (omega 3 fatty acids), fish oil, alpha-lipoic acid (alpha-lipoic acid) and chromium can increase insulin sensitivity. Well, a diet with moderate carbohydrate intake and plenty of fiber can also help improve this indicator.
On the other hand, the high-fat and severely carbohydrate-restricted diets that are now popular can reduce insulin sensitivity. Therefore, I never offer my clients no carbohydrate diets, except when they are drying for a competition, but even in such cases, the no carbohydrate regimen is used no more than once every few months and no longer than 3 weeks.
Explain how insulin sensitivity can be controlled in practice.
Well, as a rule, you can see a significant increase in insulin sensitivity after 3-4 strength training sessions per week, lasting for an hour each. To these classes, it is worth adding another 3-4 aerobic training sessions per week for 30 minutes each. If you really want to change your insulin sensitivity, aerobic exercise should be given separately from strength training.
The next post-workout step should be supplementation: 600 mg of alpha lipoic acid and concentrated fish oil containing 6-10 mg of DHA and EPA are the most active omega-3 fats in fish oil.
And finally, your diet can be decisive in the fight for insulin sensitivity. I recommend a moderate amount - 40-50% of the diet - of fibrous carbohydrates such as oatmeal, fruits, vegetables and whole grains. I also recommend consuming moderate amounts - the same 40-50% - of high-quality protein, such as casein, whey protein, chicken, beef, fish, dairy products and eggs. Finally, as far as fats are concerned, I advise limiting their intake (20% of the diet), eating olive oil, flaxseed oil, fish oil and nut oils.
All of these techniques can be combined to maximize insulin sensitivity in muscles and decrease it in fat cells. That means more muscle and less fat...the answer to the age old question of bodybuilding!
How important is insulin sensitivity if I'm a "natural" bodybuilder?
I think it's insulin sensitivity that determines your body's fat to muscle ratio, especially when you're trying to gain or lose weight. If you are more insulin sensitive at the time of mass gain, you will gain more muscle than fat. For example, with normal insulin sensitivity, you will gain 0.5 kg of muscle for every kg of fat, so the ratio will be 1:2. With increased sensitivity, you will be able to gain 1 kg of muscle for every kg of fat. Or even better.
Or, for example, if you are lean, you will lose more fat and less muscle if your insulin sensitivity is higher.
Is it important for bodybuilders? I'm willing to bet yes! Especially for those who do not use chemistry. Those who use medication achieve phenomenal insulin sensitivity! In addition, drugs improve the ratio of gaining muscle to fat. If you are a natural, you should not miss any natural way to improve this ratio.
What about other aspects of working with insulin? You talked about controlling insulin at different times of the day, right?
Yes sir. Do you remember that insulin is anabolic? This means that sometimes we need to increase its excretion without causing a constant increase in its level. To do this on time, we need spikes in insulin release in the post-workout period. I also recommend having insulin bursts twice a day, but no more than three times. So, you need to organize at least 2 insulin meals a day in order to build muscle and stay lean.
To achieve this, you need to pay attention to the so-called insulin index of food. If you think that I was mistaken and actually meant the glycemic index, you are wrong. I'm talking about the insulin index. Haven't heard of this? You are not alone. Despite the fact that the insulin scale in nutrition is not new, it has been neglected for a very long time.
What is the difference between the well-known glycemic index (GI) and the insulin index (II) you are talking about?
GI measures the rate at which carbohydrates enter the bloodstream after a meal. A high GI means that blood sugar will rise very quickly after a meal, while a low GI means that sugar will rise slowly. Traditionally, nutritionists believe that the faster the blood sugar rises, the greater the insulin release will be. To control insulin levels, they recommend eating low GI foods.
However, several studies on the subject have shown that there are low GI foods that still cause serious insulin spikes! So the glycemic index is not equal to the insulin index when it comes to certain foods. For example, dairy products have a very low GI. But the insulin surges that they provoke are comparable to foods with the highest GI. What's the matter? It turns out that there are other factors that affect the release of insulin, except for carbohydrates and the rate of their assimilation.
That's why the insulin index came about. This is an index that measures exactly the insulin response to food. So instead of measuring the rate of absorption of carbohydrates, the researchers began to measure the insulin response itself. And the results of the study were a discovery!
If a natural bodybuilder decides to take control of his insulin through diet, what foods should he focus on and what should he avoid?
Let me start by saying that there is no such thing as bad food. Well, that is, almost none. I don't think anyone can tell you the benefits of powdered sugar-coated cream donuts, other than the fact that they're damn delicious! But I hope you understand my point. Earlier I said that sometimes we need an increase in insulin - especially after training - and sometimes we don’t need it on the contrary - especially in the evening before bedtime - therefore, we need an insulin index not to give up something, but to understand when and what we should eat.
I want to emphasize that we need an insulin index to complement the glycemic index and make food choices more consciously. So our way is to use both indexes. If milk has a low GI but high AI, then you should not drink it when you want to keep insulin levels low. Another example of a food or food combination for this situation is baked beans in sauce, dinners (meaning a set of foods) with refined sugars and fats, and dinners rich in proteins and carbohydrates. All of the options listed have low GI but high AI, and none of them are good enough to keep insulin low. But remember that you will have situations when you need an insulin boost, so do not refuse such food.
To reiterate, unprocessed grains and cereals rich in fiber, as well as fruits and vegetables, are good on both indexes. As well as all low-fat protein sources.
So what time of day do we need to raise our insulin levels and when do we need to keep it in check?
I prefer to do 2-3 insulin boosts throughout the day. Let me remind you that my clients are super insulin sensitive people. I prepare workouts, diets and supplements for them. So they can manage their insulin levels and build muscle and burn fat at the same time. Now about insulin, there are natural fluctuations in insulin levels during the day, at night the level of insulin drops, so it is logical to keep it low during this period. While after a workout it's time to take the level through the roof. One option is to have 3 high-insulin meals in the morning and 3 low-insulin meals in the evening. This can be achieved in the following way:
First three meals: Protein plus carbohydrates without fat.
Last three: Protein and fat, no carbs.
Post workout: Hydrolyzed protein, simple carbohydrates, BCAAs, amino acids.
Are there drugs that provoke the production of insulin and what are their advantages?
Definitely there is! I'm just now developing a post-workout formula for this purpose. You see, as I said before, I'm sort of a "recovery specialist." I am hired as a consultant for serious athletes from Maroons and triathletes, to weightlifters, bodybuilders and sprinters. I also develop nutrition programs for them and one of my goals is to help those who have trouble recovering, those who are prone to overtraining.
One of the main tasks during the recovery period is to increase the level of glycogen in the muscles, increase protein synthesis and reduce protein deficiency. And one way to achieve this is to increase your insulin levels right after your workout. I just recently wrote a few articles on this topic.
The recovery drink I'm currently working on is a blend of glucose and glucose polymers, with whey protein hydroisolate, BCAAs, glutamine and a few other amino acids. This combination, in the right proportion, produces a large insulin surge and also helps restore glycogen and protein balance.
And the best part is that no matter what you do, this formula will be useful to you. There are only standard nutrients and no magical herbs or other components.
John, thank you very much for this informative interview. Is there anything else you would like to tell us in the end?
Remember that insulin sensitivity is a critical factor in recovery and change in your body composition. Use the glycemic index, insulin index and choose your diet wisely to bring your body to peak shape.
In the end, I wanted to focus on indexes and insulin sensitivity, but I want you to understand that there are many other factors that affect the performance of athletes and trainees. As my colleague Tom Inkeldon said: “The cells of our body are like a spaceship bombarded by meteors (hormones and nutrients)”.
The bottom line is that neither hormones nor cells exist in isolation from the rest of the body. When we focus on one thing, we risk missing out on many more. So when setting goals and developing a plan, stick to your approach. Don't try to follow someone else's path or follow a program from a magazine. Go your own way!
