Setting point and insulin secretion

[everydayupsanddowns]

"muscle contraction (in vitro or in situ) and exercise increase glucose uptake into skeletal muscle. However, the contraction/exercise pathway of glucose uptake in skeletal muscle is an independent pathway to that of insulin"

This is true, muscles can take up glucose directly, but this is not sufficient for treatment of type 1 diabetes.

People with type 1 diabetes need insulin to survive.

Before the discovery of insulin, type 1 diabetes was fatal. It could only be treated, and life could only be extended for a short time with a punitively restrictive diet, with as few carbs as was possible, and vigorous exercise.

But people still wasted away and died (you got 3-4 years after diagnosis if you were lucky). because even the basal metabolic rate needs insulin to function properly. RD Lawrence famous diabetes professor was overseas in Florence, and really struggling on a virtually zero carb menu with constantly high sugar in his urine and high levels of ketones (probably only having weeks to live), when he received a telegram about the newly isolated and still relatively experimental insulin only just available in the UK - “I’ve got some insulin, come back quick. It works.”

 

[Bubbleblower]

People with type 1 diabetes need insulin to survive.

In the Netherlands and in the US doctors think if you have beta cell function left you don’t neccessarily need exogenous insulin, but need to stimulate endogenous insulin production.

The pharmaceutical industry may be very powerfull as this topic shows, but so are insurance companies and they say we had enough and pay less and less for insulin treatment, which is palliative care. Not only in the Netherlands they are taking diabetics off insulin, the same program has been rolled out in Hong Kong and India now.


The “before the discovery of insulin” narrative, which is often repeated word after word is very popular.
Despite the fact that if you use your brain for only 2 seconds you realise it can’t be true at all.

Before the discovery of insulin we didn’t even have any types yet, these came with the discovery when we were separated into insulin dependent and independent. Very convenient for the pharmaceutical companies, less so for diabetics.

Before the discovery of insulin type 1 diabetes didn’t exist yet, so you can’t possibly say it was fatal.

The Greeks (who supposively reported the "it could only be treated" part) didn't have insulin, so there weren't any insulin dependent or independent diabetics at the time. So if you were to believe the narrative other types couldn't survive without insulin either. The discovery of type 1 diabetes

 

[everydayupsanddowns]

Before the discovery of insulin type 1 diabetes didn’t exist yet, so you can’t possibly say it was fatal.

It wasn’t called ‘type 1 diabetes’ at that stage, but it was the same condition. Caused by autoimmune attack and destruction of islet cells in the pancreas.

In the Netherlands and in the US doctors think if you have beta cell function left you don’t neccessarily need exogenous insulin, but need to stimulate endogenous insulin production.

I think that must be referring to other types of diabetes, not type 1? The version of diabetes that we call Type 1 is characterised by absolute insulin deficiency. Significant loss of beta cell mass, such that there is not enough insulin production available to maintain glucose homeostasis.

This is why one of the options for treatment is islet cell transplantation. Because in type 1, not enough islets remain. In T1 there is nothing (or not enough) to stimulate in most cases. There may be micro secretions, and a few valiant beta cells resisting attack, or being regenerated and then destroyed by antibodies on an ongoing basis.

Indeed one of the areas of research around islet cell transplantation is how to prevent the transplanted cells from being destroyed by ongoing autoimmune attack. People who get islet cell transplants sometimes get a few years injection-free, but by 4-5 years lost transplant are often needing exogenous insulin again.

Insulin isn’t a plot by big pharma and insurance companies - it‘s a naturally produced hormone which has been made available to people who no longer have the ability to produce it themselves, and who would waste away and die without it.

On the left is Leonard Thompson with no insulin. On the right, after insulin had been isolated and made available by injection.

 

[Inka]

Not only in the Netherlands they are taking diabetics off insulin, the same program has been rolled out in Hong Kong and India now.
The “before the discovery of insulin” narrative, which is often repeated word after word is very popular.
Despite the fact that if you use your brain for only 2 seconds you realise it can’t be true at all.
Before the discovery of insulin we didn’t even have any types yet, these came with the discovery when we were separated into insulin dependent and independent. Very convenient for the pharmaceutical companies, less so for diabetics.

I find it hard to believe they’re taking Type 1s off insulin in the Netherlands and elsewhere. Why? Because they’d die. Type 2s might be able to reduce insulin use and people misdiagnosed as Type 1 when they actually have a monogenic form of diabetes might be able to come off insulin, depending on the MODY type, but dead islets can’t be resurrected. Type 1s beta cells have been destroyed by the immune system.

You completely misunderstand the history of insulin and diabetes types. Type 1 (autoimmune) was always around, it just didn’t have a name because they didn’t know what was happening.

I disagree - I find insulin very convenient because without it I’d die. You’re either Type 1 and in denial or you’re Type 2/MODY. Do you not think Type 1s and doctors have tried everything over the years? I know an obsessed Type 1 who’s tried every diet, taken drugs obtained on the internet that were supposed to help, fasted for days in a special schedule for more than a year, etc. Nothing has worked. The idea that there’s some ‘secret cure’ out there that ‘big pharma’ have hidden is ridiculous frankly.

 

[Robin]

In the Netherlands and in the US doctors think if you have beta cell function left you don’t neccessarily need exogenous insulin, but need to stimulate endogenous insulin production.

I’m reckoned to have some beta cell function left. This is probably why I was misdiagnosed as Type 2 to start with, as I hadn’t gone into DKA. However, my HBA1c was 16%, in the units used then, and even with a strict low carb diet, Metformin and Gliclazide, I was still excreting glucose in my urine, and only managed to reduce my HbA1c to 9% briefly. I still felt constantly dehydrated and lacking in energy, though. Once I started on insulin (and had a positive GAD test, but I'd been started on Basal insulin to prop up my own production before the results of that test) I fared a lot better. I may have been able to live for quite a while on the low carb and tablets route, but I'd probably have been doing irreparable damage to my kidneys, not to mention developing other complications. I can only think that the people who have been taken off insulin had a better beta cell function that I have, even though I probably still have some.

 

[Docb]

This discussion adds to my thought that at times labels can be unhelpful. To my way of thinking inadequte blood glucose control is covered by a whole spectrum of causes, from complete auto immune destruction of beta cells at one end to total disruption of a perfectly adquate system by excess body fat at the other. In between we have no doubt a myriad of other things which can effect blood blood glucose control. The idea that everyting in that spectrum has to fit into one of two categories is just plain silly. Its like saying that the only colours in a rainbow are red and violet.

I get more and more sure that DUK and others could do much for the diabetic community by working towards getting rid of the type I and type II labels and devising a better way of categorising poor blood glucose control to better reflect what actually is going on in the real world. If nothing else it would help to avoid the sort of debate developing in this thead.

 

[Robin]

This discussion adds to my thought that at times labels can be unhelpful. To my way of thinking inadequte blood glucose control is covered by a whole spectrum of causes, from complete auto immune destruction of beta cells at one end to total disruption of a perfectly adquate system by excess body fat at the other. In between we have no doubt a myriad of other things which can effect blood blood glucose control. The idea that everyting in that spectrum has to fit into one of two categories is just plain silly. Its like saying that the only colours in a rainbow are red and violet.

I get more and more sure that DUK and others could do much for the diabetic community by working towards getting rid of the type I and type II labels and devising a better way of categorising poor blood glucose control to better reflect what actually is going on in the real world. If nothing else it would help to avoid the sort of debate developing in this thead.

About a year into my diagnosis, around 2008, the Oxford Radcliffe hospital trust where I still went for appointments, was trying not to ‘label' people as a particular type, reasoning that the important thing was the correct treatment, not the cause. I was discharged from the hospital clinic shortly after, but fast forward a couple of years when I attended a local DUK group talk by one of the top consultants from the hospital, and he was happily referring to Type 1 and Type 2 again. And now I’ve been referred, they seem be using 'labels' again. So maybe they tried it and found it didn’t work.

 

[Inka]

I think labels are useful in this case. We already see confusion sometimes where somebody with Type 2 thinks they’ve ‘progressed to Type 1’ because they’ve started insulin. Perhaps there could just be additional subtypes? But as the general public already get confused between Type 1 and Type 2, then it might be easier to leave it as it is.

 

[Satan’s little helper]

.

Before the discovery of insulin type 1 diabetes didn’t exist yet, so you can’t possibly say it was fatal.

So Eva Saxl was wasting her time, then??

WWII Hero Saves T1D Lives with Home-brew Insulin

Without access to dogs, calves or cows, Eva knit stockings and sold them to buy water buffalo pancreata. Then, in a laboratory in China, she got to work.

beyondtype1.org

 

[Bubbleblower]

Insulin isn’t a plot by big pharma and insurance companies

Insurance companies want to take people off insulin, because it’s too expensive.
Big pharma want to keep people on it, because it’s a big cash cow.
That’s not a plot, that is reality.

On the left is Leonard Thompson with no insulin. On the right, after insulin had been isolated and made available by injection.

View attachment 27999

That poor kid got early onset diabetes with aggressive antibodies that destroy insulin cells before they reach maturity:



My father was diagnosed before the age of 7 and at some point stopped taking insulin and I've seen the dramatic effects. But his disease was completely different than mine and so are these effects.

My C-peptide is 380 pmol/L and has been the same for more than 3 years now, it’s incomparable.

 

[Tdm]

I have recently stopped my basal insulin.
I am type 1.
I have a non-diabetic a1c
I am not in remission. I am simply still in the honeymoon phase.
I will probably need basal again soon.

If type 1s didn't need insulin, we would know. Our cgms would tell us. We would adjust our insulin doses. Which we do when we become more sensitive/resistant.

I am not scared of big pharma. Big pharma gives me high quality, consistant insulin. Big pharma
keeps me alive. And, as you have said, if insulin was not necssary the rival force of Big Insurance (in the US, the NHS in UK) would hardly keep its mouth shut.

Telling type 1s they can acheive remission is simply wrong at best, fatal at worse.

 

[Satan’s little helper]

I have recently stopped my basal insulin.
I am type 1.
I have a non-diabetic a1c
I am not in remission. I am simply still in the honeymoon phase.
I will probably need basal again soon.

If type 1s didn't need insulin, we would know. Our cgms would tell us. We would adjust our insulin doses. Which we do when we become more sensitive/resistant.

I am not scared of big pharma. Big pharma gives me high quality, consistant insulin. Big pharma
keeps me alive. And, as you have said, if insulin was not necssary the rival force of Big Insurance (in the US, the NHS in UK) would hardly keep its mouth shut.

Telling type 1s they can acheive remission is simply wrong at best, fatal at worse.

Hello, for me. If I was to intentionally stop my basal? My peaks & troughs would swing in the extreme as I attempt to manage with just Novorapid. It’s a consistent pattern if I forgot the basal the night before.
By the same token. My graph would look nothing like “remission” if I omitted bolus.

I find this topic misleading.

 

[Bubbleblower]

I find this topic misleading.

You guys put all kinds of words in my mouth, I find that misleading and derailing.

If your pancreas still produces enough insulin you don’t neccessarily need exogenous insulin.
According to my doctors that is, obviously, I am not an authority.

In the GUTDM1 study (n=500) over 30% of participants still had “substantial” C-peptide.
That still has not been published, but this also comes from it:
Residual β-Cell Function Is Associated With Longer Time in Range in Individuals With Type 1 Diabetes

There you can see who these doctors are and that the study was done in the Amsterdam University Medical Center, which is now intergrated into Diabeter, where they take “type 1s” off insulin. The later onset the diabetes is the less likely you need it.

 

[Inka]

But those are tiny amounts of residual insulin @Bubbleblower I still make tiny amounts of insulin 30 years after diagnosis but I can’t survive without exogenous insulin. And the study you linked to just says it helps TIR not that these Type 1s can stop insulin.

Again, early introduction of insulin helps preserve the remaining beta cells longer. So it’s a good thing not a bad thing.

 

[Satan’s little helper]

You guys put all kinds of words in my mouth, I find that misleading and derailing.

If your pancreas still produces enough insulin you don’t neccessarily need exogenous insulin.
According to my doctors that is, obviously, I am not an authority.

In the GUTDM1 study (n=500) over 30% of participants still had “substantial” C-peptide.
That still has not been published, but this also comes from it:
Residual β-Cell Function Is Associated With Longer Time in Range in Individuals With Type 1 Diabetes

There you can see who these doctors are and that the study was done in the Amsterdam University Medical Center, which is now intergrated into Diabeter, where they take “type 1s” off insulin. The later onset the diabetes is the less likely you need it.

I’m trying to find a case in your favour regarding what you suggest. But all I found was news back in 2018, on insulin dependant type 2s. https://www.dutchnews.nl/2018/10/new-treatment-for-diabetes-2-could-halt-need-for-injections/

 

[Inka]

There was a feature on the BBC news page about some people with MODY being assumed to be Type 1 and how C Peptide tests had identified them. Some were able to stop insulin. But that’s nothing like what BB is saying about putting Type 1 into remission. Misdiagnosis is not the same as remission.

 

[everydayupsanddowns]

There you can see who these doctors are and that the study was done in the Amsterdam University Medical Center, which is now intergrated into Diabeter, where they take “type 1s” off insulin. The later onset the diabetes is the less likely you need it.

I attended an event at Diabeter in Rotterdam some years ago (2017?).

I still know someone who works there so I’ll be interested to hear what they say.

Have you ever been checked for MODY @Bubbleblower ? Perhaps it isn’t LADA that you have?

 

[everydayupsanddowns]

Just to confirm, the suggestion that the Diabeter clinic takes people with Type 1 Diabetes off insulin is not the case.

From my friend:
“Yes I still work at Diabeter. Taking type 1 off of insulin would kill them, so no…
But maybe this is about people with MODY diabetes (who were first misdiagnosed as type 1)”

 

[Inka]

I would be interested in @Bubbleblower ‘s answer too. I’ve asked before, but BB said they thought they had “MODA”:

“I don't believe I have MODY, but MODA, in fact I believe we all do and also that it is possible to lower our setting point.”

 

[Tdm]

Hello, for me. If I was to intentionally stop my basal? My peaks & troughs would swing in the extreme as I attempt to manage with just Novorapid. It’s a consistent pattern if I forgot the basal the night before.
By the same token. My graph would look nothing like “remission” if I omitted bolus.

I find this topic misleading.

I didn't stop my basal lightly, i was only on 2 abasaglar a day and getting repeated nightime hypos...i dropped to 1, then zero.
I was a bit reluctant, actually, but your body needs what your body needs. I expect to need basal again soon.
I totally need bolus