It is generally accepted that, it is the complications of diabetes, which become a cause that leads to disability or even death. Traditionally it is believed that the main cause of late complications of diabetes is hyperglycemia.
Therefore, tight glycemic control is the primary aim of antidiabetic therapy for the last 50 years, but scientific evidence of recent years shows that this is not true.
High blood sugars are the symptom of the disease, not the actual disease itself. In type 1 diabetes, the lack of insulin is the primary cause of disease, so clearly the replacement of insulin is a cornerstone of management.
In Type 2 Diabetes however, high insulin resistance is the primary cause of disease. Therefore, logic dictates that treatment should be directed towards reversing insulin resistance rather than the symptom of high blood sugar.
Imagine that you have a life threatening infection. The infection causes a high fever. But instead of treating the infection with antibiotics, you treat the symptom of fever with Paracetamol. Is it useful? You must treat the disease and not the symptom. The same is true in type 2 diabetes. This is a disease of too much insulin resistance. Yet we treat the symptom of high blood sugars. Large scale trials had shown that tight blood sugar control was largely useless in preventing cardiovascular disease. After all, it doesn’t quite make sense to give more insulin to a patient with a disease that has too much insulin already. That’s kind of like washing clothes by putting them in water and drying clothes by also… putting them in water. Type 1 Diabetes and Type 2 Diabetes are kind of opposites since once has too little insulin and the other has too much. How on earth did we expect that they should be treated exactly the same? Are we idiots?
All the bad effects of diabetes both types 1 and 2 were considered to be a result of the high blood sugars. Under this paradigm, then, blood sugars must be lowered at all costs – even if it means injecting somebody with hundreds of units of insulin. The big insulin makers, of course, were only too happy to fund this research.
Results from ACCORD (Action to Control Cardiovascular Risk in Of Diabetes) clinical study confirmed the danger of blood sugar lowering drugs: Researchers examined the risks for heart attack, stroke, and death in 10,000 diabetic patients. ACCORD study was stopped early in 2008, after only three years after the start, because, those who reduced their blood sugar levels the most (to 6.0% A1C or lower – considered “great” by doctors) had a HIGHER risk of cardiovascular death and heart failure in patients with type 2 diabetes. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.
So, thanks to the study of ACCORD, it became quite clear that glucose-lowering drugs kill more Type 2 patients than those who don’t take them at all.
In 2010 it was published the results of another large study ADDITION (Anglo-Danish study of intensive treatment of patients with diabetes are identified by screening). The study involved 3000 people who initially received standard treatment for type 2 diabetes in European clinics, and patients were randomized to the intensive and standard treatment. The researchers did not find difference between the two groups. The study found that, the intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation.
Increased blood sugar levels in diabetes is just the tip of the iceberg! If only to remove the tip, the underwater part is not going anywhere. The very root of type 2 diabetes is not high sugars, but in fact originates from insulin resistance, and is the same cause of obesity.
The prevalence of type 2 diabetes in populations depends upon food availability. Given that condition is associated with both insulin resistance and pancreatic endocrine dysfunction, the application of Occam’s razor suggests that both underlying abnormalities were likely to be caused by the same factor.
The idea of reversing Type 2 Diabetes is still considered somewhat extreme. Opposing voices raise several objections, such as there aren’t any large, well-controlled for an extended period studies on dietary approaches like those that exist for drugs.
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