Monday, June 18, 2012

Doctors and type 2 Diabetes

Uptil last year, I used to believe that as a doctor, my job was to use medication to bludgeon a patient's blood sugar into submission.
On some level, I knew there was something wrong with it. The dietary advice I was taught to give them didn't seem to be working, and I was either blaming the patient for lying to me about what they were eating, or I was blaming the inevitable progression of the disease.
The vast majority of patients with T2DM would start of with dietary modifications and exercise, they would continue to slide down to worse glycaemic control, they would get put on Metformin, then Sulfonylureas, a Glitazone along with an aspirin and a Statin. 5 to 6 years later, they would continue to get worse, I'd despair and start them on Insulin after much argument and cajoling. No one likes going on Insulin, I can vouch for that.

To me, that was the best thing to do. There wasn't enough insulin to bring down the blood sugars, therefore I was supposed to inject insulin to top them up. Of course, there was the "small" issue of hyperinsulinaemia and insulin resistance, but it just didn't register. It was the elephant in the room that no one talked about.
I just followed protocol.

In quite a few of the early T2DM patients, there is an excess of insulin due to the constant overloading of the system with carbs.  Adding more insulin to a patient who's pancreas is pumping out an excess of insulin doesnt make sense to me, now, after using a Paleo based low carb diet.

I ask my colleagues about this, and they look blank. How else do you control the blood sugars? They ask in return. Like me, a year ago, it doesn't cross their mind that the most effective method to control blood sugars, is to stop shovelling in the "healthy" whole grains.

Recently I spoke to a very intelligent and knowledgeable endocrinologist I look up to, about the rationale of giving a hyperinsulinaemic patient even more exogenous insulin, and he was honest enough to admit that it makes the problem worse, but his justification was that there was no other way to bring the blood sugars down. I didn't get into a discussion about this with him, because we ran out of time, but it was disappointing to see such an experienced endocrinologist come so close to the solution, but then not think it through to its logical conclusion.

Stop the carb overload, and the insulin levels will drop, the insulin resistance will settle, they will lose weight, the dyslipidaemia will settle. All without a truckload of meds. Too bad there is no money to be made from taking people off meds.

Sometimes it's like banging my head against a brick wall. I speak to every physician I know about this, but either their eyes glaze over, and they lose interest, or, they look at me like a crazy dangerous person, who is out to rock the boat. How long before people see the light?

1 comment:

  1. Food that has lots of fiber and protein in it is the ideal diet for diabetes.Taking the balance diet may prevent from the further damage.