Insulin and Type 2 Diabetes

On Sunday evenings, I give an orientation to patients arriving at the Whitaker Wellness clinic for our one-, two-, or three-week Back to Health Program. I welcome them, explain the uniqueness of our approach, and let them know what to expect during their stay.

At a recent orientation, I met a 50-year-old woman who was about 100 pounds overweight—she was 5’2″ and weighed 219 pounds. As you would imagine, she had type 2 diabetes mellitus, and she’d come to the clinic because her physician back home wanted to start her on insulin. From Health & Healing she had learned about the problems with this approach, and she wanted to get a second opinion before consenting. When she told her doctor about her plans, he was furious. She told me that they’d actually had a fight about it!

This is insane. Insulin therapy in the obese type 2 diabetic is a disaster. It’s like treating alcoholics with martinis! Insulin makes overweight patients gain more weight. This excess weight drives the blood sugar up even more. Then the doctor who started the regimen in the first place will—you guessed it—increase the insulin dose, which will—you can fill in the blank here—drive the blood sugar still higher. Before long, the patient is taking an obscene amount of insulin and doesn’t have a prayer of controlling his or her ballooning weight.

A Common, Dangerous Practice

Such inappropriate use of insulin in type 2 diabetes is not uncommon. After hearing this woman’s comment, I asked the 45 other patients in the room how many had type 2 diabetes and were using insulin. Seven raised their hands. I then asked how much weight they had gained since starting on insulin. Notice I did not ask them if they had gained weight—I asked how much. One man said he’d gained 25 pounds. Another estimated he’d put on 40. Others reported anywhere from 10 to 60 pounds, for an average increase of about 30 pounds.

Folks, virtually every patient I see with type 2diabetes who has been put on insulin has gained weight. I followed one patient who gained 100 pounds over 10 years as his insulin dose was gradually increased to 100 units per day. We stopped his insulin immediately, and although it took him eight years to lose all that weight, he never went back on insulin or any other diabetic medication.

I ask these patients how their doctors respond to this deleterious and inevitable side effect of insulin. Here is where it gets surreal. In most cases, the doctor blames the patient for the weight gain! Patients are told, “You have no discipline.” “You don’t take care of yourself.” “You’re not following the appropriate diet.” One patient’s doctor actually told him that he was in denial about his condition. Imagine that—physicians blaming patients for problems they themselves caused!

This Patient Gained 170 Pounds!

The most profound insulin-induced weight gain I’ve ever seen was in a gentleman I met casually a few years ago while giving a lecture in another city. He was a hospital administrator and could have been cared for by any physician he wished. He told me that under his doctor’s regimen of increasing insulin doses he had gained 170 pounds!

I can’t help but wonder what went through the mind of this man’s physician. Here he is, sitting in front of a patient who, after following his orders of using insulin, gained 170 pounds! There has to be some kind of emotional-intellectual disconnect that blinds him to the obvious. I can only theorize that doctors like this continue the destructive use of insulin because they can’t think of anything else to do. But shouldn’t the fact that this therapy is clearly causing harm be sufficient reason to stop it?

Proven Decades Ago

As obvious as this concept is, I didn’t figure it out. It was first documented in the 1970s when the University Group Diabetes Program (UGDP), a large, long-term, government-funded study, demonstrated—contrary to expectations—that insulin use conferred no advantages for type 2 diabetics. Yes, it lowered blood sugar levels, but compared to study participants who only implemented lifestyle modifications, there were no significant differences in fatal and nonfatal complications of diabetes. Furthermore, the participants who were taking insulin gained an average of 14 pounds over the study period. (Another arm of the study found that oral diabetes drugs actually increased the risk of death from heart attack—but that’s another story.)

The UGDP researchers concluded, “These findings provide no evidence that insulin or any other drug lowering blood glucose levels will alter the course of vascular complications in the type of diabetes that is most common, adult onset [type 2] diabetes. Weight reduction has been shown to be feasible and effective in lowering blood glucose, thus dietary management deserves greater emphasis in this type of diabetes…”

A Program That Worked

Among the first to recognize the downside of insulin and oral diabetes drugs was John K. Davidson, MD, PhD. He was head of the diabetic education program at Emory University Medical School in Atlanta, Georgia, while I was a medical student and intern, and I had the privilege of studying under him.

Dr. Davidson was also director of the diabetes unit at Atlanta’s Grady Memorial Hospital, one of the largest and most prestigious diabetes treatment centers in the world. Once the results of the UGDP study were published, he did what every informed, concerned physician should have done. He immediately discontinued the use of oral diabetic drugs in all people with type 2 diabetes, and insulin in those who were overweight. (He used insulin only in patients who had reached optimum body weight.) He was, to my knowledge, the only university professor who did this.

In place of drugs, Dr. Davidson instituted a program of diet therapy, increased exercise, and weight reduction. If patients had trouble losing weight, Dr. Davidson would put them in the hospital to undergo a three- to five-day fast. They would lose weight, their blood sugar would come down, and controlling their diabetes after they were released became much easier.

This simple, easily understood program stayed in place until 1992, when Dr. Davidson retired. Today, unfortunately, Grady Memorial is chock-full of diabetic drugs. And I can only assume that Emory is no different from other medical schools nationwide, churning out docs just like the one who was “furious” with his overweight diabetic patient who sought a second opinion on the need for insulin at Whitaker Wellness.

Dr. Davidson’s Legacy

Dr. Davidson left a legacy, however—a popular medical textbook on the treatment of diabetes called Clinical Diabetes Mellitus: a Problem-Oriented Approach. In a section on Iatrogenic Factors (doctor-induced disease), he discusses the insulin issue.

“Inappropriate use of insulin can lead to increased weight gain and a further increase in insulin resistance. Many patients today fall into the category of non-insulin-dependent but insulin-receiving. It is not unusual to encounter such a patient receiving as much as 90 units of insulin/day who can be maintained without insulin after a course of aggressive dietary restriction or modified fasting.”

As I said, future medical historians will have a hard time believing that physicians once routinely prescribed insulin to obese patients with type 2 diabetes. But until that day arrives, you’re going to have to muster up the courage to say no if your doctor recommends this unwise and harmful course of treatment.

From: Health & Healing with permission from Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without permission from the publisher. To subscribe to Health & Healingclick here.