Why high blood sugar is not the main problem in diabetes
For as long as I have practiced medicine, the mantra of excellent diabetic care was tight blood glucose control. All the diabetes associations, the university professors, the endocrinologists, and diabetic educators agreed. The prime directive was “Get those blood sugars down into the normal range at all costs, soldier!” The only acceptable response was, “Sir! Yes, Sir!” Insubordination was not tolerated.
At first glance, lowering blood glucose as the primary therapeutic target seemed fairly logical. The underlying premise assumes that high blood glucose is the major cause of morbidity. But remember that high blood glucose is only the symptom. In type 1 diabetes, insulin levels are very low and in type 2 diabetes insulin levels are very high. The symptom is the same, but the diseases are essentially opposites. So how could the exact same treatment be beneficial in both cases?
It’s hard to imagine that the same solution exists for opposite problems. For example, we don’t use the same treatment for both underactive and overactive thyroids. We don’t use the same treatment for both over-eating and under-eating. We don’t use the same treatment for both fever and hypothermia. We don’t wash clothes by soaking in water and then dry clothes by soaking in water.
Type 1 diabetes is caused by lack of insulin, so logically, the cornerstone of management is the replacement of the missing insulin. Type 2 diabetes, however is caused by excessive insulin, so logically the cornerstone of management should be the reduction of the high insulin. Further, being predominantly a Continue reading