Location: Los Angeles Joined: 24 Mar 2008 Posts: 115 Born: 10 December 1977 Gender: Male
Posted: Mon Jun 09, 2008 5:26 am Post subject: Glucose control - no benefit on Diabetics heart health
So if it's not the glucose that leads to cardiovascular disease in type 2 diabetics, what is it then? Insulin? According to the studies, controlling blood glucose levels does show a reduction in glaucoma and kidney disease, but not in heart disease. Bear did state that it's the insulin that causes the myriad of cardiovascular problems.
Two large studies involving more than 21,000 people found that people with Type 2 diabetes had no reduction in their risk of heart attacks and strokes and no reduction in their death rate if they rigorously controlled their blood sugar levels.
The results provide more details and bolster findings reported in February, when one of the studies, by the National Institutes of Health, ended prematurely. At that time, researchers surprised diabetes experts with the announcement that study participants who were rigorously controlling their blood sugar actually had a higher death rate than those whose blood sugar control was less stringent.
Now the federal researchers are publishing detailed data from that study for the first time. Researchers in the second study, from Australia and involving participants from 20 countries, are also publishing their results on blood sugar and cardiovascular disease. That study did not find an increase in deaths, but neither did it find any protection from cardiovascular disease with rigorous blood sugar control.
Thus both studies failed to confirm a dearly held hypothesis that people with Type 2 diabetes could be protected from cardiovascular disease if they strictly controlled their blood sugar.
It was a hypothesis that seemed almost obvious. Cardiovascular disease accounts for 65 percent of deaths among people with Type 2 diabetes. And since diabetes is characterized by high levels of blood sugar, the hope was that if people with diabetes could just get their blood sugar as close to normal as possible, their cardiovascular disease rate would be nearly normal as well.
The two studies were presented Friday in San Francisco at the annual meeting of the American Diabetes Association and will be published next week in The New England Journal of Medicine. The Journal lifted its embargoes to coincide with the presentations at the meeting. A third study, similar but smaller, by the Department of Veterans Affairs, will be presented at the meeting on Sunday.
Diabetes researchers say that the message is that patients should obtain at least moderate control of blood sugar to protect against eye, kidney and nerve disease. But for heart disease, they say, the only proven method of preventing complications is to give statins to control cholesterol, drugs to control blood pressure and aspirin to control blood clotting, and encourage people to lose weight and exercise.
The Australian study did find one advantage to strict blood sugar control — a slight reduction in new or worsening kidney disease. The rate among those with intense sugar control was 4.1 percent as compared with 5.2 percent among those with less intense control.
But researchers disagreed about whether the kidney disease effect in the Australian study was enough to advise patients to strive for rigorous blood sugar control. The Australian investigators said it was.
Others were not so sure. The kidney effect was “a modest benefit,” said Dr. David Nathan, director of the diabetes center at Massachusetts General Hospital. Dr. W. Douglas Weaver, president of the American College of Cardiology, agreed, saying, “It’s hard to get really excited about that data.”
And the excess deaths among patients in the intensive treatment group in the American study gave Dr. Nathan and others pause.
Researchers said it was difficult to compare the studies from the United States and Australia. For example, patients in the two studies took different drugs to lower blood sugar and lowered their blood glucose at different rates — quickly in the federal study, over a period of years in the Australian one.
Those in the federal study used a wide variety of drugs. But all those in the Australian study who were assigned to rigorous blood sugar control were required to take the diabetes drug sulfonylurea gliclazide (modified release), which is not used in the United States.
The study got its major support from Servier, the drug’s maker. Servier had no influence on the conduct of the study or the analysis or publication of its results, said Dr. Stephen MacMahon, a principal investigator and professor of cardiovascular medicine and epidemiology at the University of Sydney.
In both studies, intensive control of blood sugar meant levels of a blood protein, hemoglobin A1C, of 6 percent to 6.5 percent, and less rigorous control meant an A1C goal of around 7 percent to 7.9 percent, typical levels achieved by people with Type 2 diabetes in the United States. The intense control was difficult — participants often ended up taking multiple drugs and injecting themselves with insulin. They also risked severe hypoglycemia from blood sugar levels that plunged dangerously low.
Although the studies’ failure to prove the blood sugar/cardiovascular disease hypothesis was a huge disappointment, the result may reflect how difficult it is to change outcomes in people like the study participants, said Dr. Judith Fradkin, chief of the diabetes division at the National Institute of Diabetes and Digestive and Kidney Diseases. They were middle age or older and had had diabetes for years.
“You’re trying to intervene in people in whom a lot of the damage may already have been done,” Dr. Fradkin said. Younger and newly diagnosed patients may be a different story, she said, adding, “That’s the great unanswered question.”
Still, said Dr. John Buse, president for medicine and science of the diabetes association, the blood sugar/cardiovascular disease hypothesis has failed for people with established Type 2 diabetes.
For these patients, “intensive management of A1C for cardiovascular risk probably isn’t worth it,” Dr. Buse said.
Rigorous control of blood sugar won’t save diabetics the heart ravages which come with the disease, new studies show.
Instead diabetics need to treat themselves as we heart patients do, with statins, blood pressure control, diet, exercise and a baby aspirin before bedtime. Their current regimen for controlling blood sugar may be as good as it gets.
_________________ State appointed FEMA camp nutrition director
www.thesimpleworld.net - my blog
What does all of this do to the heart? Not very good things.
There was a study done a couple of years ago, a good, down to earth nicely conducted study that showed that heart attacks are two to three times more likely to happen after a high carbohydrate meal. They said specifically NOT after a high fat meal.
Why is that?
Because the immediate effects of raising your blood sugar from a high carbohydrate meal is to raise insulin and that immediately triggers the sympathetic nervous system which will cause arterial spasm, constriction of the arteries. If you take anybody prone to a heart attack and that is when they are going to get it.
What else does insulin do?
Insulin mediates blood lipids. That patient who had a triglyceride of 2200, one of the easiest things we can do is lower triglyceride levels. It is so simple. There was just an article in J.A.M.A. an article and they were saying that the medical profession doesn't know how to reduce triglycerides dietarily, that drugs still need to be used.
It is so ridiculous because you will find that it is the easiest thing to do. They come tumbling down. There is almost a direct correlation between triglyceride levels and insulin levels. In some people more than others. The gentleman who had a triglyceride level of 2200 while on all the drugs only had an insulin level of 14.7.
That is only slightly elevated, but it doesn't take much in some people, all we had to do was get his insulin level down to 8 initially and then it went down to six and that got his triglycerides down to under 200.
The way you control blood lipids is by controlling insulin.
We won't go into a lot of detail, but we now know that LDL cholesterol comes in several fractions, and it is the small, dense LDL that plays the largest role in initiating plaque. It's the most oxidizable. It is the most able to actually fit through the small cracks in the endothelium. And that's the one that insulin actually raises the most. When I say insulin, I should say insulin resistance. It is insulin resistance that is causing this.
Cells become insulin resistant because they are trying to protect themselves from the toxic effects of high insulin. They down regulate their receptor activity and number of receptors so that they don't have to listen to that noxious stimuli all the time. It is like having this loud, disgusting rap music played and you want to turn the volume down.
You might think of insulin resistance as like sitting in a smelly room and pretty soon you don't smell it anymore because you get desensitized.
You can think about it, its not that you are not thinking about it anymore. But if you walk out of the room and come back, the smell is back. You can get resensitized is what that is telling you. It would be like you are starting to go deaf and your are telling others to speak up because you can't hear them, so if I was your pancreas, I would just start talking louder, and what does that do to your hearing?
You would become deafer. Most cases of deafness, especially in old age is due to excessive noise exposure. All the noise exposure your ears have been exposed to, well the hair cells that end up triggering your brain to allow you to hear eventually get killed. Sometimes it just takes a single firecracker.
This is the same thing with insulin resistance. What happens is that if your cells are exposed to insulin at all they get a little bit more resistant to it. So the pancreas just puts out more insulin. I saw a patient today, her blood sugar was 102 and her insulin was 90! She wasn't sure if she was fasting or not, but I've seen other patients where their blood sugar was under 100 and their fasting insulin has been over 90.
That is a fasting insulin. I'm not sure how many people are familiar with seeing fasting insulins. But if I drank all the glucose I could possibly drink my insulin would never go above probably 40. So she was extremely insulin resistant.
What was happening was she was controlling her blood sugar. Statistically she was not diabetic. She is not even impaired glucose tolerant. Her glucose is totally normal supposedly. But her cells aren't listening to insulin, she just has an exceptionally strong pancreas.
Her islet cells that produce insulin are extremely strong and are able to compensate for that insulin resistance by producing thirty times more insulin than what my fasting insulin is. And just by mass action her pancreas is yelling so loud that her cells are able to listen, but they are not going to listen forever. Her pancreas is not going to be able keep up that production forever.
Well the usual treatment once she becomes diabetic, which would be inevitable, once her production of insulin starts slowing down or her resistance goes up any more, than her blood sugar goes up and she becomes a diabetic. For many years, decades before that her insulin levels have been elevated.
They have been elevated for thirty years probably and have never been checked. That insulin resistance is associated with the hyperinsulinemia that produces all of the co-called chronic diseases of aging or at least contributes to them. As far as we know in many venues of science, it is the main cause of aging in virtually all life.
Insulin is that important. So controlling insulin sensitivity is extremely important.
How else does insulin affect cardiovascular disease?
We've only just touched upon it. Insulin is a so-called mytogenic hormone. It stimulates cell proliferation. It stimulates cells to divide. If all of the cells were to become resistant to insulin we wouldn't have that much of a problem. The problem is that all of the cells don't become resistant.
Some cells are incapable of becoming very resistant. The liver becomes resistant first, then the muscle tissue, then the fat. When the liver becomes resistant, what is the effect of insulin on the liver, it is to suppress the production of sugar.
The sugar floating around in your body at any one time is the result of two things, the sugar that you have eaten and how much sugar your liver has made. When you wake up in the morning it is more of a reflection of how much sugar your liver has made. If your liver is listening to insulin properly it won't make much sugar in the middle of the night. If your liver is resistant, those brakes are lifted and your liver starts making a bunch of sugar so you wake up with a bunch of sugar.
The next tissue to become resistant is the muscle tissue. What is the action of insulin in muscles? It allows your muscles to burn sugar for one thing. So if your muscles become resistant to insulin it can't burn that sugar that was just manufactured by the liver. So the liver is producing too much, the muscles can't burn it, and this raises your blood sugar.
Well the fat cells become resistant, but not for a while. It is only after a while that they become resistant. It takes them longer.
_________________ When the power of love overcomes the love of power, the world will know peace. - Jimi Hendrix Every day you'll see the dust
Never get off the Bus!
Location: Los Angeles Joined: 24 Mar 2008 Posts: 115 Born: 10 December 1977 Gender: Male
Posted: Mon Jun 09, 2008 5:46 am Post subject:
Interesting article, Dean.
I suspect these studies will be used by doctors and pharmaceutical companies to push meds even harder on patients who fit the criteria of being "at risk". Why is insulin control rarely mentioned in these studies? Oh, I forgot, insulin is what diabetics must take in order to continue eating carbohydrates.
Insulin is a moneymaker, can you imagine if doctors did a 180 and started saying insulin is actually damaging? _________________ State appointed FEMA camp nutrition director
www.thesimpleworld.net - my blog
Location: Canada Joined: 18 Jan 2008 Posts: 430 Born: 14 August 1976 Gender: Female
Posted: Mon Jun 09, 2008 9:33 pm Post subject:
Insulin is the devil...so is sugar... I'm going back to animal foods...read my journal for more details...the article from Rosedale got me thinking real hard...
_________________ "When you give up your dream, you die"
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I'm going back to animal foods...read my journal for more details...the article from Rosedale got me thinking real hard...