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heretk posted:
Diabetes type 2 poses a multiple health risk, not only coronary heart disease but also kidney failure. Although keeping normal blood glucose (through drugs, external insulin injections or increased pancreatic insulin production) reduces kidney risk, it increases cardiovascular risk. There is a recently published paper comparing people who maintained tight glucose control (hbA1c) through drugs (and insulin) versus those who didn't. The results were that the tight glucose group had more heart disease! There are papers indicating that high serum insulin level ("hyperinsulinemia") is an independent heart disease risk factor! It was know since a long time ago. For example, R.W. Stout studies (Lancet 1969) demonstrated that arterial plaque is stimulated by insulin and the plaque tissue grows incorporating carbon from glucose (not from fat!). However, a conundrum every diabetic doctor is facing today, is that to maintain a normal glucose level in diabetes type 2 or in metabolic syndrome, on a high carbohydrate diet, a very high insulin level secretion (or injection) is required (or some equivalent drugs)! So, they tend to mitigate an immediate risk of their patients dying from high glucose complications (kidney failure, ketoacidosis) , in the short time frame, by accepting on behalf of their patients an elevated risk of heart disease manifesting itself at some time in the future.

One has to keep in mind that a high insulin level may also be maintained by the pancreas itself, in some cases if it is strong enough and if it is stimulated by food or other factors to secrete insulin..


Conversely, a poor glucose control (without excess insulin) would render a patient much more vulnerable to kidney failure, peripheral neuropaties and eye problems , but less so to heart attacks! In the days before insulin, the main diabetic risk was from kidney failure, not from heart disease.

The key to reduce the overall risk in diabetes (type 2 and 1 (see Dr. Richard Bernstein's "Normal Sugar" book)) is to do both:

1) minimize the overall requirement for insulin

AND

2) normalize blood glucose level at all time (80-140mg/dl)

H.
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DoloresTeresa responded:
H, I don't see how you can have it both ways. On the one hand you write that tight control produces more heart disease and on the other that Bernstein's tight control reduces overall risk.

I will have to check out the fact that the carbon atom from glucose is responsible for stimulating the insulin to produce plaque. You absolutely cannot eliminate sugar all together and below an HbA1c of about 4 you are in trouble. The liver will produce it if it is lacking in the diet. It wonders me if this occurs in the presence of fat in the diet or if it happens independently. A lot to think about.

Dolores
 
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heretk replied to DoloresTeresa's response:
Re: On the one hand you write that tight control produces more heart disease and on the other that Bernstein's tight control reduces overall risk.


Yes on a high carbohydrate diet and for people with diabetes or insulin resistance! However, dr. Bernstein is accomplishing that on a 60% fat low carb diet! He is himself a diabetic type 1 and is following that himself since the 1970-ties. He is quite old.

Yes you are correct one cannot easily achieve both a normal or low insulin level and normal glucose level if you are diabetic, have metabolic syndrome and consume a high carbohydrate diet. The reason is that carbohydrates stimulate insulin secretion and carbohydrates require insulin in order to metabolize glucose. About 1 insulin unit per 10g of glucose consumed, is required. More if you consume carbs together with fat. Even more so if you are insulin resistant. Even more so if you are stressed out (or took steroids).
There is a difference in the body between maintaining the normal and stable glucose on a reduced carbohydrate diet, and maintaining the normal glucose on a high carbohydrate diet. The difference is in the insulin level required to do so!
To lower an insulin secretion while maintaining the normal blood glucose, one has to either:
a) reduce carbohydrate consumptionorb) increase insulin sensitivity of the body tissues (with drugs or by healing the insulin insensitivity).
I do not know of any other way (if anybody knows please post it).
People living off plant based diets can be healthy if they maintain (b) - yes it can be done (or they are young, don't have a metabolic syndrome). I do (a), for the last 13 years since July 1999.
Re: You absolutely cannot eliminate sugar
True! and I don't.
Re: The liver will produce it if it is lacking in the diet. It wonders me if this occurs in the presence of fat in the diet or if it happens independently.
The liver will use glycogen store first, then it will synthesize some glucose out of aminoacids (protein). It is not recommended to completely rely on the glucogenesis pathway, instead it is normally recommended to eat some carbs (50g is sufficient) and not to cut them completely to zero. I don't know if glucogenesis is fat dependent, I doubt it.


Stan
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heretk replied to heretk's response:
Auto formatting broke the point (b ) under point (a ). Sorry, I have to repost it, should be:


_ a ) reduce carbohydrate consumption
_ or _
_ b ) increase insulin sensitivity of the body tissues (with drugs or by healing the insulin insensitivity).


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