Insulin Therapy Crossroads: A Personalized Decision

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August 5, 2024

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Published: August 5, 2024 11:14 am|Last updated: August 5, 2024 11:14 am

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Many diabetic patients believe that the decline in islet function is an incurable curse. In fact, many domestic and international literature and data show that the rate of decline in islet function can be delayed or even reversed.A scientific lifestyle can slow down the rate of decline in islet function. In 1986, Professor Pan Xiaoren from China-Japan Friendship Hospital, in collaboration with more than 50 medical teams in Daqing, Heilongjiang…

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A scientific lifestyle can slow down the rate of decline in islet function. In 1986, Professor Pan Xiaoren from China-Japan Friendship Hospital, in collaboration with more than 50 medical teams in Daqing, Heilongjiang Province, conducted a study on preventing diabetes using three strategies: diet, exercise, and diet plus exercise. The results found that these three methods could significantly reduce the incidence of diabetes. This indirectly verified that a scientific lifestyle can improve insulin resistance and slow down the rate of decline in islet function.

Today, the Daqing Diabetes Prevention Study has been going on for over 30 years. Professor Pan Xiaoren has passed away, but Professor Li Guangwei is still conducting ongoing observations on the patients from those years. It has been found that the incidence of diabetes and its complications among those who strictly managed their lifestyles at that time is still lower than that of the unmanaged population.

In 2014, the UK completed a two-year randomized controlled trial involving 306 participants with diabetes without complications, divided into an intensive group and a control group. The former strictly controlled their diet, with daily intake being 1/2 to 1/3 of normal, and walked 15,000 steps per day; the control group followed a conventional diet and exercise routine. The trial results showed that the intensive group lost weight and their islet function recovered; the control group’s islet function declined, and their weight increased.

Professor Weng Jianping from the First Affiliated Hospital of University of Science and Technology of China proposed that early insulin pump intensive treatment for type 2 diabetes can allow islet B cells to recover to a certain extent, and even alleviate diabetes.

In addition to strict clinical trials at home and abroad, endocrinologists have almost all encountered cases in their clinical work where diabetic patients or diabetic obese patients they treated were able to control blood sugar levels without medication for months or years after strictly controlling blood sugar, adhering to a reasonable diet and exercise.

Professor Accili from Columbia University in the United States proposed the theory of islet B cell dedifferentiation, suggesting that islet B cells in patients with type 2 diabetes have not truly apoptosed in the early stages of the disease, but are in a temporary dormant state under the influence of factors such as overeating, inactivity, obesity, stress, and hyperglycemia. After adjusting these factors, some islet B cells can recover their ability to secrete insulin. This theory has attracted the attention of scientists.

How to effectively protect islet function

Choose drugs that can protect islet function. Currently recognized drugs that can protect islet function include insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, metformin, α-glucosidase inhibitors, and thiazolidinediones, etc.

Reasonable selection of food or nutritional conditioning. The primary condition for the control of diabetes by nutritional medicine is to regulate the metabolic balance of energy, followed by protecting and restoring islet B cell function and meeting special physiological needs. The expert consensus clearly states that special nutritional supplements that have been verified can be used for nutritional conditioning, controlling blood sugar, reducing the burden on islet B cells, and protecting islet function. Staple foods should be a mix of coarse and fine grains, and a rich diet of coarse grains and vegetables is easier to protect islet function.

Moderate exercise. Exercise allows more blood sugar to enter cells for use, lowering blood sugar levels, reducing insulin resistance, improving the toxic reaction of hyperglycemia to B cells, and indirectly protecting islet function.

Recently, two diabetic patients came to the endocrine outpatient clinic, Mr. Zhang and Ms. Liu. Mr. Zhang is 31 years old with a body mass index (BMI) of 26 kg/m², and Ms. Liu is 48 years old with a BMI of 24 kg/m². Both are newly diagnosed diabetics, but their treatment plans are different.

Case 1: Insulin intensive treatment achieved clinical remission of diabetes

Mr. Zhang had dry mouth and frequent urination for three months, and his fasting finger blood glucose measured at the clinic was 13.0 mmol/L. He came to the hospital for diagnosis and treatment, and further tests showed a fasting blood glucose of 15.8 mmol/L, hemoglobin A1c of 12.4%, blood lipids: cholesterol 5.4 mmol/L, triglycerides 2.6 mmol/L, low-density lipoprotein cholesterol 3.6 mmol/L, high-density lipoprotein cholesterol 0.9 mmol/L. Urine routine examination showed ++++ glycosuria, fasting C-peptide 0.27 mmol/L. Liver and kidney function were not significantly abnormal.

From the test results, it can be seen that Mr. Zhang’s blood sugar was significantly elevated, and he had lipid disorders and was obese.

Based on Mr. Zhang’s situation at that time, our treatment plan was to temporarily give insulin intensive treatment.

Hearing that he needed to take insulin, Mr. Zhang expressed strong refusal, saying that he was only in his thirties, felt not so bad, and his condition was not serious enough to require insulin. Moreover, if he started using insulin now, he would have to use it for life, as several diabetic patients around him had done.

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