sulfonylureas

[navkan]

I am going to controversial here but I hope you all accept that my aim is not to trash Dr. Bernstein's approach but rather to control my diabetes in the most effective and safest way possible. I was diagnosed type 2 about 7-8 years ago. I'm one of the rare skinny diabetics that the good doctor suggests may actually be a form of type 1. I have been on Diamicron, a 2nd generation sulfonylurea since diagnosis (and also, somewhat later, Avandia and Lipitor). It was only a few months ago that I discovered Dr. Bernstein and immediately went on a low carb diet in accordance with his recommendations. I think he is a lifesaver because since then my A1C has gone from 7.5 to 5.8

My doctor has been very encouraging regards my diet. When I raised the issue of beta cell burnout from the diamicron she was less supportive, pointing out, correctly I believe, that it has been a good medicine for me and after 7+ years I seem to still have a fair amount of pancreatic function. Also, millions of diabetics are prescribed sulfonylureas and the benefits seem to be clinically known. She indicated that Dr. Bernstein's theory is just that and suggested I look for documented evidence of beta cell burnout if I was concerned.

Although I am happy with my doctor's care, this has left me with a dilemma. As an engineer, I do prefer facts based on good evidence. As I have said, I consider the Bernstein diet to be a lifesaver based on the clear evidence of lower and controllable BG numbers. I would defend the good doctor with my life if I could. I did do some searching on sulfonylurea-based beta cell burnout and found lots of discussion about the topic but no evidence at all. There are other possible reasons for beta cell burnout, one being the natural progression of the disease. . I do not consider any human on this planet to be infallible. Br. Bernstein does not substantiate this theory of sulfonylurea-based burnout in his book but just indicates that he avoids this therapy and does not recommend it.

I see lots of discussions in this group on the subject of getting off sulfonylureas as soon as possible and have been silent until now. But I do question this position and would be very interested in your feedback on my experience and questions. Also if anyone thinks they can substantiate the claim of beta cell burnout by sulfonylurea drugs.

[c6h6o3]

I have no axes to grind here, since I take no oral or injected hypoglycemics of any kind. I have been successful in preserving my pancreatic function through diet and exercise alone.

However, were I in your position, realizing that sulfonylureas work by stimulating the pancreas to produce insulin, I would ask myself this:

If overstimulation of the pancreas does not induce beta cell burnout, how does Type II diabetes happen?

[jgthompson]

A month ago, I thought that 18 years of sulfonylurea usage had burnt out too many of my beta cells for my pancreas to operate on its own. At the time, I was consuming 50-60 carbs a day and had managed to lose about 8 pounds over a 9 month period, and had reduced my dosage by 85%. I had reached a plateau on both weight and bg, and my fasting bg had slowly increased to 150 from 125.
I gave it one more try by moving to Atkins Induction level and not only lost an additional 12 pounds, but this morning my fasting bg was 91. I am completely off not only the sulfonylurea, but 7 other medications as well.
Stick with the LCing, dropping the levels as low as you can tolerate and MONITOR CLOSELY. If your blood chemistry improves as much as mine, it sounds like your doctor is one that might be open-minded enough to accept the lab results as being directly related to carb intake, and support medication changes.
My doctor values highly conventional medical wisdom, and is just barely able to admit that, for diabetics at least, low-fat diets may not be the best approach. I'm NOT looking forward to admiting to him that I eliminated 7 medications without his direction to do so, but both Atkins and Bernstein point out the potential problems of not doing so with these particular drugs.

[navkan]

c6h603, thanks for your reply. At first I didn't understand it but as I continued investigating realised that I think what you are saying is that type 2 diabetes is caused by the continual flood of extra insulin produced by the body's attempt to overcome insulin resistance. (If this is wrong, please clarify for me.)

This is a theory and it may be true, however, my investigations so far have not found any support. Another theory is that the beta cell burnout is accelerated by higher BGs in the pre-diabetic stage. If so, then keeping BGs down by any means is vitally important. However, I haven't seen any studies that support this either.

So the short answer to your question "what causes diabetes?" is that I don't know, but neither, it seems does the medical scientific community either.

Mr Thompson above, whose note I also appreciate, has been on sulfonylureas for 18 years and appears to still have pancreatic function.

I will continue to LC and to try and get to a point where I can get off all meds if possible. Frankly, I'm somewhat more scared of my Avandia at the moment than my Diamicron. Anyway back to my doc in a month or so.

Thanks again

Fred

[c6h6o3]

Type II is not caused by excess insulin. It's caused by the overstimulation of the pancreas in its efforts to produce all that excess insulin. It does this because of the excess glucose produced by a high carbohydrate diet. This combined with built up excess adipose tissue and resultant insulin resistance will, over a period of years, degrade the ability of the pancreatic beta cells to produce insulin.

We know that sulfonylureas work by stimulating the beta cells to produce more insulin. I believe that Type II diabetes is caused by overstimulating the beta cells in an effort to keep up with insulin demand. In other words, it the same process in both cases; the stimulant is a drug in one case and glucose in the other. Maybe I'm wrong and diabetes is caused by something else. But if so, why is a low carbohydrate diet so effective, even with Type I?

Jim

[Lisa N]

Type II is not caused by excess insulin. It's caused by the overstimulation of the pancreas in its efforts to produce all that excess insulin. It does this because of the excess glucose produced by a high carbohydrate diet. This combined with built up excess adipose tissue and resultant insulin resistance will, over a period of years, degrade the ability of the pancreatic beta cells to produce insulin.

You're right on the money, Jim. Type 2 diabetes is when the body A) cannot produce enough insulin to move the glucose from the bloodstream into the cells or B) The cells of the body become immune to the effects of insulin even though the body is producing a sufficient supply or C) a combination of both of the above.
The body becomes "immune" to insulin or insulin resistant through a constant overproduction of insulin (hyperinsulinemia) caused by a high carb intake. The more resistant you become, the more insulin that is needed to do the job that less once did. It is this high production of insulin (remember, this is the "fat storing" hormone") that leads to the excess buildup of adipose tissue and makes it so hard to get rid of unless the insulin resistance and hyperinsulinemia is controlled first. Overworking the beta cells via insulin resistance also contributes to burnout. As with any part of your body, if you overwork them eventually they will reach a stage of exhaustion.

It's on this principle that drugs that stimulate the production of more insulin are discouraged by Dr. Bernstein. If not on the principle of beta cell burnout, at the very minimum because it can contribute to insulin resistance through the overproduction of insulin. Hypoglycemic episodes are a lot more common in those that are taking sulfonylureas than on those that take medications that work by other means to lower blood sugar such as increasing the sensitivity of cells to the existing insulin produced because insulin is being produced whether the body requires it or not and you had better have sufficient glucose there to be moved into the cells or you're going to have your blood sugars bottom out.

Beta cell burnout doesn't happen overnight or even over the period of a few years and it's impossible to predict how fast beta cells will burn out in one individual versus another but personally I'd rather not take that gamble when there are other medications available that are not likely to have that effect (or are certainly less likely to have that effect than an insulin-stimulating drug) or I can control my blood glucose through diet alone.

[alaskaman]

I will do some research and get back to you on this. Right now I know that I have seen a number of good peer-reviewed articles which state that after a few years on sulfonylureas, it is pretty usual to not have enough functioning beta cells to survive without insulin. Now, they don't come out and say the the drugs are doing it, but that is certainly one logical conclusion. So I would certainly want to avoid them if possible, with Bernsteins diet, or minimize the dose for sure.

[Andee]

Add me to the list of diabetics who have been on sulfonylureas for many years (15 in my case) & who was recently taken off them. So why do I apparently still have functioning beta cells? Until last September, I had very poor blood sugar control, however my most recent (May 2003) A1c was 5.3. So even if I continue to eat low-carb & exercise daily, will I eventually have to go on insulin?

[jgthompson]

I'm no doctor, but I have the same worries and conditions as you, including pancreatic function, kidney function, claudication in the legs, cataracts, etc. My A1c has also dropped from 7.4 to 5.4. I think that this one factor is the single most important indicator that we have overcome the greatest hazard of Type II. The high blood sugars are no longer destroying our bodies.
As long as we maintain that bg value without medication, I'm no longer going to worry about Beta cell burnout/insulin. Of course, with that drop, my lipids screen shows tremendous changes, which in turn lower cardiovascular symptoms and conditions.
Remember, stress also raises blood sugar. Lighten up a little and enjoy your success. I'm certainly going to do so!!!

[Andee]

You are right, of course, JG. I have worked so hard to get off sulfonylureas & statins and, now that I have, it's time to rejoice, relax, even celebrate. I have already experienced a heart attack, so now that all my numbers (except my weight) are excellent, it's time to LIVE & look to the future. Congratulations to both of us; we're Sulfonylurea Survivors. Thanks for the insight.