WEEKLY HEALTH BULLETIN August 7, 2009


UNSAFE AT ANY COST?
MORE DISTURBING NEWS ABOUT DIABETES DRUGS

Many people with advanced diabetes end up on insulin.  Lantus insulin has become one of the most popular forms of insulin due to its ease of use.

Once daily dosing in the evening along with careful attention to diet is often all some folks need to maintain normal blood sugars.  In some cases, twice daily dosing is needed.

Some recent studies from Europe raise the alarming specter of increasing risk of cancer in people using Lantus insulin alone over a one year period compared to other forms of insulin.

THOUSANDS OF NEW CANCER CASES A YEAR

A Swedish study shows that for every 1000 women who use Lantus for a year, one extra woman will get breast cancer compared to patients on other insulins.

Much more disturbing is a German study that shows for every 1000 patients on low dose Lantus, 4 more will get cancer.  For high dose Lantus, the count is 13 more cases of cancer.  This last number calculates out to 13,000 new cases of cancer every year for every million people treated with Lantus.

HOW INSULIN MIGHT CASE CANCER

These results should not come as a total surprise, since insulin binds to something called insulin-like growth factor (IGF-1) receptors and promotes the proliferation of cells.  Cancer involves the uncontrolled growth of cells.

I am by no means against insulin.  Insulin is in fact one of the most valuable drugs invented by modern medicine and has saved and extended countless lives.

Under the circumstances, it makes sense to consider switching to human insulin.  Increased cancer risk is not seen with Humalog (lispro) or Novolog (aspart).

FAULTY DIABETES CARE THE PROBLEM

A big problem with insulin use in general is the faulty instruction patients receive from diabetic educators.  They are shown how to “match carbs” with the amount of insulin given.  You eat as many carbs as you need to in order to “use up” the insulin dose. People are told they can eat any sort of processed carbohydrate food product — such as commercial bread, rolls or snack foods — instead of healthy whole grains and other high quality carbs.  Empty calories from processed “junk” carbs do not support good health.  I frankly can’t believe registered dietitians and other nutrition professionals are supplying this advice in diabetes centers around the country.  It’s just plain crazy.

The other problem with this flawed approach is that it makes it hard to reduce your insulin dose.  Ideally you should reduce carb intake while focusing on high quality whole food carbs such as cooked grains and heavy whole grain breads.  Unfortunately this takes more vigilance – in some cases the educator and the patient may have to be in touch with each other every day or so over several weeks.  As you fine tune the diet – reducing carbs while focusing on healthy proteins and fats – your blood sugars will drop and your insulin needs diminish.

GET OFF INSULIN

I worked with a 45 year old new onset diabetic who required over 60 units of insulin a day before we are able to keep his blood sugars in check.  By communicating with him him on a daily basis over several weeks and using a healthy whole foods low carb diet we were able to get him off his insulin.  He now requires no medication at all.

Now this outcome is not possible for everyone.  Some people are too far along in the disease process to respond as completely as this gentleman did, although when we started his fasting blood sugars were in the 300’s.  Even those who cannot come off insulin entirely can still get by lower doses working this way.

Unfortunately, the reimbursement arrangements in our scandalously inefficient, inequitable insurance system do not support this heavy upfront investment in intensive management.  As a result, I suspect we are keeping many thousands of diabetics on insulin or oral medications unnecessarily.  This may be good for the drug companies’ bottom lines but is a disservice to patients and a waste of money.  Another reason our health care costs are spiraling out of control and liable to bankrupt our country.

Alan Inglis MD
American Country Doctor

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