Are Diabetics Being Killed by Insulin-Releasing Drugs?

According to a new study, the all-cause mortality risk was almost 60% higher in patients with type 2 diabetes taking insulin-releasing sulfonylurea tablets, when compared with patients taking metformin.

The result is scary. This is an observational study, and correlation doesn’t prove causation. But it may very well be real.

Most new-onset type 2 diabetics have many times higher levels of insulin in their blood than healthy people have. They have pathologically high levels of insulin. Taking sulfonylureas makes your insulin levels even more pathologically elevated. Is it a coincidence that those treated then live shorter lives? My guess: no.

Medscape Medical News: Sulfonylurea Use Increases All-Cause Mortality Risk

Previously on insulin

PS

Discuss the benefit of your therapy with your doctor as needed – do not make any changes on your own.

31 Comments

  1. LarryB
    This doesn't surprise me at all. Back when I was following the dietary advice of the ADA and my A1c was rising steadily, my doctor added a low dose of glyburide to my already extensive pill collection. The massive blood glucose drop made me collapse in public, more than once. I was afraid to drive. I thought I was (quite literally) going to die. I stopped taking it after less than a week.

    Those kinds of blood glucose swings can't be healthy, nor can deliberately inducing all those insulin spikes in people who are already insulin resistant.

    The one good thing about my experience - it was the first time I pushed back against conventional wisdom. Now I just ignore anything a dietitian says to me and simply look at my body and my blood work and my empty, disused pill tray for confirmation.

  2. Dan
    Metformin is bad stuff, too--my doctor suggests the totally natural Berberine which has been shown to do the same job on sugars with ZERO side-effects.
  3. Alex
    My former husband was on metformin, glyburide, and two types of insulin... plus about 12-13 other medications when he died at 51. One of his "professional" medical providers told him that candy was fine for "feeding the insulin." We have a long way to go.
  4. FrankG
    So we see a recently diagnosed Type 2 Diabetic who may have already lost 50-70% of the Pancreas' Beta cell insulin secreting capacity but it still struggling to maintain high insulin levels to combat high BG levels and what does the Doctor order? Drugs to make the Beta cells work even harder! And all so that they can eat like "normal" people.

    Broken leg? Sure.. what you need to do is go jogging! Don't you know that exercise is good for you?!?

    Or maybe we could try resting that leg/pancreas and give it at least a chance to recover?

    There have been studies showing that the early use of insulin injections can help with Type 2 Diabetes but how about a reasonable change to what we eat instead? Maybe something that does not tend to drive the BG up, nor require much insulin to process?

  5. Marian
    Some of us Type 2s need insulin, no matter what we eat. I must -- and do -- restrict carbs to a severe degree, not just a reasonable degree. Even so, I must also use insulin.

    For us, earlier insulin prescriptions would be a good thing. Unfortunately, diabetes is often treated with one-size-fits all "solutions," geared toward "allowing" us to eat the Standard American Diet (at the expense of our health), rather than promoting real control.

    Reply: #6
  6. Clare
    Marion surely you have a choice? you do not and did not have to follow the SAD advice? Real control comes when a patient does own research and discusses alternatives with their doctor. My GP did the usual.... blood test, GTT, prescription for metformin.... I said no thank you I will diet... he said 'try it'.... I did IT WORKED my A1c is back in the normal range and fasting blood of a morning is down to 5.0. If I maybe so bold - we gave away too much of our own control to drugs..... time we took it back.

    One of the real problems is that many people do not understand and don't want to seem to know that by the time they receive the dreaded DM diagnosis (I am writing about t2's) they have had problems - silent ones - for up to ten years and massive damage - vascular - may have already taken place..... You do not suddenly wake up one morning a Diabetic... if only the ADA and GP's in general educated folks to this reality..... then people would have to take some responsibility for what goes in their mouths..... that old adage 'you are what you eat' makes a whole lot more sense when viewed in this way I believe. Instead, so many patients blame it on family and genes, and simply carry on regardless popping pills and needing insulin for the rest of their lives. People need to take responsibility and stop giving that away to drugs, pharmaceutical companies and diabetes educators IMHO.

    I mean no personal insult to your situation - I do not walk in your shoes.

    Reply: #31
  7. Hector Perez
    This makes a lot of sense, we know that in type 2 diabetes most of patients have a functional pancreas and much insulin. The real problem is insulin resistance and you don't overcome insulin resistance by doing the same thing the pancreas is trying to do, what is really needed is to improve is to enhance defeat resistance to insulin and this is not accomplished by augmenting insulin availability, and this is the reason why metformin works and is the drug of choice together with appropriate nutrition to treat diabetic patients.
  8. Antoinette
    I'm like Clare. I muddled along with weird vague symptoms and depression and fatigue for 10 years, before I was diagnosed with type II DM. Prescribed Metformin and the standard diet of 60,70 carbs a meal and no change in my symptoms whatsoever. Finally I took matters in my own hands, went LCHF, lost 55 lbs in no time and never had a blood sugar reading over 5.2 ever again. I feel great, take no diabetes medication.
  9. FrankG
    As I just pointed out Hector (comment #4) by the time of diagnosis the beta cells -- even in a Type 2 -- are already failing. This may be due to both glucotoxicity (yes high levels of glucose are damaging to the body) and also overwork trying to battle high BGs while working against IR.

    As Marian pointed out, she needed insulin injections early (as did I)

    In fact I am convinced that it is this stage where beta cells are failing rapidly that too often results in the overt symptoms and actual diagnosis of Type 2. Up until this point a fasting BG may still be seen as normal.. although an OGTT would likely be diagnostic.. so I agree with Clare that earlier detection would serve us better than waiting 'till it may be too late for too many of us.

    But as for "choice" and "personal responsibility" Clare I do take exception at what seems to be a judgmental attitude in your comments. I was diagnosed in 2003 and was quickly sent to an Diabetes Education Program, followed up with Dietitians etc... in that state of shock, disbelief and trauma (it was a complete surprise to me) why would I not take the advice of the "experts"?

    Maybe I am slow on the uptake or something but it took me until 2008 before I heard about LCHF in anything but terms like "oh that's just the dangerous Atkins nonsense."

    I now know better of course but as they say, "hindsight is 20/20". Hopefully things have changed in more recent years.

  10. FrankG
    I'd be interested to know when you were diagnosed Clare and Antoinette? It seems to me that back in 2003 there were no blogs like this one, there were no on-line Diabetes forums discussing LCHF.. or were there? Where did you do your research and read up on alternate dietary approaches? GCBC had not come out yet. I suppose Dr Atkins diet was around and Dr Richard K Bernstein's Diabetes Solution has been around for a while. What else was there?
  11. Antoinette
    Frank, where I live (rural Australia) it often takes 3 or 4 months to get an appointment with a dietician and diabetes educator after diagnosis. So I had to muddle along on my own. Which led to me researching diabetes and diet on the internet, all the while eating the diet of the pamphlet my GP had given me. When I started LCHF, I was so amazed by the changes in my blood sugar levels and my overall feeling of well being and my GP with me, that I canceled the appointment with the dietician and the diabetes educator. Didn't want or need the aggravation of having to listen to people not agreeing with my way of life.
    Reply: #12
  12. FrankG
    I also saw significant and dramatic changes after starting LCHF in 2008 but like I said, in 2003 I am not aware that LCHF was even being discussed on the internet; so from my perspective, there was no alternative to the conventional wisdom. Pretty much any mainstream dietary advice on the internet at that time would have (if anything) only dire warnings about eating anything resembling LCHF.

    I was brought up in an era when we could trust the experts... not so nowadays but that was then and this is now. Please don't be quick to judge me for that.

  13. Antoinette
    Just saw your comment, Frank. I was diagnosed in February 2012, so not too long ago, by my GP after a GTT. Looking back, I realise I have had symptoms as long ago as 2002, when I had a weird feeling in the skin of my toes. But being in the middle of huge changes in my life, they went largely ignored. The only thing left is the nerve damage in my feet, thankfully they're not hurting me, just feel a bit numb in the skin.
    I wouldn't dream of judging you in any way, Frank!
  14. Nate
    Dr. Richard Bernstein strongly recommends that T2's use only diet, metformin or insulin for reasons discussed in the article. His book, Diabetes Solution, was copy righted in 1997. To me, he is the best diabetologist ever. I owe him my eyesight, kidney function, toes and really my life. I always recommend diabetics read his book to find the best way to handle all aspects of diabetes - T1 or T2.
  15. FrankG
    Thanks Antoinette :-) I also had symptoms for many years prior... it just never crossed my mind that it might be Diabetes.

    It is a frustration to me that so many Doctors are so slow on the uptake when it comes to diagnosis. They recognise that it is a serious, chronic and progressive disease but fail to realise that progressive works both ways... as pointed out above: it does not suddenly appear the night before diagnosis but has been slowly and insidiously building for many years, if not decades, prior.

    Notice it sooner (an OGTT would be great, or even just random Glucometer BGs on each visit to the Doctor) and you might have a chance to STOP, or at least slow its progression to the full blown diagnosis.

    It is far easier to lower the water pressure and shore up a dam BEFORE it has burst.

  16. Barb
    LarryB - there are coming to be more and more registered dieticians and registered nutritionists such as myself that are very, very much in line with LCHF diets, especially in reference to diabetics. Before instantly dismissing the advice of a dietician or nutritionist, at least hear them out. You will know pretty darn fast if they are on board with LCHF/Paleo-ish diets or if they are still following the low fat and high carb dogma.

    It has been my experience that almost ALL T2DM's will respond very quickly and positively to a LCHF diet (sometimes combined with metformin to increase insulin sensitivity and to prevent the liver over-producing glucose, which is common in folks with metabolic issues).

    Personally, in experiences with my clients, the only folks who do not respond amazingly well to diet alone (or diet and Met) are those T2DM's who are considered "late stage", meaning that diabetic complications have already set in in earnest, and those diabetics who are actually both T1 and T2, which occurs when the beta cells in the pancreas become damaged. Then the patient will often exhibit signs of BOTH T1 and T2.

    Unfortunately... this is often a result of "being an obedient little patient" and following the conventional high carbs diet that is prescribed to diabetics. To follow this dietary advice is a literal guarantee that a diabetic will experience the myriad of major life threatening diabetic complications (heart disease, blindness, kidney disease, neuropathy leading to amputation) as well as the minor but life affecting ones such as continual infections (especially bladder), slow healing and slow stomach emptying.

    Do your own research, and once again... seek the advice of a dietician or nutritionist who has broken free from the indoctrination. Don't expect your conventional doctor to refer you to one either. You will most often have to find her or him on your own by doing some research and pavement pounding.

    Reply: #19
  17. Nate
    Thanks Barb for learning about LCHF to help control diabetes. I'm hoping more medical people will learn the benefits of LCHF sooner than later.

    BTW, what got you to change your mind about what diet to use/recommend?

  18. Nate
    I forgot to post Jimmy Moore's low carb doctor list. If you live in North America, there is a short list of doctors who say they help patients with LCHF diets. it can be found here: http://lowcarbdoctors.blogspot.com/2010/03/dr-deborah-mckay-portland-...
  19. FrankG
    Barb great to hear that you are able to offer this as an alternative. I wish I had heard about LCHF at diagnosis (or even before). Thank you for what you do... this advice truly will increase both the quantity and quality of peoples lives. :-)

    Maybe things are changing for the better but in private conversations with Dietitians here in Canada, I have learned that: even if they personally understand and realise the benefits of an LCHF approach, they are still bound by policy and guidelines to promote the "party line".

    Reminds me of the Doctors surveyed, where a large number of them would use LCHF for themselves but were not comfortable recommending it to their patients.

    For some it may be a question of registration/licensing or even malpractice insurance... if your Doctor recommends LCHF (against policy) and a month later you have an heart attack (MI) they might fear being be sued and possibly lose their license -- despite the fact that you were probably going to have that MI anyway.

    Nate you are right about Dr Bernstein. He has also had to be a maverick and a thorn in the side of the establishment to make himself heard. As Diabetics we have much to thank him for; not least being his pioneering in home BG testing.

  20. Jo tB
    FrankG, I was diagnosed with diabetes on 2nd January 2001 (because if was the first surgery day of the new year). I was put on Tolbutamide and it was increased every other week, based on the one measurement taken by the assistant. So after 2 months, I thought this is a bummer and bought my own glucose meter and started measuring 4 times a day and kept a food diary going (all advice I found on the internet) I live in Holland, so only T1's get strips and the meter refunded. T2's have to pay for everything themselves.

    My system has always been to do my own research by reading lots of books on the subject, but in 2001 the internet had arrived so I started researching by googling diabetes and going to Pubmed to find out what the experts were saying. That is how I came across Richard Bernstein (still find him absolute tops for diabetes). Everything I read said that diabetes is a defect carbohydrate metabolism and so came to my own conclusion that I should cut down on carbohydrates. Bernstein said as much as well. Since I have struggled with my weight since I was 17 (am now 70) so cutting back on potatoes and such has always been effective for me to get my weight under control again, I naturally assumed that going Atkins would be a good idea.

    What I learned at the time was how my eating pattern had changed over the decades and that instead of eating fresh vegetables and meat I was eating more and more highly processed foods like pizzas and lasagne, which had a negative effect on my weight, put all back on what I had been able to keep off for decades. Taking birthcontrol pills for 25 years, played a roll as well. It was during the 4 readings a day that I found out that I was lactose intolerant, because my Sugar levels would go up but not go down sufficiently, and even had a cumulative effect if I ate any dairy products several days in a row. The most recent finding is that the sugar in avocados has the same effect in that my sugar levels go throught the roof and it takes days to get back to normal.

    In 2001 there were several sites dealing with diabetes and low carb. The ones I used extensively was Active Low Carber and Bernstein.

    12 years down the line I am still on the same medication, and have gone more paleo than low carb (because of the dairy), so can manage my diabetes very well.

    Reply: #22
  21. Jo tB
    Dan, thanks for the tip on Berberine. I will definitely give it a try and see how it goes. I'm taking Metformin at the moment, but you have to look closely at the ingredients that are in the various brands. They can differ greatly.
  22. FrankG
    Jo tB so perhaps the issue was that I was not even looking for alternatives to the mainstream. Perhaps in my case having good access to "health care" worked against me.

    I am not looking for excuses nor do I fail to take personal responsibility for every choice I have made as an adult.. with the caveat that I thought at the time, I was acting under the best advice currently available.

  23. Ted Hutchinson
    Even without the risk of diabetes drugs the risk of earlier death for those with Diabetes is still much higher than for those without the condition.

    We should be extremely concerned about the fact that Diabetes affects one in 10 people in parts of England

    While reducing refined carbohydrate consumption is likely to be a key factor in reducing Diabetes incidence and progression, we also have to consider reducing the pro-inflammatory factors in our diet and environment while improving our natural anti-inflammatory reserves. We know what a natural Vitamin D level is, we know what optimal intakes of magnesium, omega 3, potassium are and we know how disturbance of circadian rhythm disrupts melatonin secretion.
    What we don't seem to be doing is applying any of this knowledge either before people become diagnosed with Diabetes or after.

    We know people with higher iron levels have higher stroke risk so it would be a good idea to make people aware that regular blood donation reduces iron levels and improves risk factors for metabolic syndrome.

    Give Blood - do something amazing give Blood as regularly as possible. The life you save could be your own

  24. FrankG
    "Even without the risk of diabetes drugs the risk of earlier death for those with Diabetes is still much higher than for those without the condition."

    Certainly if they are following the standard advice but I wonder how much impact it has to be applying an LCHF approach instead... perhaps only time will tell? By every risk measure, I have slowed, stopped or even reversed my own issues resulting from Diabetes.

    I agree wholeheartedly that efforts need to be applied towards earlier detection and more rational approaches to treatments.

    Of note: in the USA at least, there was a conscious decision made to DELAY diagnosis...
    Blood Sugar 101 -- Misdiagnosis By Design - The Story Behind the ADA Diagnostic Criteria http://www.phlaunt.com/diabetes/14046782.php

  25. Dr Jason Fung
    Another great post by Dr. Eenfeldt. Treating a hyperinsulinemic state (type 2 Diabetes) with insulin (or drugs that raise insulin) is like treating alcoholic withdrawal tremors with alcohol. The tremors (symptom) get better but the alcoholism (disease) gets worse.

    The problem with diabetes is insulin resistance (the disease), but our drugs treat hyperglycemia (the symptom) instead. Because of this fundamental mis understanding, we are making things worse, not better with our treatments. Once you understand that the disease is about insulin resistance, then you see that treatment must be targeted to insulin resistance (the disease) and not just lowering blood sugar (the symptom). LCHF is one way of targeting insulin resistance.

    If you make the insulin resistance better, the blood sugars will naturally get better. But if you lower blood sugars, the insulin resistance does not get better.

    Reply: #26
  26. Ted Hutchinson
    Thank you for that perceptive comment.
    For those who aren't aware:
    Magnesium intake decreases Type 2 diabetes risk through the improvement of insulin resistance and inflammation

    There is an Inverse relationship between vitamin D status and insulin resistance

    The deficiency of omega-3 fatty acids, impacts negatively on cognitive performance and brain structure, as a result of insulin resistance-associated cerebrovascular reactivity

    Nocturnal melatonin secretion is independently and inversely associated with insulin resistance.

    Combined with some basic advice on exercise and diet the ideas to improve insulin resistance are easily doable.
    There is still a problem that environmental pollutants like BPA and various fungicides can have negative effects on insulin sensitivity and we are also going to have to consider the role of antibiotic overuse (both human and farm) in the development of insulin resistance via the role of pathogenic gut microbiota

  27. Alan
    HbA1c testing and or using a glucometer is a great way to diagnose early BG troubles. I relied on an OGTT (but this is a bit toxic and stressful to the body--my BG went to 37) to diagnose my troubles. I was damaged by fluoroquinolones in 2010 (FQs; antibiobiotics such as cipro, levaquin, and avelox).
    http://www.ncbi.nlm.nih.gov/pubmed/23948133

    FQs as a class cause dysgycemia (essentially pre-diabetes). Few MDs know this. FQs are prescribed like candy. Bayer and Johnson & Johnson, both manufacturers of FQs, seem to be creating more diabetics so that they can sell more downstream drugs to treat diabetes.

    After I failed the OGTT I started reading. First I read primary scientific articles. Then I read The Diabetes Solution. By 2011 I was eating low carb. Bernstein is quite a man. First he was an engineer. And he was an early type I diabetic with early access to a glucometer. He then decided he needed an MD to fix a few things. He takes an engineers mind to medicine. I also really enjoyed Ruhl's Diabetes 101.

    My MD did not help me in the least (I "ordered" the OGTT). The vast majority of MDs treat diabetics horribly. What a breath of fresh air to have Andreas. Andreas has helped me eat more fat. I eat about 12% carb, 18% protein, and 70% fat (when I checked for the American Gut microbiome project). I think that I eat more fat lately. Grass fed butter and homemade ghee are yummy. I drink a butter (and a bit of coconut oil) coffee homogenized with an immersion blender for breakfast that keeps me very energetic and not hungry for hours.

    Reply: #28
  28. FrankG
    "The vast majority of MDs treat diabetics horribly."

    I think for too many they fail to see the progressive nature of Type 2 (which actually starts years or even decades prior to diagnosis) and based on the fact that 80% are overweight/obese by the time of diagnosis the assumption is that overweight caused the Type 2.. therefore "it is all your own fault buddy 'cos we all know that people are overweight due to gluttony and sloth"... right?

  29. Alan
    You are right FrankG. Modern medicine has forgotten its Hippocratic roots--prevention was equal to treatments.

    I wasn't obese--but I had about 10-15 lbs extra. My MD gave no advice on how to eat to avoid diabetes. She simply said that I should eat more frequent meals....

    And when my BG was 37 guess what they gave me to eat in their office? Pizza.

    When I later told my MD that I was eating low carb she tried to frighten me with some dumb notions of cholesterol...

    FrankG I always enjoy your comments. Thank you.

  30. Ted Hutchinson
    If you were impressed by Dr Jason Fung's contribution to this thread may find his You Tube talk very interesting.
    Insulin Toxicity and How to Cure Diabetes
    Has also got a website http://kidneylifescience.ca/
  31. Marian

    Marion surely you have a choice? you do not and did not have to follow the SAD advice? Real control comes when a patient does own research and discusses alternatives with their doctor. My GP did the usual.... blood test, GTT, prescription for metformin.... I said no thank you I will diet... he said 'try it'.... I did IT WORKED my A1c is back in the normal range and fasting blood of a morning is down to 5.0. If I maybe so bold - we gave away too much of our own control to drugs..... time we took it back.One of the real problems is that many people do not understand and don't want to seem to know that by the time they receive the dreaded DM diagnosis (I am writing about t2's) they have had problems - silent ones - for up to ten years and massive damage - vascular - may have already taken place..... You do not suddenly wake up one morning a Diabetic... if only the ADA and GP's in general educated folks to this reality..... then people would have to take some responsibility for what goes in their mouths..... that old adage 'you are what you eat' makes a whole lot more sense when viewed in this way I believe. Instead, so many patients blame it on family and genes, and simply carry on regardless popping pills and needing insulin for the rest of their lives. People need to take responsibility and stop giving that away to drugs, pharmaceutical companies and diabetes educators IMHO.I mean no personal insult to your situation - I do not walk in your shoes.

    Sorry, just saw this! Clare, I dumped the SAD by Week #2 -- against doctor's advice, I might add -- and eat low-carb/high-fat. I try to eat 30g carb -- MAX -- per day. Less is best! This way, I can usually avoid taking any rapid insulin at all. But I still must take basal insulin, whether I eat anything or not. My glucose levels are near-normal now, but that's what it takes to keep me there.

    I insisted on testing whether I really was Type 2, or adult-onset Type 1. Sure enough, I am a Type 2, it's just that my pancreas was pretty much gone before I was diagnosed.

    Genetics are a very real issue, and one that needs to be explored in far greater depth than it is now. My mother's family is pretty extreme, with about 100% development of diabetes by age 70 (I was only 54!) -- and we get it regardless of weight or lifestyle. Obesity is truly rare in our family.

    For us, it's not just a matter of a sensible diet. I now see that we all may have needed severe carbohydrate restriction from childhood, decades before diabetes developed. As it is, however, I don't know if that could have prevented any of us developing diabetes, or if it would simply have lessened its severity. Might not have any effect at all! In any case, no doctor or nutritionist would suggest such a thing, even now.

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