Thursday, April 18, 2013

Insulin Can Be Deadly for Type 2 Diabetes

 Insulin is an absolute lifesaver in Type 1 Diabetes, where the body doesn't produce enough insulin.

However, I have resisted giving insulin to my Type 2 Diabetic patients because they already make too much insulin.  Elevated insulin levels increases inflammation in the vessels which can cause hypertension and increase heart disease and stroke risk.  It can also cause blood disorders.

When I first started my medical practice over 20 years ago, most doctors were touting the oral medications for Type 2 Diabetes as better than insulin.  Insulin was rarely given unless a patient was completely uncontrolled.  However, over time, many of the oral agents have proven to increase risk of heart disease and other major complications, and we have seen in the last 5 years an increase in the use of insulin for Type 2 Diabetes again.
A new study was released in February 2013 in the Journal of Clinical Endocrinology and Metabolism following over 84,000 patients over 10 years and the clinical outcomes of their diabetic regimen, which confirms my reservations about using insulin in Diabetes Type 2  (

Compared to using Metformin alone, those using insulin alone had an increased risk of a major cardiac event, cancer, or early death by 80 per cent.  Insulin use nearly doubled heart attack risk, and more than doubled neuropathy risk.

Patients who took metformin and insulin together were also at high risk of suffering a major cardiac event, cancer, or early death.  And those who took sulfonylureas (Glucotrol, glipizide, glyburide, and Glucovance in combination with metformin) also had increased risk of heart disease and death over metformin alone.  This is because sulfonylureas increase insulin levels as well. 

The increase in cardiac events and death rates was independent of the average levels of blood sugars.

The conclusion of the study reads:  "In people with T2DM, exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality. Differences in baseline characteristics between treatment groups should be considered when interpreting these results."                    

Most doctors assume that decreasing blood sugar levels is the end point in maintaining health in diabetes.  Flooding the body with more insulin forces blood sugar into the cells and out of the blood stream, so increasing insulin works in the short term.  But the long term effects of excess insulin are not taken into consideration.

When patients come into my office on insulin it is hard to get them off because the body is used to the high levels.  When weaning from the insulin the blood sugar spikes high enough that it scares the patients.  However, if someone is determined to get off the insulin, we use a combination of diet, exercise, metformin, SpringTree Glucose Balance, SpringTree SuperMulti Plus, fish oil and krill oil to get them off. 

The blood sugar may spike in the beginning, but over time it often begins to come down.  The supplements help protect the body from the damaging effects of the high blood sugar, and the insulin levels come down rather than increasing, which protects the body from the inflammatory effects of high insulin.  Most patients feel better, even if their blood sugar readings are a little higher.  I would rather have higher blood sugar readings and protect the vessels through supplements than have higher levels of damaging insulin.

WARNING:  Do not stop insulin if you have Type 1 Diabetes or if your insulin level is proven to be too low.  Insulin is necessary in these situations.  However, if a Type 1 patient follows the typical advice of "eat what you want and cover yourself with insulin," more and more insulin is usually needed over time, which can cause insulin resistance and Type 2 Diabetes along with Type 1.  Then the problems caused by high levels of insulin can happen in this situation as well.  It is best to eat a diet as that recommended in the free e-book along with exercise to use as little insulin as possible to keep the blood glucose under control.

For a free booklet on diabetes go to

Until we meet again,
Dr. Judi

Sunday, April 14, 2013

Pain Relievers (NSAIDs) Increase Risk of Heart Disease

Diclofenac (Voltaren, Cataflam) and rofecoxib (Vioxx) were shown in the following study to increase significantly the risk of cardiovascular disease and deaths. Diclofenac increased the risk 91% and rofecoxib inreased the risk 66%. Vioxx was removed from the market in 2004 because of this problem, but diclofenac is still a very popular non-steroidal anti-inflammatory drug.

Even ibuprofen showed a small, dose-dependent trend for increase in cardiovascular risk. The only NSAID that didn't show an increased risk was naproxen.

Two NSAIDs Were Associated With Increase in Heart Risks

by Diana Mahoney

The nonsteroidal anti-inflammatory drugs rofecoxib and diclofenac were linked to increased cardiovascular mortality and morbidity in a nationwide cohort of otherwise healthy Danish residents, while naproxen appeared to be associated with the least cardiovascular risk, researchers reported.

Dr. Emil Loldrup Fosbøl of Gentofte University Hospital in Hellerup, Denmark, and colleagues reported that
patients in the study taking the nonselective NSAID diclofenac (Voltaren, Cataflam) had a 91% increased risk of cardiovascular death, compared with patients with no NSAID history, and patients taking the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib (Vioxx), which was withdrawn from the market in 2004 because of poor cardiovascular safety, had a 66% increased risk.

The investigators also observed a small, dose-dependent trend for increase in cardiovascular risk associated with ibuprofen, while no such relationship was observed with naproxen, they wrote (Circ. Cardiovasc. Qual. Outcomes 2010 June 8 [doi: 10.1161/CIRC OUTCOMES.109.861104]).

The epidemiologic study included data for
1,028,437 individuals, median age 39, collected from 1997 through 2005. Approximately 45% of the cohort had a history of some NSAID use during this time....

Ibuprofen showed a dose-dependent association with coronary and stroke event risk in the Cox analyses, with a decreased risk of coronary death, nonfatal MI, and stroke in low doses and trend for increased risk in high doses, and, as in the crossover analysis, “naproxen was associated with a trend for neutral or decreased risk of all the examined end points,” they wrote.

In repeat analyses conducted on a population of NSAID users and sex-, age-, and time-matched NSAID nonusers,
a trend for a higher increase in cardiovascular risk was associated with use of all of the NSAID drugs, the authors reported.
Disclosures: The authors report no financial conflicts relevant to this investigation.

Family Practice News, Volume 40, Issue 12, p. 18 (July, 2010)

Dr. Judi here: NSAID use has shown increased risk of ulcers and intestinal bleeding which has lead to death, increased risk of kidney failure which has lead to death, increased risk of kidney cancer which has lead to death, and now increased risk of heart disease.  As with any drug, even over-the-counter medications, do your homework and make sure that the benefit of taking them is greater than the risk.

When people are in pain now, it is hard to ignore the painkilling effects of NSAIDS.  Acetaminophen has it's own problems causing liver damage and failure.  What can be used instead, without going on to opiate medications?  This will be addressed in future blogs.

Until we meet again,
Dr. Judi