Glucagon--the Forgotten Blood Sugar Hormone that can Make Diabetes Worse

Glucagon is often overlooked as a possible cause of high blood glucose levels. 

Glucagon is a hormone that works opposite to insulin. 

Insulin allows glucose into cells, and when the cells have adequate glucose, insulin causes the glucose to be stored in the liver and muscles as glycogen.

Glycogen--linkages of glucose

When blood sugar levels drop, glucagon is released to cause the glycogen to break down into glucose to bring the blood glucose levels up.

So in general, insulin decreases blood glucose levels by causing glucose to go into cells and storing glycogen, and glucagon increases blood glucose levels by breaking down glycogen into glucose.

Most people with Diabetes Type 1 who take insulin shots also have an emergency kit with a glucagon shot to help bring up the blood glucose if the levels drop too low.

Doctors usually concentrate on insulin levels to deal with diabetes.  However, most doctors don't realize that glucagon can also play a role in elevated blood sugar in people with diabetes.

Whenever the pancreas senses the blood sugar levels are too high it will release insulin to open the cells to accept glucose.  And whenever the pancreas senses the cellular glucose levels are too low, it will release glucagon to bring the glucose levels up.  You need a healthy balance of both hormones to keep your blood sugar in check.  But with diabetes, this delicate balance is disrupted.

In Diabetes Type 1, the pancreas can't make enough insulin, and so not enough glucose can move into the cells.  In Diabetes Type 2, the cells become resistant to the insulin, and so not enough glucose can move into the cells.  In both situations the blood glucose levels are too high, but there isn't enough glucose in the cells to make energy.  Because there isn't enough glucose in the cells, glucagon is released to break down the stored glucose in glycogen so the glucose goes higher.  Instead of working with insulin to maintain healthy blood sugar, it can send your blood sugar levels sky high.

Because of this, more and more insulin is needed to bring glucose levels down and make more glycogen, but in both Type 1 and Type 2 diabetes the cells can become more insulin resistant, causing more glucagon to be released, making it much more difficult to control blood sugar.

The good news is, there has been a recent breakthrough discovery of a 5,000 year old Chinese nutrient that naturally lowers glucagon levels while supporting healthy insulin levels and helping your body burn off excess blood sugar.

For centuries this nutrient was used to treat infections and fight inflammation.  But recently, modern medical science discovered that it can have a powerful effect on blood sugar as well.

Berberine

This amazing nutrient is called berberine.  It is found in many natural plants such as barberry, goldenseal, oregon grape, and more. 

In a study in 2008, Efficacy of Berberine in Patients with Type 2 Diabetes (Jun Yin, et. al.) berberine was given to a group of diabetics.  A placebo was given to another group.  During the 12 week trial, the patients given berberine saw their fasting blood sugar go from an average of 172 to 97!  Their glucose tolerance, a measure of how well they metabolize excess glucose, improved by 44%, and their hemoglobin A1C decreased from an average of 8.1 to 7.3.

Further studies showed that berberine helps lower glucagon levels, slows down carbohydrate digestion, promotes healthy insulin levels, reduces inflammation, lowers cholesterol and helps release AMPK, which works as a metabolic "master switch."  It has shown to be as effective as equivalent doses of Metformin in balancing blood sugar and insulin.

We are pleased that one serving of our SpringTree Glucose Balance contains 600 mg of berberine, more than you will find in most other glucose support supplements, as well as many other nutrients and herbs which support the balance of glucose, insulin and glucagon.  You can go up to 1500 mg. of berberine a day without major problems.  If you have diabetes, I highly recommend berberine as part of your daily supplements.

Until we meet again,
Dr. Judi

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  (http://jcem.endojournals.org/content/98/2/668.abstract?sid=431db3d9-1303-4a28-b796-89e12ee5c0d2).

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 www.springtreehealth.com.

Until we meet again,
Dr. Judi

About the Medicines Used for Diabetes

The information in this blog is rather technical and probably boring for someone who doesn't have diabetes. However, if you are on any type of medication for diabetes I recommend that you at least read about the medicines you are taking. It is important to be knowledgable about what you are taking into your body, so that you can be aware of what is helping and what may be causing a problem.

Type 1 diabetes is always treated with insulin. Without insulin, a person with type 1 will develop hyperglycemia that progresses to ketoacidosis, and eventually death. They are usually given a long acting insulin that is given in shots once or twice a day, depending on the type, and then supplement it with short acting insulin at mealtime to cover the amount of carbohydrates they eat. There are various brands and types of long-acting and short-acting insulin, and sometimes they are put together in one shot. The combination shot may work for some people with type 2 diabetes, but I don't recommend it for type 1.

Type 1 diabetics now have the option of using an insulin pump, which keeps a more steady flow of insulin. However, they often still may need to give extra short acting insulin to cover their meals.

Often I have heard doctors tell type 1 diabetics that they can eat what they want; just cover the amount of carbohydrates with adequate insulin. However, if type 1 diabetics eat high carbohydrate meals or eat too much so that they need large amounts of insulin, eventually their cells become resistant to insulin and they also develop type 2 diabetes. High levels of insulin also increase fat deposition and increase inflammation in the body, which increases hardening of the arteries, heart disease and stroke risk. I believe that it is very important for all diabetics to watch what they eat, and recommend the Sugar Stabilization Program given later in this book.

Type 2 diabetes is usually treated with oral medications, unless it advances to a level where they no longer work, and then insulin is given.

Please read the following carefully if you are taking oral medications for diabetes. Make sure the medication you are taking is not causing you serious side effects.

The various types of oral medications can be catagorized as follows:

•Sulfonylureas. Sulfonylureas used to be the first medication to be prescribed for type 2 diabetes. However, with the newer drugs, they are usually now added after the other drugs are not giving enough control. Sulfonylureas lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent, have more side effects, and are shorter-acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab, and Amaryl. These drugs can cause a decrease in the hemoglobin A1c (HbA1c) of up to 1%-2%.

Sulfonylureas often induce hypoglycemia (low blood sugar) which often prevents a diabetic from achieving good glucose control; people usually keep their blood glucose elevated above optimal in order to reduce the frequency and severity of hypoglycemia, which can cause coma.

Like insulin, sulfonylureas can induce weight gain, which increases problems associated with diabetes. Other side-effects can be abdominal upset, headache and hypersensitivity reactions.

Sulfonylureas are potentially harmful to the fetus and should not be used in pregnancy or in patients who may become pregnant. Impairment of liver or kidney function increase the risk of hypoglycemia, and are contraindications.

The use of sulfonylurea agents has been reported, but not proven in all studies, to increase the risk of death from heart and blood vessel disease, probably because they cause an increase in insulin levels. Patients with diabetes are already more likely to have these problems, but they should be aware that many of these drugs make heart disease worse. However, glyburide (Micronase, Diabeta and Glynase) and gliclazide (Glipizide) have been shown in studies to have a positive effect on heart and blood vessel disease.

•Biguanides. Metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza) is the most commonly used oral diabetic agent, and actually originates from the French lilac (Galega officinalis), a plant known for several centuries to reduce the symptoms of elevated blood sugar.
Metformin works by reducing glucose production by the liver (gluconeogenesis). The "average" person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third. Metformin also causes the cells to become more sensitive to insulin, increasing glucose uptake by the cells and therefore lowering blood sugar. Meformin can decrease the HbA1c 1%-2%. It also increases fatty acid oxidation, which reduced triglyceride and LDL cholesterol levels.

Unlike other diabetic medications, metformin does not cause low blood sugar, one of the most dangerous side effects of most medications. It has a lower side effect profile than the other drugs.

The most common side effect is gastrointestinal upset, including diarrhea, cramps, nausea, vomiting, and increased flatulence. GI upset happens most often at the beginning of use, or when the dose is increased. It is better to start low and slowly increase.

Metformin should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients, which can cause death.

•Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Rosiglitazone (Avandia) and Pioglitazone (Actos) are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications.

These drugs may take a few weeks before they have an effect in lowering blood sugar.
The main side effect of all thiazolidinediones is water retention, leading to edema, generally a problem in less than 5% of individuals, but a big problem for some and potentially, with significant water retention, leading to congestive heart failure. Therefore, thiazolidinediones should be prescribed with both caution and patient warnings about the potential for water retention/weight gain, especially in patients with decreased ventricular function (NYHA grade III or IV heart failure).

Recent studies have shown there may be an increased risk of coronary heart disease and heart attacks with rosiglitazone.

Pioglitazone treatment, in contrast, has shown significant protection from both micro- and macro-vascular cardiovascular events and plaque progression.

•Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.

•Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.

However, these medications can still cause hypoglycemia to some degree. They can also cause weight gain because of the increased levels of insulin.

•Dipeptidyl peptidase IV (DPP-IV) inhibitors, including sitagliptin (Januvia). Januvia works to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain, and often reduces appetite. The medication may be taken alone or with other medications such as metformin.

Side effects include headache, nausea, diarrhea or constipation, sore throat and respiratory tract infections. More rare but serious side effects include fever and a headache with a severe blistering, peeling red rash. Many report an increase in joint pain. The FDA has warned of serious pancreatitis that can lead to death.

•Incretin mimetics. Exanitide (Byetta) is a new class of medication approved in 2005. Byetta is administered as a subcutaneous injection (under the skin) of the abdomen, thigh, or arm, 30 to 60 minutes before the first and last meal of the day. It is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster. It enhances the glucose-dependent secretion of insulin, suppresses glucagon secretion, and slows gastric emptying. It supposedly reduces appetite and assists with weight loss.
The main side effects of Byetta use are gastrointestinal in nature, including acid or sour stomach, belching, diarrhea, heartburn, indigestion, nausea, and vomiting. Other side effects include dizziness, headache, and feeling jittery. The FDA has issued a warning about severe pancreatitis that can lead to death associated with Byetta.

•Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.

When blood sugars are not able to be controlled with oral medication, a person with type 2 diabetes may also be placed on insulin.

The next blog will be about diets used for diabetes, including my Sugar Stabilization Program.

Until we meet again,
Dr. Judi