With chronic physical inactivity and excessive feeding, the muscle cells have inherent ability to “resist” the action of insulin and shut off glucose entrance, leaving excessive amounts of both insulin and glucose in the blood stream – a condition called insulin resistance. So, the road to diabetes starts with the muscle’s refusal to pick up glucose in the blood stream, leaving dangerous levels of glucose in the blood stream.
There is a popular saying among Yoruba speaking people in Nigeria that, “what you are desperately searching for in Sokoto (an ancient town in Northern Nigeria) is readily available in your sokoto (pocket trousers).” I should add here that Sokoto was my adopted town for four years and it was in Sokoto that I had my first four-year clinical experience as a young physiotherapist, before coming to the United States. Equally important, Sokoto was where I met my beautiful wife and my affection for Sokoto is limitless even till date.
According to Google, the distance between Lagos, the most popular city in the Yoruba speaking area, to ancient city of Sokoto is 986 kilometres, and it would take a 16 hours, 19 minutes drive to get there by car. Now, if what you want 986 kilometres away can equally be obtained with a dip into your pocket, its no brainer what anyone’s rational choice would be.
Confusing Definitions of Type 2 Diabetes
However, when it comes to non-infectious chronic diseases, we always seem to defy logic and are quick to medicate diseases that have origins in the modern lifestyle of excessive food consumption and insufficient physical activity. A case in point is type 2 diabetes, which is conventionally described as “when the body cannot produce enough insulin to regulate blood sugar levels.” The American Diabetes Association describes type 2 diabetes as when “your body does not use insulin properly.” Well, the International Diabetes Federation says insulin is “a hormone…that…lets glucose from the food we eat pass from the blood stream into the cells in the body to produce energy”. A study published in November 2018 predicted that in twelve years (i.e. 2030), about 40 million people who need insulin would not have access to it. The question is why is insulin being pushed as a long-term necessity in controlling blood glucose?
The lack of specificity about definition of type 2 diabetes implies that the use of insulin is inevitable when in fact it’s not. I have been a physiotherapist for just over 30 years, and I know a lot of pharmacists, both as friends and colleagues, and they would often explain the function or “mechanism of action” of a particular drug based on its “target cell or organ”. This clarity is not demonstrated to the general public as far as type 2 diabetes is concerned. Again, if all you know about type 2 diabetes is the confusing information about the “…body does not use insulin properly” or insulin helps to drive glucose “…into the cells in the body to produce energy”. The question is, which cells do the insulin act on? Or which main organ in the body does insulin exert the most effect on? In other words, what is the target organ of insulin action, instead of the words like “cells” or “body”?
… medical evidence shows that skeletal muscle contributes 70 to 80 per cent of total glucose clearance from the blood stream, with the help of insulin, following feeding. Better still, skeletal muscle has the ability to pick up glucose without the assistance of insulin during physical activity through muscular contractions.
Skeletal Muscle: The Ignored Organ in Type 2 Diabetes
You might be shocked to know that the misery “cells” or the so called “body” is the skeletal muscle, which is the biggest organ in the body. Skeletal muscle is the principal site where glucose is burnt to make chemical energy called ATP. Therefore, insulin acts on skeletal muscle cells where it is burnt to make useful energy. Here is another shocker, the liver which stores glucose as glycogen does not need insulin to pick up glucose from the blood stream.
In fact, medical evidence shows that skeletal muscle contributes 70 to 80 per cent of total glucose clearance from the blood stream, with the help of insulin, following feeding. Better still, skeletal muscle has the ability to pick up glucose without the assistance of insulin during physical activity through muscular contractions. Therefore, the skeletal muscle is the target organ when it comes to insulin and major glucose clearance from the blood stream. The effectiveness of insulin on the skeletal muscle depends on the level of physical activity of an individual.
The “Road” to Diabetes Starts With Insufficient Muscular Contractions
With chronic physical inactivity and excessive feeding, the muscle cells have inherent ability to “resist” the action of insulin and shut off glucose entrance, leaving excessive amounts of both insulin and glucose in the blood stream – a condition called insulin resistance. So, the road to diabetes starts with the muscle’s refusal to pick up glucose in the blood stream, leaving dangerous levels of glucose in the blood stream. Over time, high levels of blood glucose may cause damage to the eyes, even before the diagnosis of diabetes. Hence diabetes is a disease of physical inactivity, a dietary disease or if you will, a disease of civilisation. This explains why diabetes is rarely found in hunting and gathering societies or among the indigenous populations all over the world.
Excess Insulin Promotes Fat Formation in the Liver
Prolonged high levels of blood glucose puts undue burdens on the pancreas to secrete excess insulin into the blood stream (hyperinsulinemia). Although the liver does not need insulin to remove blood glucose, it is especially sensitive to excess insulin for the formation of fat from excess glucose, which is then exported to the fatty tissues where it is properly stored. Now, if the fat depot is full, the excess fat can be sent to anywhere in the body, including the pancreas where, over time, it blocks the production and secretion of insulin, a condition called pancreatic failure. Pancreatic failure is the usual “medical justification” for insulin shot after years of the body’s inability to handle high levels of glucose and fat.
Lifestyle treatment would not only reduce the demand for insulin, it would improve access to people with type 1 diabetes who actually need it. As stated by Dr. Sarah Hallberg, a US endocrinologist who advocates keto diet for diabetes, “you don’t treat food disease with medicine.”
Put simply, at the time someone needs insulin, the insulin resistance is well established in the skeletal muscle and the “target organ” for glucose removal is the liver, which converts this excess glucose into fat for storage. Therefore, insulin is often referred to as storage and hunger hormone, as the majority of people on insulin stay hungry with the tendency for weight gain.
More Insulin Is Not Better
A high level exposure of the skeletal muscle to huge levels of insulin increases its resistance, causing the liver to make more fat. As noted by Jason Fung, a Canadian doctor, no doctor would continue to treat a known infection that is resistant to certain antibiotics with the same old antibiotics, and no alcoholic would be advised to consume more drinks to get sober. Yet most anti-diabetic drugs act to stimulate pancreas (insulin secretagogues) to secrete more insulin or act temporarily to improve insulin resistance until the pancreas is unable to secrete any more insulin. This explains why 50 per cent of patients with diabetes on aggressive glucose lowering drugs would need insulin injection within 10 years, as noted per medical literature.
Diabetes Is Reversible
Studies have clearly demonstrated that that obese people with diabetes who underwent bariatric surgery purposely for weight loss had their blood sugar normalised within a week because of forced drastic change in consumption. There have also been studies that showed that individuals with diabetes normalised their blood sugar with the keto diet and low carbohydrate, high fat diet, because fat consumption hardly provokes insulin secretion during feeding. In addition, intermittent fasting and regular exercise under medical supervision allow the body to deplete excess glucose and fats and thus reduce insulin levels with the added advantage of weight loss.
As they say, when you are in the hole, stop digging. Long term insulin shots worsen insulin resistance in the skeletal muscle and cause the liver to make more fats. To the Nigerian endocrinologists, the anticipated worsening access of insulin in 2030 should be embraced as a welcome opportunity to focus on lifestyle interventions that reverse diabetes, instead of advocating for lifting the tariff on insulin, which the majority of our people are unable to afford anyway. If I may repeat, what you are desperately searching for in Sokoto is readily available in your sokoto. Lifestyle treatment would not only reduce the demand for insulin, it would improve access to people with type 1 diabetes who actually need it. As stated by Dr. Sarah Hallberg, a US endocrinologist who advocates keto diet for diabetes, “you don’t treat food disease with medicine.”
Mukaila Kareem, a doctor of physiotherapy and physical activity advocate, writes for the USA and can be reached through email@example.com.