How Diabetes drugs stop us losing weight (and do nothing but delay the inevitable)

Drug companies have a solution to Type II Diabetes unfortunately their ‘solution’ will make us almost as fat as their wallets (and won’t change the outcome).  The real solution is much simpler and you don’t need to buy anything from anyone to implement it.
Our body is a machine that runs on a fuel of pure glucose.  When we eat carbohydrates (like fruit, vegetables, bread, pasta and rice) our liver converts the starch in those foods to glucose.  Almost every cell in our body can burn (or oxidise to be more precise) the glucose to create energy. 

Managing the fuel (glucose) levels in our blood is therefore pretty important to our wellbeing.  The level of glucose is managed by two primary hormones.  We release insulin when blood glucose goes up and glucagon when it drops. 

The insulin helps cells access the glucose in the blood and either use it (if they need it) or turn it into fat for storage.  Either way, a primary function of the insulin is to lower the amount of glucose in our bloodstream.  If blood sugar stays high for a long time, damage starts to occur in places where we have lots of small blood vessels, such as our kidneys, our eyes and eventually our hands and feet.
Glucagon does the same thing in reverse.  The combination of the two hormones working together means that normally our blood glucose levels stay in tight range regardless of what (or when) we eat.
Sometimes we can become resistant to insulin.  This simply means that cells do not respond as efficiently as they should and glucose stays in our blood for too long.  
Doctors can tell when we are insulin resistant because our blood glucose levels remain too high for too long after eating.  But (at least at first) there are no real symptoms that we have the problem.  And so a majority of people who are insulin resistant don’t know it.
If you remain insulin resistant for long enough, at certain levels, you will be declared to have Type II Diabetes.
Our body usually responds to insulin resistance by pumping up the insulin levels until the glucose is cleared.  If we ask our body to run on overdrive like that for years, for most of us, our pancreas (the insulin maker) will pack it in and we will need to get daily insulin injections to live.
One carbohydrate (and only one) does not work this way.  Fructose is not normally converted to glucose and does not trigger an insulin release. It is instead converted to saturated fat by our liver.  So for a long time, fructose was prescribed as a perfect sugar for Type II Diabetics.  Unfortunately it looks like that cure is turning out to be the cause of the disease. 
Last week, the American Heart Association issued a scientific position statement which makes it clear that they are satisfied that fructose does indeed create dangerous levels of circulating fats (called triglycerides).  The statement went further and warned that the creation of triglycerides is directly linked to the onset of the insulin resistance which leads to Type II Diabetes.  In other words, fructose consumption is likely to be a significant cause of Type II diabetes.
The primary source of fructose in the Australian diet is sugar.  So the obvious cure for Type II Diabetes would be to tell people to stop eating sugar.  But there is no money in telling people to not eat something.
No, if you are diagnosed with Type II Diabetes in Australia today you will be put on drugs to sort you out (after a perfunctory nod to ‘lifestyle interventions’).  
The standard treatment for high blood sugar (and therefore diabetes) is a prescription of ‘eat less fat and exercise more’. When that doesn’t work (as it almost never does) the prescription is changed to a combination of drugs.
There are a few different types of medication but the ones most commonly used in Australia work by stimulating the body to produce more insulin.  The drugs squeeze that little bit more insulin out of our pancreas to help clear the blood sugar. As you might expect, putting the pancreas on overdrive eventually results in it conking out completely. Then the only option is to start injecting insulin every day.
Unfortunately a side effect of the drugs is weight gain. Insulin does clear glucose from the bloodstream,  but if the cells don’t need the glucose, they just turn it into fat.  Giving people more insulin (or giving them drugs to force them to produce it themselves) simply channels sugar out of the bloodstream and converts it into body fat.
Using drugs to force insulin resistant person to make more insulin just moves the immediate problem from the bloodstream to the tummy (or bot-bot). And even then it only works until the pancreas packs it in anyway.  Removing the cause (fructose) would be infinitely more effective but if the drugs remain part of the prescription while that is going on, motivation will soon be a problem (because it will be very difficult to lose weight).
We need a new approach to treating insulin resistance.  We need an approach based on the science rather than one based on a drug manufacturer’s bottom line.  People diagnosed as being insulin resistant (or ultimately Type II Diabetic) should be told the truth about sugar and then told how to remove it from their food supply. 

When this happens (and only when this happens) will we start to make a real difference in the progress of a disease that is responsible for more than 9 limb amputations a day in Australia and is our 6th biggest killer (heading for #1 with a bullet).

Join the discussion 12 Comments

  • Jillian says:

    Most refined or starchy carbohydrates convert to sugar (I’m talking bread, cakes, cookies, potatoes, pasta, breakfast cereals). The only way to fight diabetes is to reduce these carbs and processed foods laiden with sugar.

  • Browney says:

    I scored a 5.6 in a recent fasting glucose blood test, which means I have to sit for an oral glucose tolerance test.
    I don’t eat added sugar and have minimal carbs, and think i eat a reasonably balanced diet, I exercise 3 days a week. I can’t place why my FGT would read high, can you offer any help?

  • Jane Grey says:

    I’ve just read Gary Taubes, Why We Get Fat (Knopf, New York 2011). He writes that when blood glucose levels are low, as he says they are every night when it’s some hours since a meal, our system runs on ketones plus some glycerol (see p. 177). He advocates not just low sugar but very low carbohydrates.
    Could you comment on the role of ketones?

  • Farmer girl says:

    Hi David, I am wondering what your thoughts are on a recent review in Nutrition and Metabolism journal – Salwa W Rizkalla Nutrition & Metabolism 2010, 7:82 (4 November 2010) and this one: Dolan LC, Potter SM, Burdock GA: Evidence-based review on the effect of normal dietary consumption of fructose on development of hyperlipidemia and obesity in healthy, normal weight individuals.Crit Rev Food Sci Nutr 2010, 50:53-84.

    Thanks for an interesting blog site. Anne

  • Anne – those two studies are excellent examples of the current strategy being pursued by the sugar industry – what I like to call selective meta-analysis.

    The Rizkalla study selects studies apparently at random (and at some length), but in the end of the day relies heavily on a flawed analysis prepared by Livesy and Taylor.

    An editorial in the same issue of the journal in which it was published pointed out: “This meta-analysis is difficult to interpret, because it involves randomized and nonrandomized studies of differing designs, mixed populations (diabetic and nondiabetic, lean and obese), different control diets (including some sucrose-based diets that contained fructose), different study durations, and limited endpoints; it also represents an analysis by an industry-sponsored group of a highly selected list of studies (42 of 3331).”

    That ‘study’ was sponsored by Danisco, the world’s largest purveyor of fructose.

    The Dolan meta-study is a similarly selective look at the evidence which results in a review of just 10 studies. It was sponsored (and to a large degree conducted by Tate & Lyle – one of the world’s largest sugar producers.

  • Susan C says:

    Ok, I’m insulin resistant. What’s the answer other than the obvious cut out sweets such as candy cakes cookies. Most of us can get that far. But when it comes to naturally occurring sugar fruit, pasta, etc we don’t know what to eat or not eat. Do you have another post about that?

  • I don’t really have a post about that Susan, but I have written a book about it … details here:


  • Shelley Dark says:

    David I looked at the Annals article, and it seemed that the scientists were differentiating between fructose and glucose, or indeed other forms of sugar, and recommending more research. You lump all sugars together, and use the Annals quote to support your argument. Being keen on consuming sugar (although I am not fat) I am very interested in theories which portray sugar as a “killer”, but your arguments come across as a little evangelical rather than scientifically sound and emotionally detached.

  • Shelley Dark says:

    Last night I was listening to ABC radio on Tony Delroy’s nightlife. Leigh Dayton, the science writer for The Australian, spoke on how there is no evidence to support the theory that sugar is bad for us. Consultant dietitian Bill Shrapnel, deputy chairman of the Sydney University Nutrition Research Foundation, agrees. It’s impossible for a layman to sort out he truth in all this. But David you are a lawyer, not a doctor, so it’s much harder for you to persuade from that background.

  • Betty says:

    Shelley, have you read David’s book? In it he focuses on the dangers of consuming too much fructose, in particular. From my readings, he does not seem to be lumping all sugars together. He talks in detail about different sugars and the different ways they are metabolised by the body. For example, lactose and glucose are far safer than fructose.

  • rain says:

    It has to be investigated further. The medication is still not known.

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  • Bethany says:

    It is no surprise that certain drugs will have these negative effects. I tried talking with a chemist about this and he said that we can not generalize every medication for what it does to some. This is why you need to consult an expert before taking anything.

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