Chapter 2 – What is diabetes? (treatment)

As you might expect almost all of the treatments for diabetes focus on increasing insulin levels, or trying to overcome the build-up of resistance to the effects of insulin in two organs, the liver and skeletal muscle (what you or I would call muscle). For these are the only two parts of the body where a problem, if it can be called a problem, exists.

Muscles can store glucose, about one thousand calories in an average sized person. Glucose is stored as glycogen (lots of glucose molecules stuck together as a ‘polymer’). This reduces the amount of water needed to surround each glucose molecule. The liver can store about five hundred calories, also as glycogen.

So, three mars bars and your sugar/glycogen stores are full. Once this happens the liver switches on a different system, known as lipogenesis (the creation of fat). Thus, after a high carbohydrate meal, if your glycogen stores are full, the liver will start producing fat, from glucose. It will then send this excess fat out, wrapped up in triglycerides (also known as very low density lipoproteins VLDL) – as these lose fat, they shrink down to become LDL (low density lipoproteins a.k.a. ‘bad’ cholesterol).

Anyway, with regard to the drugs used to treat diabetes, we have metformin – the most commonly used. This helps to reduce release/ formation of glucose, from glycogen, from the liver (gluconeogenesis), and increases insulin sensitivity in the muscles. We also have sulphonylureas, there are many of these, which flog the beta-cells to produce more insulin. We have pioglitazone, which is supposed to increase insulin sensitivity in muscle and does something beneficial in the liver.
We have acarbose, which stops the body digesting carbohydrates (which are all turned to sugar in the gut). We have other new drugs that increase hormones produced in the gut which stimulate insulin production after eating – in various ways. The most recent drugs are those that prevent the kidneys from reabsorbing sugar, so more sugar is lost in the urine. Hmmmm.

As you can see these are all focussed on insulin, and sugar, and nothing much else. Finally, of course, we have insulin itself. More and more people with T2DM are put on insulin to keep the blood sugar down. Of course, people are also told to lose weight and exercise more. People have been told to do this for the last forty years. Obesity and diabetes have both exploded in the past forty years. So this advice has been splendidly effective.

Extract from Chapter 2 – Diabetes Unpacked, by Dr Malcolm Kendrick