Insulin Injections and Diabetes – A Love Hate Relationship


Do you want to gain weight? Inject yourself with insulin and you will surely accomplish that goal. It does not matter if you are diabetic or not, insulin signals our fat cells to absorb food energy and make us fat.

On the short term insulin therapy might help to regulate blood sugars, but over the long haul insulin therapy is rather costly to our health as it is fattening, inflammatory and can worsen other chronic diseases like atherosclerosis and heart disease.

This is not to say that insulin therapy should be avoided altogether, it is just a matter of appropriate use. The American Diabetes Association (ADA) guidelines for years have pushed the use of insulin therapy in type 2 diabetic patients without much regard to endogenous (pancreatic) insulin production and more importantly proper diet.

Indeed, we cannot live without insulin. There is an absolute need for insulin, to the tune of 50-100 units or less per day depending on diet. Normally the pancreas can handle insulin production. The problem with type 2 patients is that insulin receptors become resistant to the insulin signal and the pancreas struggles to keep up with insulin demand. Eventually the pancreas loses its ability to produce insulin. It is at this point where insulin therapy makes sense.

The problem we often see (based on ADA guidelines) is patients starting insulin therapy prematurely despite a functioning pancreas. Long term these patients gain weight and require more and more insulin. On high carbohydrate standard American diets (SAD), patients and healthcare professionals have few medical options.

Let us stop this insanity. The only way to reduce insulin requirement is to reduce the consumption of carbohydrates in the diet, period!

I cannot tell you how frequently I see overweight type 2 patients who are taking massive amounts of insulin to the tune of 150-250 units per day. The story is always the same. They all gained weight with the initiation of insulin therapy, especially the short acting varieties.

Teach patients how to eat low carb high fat (LCHF) foods, they lose weight and overnight insulin requirements are cut in half. Insulin resistance and type 2 diabetes are metabolic disorders caused by dietary carbohydrates and insulin overload. Insulin injection therapy is not the answer and should only be reserved for type 1 and type 2 patients who no longer produce endogenous insulin.

12 Responses to “Insulin Injections and Diabetes – A Love Hate Relationship”

  1. Larry Oct 19, 2012 at 12:11 pm #

    If only all doctors had this logic!

  2. Peggy Holloway Oct 19, 2012 at 9:29 pm #

    My sister has had a terrible time controlling her blood sugar, even on a LCHF diet. Her fasting blood sugars are often as high as 300 (she appears to experience the “dawn syndrome” as it falls during the day and doesn’t appear to be related to anything she eats) and her last HA1c was 10. Her doctor of course wants to put her on insulin, but she is very reluctant and the idea concerns me greatly. Why is her blood sugar so out of control? Since she is still overweight (after 14 years on a low-carb diet), does that mean her pancreas is still producing insulin? How can she find out if she is producing insulin and if she is one who really must take insulin to control her blood sugar?

    • Jeffry Gerber, MD Oct 20, 2012 at 12:14 am #

      Peggy – Hard to say what is going on with your sister, but it is concerning. Fasting Insulin, pro-insulin and or c-peptide levels will determine if the pancreas is still producing insulin. Her doc needs to keep close tabs on her!

      • Peggy Holloway Oct 20, 2012 at 3:03 pm #

        Do you think you could be of help if she came to see you? Denver is not out of the question in terms of willingness to travel for help. In fact, I have a son who lives in Denver.
        She did go to Lawrence to see Dr. Vernon which was an abject failure, but she might be open to seeing you if that were possible. Her own doctor is a small-town FP who is very conventional in his approach.

        • Jeffry Gerber, MD Oct 20, 2012 at 7:34 pm #

          Peggy – Our door is always open to new patients. However, any local endocrinologist in your area would be able to help your sister with a metabolic work-up. Also you might want to look at some newer medications including Byetta, Bydureon and Victoza. These medications along with a LCHF diet help type 2 patients lose weight. Please call our office to inquire further as this is a public forum. Our staff can assist you if you have more specific questions.

  3. Lori Oct 19, 2012 at 11:28 pm #

    There are blood tests that you can take to determine how much insulin your body is producing. I am certainly not a doctor but I am a Type 2 diabetic myself and your sister’s blood sugar is dangerously high. An HA1c of 10 means that her blood sugar averages 240 around the clock — more than two and a half times what it should be. Unless her blood sugar is brought under control, she is at great risk of developing the debilitating complications of diabetes — amputation, kidney failure, heart disease, blindness.

    If she is faithfully following a LCHF diet and not cheating in any way and still has such high blood sugar levels, there is a good chance that she is in the position that Dr. Gerber writes about at the end of this article — she no longer produces enough endogenous insulin to exert any kind of control over her blood sugar levels and therefore must begin taking insulin through injections. If that is the case, she needs to do this even though she is reluctant. I suppose it’s possible that she might be able to try a drug such as metformin before trying insulin but she clearly needs to start working with a doctor to find a way to lower her blood sugar.

    I am now going to be blunt with you, but please know that it is because I care. I read a lot of low carb blogs and I know that you’ve been asking this question about your sister on different blogs for a while now. Both you and she need to realize that there is no magic answer on the internet and sometimes diet alone won’t work. It’s time for her to try something else.

    • Jeffry Gerber, MD Oct 20, 2012 at 12:03 am #

      Lori – Great reply addressing Peggy’s concerns. Metformin won’t be that helpful for her sister at this stage. It is hard to say what is going without taking a close look at blood work and diet.

      • Peggy Holloway Oct 20, 2012 at 2:59 pm #

        She’s been taking metformin for 14 years and has also been on Januvia. I believe she currently takes both. She works closely with her doctor who seems clueless about how to treat her. She is very strict with her low-carb diet and is willing to go as strict as necessary and has continually tweaked her diet to make it higher in fat and lower in carbs. She saw Mary Vernon who had no clue either, other than to put her on a low-carb diet. Vernon didn’t seem to be able to understand that she had been on a low-carb diet for years and did not dig any deeper into hormonal or other issues. No one seems to ever have considered determining her insulin levels. This is incredibly frustrating. I was such a believer that eating low-carb was the answer to preventing and even reversing Type II, but now I don’t know. I’m scared for myself as I’ve been complacent that my careful diet was rendering me “immune” to this horrible “family disease” that destroyed the health of my father and grandfather, and now my sister.

  4. Guest Oct 22, 2012 at 10:47 am #

    I was under the impression that Insulin resistance is a

  5. Scott Slifer-Mosher Oct 22, 2012 at 11:06 am #

    I was under the impression that Insulin resistance is more closely related to a disfunction of the liver not just a lack of production by the beta cells, seeing as glucose can transverse cell membranes without insulin via glut-4. Insulin is not required for muscle and fat cells to access it, but it will enhance uptake at a certain level.

    “These results suggest that a low-dose infusion of insulin can lower plasma glucose entirely by reducing glucose production. Since at least 8O°O of glucose production in the fasting state is hepatic’- this strongly suggests that low concentrations of insulin act primarily on the liver by reducing either glycogenolysis or gluconeogenesis or both. Only when insulin was administeredat rates producing high physiological concentrations (about100 mUJ l ) did an increase in peripheral uptake of glucose by fat and muscle tissue contribute to lowering the plasma glucose concentration. These results confirm in man the results obtained by Issekutz on alloxan-diabetic dogs.'” We believe that theconcentration-dependent effect of insulin on hepatic glucose production and uptake by peripheral tissues has important implications for insulin-treated diabetics.” –

    Hence the High Fasting blood sugar is not coming from a damning back of glucose into peripheral and fat tissue but rather from unregulated gluconeogenesis and glycolysis in the liver. Insulin makes a newly diagnosed diabetic “fat” by keeping glucose in the body seeing as much of it was being excreted through the urine due to to high ketone bodies coming from unregulated ketogenesis before treatment began.
    So it may end up being in some instances that the Beta cells are fine, producing more then enough insulin, glucose is transversing fine into the peripheral tissue but the liver is resistant to insulin so it will not get the signal to inhibit actions when glucose levels are raised. In essence, the rate of disposal does not match the rate of production, producing high blood sugar, high ketone bodies, etc. An Lc Diet may not necessarily fix that in all instances and may do more harm then good when seen from this perspective.

    • Jeffry Gerber, MD Oct 22, 2012 at 12:50 pm #

      Scott – Your comments are very insightful. Liver production of glucose significantly contributes to blood sugar but again the problem is insulin resistance and also glucagon production. In type 2 patient’s as insulin resistance worsens there is a paradoxical rise in another hormone called glucagon, also produced by the pancreas. Glucagon promotes gluconeogenesis from glycogen and the release of glucose into the blood stream, not so good when blood sugars are already elevated.

      Early on insulin therapy will help to lower blood sugars via many pathways but insulin therapy does very little to alter blood glucagon levels and gluconeogenesis as diabetes worsens. Metformin might help a little, but newer medications such as the GLP1 analogs (Byetta, Bydureon and Victoza), are insulin sensitizers and also work on the liver directly and also diminish glucagon production and the release of glucose from the liver. GLP-1 analogs were not available when the paper you cite was written back in 1978.

      Remember that insulin will also promote lipogensis or fat production in the liver. The goal here is to reduce insulin requirements with carbohydrate restriction, less insulin therapy, and or insulin sensitizers.

  6. Margaretrc Oct 22, 2012 at 6:03 pm #


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