Diabetes type-2 patients can stop insulin treatment when following the low carbohydrate lifestyle

Transcription

1 Diabetes type-2 patients can stop insulin treatment when following the low carbohydrate lifestyle EFAD Congres, Rotterdam, The Netherlands November 2018 Harriet Verkoelen, Dutch dietician and Diabetes nurse specialist Boardmember of the Dutch Knowlegde Centre for Dieticans on Overweight and Obesity, Netherlands

2 Disclosure Rotterdam, november 2018 Owner of dietician practise Prima Vita No employees No connections with industry Wrote 3 books on the low carb lifestyle Colleagues trainings Boardmember of the Dutch Knowlegde Centre for Dieticians on Overweight and Obesity, Netherlands

3 Prevalence of T2 diabetes Estimated increase: 425 million people in million people in million people in 2045 International Diabetes Federation. IDF diabetes Atlas. 8th ed. IDF,

4 Guidelines 1. Nutrition / lifestyle changes 2. Pharmacotherapy Weight management is a cornerstone of metabolic health

5 Problem pharmacotherapy Unwanted side effect of diabetic pharmacotherapy (Sulfonyl Ureuam (SU) and insulin): WEIGHT GAIN! Dr Jason Fung in Diabetes Unpacked : Blood sugars get better with insulin but the diabetes is getting worse de Wit, H., Vervoort, G., Jansen, H. et al. NED. TIJDSCHR. DIABET. (2014) 12: 29. Yadgar-Yalda, R., Coman, PG., Fourlanos, S. et al. Intern Med J Jul;46(7): doi: /imj

6 Exciting Switch Symptomatical vs causal treatment Pharmacotherapy vs lifestyle / stimulating weight loss Break the progressive development of T2DM Reversing T2DM through diet Volek, JS.,Fernandez, ML., Feinman. RD., et al dietary carbohydrate restruction

7 Low carb dietary advice Low carbohydrate lifestyle decreases the need for insulin Low insulin (anabolic hormone) levels induce fatburning and thus weight loss

8 Approach of my research In T2DM and insulin treatment: - Reduce carbs quantity < 50 grams a day - Reduce insulin quantity, goal is zero insulin - I registered for half a year

9 Included Included were: - all T2DM patients with insulin treatment - at least 2 Hba1c levels known at start and after half a year Also 2 type 1 patients (T1DM) were treated with a very low carbohydrate diet because of poor diabetes regulations Of course they could not reverse their diabetes

10 Results I found a total of 38 T2DM patients included 35 stopped insulin treatments (92 %) Results are similar to other programs like Virta Health and also of Dr David Unwin

11 Population 38 T2DM patients with insulin treatment 9 male; 29 female Average age: 61.3 years Youngest: 31 Oldest: 71

12 Type 1 diabetes 2 T1DM patients 1 male; 1 female 26 and 28 years HbA1c levels at start: 53 mmol/mol (7%) and 80 mmol/mol (9.5%) After 6 months (carbs grams/day): 46 mmol/mol (6.4%) and 50 mmol/mol (6.7%) Minus 16 and minus 11 units insuline (Insulin from 40 to 24 units and 36 to 24 units)

13 Carbohydrates The dietary advice was reduced carbohydrates to less than 50 grams a day Average carbohydrates per day was: 31 grams

14 stopped 39 type1 40 type1 Grams of carbs a day 70 carbs/day (g)

15 Insulin Total amount of insulin in 38 T2DM patients before: 2537 units Average: 66.8 units After: 266 units In total 2271 units less units insulin is 90% less units insulin

16 Insulin change 300 Insuline change insuline start insuline end

17 HbA1c Average HbA1c before 63 mmol/mol (7.9 %) Average HbA1c after 57 mmol/mol ( 7.1%) 1 person dropped 28 mmol/mol (4.7%) In total : - 25 dropped - 4 stayed equal - 7 raised in HbA1c

18 HbA1c change 100 HbA1c in mmol/mol HbA1c start HbA1c end

19 Weight Weight loss in total kg s of 34 persons (4 unkown) Average of 13.3 kg s

20 stopped 39 type1 40 type1 Weight change Weight change 160,0 140,0 120,0 100,0 80,0 60,0 40,0 20,0 0,0 Weight start Weight end

21 Remarkable findings 1 Male, T2DM, BMI 33 Insulin for 25 years: 250 units HbA1c 73 mmol/mol (8.8%) Started a verry low carb diet (30 grams) After 1 year: no insulin! HbA1c 46 mmol/mol (6.4%) Follow up: almost 4 years without insulin

22 Remarkable findings 2 Male, BMI 22 Half a year ago diagnosed with DM, no antibody s HbA1c 114 mmol/mol (12.6%) Fasting glucose 18.4 mmol/l (331 mg/dl) Got sick of SU-tablets Refused insulin that was recommended Started verry low carb diet (<50 grams) After half a year (1500 mg metformine) HbA1c 40 mmol/mol (5.8%) Fasting gluc 5 mmol/l (90mg/dl)

23 Type hier een titel type hier tekst

24 Bloodglucoselevels vs insulinlevels Joseph Kraft Diabetes epidemic & you OGTT with insulin measurements (Kraftcurves): Hyperinsulinemia is worse than hyperglycemia

25 Kraftcurve Glucose Insuline

26 LDL-cholesterol In low carb diets LDL-C particles change from small dense to high dens particles, which is good

27 Conclussions T2DM needs a causal treat Focus on weight and low carbohydrate lifestyle Insulin can often stop indepent of bloodglucose

28 Discussion Only 38 T2DM and 2 T1DM patients Short period of time My patients are likely to be more motivated Hyperinsulinemia is worse than hyperglycaemia Change protocol? Measure insulin first?

29 Diabetes defeated! Thank you for your attention!