Questions about Diabetes?

materia3,

Nice informations. There are two types of oral medicines. 1.Hypoglycemic as sulphonylureas
2.Insulin senstizers as metformin.

If we look deeply we may find that treatments by senstizers, diet & excercise of IR--all may lead to lowering of insulin levels either by excess uses or by lowering its secretions. Acc. it can be thought that higher insulin in blood at pre-diabetic( due to occasional & excess eating habit, may be due to genetical pre-disposed causes of excess & occasional insulin & gastric acid secretions OR due to Modern lifestyles) & diabetic stages may lead to IR condition.

But the question here is that, when we have excess insulin levels why we need Hypoglycemic as sulphonylureas or outside insulin(commonly prescribed)? We can't say it is a strong shot or deficiency of insulin as it remains present in blood in excess most of the time in IR cases. We even can't differanciate in quality of insulin so induced in excess. Will insulin senstizers or diet & excercise or may be fasting(?) not be sufficient to treat it?

Reg: calcium, HBP medicine calcium channel blocker is said to cause hyperglycemic effect.
 
Regarding your comment on calcium channel blockers (CCBs) and insulin resistent Type II diabetes. I THINK (not sure) you said they were harmful by saying they cause hyperglycemia. If so, you are correct, they can be harmful. And it is true that hypertension is a very common co-morbid condition in obese Type II diabetics, both insulin resistant and non- and should be aggressively controlled. If unchecked HTN causes stroke, CAD, PAD/PVD-(leading to skin ulcers, gangene, amputation) retinopathy (blindness), nephropathy (renal failure) and painful peripheral neuropathy (which stymies exercise).

By mentioning CCBs do you think these are the agents used to control HTN in diabetics? They are NOT. They are the 4th or 5th category choice and even then should never be given as a sole agent but only as a last resort along with other agents. Such patients should first be treated w/ angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers and diuretics, as the initial step in therapy. In fact studies have shown that dihydropyridine calcium channel blockers (DCCB) have been associated with increased cardiovascular morbidity in diabetics unless given with other agents (ACE inhibitors and beta blockers). So if you are implying that CCBs or DCCBs are given to type II diabetics, you are once again making an incorrect assumption or perhaps you are the recipient of incorrect information from questionnable sources.

Diet, exercise and weight loss including cessation of nicotine and caffeine intake are the preferred ways of controlling HTN in obese Type II diabetic patients. Diagnostic testing for obstructive sleep apnea and, if found, its correction by continuous positive airway pressure. CPAP/airway pressure therapy not only prevents breathing obstruction, but has the added benefit of lowering blood pressure (without drugs) and preventing congestive heart failure due to its raising the intrathoracic pressure during the time spent in bed asleep, or awake as the case may be.

In dealing with insulin resistant type II diabetes you once again focus on a situation that you believe is universal. An important part of the management strategy is to check one's own blood glucose levels. I am not sure where you live but in the U.S., Europe and most of the world people can do this themselves at will or on a schedule, several times a day using small and inexpensive analyzers that do this with a drop of blood. In the U.S. it is as much the diabetic patient's participation in their treatment as it is the physician's and diabetic educator's role to tell such folks how to deal with their disease. Now this may not sound important but it is. If glucose levels tested by this way remain high there are responses the patient must make in terms of what meds to take and what foods to eat or not eat to reverse this situation. As I said above this is about management strategy, not about textbook biochemistry; even though that strategy is based on such biochemistry you cannot take that biochemistry and simply throw it at every person with this diagnosis at all times which it seems you are doing.

If you are treating type II insulin resistant diabetics, after they learn to test themselves and how to respond to results, the suggestion is to impose special diet, exercise (as tolerated), wt loss, CPAP therapy if necessary following tetsing for sleep apnea, controlling of blood pressure (not using CCBs first but only last if nec and then only with other agents) and then anti-diabetic oral agents, not necessarily insulin promoters. But increasing the insulin levels by oral agents to mop up extremely high glucose levels may be required in some instances but not routinely every day all the time as you seem to think is the case.
Review and study of home glucose testing results bears this out.

It is the case with basically stupid, arrogant, non-compliant idiotic patients who refuse to listen to their doctors and health care professionals. It is also the case with patients who rely on unregulated, unproven (dose-response, etc) so-called herbal medications and homeopathic remedies which, if you are from India, you know is quite the rage there. When a patient becomes non-compliant, uncooperative and "stupid" as many of this class of patient often are, and if they still have full control of their faculties and know exactly what they are doing, then there is nothing that can be done for them except to wish them luck and all the best.
 
Kumar said:
It looks quite odd. When insulin is already available in blood, how additional insulin will help? We are not giving any stronger insulin alike louder(stronger) voice as you indicated.
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"Kumar" this is another one of those choices. Learn from the analogy or not, but don't waste our time.

With respect to "We are not giving any stronger insulin alike louder(stronger) voice as you indicated." is this a deliberate attempt to appear to be stupid? What do you think is happening when extra insulin or an insulin secretagogue is given?
 
materia3 said:
Regarding your comment on calcium channel blockers (CCBs) and insulin resistent Type II diabetes. I THINK (not sure) you said they were harmful by saying they cause hyperglycemia. If so, you are correct, they can be harmful. And it is true that hypertension is a very common co-morbid condition in obese Type II diabetics, both insulin resistant and non- and should be aggressively controlled. If unchecked HTN causes stroke, CAD, PAD/PVD-(leading to skin ulcers, gangene, amputation) retinopathy (blindness), nephropathy (renal failure) and painful peripheral neuropathy (which stymies exercise).

That is true. But I want to check relation of Calcium with insulin resistance & DM2 conditions in view of CCBs hyperglycemic effect. As hyperglycemic, these can be harmful in diabetics, but I am not sure whether lowering of BP can be a reason of less blood circulation in extremities and other senstive parts. Can you tell how medicine for HTN can effect blood circulation to extremities & OTHER sensitive parts as kidney?

By mentioning CCBs do you think these are the agents used to control HTN in diabetics? They are NOT. They are the 4th or 5th category choice and even then should never be given as a sole agent but only as a last resort along with other agents. Such patients should first be treated w/ angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers and diuretics, as the initial step in therapy. In fact studies have shown that dihydropyridine calcium channel blockers (DCCB) have been associated with increased cardiovascular morbidity in diabetics unless given with other agents (ACE inhibitors and beta blockers). So if you are implying that CCBs or DCCBs are given to type II diabetics, you are once again making an incorrect assumption or perhaps you are the recipient of incorrect information from questionnable sources.

As hyperglycemic, naturally these CCB can be harmful in diabetes. But do we have medicines for HTN which are hypoglycemic or with no effect on BG? I think some medicines esp. CCBs(one type) are good for constipated patients and other may cause constipation/unclear motions. Can you tell this concept? Is it not that all types of HTN medications causes constipation/unclear motion except one type of CCB? Previously,when I was trying to know antacids, clear/unclear motions was found to be relevant with differant antacids as MOM/Sodium based for costipated people. It looks me that differant medicines are lso related to differant type of constitutions of person & opposite type of medicine(for same disorder) may effect just OPPOSITE esp. if their effects are related to digestive pHs, clearing/unclearing motions & other common disorders(not diseases)

Thanks for other informations but all those are just routine of handling this condition. But when we want to understand differantly & more deeply, we may have to look diffrant possibilities. You know so many conditions/aspects are still unclear or 'couldn't yet be known/found'. About alt. systems, it looks me quite easy & possible to handle all the coditions as you indicated, under TR system by simple tissue remedies.
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Kumar said:
various pieces of misdirection to distract from the avoidance of previous topics
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Funny isn't it that when "Kumar" gets boxed in to being required to contribute something useful through his own efforts he heads off at a tangent, yet again.

Let's remember that he is avoiding dealing with this issue;

"With respect to "We are not giving any stronger insulin alike louder(stronger) voice as you indicated." is this a deliberate attempt to appear to be stupid? What do you think is happening when extra insulin or an insulin secretagogue is given?"

Edited to add: in order for you to get out the corner into which you have painted yourself and preserve a modicum of credibility, your job is to explain in your own words why increasing insulin doses in a situation of insulin-resistance are necessary to bring blood glucose down and are not themselves the cause of the rise in blood glucose. Do you see a pattern here? You have two threads in which you have been given answers and are refusing point-blank to put those answers to good use. In both cases you are being offered a route towards gaining credibility. The question is whether you will take the opportunity.
 
Kumar: it looks me quite easy & possible to handle all the coditions as you indicated, under TR system by simple tissue remedies
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what Kumar is backing for the treatment of diabetes and other diseases, including his digression into the realm of constipation (the cause of all evils) is biochemic tissue salt therapy -- check out for sme definitions. Scroll this doc.

http://www.homeopathyeurope.org/publications/thesaurus_01.html


I wish you, your patients and family and friends with diabetes the best of luck as you all will need it. I appreciate that homeopathy and other alernative remmedies are in widespread use in your country and that you also have some ancient systems of medicine as well and that all the MD doctors sent by India overseas to study rarely return there to practice modern medicine leaving your people to rely on these methods because they frequently have little else. I have seen miraculous cures with your methods in type II diabetics who who dieted, exercised and lost weight. I attribute none of the success of of these cases to your biochemic salts or vials of homeopathic water or sugar pills and all of it to the diet, weight loss and exrecise, Lifestyle changes do work well
as does the powerful force of the placebo effect.
 
To a person who is hard to hear, you have to speak loud not just repeat your words with same voice repeatedly. If you speak even ten times--he may not hear but if you speak much louder he may hear. Alike additional insulin is just repeating or adding not giving any stronger type of it, in case when insulin is already in excess. It is easiest to understand.

Moreover, I usually avoid to awnser trolling type posts & you are also free avoid similarily, if you feel & find so. Furthur, I usually ask questions & contradict or again question on questions, if either it does not satisfy me or I couldn't follow it or I have some doubts & differant views.

Is it clear to you? If you will go on alike this I will completely ignore you, BSM,zep or any other, which you may note finally.
 
Kumar said:
To a person who is hard to hear, you have to speak loud not just repeat your words with same voice repeatedly. If you speak even ten times--he may not hear but if you speak much louder he may hear. Alike additional insulin is just repeating or adding not giving any stronger type of it, in case when insulin is already in excess. It is easiest to understand.

Moreover, I usually avoid to awnser trolling type posts & you are also free avoid similarily, if you feel & find so. Furthur, I usually ask questions & contradict or again question on questions, if either it does not satisfy me or I couldn't follow it or I have some doubts & differant views.

Is it clear to you? If you will go on alike this I will completely ignore you, BSM,zep or any other, which you may note finally.
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Kumar - lets face it, you will never be satisified because you are opposed to modern western medicine and prefer to practice tissue salt and homeopathic therapy. Just admit it and stop asking for information you have no use for.

If you still don't understand that increasing a dose of a medicine is a quanitative move and not a qualitative one (which would be increasing strength or conc), then you have conceptual problems in how insulin causes glucose to be metabolized.

To use your own analogy:

If you have only ten singers in the choir and you can't hear what they are singing and you add fifty more singers, does the sound of their voices now become audible? Does one person in the middle of the field talking make a lot of noise or do fifty people, all talking at the same level, make more noise?

If you consume one sugar wafer with X amount of sugar and then you swallow ten sugar wafers of the same type with the same amount of sugar do you get the same amount of sugar as you did for eating one? No, you get ten times as much.

But beyond this, you also seem to be unaware that insulin comes in different strengths and forms as well as doses.

from eli lilly package insert insulin products

The concentration of Humulin 70/30 is 100 units/mL (U-
100).

Human insulin manufactured by Eli Lilly and Company has the trademark Humulin and is available in 6 formulations--

Regular (R), NPH (N), Lente (L), Ultralente® (U), 50%
Human Insulin Isophane Suspension [NPH]/50% Human Insulin Injection [buffered
regular] (50/50), and 70% Human Insulin Isophane Suspension [NPH]/30% Human
Insulin Injection [buffered regular] (70/30).

Your doctor has prescribed the type of insulin
that he/she believes is best for you. DO NOT USE ANY OTHER INSULIN EXCEPTON HIS/HER ADVICE AND DIRECTION
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as are oral anti diabetes agents preferred for managing type II IR diabetes.
 
materia3 said:
Kumar - lets face it, you will never be satisified because you are opposed to modern western medicine and prefer to practice tissue salt and homeopathic therapy. Just admit it and stop asking for information you have no use for.

It is not the case. I never opposes any MASS EXISTING...KNOWLEDGE, whether it is modern or old. Alike it, I also expect others should also behave similarily atleast in disucussions/interactions with me. I respect all knowledges & similarily contradict/try to clear doubts all these unless anything looks be somewhat "absolute". But due to so many involvements in any system with hudge & overloaded studies & prescriptions & so much patients, chances of 'Miss' can be there, with or without adversities depending upon type of medicines prescribed. Let us see antacids. A person with hyperacidity with constipation, if prescribed Aluminium Hydroxide or other antacid also causing constipation--what can happen. While checking few medicines esp. persisting medicines since long, I feel there is no mistake in medicine but can be a common mistake in prescription(as in consideration of so much involvements & adversities--it may be common problem unless prescriber is just equielant to research scientist & knowing all physiological effects on particular patients, disease type & medicine type. Moreover insulin is a replacement not modren medicine & so can be common to all systems.

If you still don't understand that increasing a dose of a medicine is a quanitative move and not a qualitative one (which would be increasing strength or conc), then you have conceptual problems in how insulin causes glucose to be metabolized.

To use your own analogy:

If you have only ten singers in the choir and you can't hear what they are singing and you add fifty more singers, does the sound of their voices now become audible? Does one person in the middle of the field talking make a lot of noise or do fifty people, all talking at the same level, make more noise?

If you consume one sugar wafer with X amount of sugar and then you swallow ten sugar wafers of the same type with the same amount of sugar do you get the same amount of sugar as you did for eating one? No, you get ten times as much.

That can only be true if existing insulin in blood is not effective. Don't you think that that much added insulin can create 'hyperinsulinemia' type adverse effect? You have not anwsered that; WHAT CAN HAPPENT TO CELL RECEPTORS IF WE CONTROL OR REDUCE INSULIN & GLUCOSE LEVELS..?
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Kumar said:
Alike additional insulin is just repeating or adding not giving any stronger type of it, in case when insulin is already in excess. It is easiest to understand.
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That's just plain wrong. Read materia3's explanation.

"Kumar" if you don't even understand the basic conception that an increased dose will result in an increased blood concentration of a drug and thus, for any pure agonist, an increased effect then you are incapable of understanding any medical principles. Do you really want us to believe this?
 
Kumar said:
It is not the case. I never opposes any MASS EXISTING...KNOWLEDGE, whether it is modern or old.
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Well that, chum, is your mistake not ours.

Kumar said:
That can only be true if existing insulin in blood is not effective.
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No. Wrong.

Kumar said:

WHAT CAN HAPPENT TO CELL RECEPTORS IF WE CONTROL OR REDUCE INSULIN & GLUCOSE LEVELS..?
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What do you mean by " CONTROL OR REDUCE INSULIN & GLUCOSE LEVELS"? There are at least 4 different and separate concepts buried in that question- controlling and reducing are different things, insulin and glucose are different things. Beyond that, reducing exogenous and endogenous insulin are different concepts.
 
I will try one more (only) --[fake] example.

Kumar, you agree that insulin at 100 units per ml is a concentration of insulin?

Hypothetically lets give this to a small mammal, a mouse (working with smaller numbers help because I hate a lot of decimal places). This mouse has a circulating blood volume of 5 mls. okay?

So I give Mr Mouse 1 ml of insulin which means that 100 units of insulin is now divded up into 6 mls of solution (5 blood and 1 of the original diluent). Right? This means Mr Mouse has an insulin level of 100 divided by 6 or 16.666 units per ml of total circulating blood/fluid? Right?

Okay, not enough. Mouse glucose levels are still very high. In people insulin and orals are regulated by frequent self testing as well.

So I give Mr Mouse 2nd dose for total of 2 mls of 100 unit/ml insulin. Mouse now has 200 units of insulin mixed with 7 mls of blood and diluent? Right? Divide 200 by 7 and what do you get besides a seriously fluid overloaded and bloated mouse? If his kidneys are working he'll piss out the excess fluid quick enough.

Mickey now has 28.5714 units of insulin in each ml of blood.

Have I suceeded in increasing the %of insulin by using the same old 100 unit/ml dose? Yes. Testing shows glucose levels down to normal. But if overdosed on insulin and now hypoglycemic, then mouse has to eat some sugar or carbs. This is what people do.

This is why self-testing ad lib is so important.

You can indeed change concentration and do this two ways: by increasing dose or using a greater strength. Both ways work.

In a mouse example using a higher %concentration of insulin to achieve the desired blood level is far more cricitical (because of its small blood volume) than it is in an average adult human with approx 5000 ml of circulating blood volume. Taking one or even several mls in a human has NO effect on fluid balance whereas in the mouse example I gave it represented a signif% increase causing significant fluid overload.

By your refusal to recognize this you are turning mathematics, chemistry, biochemistry etc upside down I assume only one discipline that I know of that does this so I believe you are looking at this problem from a homeopathic perspective. SO I ask you to consider the non-homeopathic way of looking at this and forgetting that less is more and face the the very simple mathematical and logical certainty that you are wrong.

And if you want to talk about constipation then a separate thread should be employed rather than using it as a diversionary topic.
 
materia3 said:
I will try one more (only) --[fake] example.

Kumar, you agree that insulin at 100 units per ml is a concentration of insulin?

Hypothetically lets give this to a small mammal, a mouse (working with smaller numbers help because I hate a lot of decimal places). This mouse has a circulating blood volume of 5 mls. okay?

So I give Mr Mouse 1 ml of insulin which means that 100 units of insulin.
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materia3,

Mathematically that is ok. But biochemically what is the use of increasing insulin to 6ml in above example, when 5ml is already in excess & not working properly. It is somewhat like putting more water on a stone which is already in water & not getting dissolved.

Is it not the basic understanding that 'to add more insulin in blood, Insulin should be defficient in system to metabolize the available glucose'.

Anyhow, pls explain to me how adding more insulin will help in metabolizing excess glucose when insulin in system is already in excess due to IR? Can more glucose go into cells due to excess insulin? Pls also tell: how excess insulin as such can cause hypoglycemia? Whether hypoglycemia means low glucose extra or intra cellular?

"Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities."

When glucose is more taken by cells due to adding more insulin:How the question of 'too low to provide enough energy' comes in to picture?
 
What's most humorous to me is that this thread is titled, "Questions about Diabetes?"

It should actually be titled, "My unrelenting attempt to defend and convince people about a nutty theory I have about Diabetes"

-TT
 
Kumar said:
materia3,

Mathematically that is ok. But biochemically what is the use of increasing insulin to 6ml in above example, when 5ml is already in excess & not working properly. It is somewhat like putting more water on a stone which is already in water & not getting dissolved.

Is it not the basic understanding that 'to add more insulin in blood, Insulin should be defficient in system to metabolize the available glucose'.

Anyhow, pls explain to me how adding more insulin will help in metabolizing excess glucose when insulin in system is already in excess due to IR? Can more glucose go into cells due to excess insulin? Pls also tell: how excess insulin as such can cause hypoglycemia? Whether hypoglycemia means low glucose extra or intra cellular?

"Hypoglycemia, also called low blood sugar, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for your body's activities."

When glucose is more taken by cells due to adding more insulin:How the question of 'too low to provide enough energy' comes in to picture?
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This was a HYPOTHETICAL example to disprove your assertion that %conc of a drug, any drug, cannot be increased by giving more of it.

Insiofar as the rest of your assertions, management of all 4 types of diabetes is a complex combination of many different types of insulin, with or without many different types of oral anti-diabetes agents or oral agents alone and diet plus ad lib self-testing.

Outcome, based on self-testing and clinical lab studies is the only
criteria for establishing a regimen that provides adequate glycemic control and a dimunition of the potentially fatal complications of this disease. As you are no doubt aware the literature and research on diabetes is extensive and growing daily. Each patient's regimen must be individually tailored and often changed with diet as a cornerstone of success.

Being dogmatic about your own theories regarding this just doesn't fit. In fact I am not even sure what they are. But insofar
as your claim that giving a larger dose is not the same as giving a higher concentration (of insulin or any drug) is just wrong from the receiving organism's side. As anybody knows, if you are required to take say 50 mgs of a drug and only have 25 mg tablets, then taking two of them is precisely equivalent to taking one 50 mg dose. If you need 200 units of insulin but only have 100 unit/ml insulin then taking two mls works.

High insulin levels accompanying high glucose levels in an IR individual requires then either higher levels, a different type of insulin, or insulin in combination with oral A-D agents as well as tweaking of diet.
 
Kumar said:
Mathematically that is ok. But biochemically what is the use of increasing insulin to 6ml in above example, when 5ml is already in excess & not working properly. It is somewhat like putting more water on a stone which is already in water & not getting dissolved.
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Oh, for pity's sake Kumar, this is a classic example of why you need to go and learn the basics before you try to challenge people who do know what they are talking about.

DOSE RESPONSE CURVE!! What is the practical implication of "shifting" a dose response curve?
 
Badly Shaved Monkey said:
Oh, for pity's sake Kumar, this is a classic example of why you need to go and learn the basics before you try to challenge people who do know what they are talking about.

DOSE RESPONSE CURVE!! What is the practical implication of "shifting" a dose response curve?
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Here. I translated your response into Italian, then I translated it back to English. I think it will make more sense to Kumar this way (slightly cleaned up due to some idioms that didn't make it all the way back...)

Oh, not interested Kumar of pity's, this is an example classic why you must go to learn the fundamental principles before that you try to defy people that knows about that what is speaking.

CURVE OF REACTION TO THE DOSAGE!! That what is practical implication of "shifting" one curve of reaction to the dosage?
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Maybe that will clear things up for him! :D

-TT
 
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