A Case Report of 3 Diabetic Patients that are Weaned Off Insulin

Why would someone wean insulin from a Type 2 diabetic (adult-onset)? Isn’t insulin medicine for diabetes?

Good question. While insulin may lower the blood sugar and prevents immediate problems with very high blood sugars, injected insulin has its own long-term disadvantages.

Insulin Effects

Insulin stores fat and increase weight. The American Diabetes Association’s recommendation for diabetics is to lose weight. See the problem?
The fat gets deposited inside and around the organs of the abdomen. This visceral fat is laden with white blood cells called macrophages that produce pro-inflammatory cytokines that go all over the body.
After spreading, the cytokines alone or in concert with other factors cause inflammation that leads to other diseases.
The increased weight leads to higher insulin resistance that will need more insulin, forming a vicious cycle causing deterioration of other organs. This multi-system involvement manifests as end-stage kidney disease requiring dialysis, cardiovascular disease, peripheral vascular disease, and blindness, to mention a few.
Injected insulin does not solve the existing hyperinsulinemia that comes with insulin resistance.

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Intermittent Fasting in Type 2 Diabetes

Intermittent Fasting (IF) has been around for centuries, and anecdotal pieces of evidence exist about its effectivity for weight loss and diabetes control. The following case report was made in Toronto, Canada, and at the time of its publishing, it is the first study documenting IF use in diabetes resulting in insulin discontinuation.

The investigation involved 3 patients with Type 2 diabetes that are weaned off insulin with intermittent fasting (IF). It was published in BMJ Case Reports in 2018.

All 3 patients, ages 40, 52, and 67, have Type 2 diabetes, hypertension, and hypercholesterolemia.

Intermittent Fasting Method

24 hours of IF were done every other day. The total length of the study was 7 months for 1 and 11 months for 2 patients. All patients had a health lecture at the start. Then they were instructed to reduce their insulin doses and to monitor and record their blood glucose and insulin doses.

On fasting days, the patients ate only dinner. On non-fasting days, the patients ate lunch and dinner. Low-carbohydrate meals were recommended for all patients.

Follow up was done about twice a month, the patients were assessed, and blood sugar diaries were reviewed. Dietary and medication adjustments were then made.

Results

Insulin was discontinued in all 3 patients. It took 5 days in 1 patient and up to 18 days for the other one to stop insulin. In 2 patients, all diabetic medications were discontinued. In 1 patient, 3 out of 4 diabetes medicines were discontinued.
The HbA1C became lower for all 3. HbA1C is a measure of blood sugar control for the past 3 months.
Patient 1 had a 12% weight loss and 13% waist circumference (WC) reduction.
Patient 2 has 18% weight loss and 22% WC reduction.
Patient 3 had a 10% reduction in both weight and WC.
The patients tolerated the IF without difficulty and felt “excellent” and “terrific.” Patient 3 described the fasting as “easy” and reported have higher energy levels. His carbohydrate cravings disappeared.

What Happened?

During the fasting, the body was able to use the circulating glucose for energy. Once the blood sugar goes down to a certain level, the stored visceral fat, including the ones in the liver (fatty liver), becomes glucose and gets used. The processes described making the body more sensitive to the effects of insulin, which is why less injected is needed. Eventually, the body’s own insulin will be enough to regulate the blood sugar.

Insulin resistance is accompanied by salt and water retention. Once insulin sensitivity normalizes, the excess salt and water will be excreted. Less water and body fat translate to decreased weight and waist circumference.

Note that Type 1 insulin patients (juvenile-onset) should be on insulin.

This case study has a tiny number of subjects. More studies with more subjects (tens of thousands) are needed before intermittent fasting becomes part of any “official” guidelines.

It is always wise to talk to your doctor before starting any intermittent fasting and exercise program. Significant medication adjustments may be needed.

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