How Intermittent Fasting Breaks Free From Insulin Dependency

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

Good question. While insulin may lower blood sugar and prevent immediate problems with very high blood sugar, injected insulin has long-term disadvantages.

Insulin Effects

1. Insulin stores fat and increases weight. The American Diabetes Association’s recommendation for diabetics is to lose weight. See the problem?
2. Fat is 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 travel all over the body.
3. After spreading, the cytokines alone or in concert with other factors cause inflammation, leading to different diseases.
4. Increased weight leads to higher insulin resistance, which requires more insulin, forming a vicious cycle that causes the 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.
5. Injected insulin does not solve the existing hyperinsulinemia that comes with insulin resistance.

Intermittent Fasting in Type 2 Diabetes

Intermittent Fasting (IF) has been around for centuries, and there is anecdotal evidence about its effectiveness for weight loss and diabetes control.

The following case report was made in Toronto, Canada, and at the time of its publication, it was the first study documenting IF use in diabetes, resulting in insulin discontinuation.

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

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

Intermittent Fasting Method

Twenty-four hours of IF were done every other day. The total length of the study was 7 months for 1 and 11 months for two 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

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

What Happened?

During 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 make the body more sensitive to insulin’s effects, which is why less insulin is needed. Eventually, the body’s insulin will be enough to regulate 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.

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

Further readings

• Mastering Diabetes: Prevent Hypoglycemia with Smart Medication Adjustments

Intermittent Fasting

1. The Kaizen Way of Intermittent Fasting
2. Keto and Intermittent Fasting, a Beginner’s Guide 
3. The Science of Fasting
4. Are You Skipping Breakfast?
5. The Difference between Intermittent Fasting and Starvation
6. Why Can’t I Lose Weight? – cartoon video

Exercises

1. How to Start a Fire or How to be Active from Sedentary
2. High-intensity interval training (HIIT)
3. High-Intensity Interval Training can Activate Ischemic Preconditioning
4. Physical Activity Correlates with Life Span
5. The Surprising Benefits of Sweating
6. The Benefits of Resistance Training
7. The Good and Faithful Servant
8. Effect of Short Term Exercise on Mortality
9. What are Exerkines?
10. Exercise Guidelines
11. How Does Exercise Prolong Life?
12. Why do You Need an Excellent Performance Status?
13. Myokines: An Introduction
14. How the Body Saved Itself
15. How Does Exercise Burn Visceral Fat? – cartoon video

Reference:

• Furmli S, Elmasry R, Ramos M, et al. Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. Case Reports 2018;2018:bcr-2017-221854.

Image Credits:

• Insulin and syringe Public Domain, https://en.wikipedia.org/w/index.php?curid=8462349

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