HOW TO REVERSE DIABETES MELLITUS

Abstract
The paper offers a new paradigm to understand type 2 diabetes and treating it efficiently. The disease
exact tremendous toll on the society by hampering the health of individuals and quality of life.
Antidiabetic medications helps to deal with the disease at certain level but fails to stop the
continuance and patient get complications such as diabetic nephropathy, diabetic retinopathy,
blindness, amputation and so on. Hepatic de novo lipogenesis is abnormally increased during insulin
resistance. Understanding the pathogenesis of insulin resistance has become important to guide the
development of future therapies. This paper revels that diabetes type 2 is a dietary disorder and needs
a dietary solution. Multiple snaking in between meals is disaster to human health. Intermittent fasting
and Mediterranean diet helps the diabetic patient to reverse the disease completely. Fasting is a tool
that assists in rejuvenation of body cells. Once we understand that hyper glycemia and hyper
insulinemia is the cause of insulin resistance we can now devise a rational treatment. Intermittent
fasting lowers the insulin as well as blood glucose level to normal range and also assists in restoration
of pancreatic beta cells. Once you reverse insulin resistance, you cure diabetes type 2 completely
without medications.
Keywords de novo lipogenesis, diabetic nephropathy, diabetic retinopathy, amputation, insulin
resistance, intermittent fasting, Mediterranean diet, bariatric surgery, gastric banding, hyper glycemia
and hyper insulinemia.
Introduction
Diabetes mellitus (type 2 diabetes) is a chronic metabolic disorder represented by high level of blood
glucose level and insulin resistance. The national diabetes statistics report, 2017 provides information
that about 84 million population of America is prediabetic and 9 million people living in country are
diagnosed as diabetic. Nearby 1 in 10 have diabetes and 1 in 3 are prediabetic. The report shows that
diabetes is at 7th position that leads to death among population. Now the time come to study the
disease once again thoroughly. Here we need a new paradigm of insulin resistance. Human body is
very well designed to store the food energy. The main storage is glucose as glycogen in liver and
triglycerides in adipose tissue. When you eat (fed state), you are putting energy in your stores. When
you don’t eat (fast state) you are pulling food energy out. In this fed and fast state insulin plays the
important role. Insulin hormone binds the receptor on different tissues of body and let the glucose to
move inside the cell. During insulin resistance cells doesn’t sense the insulin. Thus, glucose is
blocked by the closed gate and pilled up outside the cell in blood, which is detected as hyper glycemia
and make clinical diagnosis of diabetes type 2. Glucose can’t go in the cell so pancreas signalled to
release more insulin, to put the glucose in the body tissues. This is compensatory mechanism of the
body to deal with the situation. After a long period of time our body compensatory mechanism fails
and we develop insulin resistance. Hepatic de novo lipogenesis is abnormally increased by >2 fold in
insulin resistant subjects. This indicate that there is not any problem in the receptor and the insulin
structure. Instead of lock and key model we need “overflow model” to explain insulin resistance.
Obesity is the major risk factor for developing the disease. Leptin resistance occurs in presence of
insulin resistance. Hence person feels more hunger and eat more. Fasting helps to deplete the extra
stored food energy and lower the blood glucose level down. When we don’t eat insulin level
decreases, glucagon and growth hormone level go up. It is important to decrease the meal frequency
because every time we eat insulin level goes up. Refined carbohydrates, dietary sugar (glucose and
fructose), packed food stuffs are main component of the diet nowadays. Snaking between meals is the
main dietary habit that play a major role in development of the diabetes. Decreasing the meal
frequency is a magical key to get rid of extra glucose.
The main part
Insulin is an anabolic hormone that tells the body tissues to store energy as glycogen and fat. Liver
has limited capacity to store glycogen. Extra glucose coming from carbohydrate rich diet promote
lipogenesis in the liver cells by activating the SREBP pathway. Liver get rid of extra glucose by the
help of lipogenesis. The old lock and key model of insulin and insulin receptor shows that insulin
(key) binds the receptor (lock) present on different tissues of the body that take glucose only when the
insulin binds their receptor. It is something like the key opens the lock and glucose enter the cell.
When cell become insulin resistant, they don’t sense insulin. Glucose is unable to go into cell.
Therefore, cell is under internal starvation mode. Insulin has two major functions stop production of
glucose and increase production of fat. If liver become insulin resistant the two process should stop.
According to internal starvation model liver should do gluconeogenesis and stop lipogenesis. But
when we see diabetic type 2 patient liver cells are still under lipogenesis process. Patient also gain
weight. How is this possible? At one hand we say cells are insulin resistant on the other hand hepatic
lipogenesis still occur in presence of insulin resistance. This situation is very well explained by new
paradigm of insulin resistance “the overflow model”. According to this paradigm cells are
overflowing with glucose. liver cells try to get rid of this extra glucose by throwing out the glucose
which seems to be gluconeogenesis and lipogenesis still occur. Cells are already filled with glucose so
they don’t allow the glucose to enter. Cells don’t respond to insulin. Body start producing more
insulin by influencing beta cells of pancreas to compensate with the extra glucose in the blood. Some
researches show that dietary glucose and fructose promote the development of non-alcoholic fatty
liver which itself can result in hepatic insulin resistance a key of diabetes type 2. Obesity is associated
with non-alcoholic fatty liver and diabetes type 2. Hepatic fat accumulation decreases insulin
activation of glycogen synthase and increases gluconeogenesis. Hyper insulinemia and elevated
hepatic glucose production are the hall mark of insulin resistance. The paradigm makes the difference
of insulin resistance that cells are overfilled so don’t respond to insulin. Once they get rid of this extra
resource, they again get insulin sensitive. The whole phenomenon emphasis that due to more frequent
meal we are putting more than extra energy we need in the body. Diabetic type 2 patient are often
obese. This shows physically that cells are not under starvation condition. It is more important to treat
the disease by fasting rather than by medications. It’s a lifestyle disorder that needs techniques that
improve our lifestyle. We all know the main symptom of diabetes type 2: hyper glycemia and hyper
insulinemia. Fasting will solve the both problems. Fasting means no intake of food from outside. No
food no insulin release. As we all know insulin inhibit lipolysis. During fasting insulin level goes
down glucagon level goes up. Glucagon is catabolic hormone that assists lipolysis. Fatty acid
oxidation occurs in liver. Ketone bodies are formed which help to reserve the glucose for the tissue
that can only use glucose as their fuel example red blood cells. Brain cells can use both glucose as
well as ketone bodies as their fuel. Hence protein tissue is conserved during fasting. Mediterranean
diet is the low carb -high fibre- moderate protein -high fat diet. In this diet pattern we eat at 1 pm one
major meal full of healthy nutrients and one small meal in evening at 6pm. There are essential fatty
acids, essential amino acids and minerals that should be taken from outside. There is no essential
carbohydrate so we can survive well without eating carbs. Our body cells can generate glucose by the
glycerol and carbon skeleton of amino acids. Intermittent fasting is very easy to start and it is very
simple. According your work schedule you can design it. For example, you start your fast by stop
eating at 7 pm at night and break your fast at 12 pm next day and drink plenty of water the whole day.
Take small meal at 7 pm again. First 2-3 days of fast makes you crazy and you may feel hungry
because of the hunger hormone ghrelin. After two days body will adjust and you will fell less hunger.
You will see healthy changes in your body. One can do regular intermittent fasting, if possible do at
least one day full only water consuming fast in a week. Fasting increases apoptosis and help in
rejuvenation of body cells. Human growth hormone is increased during fasting thus there is no
depletion of metabolism. Medications are still important in treating diabetes type 2 patient.
Metformin, is a biguanide that lowers the blood glucose level by inhibiting the liver cells to produce
glucose and increasing peripheral sensitivity of insulin. Sulfonylureas increases insulin secretion.
Alpha glucosidase, inhibit the absorption of glucose from intestine. Canagliflozin inhibits the glucose
reabsorption from kidney. This drug inhibits the SGLT2 (sodium glucose co-transporter 2) present in
the tubules of nephron, helps too excrete glucose through urine. Research shows that canagliflozin
contributes to reverse the molecular processes in relation with inflammation, fibrosis and extracellular
matrix turnover. Canagliflozin helps to resolve kidney function decline.
Conclusion
Medical practitioner should realise that diabetes type 2 is dietary disease that needs a dietary solution.
Fasting is a tool like other medications. Doctor should not ignore its brilliant results on improving
blood glucose level as well as reversing insulin resistance. After sometime patient doesn’t need any
antidiabetic medications at all. Eating after every 2 hours will ruin your health and soon transfer a
healthy person to prediabetic then to diabetic stage.

References

Dr Jason (2018). The diabetic code-new paradigm of insulin resistance.

Richard A. Harvey. Lippincott’s biochemistry textbook (6th edition)

Richard A. Harvey. Lippincott’s pharmacology textbook (6th edition)

Dr Jason (2016). Complete guide to fasting.

Ginsberg, H. N., Zhang, Y. L., & Hernandez-Ono, A. (2005). Regulation of plasma

triglycerides in insulin resistance and diabetes. Archives of medical research.

Summary

Hyperinsulinemia and elevated hepatic glucose production are the hallmarks of insulin resistance
which in turn is key for diabetes type 2. Physically patient of diabetic type 2 are found obese that
revels, cell aren’t starving. Leptin is the hormone that tells not to eat more but in case of high insulin,
leptin resistance occurs. Person feel more hunger. “we become fat not because we eat more instead,
we are fat that’s why we eat more”. Human being designed in such a way that during feed cycle we
eat and store energy for the period we don’t eat. This feed and fast cycle is normal in physiologic
conditions. During feeding phase insulin released from pancreas helps the glucose to get into tissues.
During fasting stage glucagon is released by alpha cell of pancreas to use the reserved energy that is
glycogen and fat. High insulin level in blood don’t allow the body to burn the stored fat. To get rid of
this excess glucose medical practitioners uses drugs that influence the insulin level and the drugs that
excrete excess glucose from kidney. By such method we are cleaning our house, not throwing the
extra stuff outside the house but hiding somewhere under the table or under the sink. After sometime
the whole house stings same in case of diabetes type 2. Antidiabetic medications are not permanent
solution for curing the disease. We are doing only symptomatic treatment without getting to the roots
of disease. Intermittent fasting is the most efficient method to get rid of both excess glucose and
excess insulin. During fasting the growth hormone increases and apoptosis also occurs. Hence body
get time to rejuvenate. After sometime, pancreas retain its vitality. “Fasting is the most powerful than
any drug on the earth”. Fasting is very easy to follow, simple just don’t eat. Fasting isn’t new it was
practiced frequently by our ancestors due to religious purposes in every religion and also food was not
so easily available as today.