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Source: Diabetes.co.uk

Sometimes, people with type 2 diabetes need to start insulin therapy. That therapy is unique to the individual depending on how much insulin their body continues to produce as well as their diet, other medications they are using, and how sensitive their cells are to insulin.

About half of the body’s insulin requirements are for background or basal needs. Basal insulin controls blood glucose overnight and between meals. The other half, bolus insulin, controls blood glucose after a meal or as a correction for high blood sugar. People with type 2 diabetes may need just basal, just bolus, or both.

The University of California San Francisco Medical Center offers these tips on how to calculate insulin doses for people with type 2 diabetes:

University of California, San Francisco: Diabetes Education Online: Calculating Insulin Dose

Some highlights:

Bolus Insulin Dose - Carbohydrate Coverage
Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress.

Bolus Insulin Dose – High Blood Sugar Correction
Generally, to correct a high blood sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl. This drop in blood sugar can range from 15-100 mg/dl or more, depending on individual insulin sensitivities.

Basal Insulin Dose
Bear in mind, this may be too much insulin if you are newly diagnosed or still making a lot of insulin on your own. And it may be too little if you are very resistant to the action of insulin. Talk to your provider about the best insulin dose for you as this is a general formula and may not meet your individual needs.

[First you will need to calculate your body’s total daily insulin requirement. About half that insulin will cover your basal needs:]

• The general calculation for the body’s daily insulin requirement is: Total Daily Insulin (TDI) Requirement (in units of insulin) = Weight in Pounds ÷ 4
• Basal/background insulin dose = 50% of TDI.

The UCSF Medical Center website has calculation examples and other information about insulin types and dosing schedules:

University of California, San Francisco: Diabetes Education Online: Type 2 Insulin Rx

There were two studies published in the Public Library of Science (PLOS) journals this month that found benefits for eating more plant-based foods and reducing the amount of animal food in the diet.

In the first study, researchers in Korea randomized participants who had been diagnosed with type 2 diabetes to either a vegan diet (excluding all animal-based food including fish) or a conventional diet recommended by the Korean Diabetes Association 2011:

Effect Of A Brown Rice Based Vegan Diet And Conventional Diabetic Diet On Glycemic Control Of Patients With Type 2 Diabetes: A 12-week Randomized Clinical Trial, PLOS ONE, 2 June 2016

The vegan group followed a diet consisting of whole grains, vegetables, fruit, and legumes. They were instructed to avoid all animal food products including meat, poultry, fish, dairy, and eggs. They had no restriction on calories.

The conventional diet group were told to limit their calories and to consume a diet consisting of 50–60% carbohydrate, 15–20% protein, less than 25% fat, less than 7% saturated fat, minimal trans-fat, and less than 200 mg/day cholesterol.

After 12 weeks, those who followed the vegan diet had greater reductions in HbA1c and fasting glucose. They also lost more weight and reduced their waist circumference compared to those following the conventional diabetes diet.

Conclusion: Both diets led to reductions in HbA1c levels; however, glycemic control was better with the vegan diet than with the conventional diet. Thus, the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment.

In the second study, researchers from Harvard analyzed the diets of over 200,000 participants of the Nurses’ Health Studies 1 and 2 and the Health Professionals Follow-Up Study:

Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies, PLOS Medicine, 14 June 2016

Those who consumed the most plant-based foods including whole grains, fruits, vegetables, nuts, and legumes lowered their risk for developing type 2 diabetes compared to those who consumed more animal products such as dairy food, eggs, and meat (including poultry and seafood).

The researchers attribute the benefit of a plant-based diet to its dietary fiber, antioxidants, unsaturated fatty acids, and micronutrients such as magnesium, as well as its low levels of saturated fat. They also suggest that a plant-based diet may benefit the gut microbiome.

Conclusions: Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods.

The study’s senior author, Frank Hu, from Harvard’s T.H. Chan School of Public Health said:

“A shift to a dietary pattern higher in healthful plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal-based foods, especially red and processed meats, can confer substantial health benefits in reducing risk of type 2 diabetes.”

A new study in the British Medical Journal that reanalyzed old data is challenging the advice to replace saturated fat with vegetable oil:

Re-Evaluation Of The Traditional Diet-Heart Hypothesis: Analysis Of Recovered Data From Minnesota Coronary Experiment (1968-73), BMJ 2016

The original study randomized over 9,400 people to either a diet that replaced saturated fat with corn oil, or to a control group that ate an equivalent amount of saturated fat. People who switched from saturated fat to vegetable oil did lower their cholesterol, but they did not live longer than those who continued to eat saturated fat.

Dr. Christopher Ramsden, lead author of the study, said:

“In fact, participants who had greater reductions in cholesterol had higher, rather than lower, risk of death.”

There was a 22% higher risk of death for every 30 mg/dL reduction in serum cholesterol.

The researchers hypothesized that unsaturated fat contributes to oxidation:

Increasing dietary linoleic acid has been shown to increase oxidized linoleic acid derivatives in a dose dependent manner in many tissues. These oxidized derivatives, along with other non-cholesterol lipid mediators, have been implicated in the pathogenesis of many diseases including coronary heart disease, chronic pain, and steatohepatitis.

The study concluded:

Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.

Researchers in the UK placed 30 overweight adults with type 2 diabetes on a very low calorie, mostly liquid diet for 8 weeks. (Nestle’s OPTIFAST was provided.) Participants underwent a follow-up, 6-month intensive weight management program. At the end of the 8-week plus 6-month program, 13 of 30 (43%) participants essentially reversed their diabetes by maintaining a fasting glucose below 126 mg/dL while taking no glucose-lowering medications:

Very-Low-Calorie Diet And 6 Months Of Weight Stability In Type 2 Diabetes: Pathophysiologic Changes In Responders And Nonresponders, Diabetes Care, 21 March 2016

OBJECTIVE Type 2 diabetes mellitus (T2DM) is generally regarded as an irreversible chronic condition. Because a very-low-calorie diet (VLCD) can bring about acute return to normal glucose control in some people with T2DM, this study tested the potential durability of this normalization. The underlying mechanisms were defined.

RESEARCH DESIGN AND METHODS People with a T2DM duration of 0.5–23 years (n = 30) followed a VLCD for 8 weeks. All oral agents or insulins were stopped at baseline. Following a stepped return to isocaloric diet, a structured, individualized program of weight maintenance was provided. Glucose control, insulin sensitivity, insulin secretion, and hepatic and pancreas fat content were quantified at baseline, after return to isocaloric diet, and after 6 months to permit the primary comparison of change between post–weight loss and 6 months in responders. Responders were defined as achieving fasting blood glucose

RESULTS Weight fell (98.0 ± 2.6 to 83.8 ± 2.4 kg) and remained stable over 6 months (84.7 ± 2.5 kg). Twelve of 30 participants achieved fasting plasma glucose

CONCLUSIONS A robust and sustainable weight loss program achieved continuing remission of diabetes for at least 6 months in the 40% who responded to a VLCD by achieving fasting plasma glucose of

The average weight loss after 8 weeks was 14.2 kg or about 31 pounds. Most succeeded in maintaining their lower weight for 6 months.

There were improvements in blood pressure, triglycerides, and cholesterol over the 6-month maintenance period. Plasma insulin levels also fell in the group.

It has previously been shown that a low-calorie, weight-loss diet can reverse type 2 diabetes. Keeping the weight off is key, however, and one criticism of this study is the short 6-month weight maintenance phase.

A more detailed description of the diet, from Medscape:*

The 8-week very low-calorie diet consisted of a three-times daily liquid formula containing 43% carbohydrates, 34% protein, and 19.5% fat, providing about 624 kcal/day. Subjects were also allowed to eat nonstarchy vegetables and were encouraged to drink at least 2 L/day of calorie-free beverages and to maintain normal activities. One-to-one support was provided via telephone, email, text messages, or face-to-face contact.

After the 8 weeks, solid food was gradually introduced in weight-maintaining quantities (approximately 1600 to 2000 kcal per day, although the focus was on weight of food portions).

* Very Low-Calorie Diet May Trigger Type 2 Diabetes Remission, Medscape, 31 March 2016

Dr. Greger of NutritionFacts.org says that dietary fat contributes to insulin resistance. And, “we can decrease insulin resistance by decreasing fat intake.”

A new placebo-controlled study found no benefit of taking high-dose vitamin D (30,000 IU vitamin D3 once weekly) for glucose management:

No Effect of High-Dose Vitamin D Treatment on β-Cell Function, Insulin Sensitivity, or Glucose Homeostasis in Subjects With Abnormal Glucose Tolerance: A Randomized Clinical Trial, Diabetes Care, March 2016

OBJECTIVE There has been conflicting evidence regarding the potential role of vitamin D in glucose homeostasis. This study was designed to investigate the effect of high-dose vitamin D3 treatment on β-cell function, insulin sensitivity, and glucose tolerance in subjects with prediabetes or diet-treated type 2 diabetes.

RESEARCH DESIGN AND METHODS Subjects (n = 44) were randomized to 30,000 IU vitamin D3 once weekly or placebo for 8 weeks. Hyperglycemic clamp assessed first-phase (0–12 min) and second-phase (12–120 min) insulin response, insulin sensitivity, and disposition index (DI). An oral glucose tolerance test assessed glucose tolerance and glycosylated hemoglobin assessed glycemic control.

RESULTS A total of 21 (vitamin D) and 22 (placebo) subjects completed the study, respectively. Season-adjusted 25-OH-vitamin D [25(OH)D] levels were doubled in the active treated group (43–82 nmol/L). No effect of vitamin D treatment, compared with placebo, was seen on first-phase or second-phase insulin secretion. There were no group differences in insulin sensitivity, DI, or any measures of glycemic control. No hypercalcemia or other adverse effects of vitamin D treatment were seen compared with placebo. Subgroup analyses of those with the lowest basal and greatest increase in 25(OH)D levels did not change these results.

CONCLUSIONS This study gives no support for any substantial effect of high-dose vitamin D treatment for 8 weeks in prediabetes or diet-treated type 2 diabetes on β-cell function, insulin sensitivity, or glycemic control.

Researchers in Texas examined the association between statin use and new-onset diabetes, diabetic complications, and overweight/obesity in healthy adults. They found an increased risk for diabetes from taking statins. They also found more diabetic complications in those taking statins:

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults, Journal of General Internal Medicine, November 2015

Conclusions: Diabetes, diabetic complications, and overweight/obesity were more commonly diagnosed among statin-users than similar nonusers in a healthy cohort of adults. This study demonstrates that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention.

They tracked participants for 6.5 years. About 75% of the statin prescriptions were for simvastatin (trade name: Zocor).

Troy Brown, in an article in Medscape (Statins Linked to Diabetes and Complications in Healthy Adults:

After adjustment for confounding factors — including the fact those who used statins had more visits with healthcare providers than nonusers — those who took statins still had an 85% higher risk of developing new-onset diabetes (odds ratio [OR], 1.85) and more than double the risk of diabetes with complications (OR, 2.53), as well as in increase in overweight/obesity (OR, 1.12) compared with those who didn’t take statins.

The results also show that high-intensity statin therapy was associated with the highest risk of diabetes, diabetic complications, and overweight/obesity (adjusted ORs 2.55, 3.68, and 1.58, respectively), thereby demonstrating a dose–response relationship.

Lead author, Dr. Ishak Mansi, MD:

“I myself am a firm believer that these medications are very valuable for patients when there are clear and strict indications for them,” he said. “But knowing the risks may motivate a patient to quit smoking, rather than swallow a tablet, or to lose weight and exercise. Ideally, it is better to make those lifestyle changes and avoid taking statins if possible.”

The study appeared in the December issue of Diabetes Care:

Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia, Diabetes Care, 17 December 2015

CONCLUSIONS Individuals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.

For all types of dementia including Alzheimer’s disease, men and women had about the same increased relative risk (60%) if they had diabetes. But for vascular dementia, women’s risk was 19% greater than men’s risk.

This was a big study. From Medscape:¹

The analysis included data on over 2.3 million people and over 100,000 cases of dementia — more than seven times the data in past reviews on the issue.

Senior author Dr. Rachel Huxley said:¹

Diabetes confers a greater risk of developing heart disease, stroke, and now vascular dementia in women compared with men.

Are the sex differences a result of social influences, for example, inadequate care in women? Or are they physiological? More study is needed.

¹ Type 2 Diabetes Ups Vascular Dementia Risk in Women, Medscape, 29 December 2015