How to use basal insulin: Benefits, types, and dosage Basal, or background, insulin helps regulate blood sugar levels in people diagnosed with diabetes. It keeps glucose levels steady throughout the day and night. It is taken as injections, once a day or more often. The type of insulin and number of daily injections varies. Find out more about the options available. Read now
“The field has suffered from a checkered history 20, 30 years ago, when there were operations that were dangerous. But modern metabolic surgery is very safe,” Cummings said. “The risk of dying from a laparoscopic gastric bypass is a little bit less than the risk of dying from having your gallbladder or appendix removed. But we never consider those risky surgeries; they’re totally bread-and-butter procedures.”
For over a decade, Cummings and others have tried to reframe the very concept of bariatric surgery (they prefer “metabolic surgery”). Their work has shown these procedures just don’t change how much food the stomach can fit; they trigger a cascade of metabolic and bodily changes, many of which help people with type 2 diabetes naturally get their blood sugar under control. Some changes even start happening before a patient loses weight, such as higher levels of peptide production in the gut that seem to restore a patient’s sensitivity to insulin.
Anecdotally, Cummings knows at least one person in the US who got their surgery paid for through their partner’s employer insurance, despite only having a BMI of 31. And he notes that many countries with a robust public health care system have already lowered their BMI limits to mirror the DSS-II guidelines, such as the UK and Saudi Arabia. He also believes that Medicare and Medicaid officials are deliberating whether to adopt the DSS-II guidelines, based on discussions he’s had. “I don’t know how long it’ll take, but we’re crossing our fingers and hoping,” he said.
Insulin is a hormone produced by cells in the pancreas called beta cells. Insulin helps the body use blood glucose (a type of sugar) for energy. People with type 2 diabetes do not make enough insulin and/or their bodies do not respond well to it, leading to elevated blood sugar levels. Oral diabetes medications bring blood sugar levels into the normal range through a variety of ways.
The reason the body stops producing insulin is that it kills off the pancreas’ beta cells, which produce insulin. People with Type 1 diabetes must get their insulin from injections or ingestion, a cumbersome and often imprecise task. Too little insulin and blood sugar levels stay high for extended periods, potentially damaging the body; too much and blood sugar levels crash, possibly causing a person with diabetes to faint or experience an even worse problems, such as a stroke.

People with diabetes are unable to control the level of sugar in their blood, usually due to a breakdown in how their bodies use the hormone insulin. It’s not completely clear how obesity can contribute to diabetes, but it is known that excess weight is associated with chronic inflammation and a dysfunctional metabolism. And these factors in turn make it easier for someone to stop responding to the presence of insulin as easily as they once did. So by using surgery to help very obese people with diabetes lose weight, the logic goes, you can indirectly treat or prevent the condition. But doctors such as David Cummings, a senior investigator at the University of Washington’s Diabetes & Obesity Center of Excellence, are pushing back against this way of thinking.
• The vegetable/fruit called bitter melon, bitter gourd, or karela seems to stop insulin resistance. It gets glucose into cells. You can cook with it (many Chinese recipes incorporate this ingredient), eat it raw, or juice it. You can get it at Asian markets or farmers’ markets, or sometimes in supermarkets. It can also be taken as capsules or a tea.

The twin cycle hypothesis of the etiology of type 2 diabetes. During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis, which particularly promotes fat accumulation in the liver. Because insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will accumulate liver fat more readily than others because of higher plasma insulin levels. In turn, the increased liver fat will cause relative resistance to insulin suppression of hepatic glucose production. Over many years, a modest increase in fasting plasma glucose level will stimulate increased basal insulin secretion rates to maintain euglycemia. The consequent hyperinsulinemia will further increase the conversion of excess calories to liver fat. A cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established. Fatty liver leads to increased export of VLDL triacylglycerol (85), which will increase fat delivery to all tissues, including the islets. This process is further stimulated by elevated plasma glucose levels (85). Excess fatty acid availability in the pancreatic islet would be expected to impair the acute insulin secretion in response to ingested food, and at a certain level of fatty acid exposure, postprandial hyperglycemia will supervene. The hyperglycemia will further increase insulin secretion rates, with consequent enhancement of hepatic lipogenesis, spinning the liver cycle faster and driving the pancreas cycle. Eventually, the fatty acid and glucose inhibitory effects on the islets reach a trigger level that leads to a relatively sudden onset of clinical diabetes. Figure adapted with permission from Taylor (98).

The extent of weight loss required to reverse type 2 diabetes is much greater than conventionally advised. A clear distinction must be made between weight loss that improves glucose control but leaves blood glucose levels abnormal and weight loss of sufficient degree to normalize pancreatic function. The Belfast diet study provides an example of moderate weight loss leading to reasonably controlled, yet persistent diabetes. This study showed that a mean weight loss of 11 kg decreased fasting blood glucose levels from 10.4 to 7.0 mmol/L but that this abnormal level presaged the all-too-familiar deterioration of control (87).

They also have to balance the food they eat with the amount of insulin they take and their activity level. That's because eating some foods will cause blood sugar levels to go up more than others, whereas insulin and exercise will make blood sugar go down. How much the blood sugar level goes up after eating depends on the type of nutrients the food contains.

It is important to note that these herbs and spices are intended to support blood sugar maintenance and are not meant to replace diabetes/hyperglycemic medications. Research does show benefits to incorporating these herbs and spices, so enjoy incorporating them daily into your favorite recipes for a boost of flavor and blood sugar-lowering benefit.


Dr. Fung says he decided to experiment with intermittent fasting because he was frustrated seeing so many diabetic patients with kidney failure. “It occurred to me that fasting was an underutilized therapeutic option for losing weight,” he recalls. “I started doing this five years ago, and a lot of people got incredibly good results – it reversed their diabetes.”
Why do people develop prediabetes? Prediabetes develops through a combination of factors that are still being investigated. For sure, lifestyle factors (food, exercise, stress, sleep) play a role, but family history and genetics certainly do as well. It is easy to assume that prediabetes is the result of being overweight, but the relationship is not that simple. While obesity is one underlying cause of insulin resistance, many overweight individuals may never develop prediabetes or type 2 diabetes, and a minority of people with prediabetes have never been overweight. To make matters worse, it can be increasingly difficult to make healthy choices in today’s toxic food environment that steers all of us to make the wrong food choices, and there are many factors that can contribute to weight gain in addition to diet.
7. SGLT2 Inhibitors These drugs work by increasing the amount of glucose excreted in the urine. They've been associated with weight loss and improvement in blood pressure. Side effects may include urinary tract infections and diabetic ketoacidosis, a serious condition in which acid blood levels rise. They are Invokana (canagliflozin) and Farxiga (dapagliflozin).

Dr. Steven Lin is a dentist who focusses on the mouth-body connection. Through ancestral nutrition, the oral and gut microbiome, and epigenetics, his programs aim to prevent chronic dental and systemic disease. His book 'The Dental Diet', will be released on January 18'. To receive free updates on functional oral health from Dr. Lin, subscribe to his newsletter below.
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