The American Diabetes Association contends the promise of an unlimited source of beta cells from stem cell technology is likely to become a reality in the next several years, in an article on its site. “However, how to use this new source of cells, how these cells live and function after transplantation, and how to best control immune responses against the transplanted tissue present additional barriers to the widespread use of islet transplant. Research in these areas will be essential for the realization of the potential of stem cell derived islets for the cure of diabetes.”
Clearly separate from the characteristic lack of acute insulin secretion in response to increase in glucose supply is the matter of total mass of β-cells. The former determines the immediate metabolic response to eating, whereas the latter places a long-term limitation on total possible insulin response. Histological studies of the pancreas in type 2 diabetes consistently show an ∼50% reduction in number of β-cells compared with normal subjects (66). β-Cell loss appears to increase as duration of diabetes increases (67). The process is likely to be regulated by apoptosis, a mechanism known to be increased by chronic exposure to increased fatty acid metabolites (68). Ceramides, which are synthesized directly from fatty acids, are likely mediators of the lipid effects on apoptosis (10,69). In light of new knowledge about β-cell apoptosis and rates of turnover during adult life, it is conceivable that removal of adverse factors could result in restoration of normal β-cell number, even late in the disease (66,70). Plasticity of lineage and transdifferentiation of human adult β-cells could also be relevant, and the evidence for this has recently been reviewed (71). β-Cell number following reversal of type 2 diabetes remains to be examined, but overall, it is clear that at least a critical mass of β-cells is not permanently damaged but merely metabolically inhibited.
According to the Centers for Disease Control and Prevention (CDC), from 1980 through 2010, the number of American adults aged 18 and older with diagnosed diabetes more than tripled—soaring from 5.5 million to 20.7 million. Moreover, the diabetes epidemic shows no signs of slowing down, affecting 25.8 million people in 2011. Another 79 million adults have prediabetes, putting them at greater risk of developing type 2 diabetes down the road, according to the CDC.
Before making any fiber recommendations, Dean has her patients tested for “pancreatic insufficiency.” She believes people with pancreatic insufficiency should be given digestive enzymes along with fiber, “otherwise the fiber will just bloat them up, and they’ll be quite unhappy,” she says. Dean uses a glucomannan fiber supplement for her patients with type 2 diabetes.
First, avoid the One-A-Day brand. All of the well-known One-A-Day products contain poor-quality products at low doses, and are full of unhealthy excipients, fillers, and preservatives. A high-quality multiple will require you to take three to six capsules a day, but will cover all the nutrients your body needs. For children, there are good liquid or powder multiples.
Benari, an Ashkenazi Jew, doesn’t fall into that category. But Cummings and other bariatric experts I spoke to said that surgery should be a possible option for any person whose diabetes isn’t improving. Cummings himself is currently working on a clinical trial in India of bariatric patients with BMIs as low as 25. And he expects similar trials will come down the pipeline.
“Diabetes type 1 is very different from your standard disease. Insulin requirements vary greatly from one day to another and there is no way patients can know what they need,” Roman Hovorka, Professor at the University of Cambridge, explained to me during an interview. His research group is working on the development of an algorithm that can accurately predict insulin requirements for a specific patient at any moment.
8. Amylin Mimetic This type of medication stimulates the release of insulin, and is used along with insulin injections. It may also help suppress hunger and promote weight loss. It’s less commonly used because it’s a shot administered in addition to insulin at each meal. Side effects can include low blood sugar, nausea, vomiting, headache, and redness and irritation at the injection site. Symlin (ramlintide) is what your doctor will prescribe you.
You should have no more than three of these “feeding times” per day. The reason limiting the number and duration of your meal times is so important has to do with staying out of the vicious cycle of increasing insulin resistance. To get smart on insulin resistance — the cause of both type 2 diabetes and obesity — read Dr. Jason Fung’s book, The Obesity Code: Unlocking the Secrets of Weight Loss, or watch his free lecture on YouTube.