Category: Physical Wellbeing

Water: How to Hydrate Properly

The Importance of Hydration In Healing

The content of the HealingT1D website is for educational and information purposes only. It does not contain medical advice. The contents of this website are not intended to substitute for professional medical advice, diagnosis or treatment. Please always consult with your doctor, physician, or other qualified healthcare professional before making any adjustments to your routine or healthcare regime. HealingT1D and all associated with it will not be held liable for any risks or issues associated with using or acting upon the information on this site.

Summary: Living in the Middle East has heightened my appreciation for water’s essential role in health. For Type 1 diabetes, maintaining hydration is critical during both daily life and illness to manage blood sugar levels. Monitoring urine colour and using apps like ‘My Water Balance’ help ensure adequate intake, supporting overall well-being and hydration goals.

Since arriving in the Middle East, I have become so much more mindful of the importance of water in my daily life. It is a precious commodity out here, one that you do not want to be without. The few days of rain that happen are greeted with a sense of wonder and even the occasional moment of celebration or joy.

Hydration For Type 1 Diabetes During Illness

Somewhere in the back of my mind, I guess I’ve always known that there is a connection between T1D and hydration. After all, I can still recall those feelings as a kid of severe thirst that accompanied a way-too-high blood sugar – whether due to illness or any other one of an unending list of factors that randomly caused my blood sugars to spike! I recall that feeling of believing that, no matter how many cups of water I drank, it would never be enough. It felt like my thirst would never again be quenched.

I also recall the time, as a teenager, I had horrible tonsillitis and couldn’t swallow anything food- or liquid-based for days. That resulted in a trip to hospital and a drip attached to each arm. Hydration during illness for a type 1 diabetic is CRUCIAL. Indeed, the excellent diabetologist Dr Richard K Bernstein states emphatically how, during illness, the most likely risk to life for Type 1 Diabetics is not the illness itself but the dehydration that ensues from it. In his book, ‘The Diabetes Solution‘, Dr Bernstein includes dehydration salts as one of the key supplies that all diabetics should always have to-hand.

Hydration In Daily Life

Okay, so we pretty much all understand that hydration during illness is a biggie for us diabetic types. But what about the other (hopefully) 99% of our lives, when we’re just tootling about in our days in normal (perfect?!) health…? Is it important then?

Adequate hydration is important for every person. H. H. Mitchell and colleagues demonstrated that our bodies are made up of almost 70% water and, importantly for us, the pancreas itself consists of 73% water (so a healthy, working pancreas needs water!). In fact, water is involved in all processes in the body, including the normal metabolic processes of urination, sweating, breathing, thinking and digestion. Thus, replenishing this water in adequate amounts each day is vital to sustained health and functionality.

For type 1 diabetes, hydration is even more important. In fact, dehydration has been found to favour the development of hyperglycaemia (high blood sugars) in diabetes. I searched around for more information on why that might be the case. Whilst I couldn’t find anything directly related to type 1 diabetes, I did come across an interesting study that investigated the relationship between water intake and blood glucose regulation in type 2 diabetics.

This study found that reduced water intake for just three days led to an increase in the ‘stress hormone’ cortisol. This increase in cortisol impaired blood glucose response for an oral glucose tolerance test i.e. blood glucose levels were higher than optimal. So this study suggests, but doesn’t necessarily prove, that being insufficiently hydrated puts the body at risk of higher blood sugar levels due to the increase of cortisol in the blood. So, if you’re stressed, if you’re ill, if you’re not sufficiently hydrated and want better blood-sugar control… DRINK UP!

How Much Water Is Enough Water?

I am grateful to my parents for raising me to fall in love with drinking the pure stuff… My preferred choice of beverage always was, and still is, water. But how much of it should I be drinking?

I think most people have heard the old adage about drinking 8 cups of water a day to stay hydrated. But that turns out to be a bit of a fable… It is based on a study conducted in 1945 by the U.S. Food and Nutrition Board, who found that drinking 2.5 litres of water per day was sufficient to hydrate the human body. HOWEVER, this study stated that this fluid comes from both drinks and food. I don’t know about you, but I’ve never been able to accurately calculate the amount of fluid in any meal that I’ve eaten!!

Taking that 8 cups of water as a baseline, there are still certain factors that cause this quantity to be revised for any given individual. These factors include:

Table 1: A Selection of Research Findings to Illustrate How Optimum Water Consumption Varies with a Range of Individual Factors

Variable	Exemplar Research Findings
Gender	The average woman requires 2.7 litres of water per day, whilst the average man requires 3.7 litres. [1]
Age	Elderly people who drink 8 glasses of fluid per day may actually be overhydrated. [2]
Socioeconomic Status	Water intake is lower in lower-income adults and those with lower education. [3]
Environment	Hot climates, such as those found in desert environments, cause increased fluid loss due to sweating. [4]
Exercise	Strenuous exercise can cause sweat rates up to 2-3 litres per hour. [5]
Medical Conditions	Excess hydration should be avoided for people with cardiovascular disorders, pronounced chronic renal failure and endocrinopathies, amongst other medical disorders. [6]

So I think that this shows how most, if not all, people are likely to not need the ‘standard’ amount of recommended water intake! So how can I, or anyone else, work out how much their particular body, with its own particular nuances, needs to stay healthy? Thankfully, our bodies have their own built-in alert system…

The Human Body’s ‘Hydration Alert System’… Thirst And Urination!

Our bodies have all the expertise they already need, just packed away inside them. All we have to do is listen and pay attention!

So, hydration… The first and obvious sign of lacking sufficient water is that you will become thirsty. This is your cue to drink. So do so! Unfortunately, in today’s world, the thirst system in the human body can go offline. If you have ignored your body’s cries for water a few too many (thousand!) times, then your body is likely to save its cries for the most extreme times, when hydration is a must. Therefore, if this might be the case for you, check your urine… What colour is it?

If your urine is anything darker than a light summer lemonade, then you are dehydrated (or, if very dark, you could have another medical issue going on and you should go to your doctor pronto!). Each time you urinate, check the colour. In an ideal world, you would check your colour by taking a sample in a suitable collecting container that only has the urine sample in it. However, as most of us probably go to the toilet in the, yep, toilet(!) with the water already in the toilet bowl, we’ll just have to use that as a best guess effort. But, bear in mind, if the urine in the toilet bowl is darker than it should be, then you are definitely dehydrated and need to take action soonest.

Generally, if you have a pale straw-like colour of urine, drink frequently and rarely feel thirsty, then you’re on the right track. I, on the other hand, know that I have some work to do on this! Now where did I leave my water bottle…??

Improving Water Intake

In trying to improve water intake, there are a couple of things that have worked for me. First of all, I have found an app called ‘My Water Balance-Intake Drink’ by Viktor Sharov. It has a nice reminder feature that gently nags (reminds?!) me through the day to take another sip. I like that it shows me what percentage of my water has been drunk whenever I input a drink so that I feel that I’m making progress each day.

I also have a gentle reminder about water consumption every time I visit the ladies’ room! If my urine isn’t clear in the toilet bowl, it automatically reminds me to go and get another drink.

The other thing that has really helped me is creating habits around fluid intake. First thing in the morning, I go downstairs to get a litre bottle of water. That comes with me into my meditation space and I sip on it during that first hour of my day that I devote to my spiritual practices. Having already had 1 litre by the time I finish that hour, I already feel confident about completely my water intake for the day. I also have the habit to sit down with a glass of water with every meal. I understand that drinking water half an hour before a meal helps with digestion and not overeating but that habit’s never stuck with me so I go for the ‘glass with a meal’ approach instead – it’s better than not having any!

How do you track your fluids? What do you do to encourage yourself to hydrate more? I’d love to hear and learn from your ideas too!

References:

1. Food and Nutrition Board. (2004) Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press.

2. Picetti, D., et al. (2017). Hydration health literacy in the elderly. Nutrition and Healthy Aging, 4(3), 227-237. [Link]

3. Rosinger, A. Y., et al. (2018). Disparities in plain, tap and bottled water consumption among US adults: National Health and Nutrition Examination Survey (NHANES) 2007-2014. Public Health Nutrition, 21(8), 1455-1464. [Link]

4. Sawka, M. N., et al. (1998). Hydration Effects on Temperature Regulation. International Journal of Sports Medicine, 19, S108 – S110. [Link]

5. Shirreffs, S. M. (2009). Hydration in sport and exercise: water, sports drinks and other drinks. Nutrition Bulletin, 34(4), 374-379. [Link]

6. Manz, F. (2007). Hydration and Disease. Journal of the American College of Nutrition, 26(5), 535S-541S. [Link]

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Natalie Leader

Natalie is a blogger with Type 1 Diabetes. Natalie’s special gifts are questioning the status quo and being a rebel. She is using these gifts to question medical ‘knowledge’ and find a true cure for Type 1 Diabetes.

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March 29, 2021

Healing Attention Deficit Disorder
Green Tea, Classical Music and Walks In Nature

The content of the HealingT1D website is for educational and information purposes only. It does not contain medical advice. The contents of this website are not intended to substitute for professional medical advice, diagnosis or treatment. Please always consult with your doctor, physician, or other qualified healthcare professional before making any adjustments to your routine or healthcare regime. HealingT1D and all associated with it will not be held liable for any risks or issues associated with using or acting upon the information on this site.

The Neurotransmitter Dopamine

Summary: The author explores how dopamine fluctuations, resulting from swinging blood sugars, impacts her ADHD-like symptoms. She links insulin levels to dopamine regulation, noting sugar’s role in affecting mood and motivation. To heal her ADHD symptoms naturally, the author adopts green tea for dopamine, classical music for focus, and nature walks for exercise and emotional balance.

I’m having one of those diabetes days… As I’m sitting here trying to write this, my blood sugars keep dropping. Oh, but wait… They’re up, they’re in range! Oh nope, they’re not. Down again. Yep, yep, got them up… Oh no, I haven’t! Ah, made it! At last, I’m back on point…!! So, anyways…  Back to Healing ADD!

As I discussed in my last blog post, I believe that I’ve got Inattentive ADD (although I’ve not been officially diagnosed with it). Dr. Amen discusses in his book ‘Healing ADD’ how ‘dopamine is generally considered the neurotransmitter involved in Inattentive ADD’ (Amen, 2013 p. 104).

What Is Dopamine?

The classic introduction to Dopamine usually includes a spiel about how it is a neurotransmitter, how it works in the brain to enable a person to focus and how it gives a person motivation, desire and drive to achieve a task. Even this preliminary information is still useful to me. Taking Dr Amen’s view that dopamine is involved in ADD, it is easy for me to understand why my motivation is erratic at best and completely absent at worst.

The Other Side Of Dopamine

Knowing that dopamine is impacting my motivation towards healing is all well and good but, for me, that isn’t the full picture. As I already discussed in my post on Candace Pert’s neuroscientific work, there is no clear distinction between the ‘neurotransmitters’ of the brain (which Dopamine is classed as) and the ‘hormones’ of the body. Instead, our body consists of peptides that link communication and action between the nervous, endocrine and immune systems. Indeed, researchers now seem to be garnering support for Candace Pert’s theory…

The Link Between Insulin And Dopamine

I was interested to find a preliminary study conducted in 2007 by a group of researchers at the Vanderbilt University Medical Center that identified insulin as having an important role in the dopamine pathways in the brain

This study showed that, when insulin levels are low in the brain (which occurs when a diabetic has high blood sugar levels), the dopamine pathways in the brain is unable to produce normal levels of dopamine. I would therefore anticipate that, when a diabetic has higher than non-diabetic blood sugar levels (which occurs for most diabetics after every carbohydrate-based meal), dopamine is suppressed and ADD symptoms are likely to be present.

So, as a diabetic with unnaturally oscillating blood sugars, it’s a double whammy. If my blood sugars are out of whack, my dopamine levels are too and my motivation goes down the plughole. So then trying to get motivated to get my sugars back in range is all that bit harder! So how do I square this circle??

Sugar And ADD

Sugar Can Give A Quick Boost To Dopamine Levels But Can Leave Naturally Occurring Dopamine Levels Depleted in the Longer Term [Image by Myriam Zilles from Pixabay]

I believe that, the majority of time, my dopamine must be depleted. I spend more of my time lacking in enthusiasm and energy, rather than hyperactive and overzealous (although that does occasionally happen too!). Something I also contend with on a daily basis is my cravings for sugar. I crave sugar all the time! And now I understand how these two facts are related…

Sugar provides an exogenous method for increasing dopamine levels in my system. When I eat something sugary, my brain lights up with increased dopamine levels and I get back in my groove. So every time I reach for a piece of chocolate, a slice of cake or some other sugar-rich food, I am finding a way to increase my depleted dopamine levels. But each additional sugar feeding also leads to weight gain. Indeed, it has been found that obese people have a five to ten times increased rate of ADHD than the general population.

As if that isn’t bad enough, each time I eat sugar, I am increasing dopamine levels in my system artificially, by outside means. Therefore, my brain is learning that it needs to make less dopamine endogenously because the sugar will be along soon to increase dopamine again. And so the vicious cycle begins… Dopamine levels are low in my brain, my system waits for the sugar, I eat the sugar, my brain learns it doesn’t need to manufacture its own and therefore makes even less!

How Can I Heal My ADD Naturally?

If I can find a way to naturally increase my dopamine levels, then my ADD is (or at least its symptoms are) likely to reduce or disappear. Having just discussed the benefits of removing sugar (something I did successfully during my Whole30 challenge), eliminating sugar in my diet seems like an obvious first step. But my intuition is saying no to this.

I have eaten a low-carbohydrate diet for periods of my life with success but the longest I have ever achieved was seven months. Then, Christmas came along and the deprivation I felt at not being able to eat the foods I loved was too great.  Every time I have tried to eat low-carb since then, the same thing always happens.

In order to achieve great healing, both physically and emotionally, I personally need to do something that does not feel so punitive or restrictive to me. Please don’t misunderstand me… I know of several diabetics that are hugely successful long-term with low-carbohydrate eating and it brings great quality to their lives. I have great respect for their way of life. But I also believe that healing is a very individual journey and you have to respond to what feels right for you as an individual. I know that I need an alternative to low-carbing.

Low-Carbing Can Be Very Effective for Blood Sugar Control, But It’s Not Right For Me! [Image by RitaE from Pixabay]

Initial Steps To Healing My ADD

I have a tonne of ideas about where to start with healing my ADD. But, if I’ve picked anything at all up from my reading in this area, I really think, for now (and ever after!), I need to start small. My usual plan is to go in with everything at the same time and then give up or stop with exhaustion within a month.

And most importantly…

What can I commit to now that I will be able to continue to do in the future?

To work out what to do to heal my ADD, I want to tap into my intuition, my inner wisdom. I am sure that my path to healing is already known within me, I just have to listen to it. For now, I am going to focus on only three simple things. These are my first three steps on a road of a thousand miles…

1. Green Tea

Green tea contains the amino acid L-Theanine, which is a building block for dopamine in the brain. [Image by Owen Carver from Pixabay]

My gut instinct is still telling me that Kelly Turner’s research (see my post here) has tapped into the inherent mechanism by which the body heals from any health issue, not just cancer. So I wish to try to use her strategies where possible.  Therefore, a first easy step for me is to take follow her protocol to take some herbs and/or supplements. But which ones?

I want to start small yet consistent and I feel that a cup of green tea each morning, before I have breakfast, fulfils those requirements. Green tea contains the amino acid L-theanine. L-theanine not only has a direct effect on your mental alertness, enabling your to relax, but L-theanine is also a building block for dopamine in the brain. All from a good old cup of tea!

2. Listen To Classical Music

Listening to Classical Music Increases Dopamine Levels in the Brain [Image by Jiradet Inrungruang from Pixabay]

I found a piece of neuroscientific research that found that classical music increases dopamine production in the brain.

I am not an expert on classical music, let alone its effects on my brain(!), so I was unsure which pieces of classical music should be on my playlist. Thankfully, the experts over at the ADDitude blog have already put together a list of suitable music!

I have uploaded it onto Spotify as a playlist and called it ‘Classical Music for ADHD’. I am going to hit the play button for 30 minutes every weekday morning as I get ready for my day and hopefully my dopamine levels will rise beautifully!

3. Get Out In Nature

Walking in Nature Increases Dopamine Levels Both Through the Exercise And Also Through The Environment [Image by Valiphotos from Pixabay]

I love nature and really don’t need any excuse to get out in it! Life is always busy and I guess I don’t prioritise doing this as much as I would like to. This one is on my list of action items for multiple reasons.

Firstly, I feel good in nature. Kelly Turner emphasises the need to increase positive emotions and reduce negative emotions as part of your healing journey. Nature does this for me.

Secondly, multiple studies highlight the direct link between exercise and increased dopamine levels. So walking in nature also ticks this box.

Thirdly, this one feels so intuitively right (although, at the moment, it’s a sweltering 30-degrees plus out my window and a part of me just wants to run and hide in a deep freezer rather than go out and walk!!). Therefore, I am going to commit to walking for at least 15 minutes in nature five days each week. Ideally, I would like to do 30 minutes but I want to make sure it is achievable rather than setting myself up to fail.

A Helping Hand…

Until My Natural Dopamine Levels Have Re-Established Themselves, I Will Reach Out To Others’ For Help and Motivation [Image by Sasin Tipchai from Pixabay]

I discussed above about the vicious cycle that is set up in ADHD where a depletion of dopamine causes you to lack the motivation necessary to make the changes that will lead to you increasing your dopamine. For example, lacking motivation means that you won’t go for that great twenty-minute run that will naturally increase your dopamine. I really struggle with this lack of motivation and therefore I am desperate to find a way to solve this Gordian Knot. And I think I may have found the answer…

Accountability Buddies!

Until I have been doing my dopamine-focussed tasks and activities long enough to have built up a more-naturally-occurring dopamine supply in my system, my motivation is likely to be sporadic or non-existent. So I am going to have to rely on the dopamine, and resulting motivation, of others!! My husband is going to be my main buddy in this but I will also be recruiting my friends into this (unbeknownst to them!). This will particularly be required for getting out in nature.

Drinking my green tea should be fairly straightforward. I have linked it to my first meal of the day. I have put my teacup on top of the plate I usually have for breakfast so hopefully that will work!

Listening to classical music for thirty minutes should be the easiest. I have asked my Amazon Alexa to play my ‘Classical Music for ADHD’ playlist at 8am each morning. So there are no excuses for that one!

Let’s see how this goes!
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Natalie Leader

Natalie is a blogger with Type 1 Diabetes. Natalie’s special gifts are questioning the status quo and being a rebel. She is using these gifts to question medical ‘knowledge’ and find a true cure for Type 1 Diabetes.

The content of the HealingT1D website is for educational and information purposes only. It does not contain medical advice. The contents of this website are not intended to substitute for professional medical advice, diagnosis or treatment. Please always consult with your doctor, physician, or other qualified healthcare professional before making any adjustments to your routine or healthcare regime. HealingT1D and all associated with it will not be held liable for any risks or issues associated with using or acting upon the information on this site.

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August 3, 2020

Coronavirus and Type 1 Diabetes

Heightened Risks And The Added Need For Stable Control

Summary: Amid the COVID-19 pandemic, the author reflects on the heightened risks faced by Type 1 Diabetics, who are more likely to die from the virus than those without diabetes. Maintaining stable blood sugar levels becomes crucial for bolstering immunity. Adjusting routines and embracing self-forgiveness are vital amidst the challenges of managing diabetes during this global crisis.

Yeah, so this happened…!! The world has been ransacked and people have been left quaking in their boots by the virus that is not-so-affectionately known as COVID-19.

It seems like a long time ago now but there was a time when Coronavirus didn’t exist (like, less than a year ago…!!). In those days, Type 1 Diabetics were ‘just’ battling through their days as best they could with the general level of challenge that this medical condition presents.

But, for me now, it feels like a whole new level of challenge has entered my life. I now have my daughter at home permanently (at least for now!) so time has evaporated and my usual life activities are all on hold. As such, I anticipate that my blogging will be erratic for a while but please know that I haven’t given up. I will be dropping in here as often as I can to think, write and respond as best I can.

If I have learnt anything during this time, it is about being gentle. Gentle with my family and friends in this time of stress and uncertainty. Gentle with myself by lowering my expectations for both myself and others. At the moment, it is okay to just aim to be what I am. Anything else can come later.

I did, however, want to try to use this moment to put a few thoughts down about the particular challenges of having Type 1 Diabetes in these Coronavirus times.

Increased Risk Of Death For People With Type 1 Diabetes

So this is not a heading I ever wanted to write in my blog. But I think that, at a time like this, honesty and openness about the dangers are important. If for no other reason, truth can diminish the erratic thoughts that result from out-of-control fear. They can also offer hope.

Early on in the pandemic, at least where I am in the UK, the newspapers circulated information about the risks of death from COVID-19 for various medical conditions. For diabetics, the statistics were stark reading…

What Are The Most Common Health Conditions Among People Who Die Of COVID-19?

HEALTH CONDITION	% OF TYPE 1 DIABETICS WITH THIS CONDITION
Cardiovascular Disease	10.5%
Diabetes	7.3%
Chronic Respiratory Disease	6.3%
Hypertension	6%
Cancer	5.6%
No Health Condition	0.9%

So, according to this, once diabetics have contracted COVID-19, their risk of dying from the disease is greater than people suffering from chronic respiratory disease, hypertension and even cancer!

It was assumed that people with Type 2 Diabetes were generally more at-risk because they are generally older and also often have co-morbid health conditions, making their overall health poorer than those with Type 1 Diabetes.

However, a study by the National Health Service in the UK has now published a study that says otherwise…

Type 1 Diabetics Three Times As Likely To Die From COVID-19

As shown in this article by the Guardian newspaper, the NHS has found that those with Type 1 Diabetes are three-and-a-half times more likely to die from Coronavirus than non-diabetics. Type 2 diabetics are ‘only’ twice as likely (note: that’s still a huge increase!). Of course, the number of actual deaths of Type 1 diabetics will be substantially lower than Type 2s, since Type 2s are so much more numerous in the population.

What Is The Takeaway Message?

COVID-19 is a dangerous virus for those with Type 1 Diabetes. Once contracted, death is more likely than for other tranches of the population.

HOWEVER…

As I discussed in this blog post, the immune system of Type 1 Diabetics may actually not be compromised. Only the sub-optimal blood sugar control impacts the immune system. Therefore, stable blood sugars are our best fight against this disease. This will enable us to keep our immune system strong and therefore reduce our likelihood of catching COVID-19. Of course, combining tight blood sugar control with social distancing measures reduces our risks further.

Easier Said Than Done…?

Perfect blood sugar control when the world has gone to hell in a hand basket seems like a tall ask! When your whole routine – the thing our diabetic bodies thrive on – has gone out the window, how is that possible?

I have started by establishing a new routine. My usual exercise routine is gone and has been replaced by a good hour of walking early in the afternoon each day with my husband and daughter. I have worked out new meal timings that work not only for me but for my family as a whole. I am accepting that I have gained some weight, which has increased my total daily units. I accept that I am unlikely to drop this weight whilst under the stress of this pandemic. And I am learning to forgive myself for the deviations that I inevitably make in my attempts to keep myself as well as I can.

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Natalie Leader

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March 30, 2020

How Does The Quantity and Quality of Sleep Impact Type 1 Diabetes?
More Better Quality Sleep = Better Diabetes Control

The content of the HealingT1D website is for educational and information purposes only. It does not contain medical advice. The contents of this website are not intended to substitute for professional medical advice, diagnosis or treatment. Please always consult with your doctor, physician, or other qualified healthcare professional before making any adjustments to your routine or healthcare regime. HealingT1D and all associated with it will not be held liable for any risks or issues associated with using or acting upon the information on this site.

Summary: The post discusses the profound impact of sleep on managing Type 1 Diabetes. It highlights how inadequate sleep reduces insulin sensitivity, exacerbates blood sugar swings, and increases inflammation. Circadian rhythms and sleep quality are crucial, with suggestions to optimise sleep routines and environment. Strategies include managing blue light exposure and even sleeping naked for better quality sleep and health outcomes.

Ah, the elixir of sleep! Like the majority of people I know, I want more of it and better quality too! I think sleep has become particularly prominent in my mind recently because I have just had the fun of crossing timezones to go on holiday. Whilst I had a lovely time away, I am now left juggling the resulting jet lag. I just wish I could be asleep right now!!

Lack of Sleep Decrease Insulin Sensitivity in Type 1 Diabetes

I’ve seen this happen SO many times… I’ve had a good night out with friends and stayed up pretty late. I’ve given my night-time injection as usual and, in the morning, WHAM! High blood sugars. I followed all the rules but it just didn’t work. It sucks. So I’m fighting high blood sugars for several hours as well as feeling more-than-just-a-bit tired from my night out. What gives?!

It turns out that reduced insulin sensitivity after a poor night’s sleep is an expected physiological phenomenon. For example, having just one night of four hours of sleep (between 1am and 5am) results in a decrease in insulin sensitivity of between 14-21% the next day! [1] So, after a night out, my average total daily dose of 18.2 units would need to increase to 20.7-22.0 units!

Similarly, one single night of no sleep (hello new parents!!) results in MORE insulin resistance than eating a high-fat diet for SIX MONTHS!! [2] These effects also seem to be cumulative, with insulin resistance also found to be significantly increased over longer periods of time with reduced sleep. [3]

This increased insulin requirement is, of course, not uniform. I cannot sit down the morning-after-the-night-before and know for sure that if I increase all of my insulin levels by, say, 14% my blood sugars will be spot-on. What is more likely to happen is that my blood sugars will swing about for most of the day as I try to guess my insulin ratios. This will then set off a cycle of under- and over-correcting that is likely to further increase my overall insulin dose, beyond the initial 14%, for that day.

In short, my blood glucose levels are likely to be doing this (minus the fun!)…!!

My Blood Sugars After a Poor Night’s Sleep

Sleep and Inflammation

Multiple experimental studies have highlighted the link between sleep loss and mediators of inflammation. These mediators, known as cytokines, are secreted by cells of the immune system and are responsible for regulating levels of inflammation in the human body.

Levels of cytokines rise in the bloodstream following sleep deprivation, as demonstrated in both sleep deprivation studies (no sleep) and also in reduced sleep studies (for example, sleeping between 25-50% of the normal sleep requirement) [4]. Whilst these studies indicate that the changes in the levels of basal inflammatory cytokines are subclinical (i.e. not dramatically huge), I believe that these shifts are still likely to contribute to the overall level of chronic inflammation in my diabetic body (see my post on allostatic load for an explanation on how I understand the mechanism by which inflammation builds up in my system).

Circadian Rhythms Impact The Immune System

Human bodies function on a circadian rhythm. ‘Circadian rhythm’ is the term used to describe your body’s natural sleep-wake cycle. During any 24-hour period, you are likely to experience times when your body requires sleep more than others. Over time, with a regular sleeping schedule, your body’s circadian rhythm will match the sleep/wake cycle that you have and you will feel more alert and awake during your days. Here, then, regularity in the cycle is key.

The link between circadian rhythms and the immune system is discussed in detail in this post by the Sleep Doctor. To summarise, he highlights how, when sleep is irregular or less than the body requires, it disrupts circadian rhythms, which as a knock-on effect on the immune system. [5]

Not All Sleep Is Created Equal…?

But what time should this cycle take place? I know I’ve certainly heard of the night owl and the morning lark (and also the joke about the alternative option of the permanently exhausted pigeon!!). I’ve always thought of myself as a night owl. In my ideal world, I’d like to be up late and have a good ol’ lie-in every morning, at least beyond all those horrible single-digit hours!! But is that actually good for me?

Sleep quality changes as the night progresses. In the first part of the night, usually from 8pm to midnight, sleep is likely to consist mostly of the deep, restorative sleep known as ‘non-REM sleep’ [6].

In the latter part of the night, REM sleep then dominates. It appears that the switch from mostly non-REM sleep to mostly REM sleep happens at a set time of night, in the early hours of the morning, independent of the time you went to bed. So, for a night owl like me, I am likely to have more REM-heavy sleep, which is not as deep as non-REM sleep. The following morning, I will not feel as refreshed as I could be. So getting to sleep earlier is crucial.

How Can I Improve My Sleep?

Sleep by Nick Littlehales is a powerhouse of information on how to improve your sleep. It is written by Nick Littlehales, a sleep expert who coaches a variety of top-class athletes and footballers, including Olympians and members of the Premier League, on how to sleep effectively.

It appears that preparation is the key to effective sleep! Nick Littlehales goes into great detail (in a short and easy-to-read 177 pages!) on all aspects of sleep and how to optimise it. He includes details on:
The importance of pre- and post-sleep routines: how to prepare well for it and ‘recover’ from it for optimal functioning in your day.
The importance of a regular sleep schedule.
How to prepare your sleep environment (what he terms ‘the Recovery Room’!) for better quality sleep
How to work out the amount of sleep your body actually needs to be effective
I have just started implementing Nick Littlehales’ recommendations into my life and I am already seeing a dramatic increase in my readiness to sleep at night and the increased level to which I feel restored in the morning.

The Effects of Blue Light on Sleep

The Effects Of Blue Light From Technology May Be Disruptive To Sleep

Blue light is bad for sleep. We shouldn’t be using our phones or laptops or Apple watches or iPads or anything else that emits ‘blue light’ anywhere near when we want to fall asleep. This fact has almost become myth in today’s society and is cited widely (see here , here and here for just a few examples).

Is it true? Well, the jury seems to be out on this one. Manchester University has recently demonstrated that blue light may not actually be as bad for us as today’s myth suggests [8]. In fact, the researchers from this study suggest that blue light may in fact be more beneficial for our sleep than the bright, warmer-coloured lights that are normally used in households.

However, in this study, the light was controlled for brightness, such that the colour of the lighting was changed from yellow to blue without affecting its brightness. I wonder if, for electronics that tend to have bright lights with a blue tone, it is in fact the brightness, rather than the colour, that has the impact.

Whilst the jury may be out in the research world, I know for certain that on the evenings when I have not used any electronics – perhaps just read a book – my mind is not buzzing and I fall asleep much more quickly. So, for me, gadgetry has to go in the last few hours of my day.

Bonus Tip: Sleep Naked!

As I wandered through the literature on sleep and Type 1 Diabetes, I was surprised to find several references to the benefits of sleeping naked!

1. Sleeping Naked Promotes Sleep Quality

When you sleep naked, your body temperature lowers. This lowered body temperature signals to your circadian rhythm that it is time for sleep and also induces deeper (non-REM) sleep. This deep-sleep state in turn promotes longer lasting sleep since it is less likely you will be disturbed from this deep-sleep state. [9]

Better quality sleep also helps restore normal levels of the stress hormone cortisol in the body. So, with better quality sleep, you will feel less stressed in the morning no matter how stressful your life may be in waking hours. Sleeping naked, as discussed in the previous paragraph, promotes better quality sleep and therefore helps reset your stress counter.

Reduced cortisol also reduces both inflammation and insulin resistance [10], which will decrease my overall need for insulin further.

2. Sleeping Naked Helps You Lose Weight

In a study conducted by the National Institutes of Health [11], it was found that decreased room temperature when sleeping (which can also be achieved by removing clothing!) led to an increase in brown fat and a decrease in white fat in the study participants. Brown fat keeps your body warm by boosting the metabolism. This increase in your metabolism lasts all day and therefore helps burn more calories!

So it looks like I’m going to be experimenting with sleeping in the buff from now on!!

References

Donga, E., van Dijk, M., van Dijk, J. G., et al. (2010). Partial Sleep Restriction Decreases Insulin Sensitivity in Type 1 Diabetes. Diabetes Care, 33(7), 1573-1577. [Article]
Obesity Society (2015). One Night of Poor Sleep Could Equal Six Months on a High-Fat Diet, Study Shows. Retrieved 21st February 2020 from the World Wide Web: https://www.newswise.com/articles/one-night-of-poor-sleep-could-equal-six-months-on-a-high-fat-diet-study-shows.
Buxton, O. M., Pavlova, M., Reid, E. W., et al. (2010). Sleep Restriction for 1 Week Reduces Insulin Sensitivity in Healthy Men. Diabetes, 59(9), 2126-2133. [Article]
Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K., and Haack, M. (2010). Sleep Loss and Inflammation. Best Pract Res Clin Endocrinol Metab, 24(5), 775-784. [Article]
Comas, M., Gordon, C. J., Oliver, B. G., et al. (2017). A circadian based inflammatory response – implications for respiratory disease and treatment. Sleep Science and Practice, 1(18). [Article]
Heid, M. (2017). What’s the Best Time to Sleep? You Asked. Retrieved 22nd February 2020 from the World Wide Web: https://time.com/3183183/best-time-to-sleep/
Littlehales, N. (2016). Sleep. London: Penguin Random House UK. [Link]
Mouland, J. W., Martial, F., Watson, A., et al. (2019). Cones Support Alignment to an Inconsistent World by Suppressing Mouse Circadian Responses to the Blue Colors Associated with Twilight. Current Biology, 29(24), 4260-4267. [Article]
Bradberry, T. (2016). 4 Reasons Sleeping Naked Makes You Healthier And Wealthier. Retrieved 21st February 2020 from the World Wide Web: https://www.forbes.com/sites/travisbradberry/ 2016/09/13/4-reasons-sleeping-naked-makes-you-healthier-and-wealthier/#4c9f2fb969b4
Holmang, A., and Bjorntorp, P. (1992). The effects of cortisol on insulin sensitivity in muscle. Acta Physiol Scand, 144(4), 425-431. [Article]
Lee, P., Smith, S., Linderman, J., et al. (2014). Temperature-acclimated brown adipose tissue modulates insulin sensitivity in humans. Diabetes, 63(11), 3686-3698. [Article]

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Daniel Darkes

Miraculously Cured From Type 1 Diabetes

Enjoyed this post? Check out my post on ‘MORE Spontaneous Remissions From Type 1 Diabetes!’ too. But please also check out the update on Daniel Darkes here.

Summary: This article discusses the ‘miraculous’ healing of the Type 1 Diabetes veteran Daniel Darkes, who healed after having T1D for multiple years. His diet, exercise and vitamins regime are outlined, along with thoughts about how this information can help more to heal.

Who Is Daniel Darkes?

Daniel Darkes is the first man (in the Western World, at least) to be cured of Type 1 Diabetes. He has become the talk of the town in diabetes communities as people try to understand how this incurable, lifelong condition is no longer incurable or lifelong!

Daniel Darkes was diagnosed with Type 1 Diabetes in 2010, aged 23. He has left the British Army Grenadier Guard just four weeks before his diagnosis. He has stated that he was discharged from the army on medical grounds but it is not clear what medical issue this was.

Before Daniel’s body started to heal, he was originally taking 5-6 units of Novorapid for meals and 8 units of Lantus at night-time for a period of 7 years.

Daniel Stops Taking Insulin

In November 2016, Daniel started having episodes of recurrent hypoglycaemia at night. Before this point, night-time hypo’s had been extremely rare for him. Under the medical guidance of Northampton General Hospital, Daniel gradually reduced his insulin doses to try to prevent further hypoglycaemic episodes. However, no matter how little he gave, he continued to hypo. Eventually, it got to the point that Daniel’s consultant made the decision to stop insulin altogether.

The Impossible Becomes Possible

When I think about Miracle Dan (as Daniel Darkes has been named by his friends), I am reminded of the story of the four-minute mile. On May 6th 1954, Roger Bannister was the first man to run a mile in under four minutes. Athletes had tried since 1886 to break this barrier and none had succeeded. It was therefore assumed that this was a feat beyond human capability, something that the human body just could not do. However, once Bannister broke this barrier, many others followed. The impossible had become possible. Once they saw it could be done, many others did it too.

For me, Daniel Darkes is the Roger Bannister of Type 1 Diabetes. He has broken the barrier and shown that this ‘incurable’ condition is curable. We now know the impossible is possible.

Reactions To Daniel Darkes’ Cure

The medical and diabetic communities have not been wholly receptive to the news of Daniel Darkes’ cure. For example, Live Science wrote a piece highlighting what they believed to be inconsistencies in Daniel Darkes’ story. Firstly, they questioned the validity of his original Type 1 Diabetes diagnosis. They also used Daniel Darkes’ refusal to provide his medical records (actually, it was his NHS trust that refused due to patient confidently laws in the UK), plus the absence of a published medical case study, to infer that this may be some kind of hoax.

As I ponder this reaction, I am reminded of quote by Arthur Schopenhaueur:

It appears to me that, unfortunately, Daniel Darkes’ healing is encountering the first two stages of truth – ridicule and violent opposition. Change in the medical world takes time.

Daniel Darkes has stumbled across the way to heal Type 1 Diabetes. So, whilst the medical community is adjusting its lens to the new reality, I’d like to get on with actually learning as much as I can about how he achieved it!

What Do We Know About Daniel Darkes’ Miracle Cure?

Daniel’s Diet

Daniel appears to have a very healthy diet. He runs a lot (see below) and therefore takes care of his nutrition for this. When not running, his diet tends to consist of a lot of fish, chicken and vegetables, basically pretty low-carb. He might eat fruits, nuts and crackers for lunch. He doesn’t eat sweet stuff, chocolate or have sugar in his tea. But, before I panic about such a restrictive diet, he does admit to also having the occasional beer or sweet treat or takeaway at weekends!!

On days when Daniel is running a long run, he will increase his carbohydrate intake by adding in a serving of rice, pasta or sweet potato for dinner and/or porridge for lunch. He will also have gels or sweets on the runs to top up his blood sugars, if needed.

Foodstuffs Found In Daniel Darkes’ Diet

Daniel’s Vitamins and Supplements

Daniel has said that he takes the following vitamins and supplements on a daily basis:

Daniel’s Exercise Routine

Daniel is a long-distance runner. He regularly runs marathons and ultra-marathons. He is dedicated to his fitness. He tends to run 15-30 miles a couple of times a week and then does a longer run at the weekend.

Enjoyed this post? Check out my post on ‘MORE Spontaneous Remissions From Type 1 Diabetes!’ too.

What The Experts Think

Daniel Darkes says that the experts on his case have identified a rare gene that he possesses that is acting as a back-up immune system by recharging the pancreatic cells to produce insulin.

What I Think

Issues With The Experts’ Explanation

Hang on a minute! The old-school way of looking at diabetes said that the beta cells in the pancreas – the ones that produce the insulin – have been obliterated by our misfiring immune systems. And now they can recharge?! This fits in with what I have so far argued on my blog – that this theory of ‘burnt out beta cells’ has little scientific support and has actually been replaced with the finding that beta cells do still exist in the pancreas and can, under the right environmental conditions, start producing insulin again.

I also have an issue with this ‘rare gene’ hypothesis… My issue sits in the findings of epigenetics. Epigenetics argues that individuals are not necessarily destined to suffer (or enjoy!) the blueprints of their inherited DNA sequences. In other words, you may receive programming, via your DNA, from one or other parent but that does not mean that you are destined to have that gene expressed and acted out in your life. Instead, genes have been found to be affected throughout a person’s lifespan by a range of factors, including diet, exposure to pollutants and even emotions. it is the epigenetics, influenced by this diverse range of factors, that determine whether genes are turned on or off. Why this is relevant to Daniel Darkes is because this ‘rare gene’ may have in fact been created during his healing process, as a result of epigenetics. Equally, this may be a gene that we all possess, but as yet Daniel is the only one who has found a way to get this gene turned on and working.

Western Medicine Has Not Undertaken A Holistic Investigation

I struggle with the findings, and lack of findings, that I have so far heard about Daniel’s case. So far, all investigations seem to have proceeded down only the expected avenues… Inquiries into diet, exercise, supplements, blood sugar readings and so on. In other words, all focus has been on medical questions, which treat the body as a machine with a broken component (see my post on Descartes for more information). As such, I believe the lens of inquiry is too narrow.

We Also Need To Be Asking Daniel About…

Nobody is asking Daniel about the wider healing that he may have undertaken. As I highlighted in my post on neuropeptides, the brain is highly interrelated with the body via emotions. Has anybody asked Daniel what his emotional journey has been like over the time his healing took place? Were there any shifts in his emotional outlook, for example? Candace Pert would argue that emotional healing is as likely to improve health as much as any medical intervention.

I also wonder about his running. The experts have said that his long-distance running has somehow ‘shocked’ his immune system, via this rare gene, to start working again. How do they know that it wasn’t some other factor to do with running that would have helped? For example, Daniel is likely to have maintained good hydration to be able to run. He is also likely to have spent a lot of time outdoors in nature, which in itself can be very healing. The added benefit of sunshine on the body, and the resultant levels of vitamin D, are also worth questioning. Perhaps it was any one of these factors, or the combination of all of them, rather than the running itself, that led to his healing.

I have also heard about the great benefits of fasting and its ability to regenerate the immune system (although fasting can come with great risks for diabetics). Did Daniel have any intentional or unintentional periods of fasting, perhaps due to long runs or periods of illness, which may have instead been responsible for kickstarting his immune system?

I have seen no evidence that the medical teams are asking these kinds of questions. If they are not, they are not controlling for extraneous variables in their research design and, as such, according to the rules of scientific research, their method and findings are confounded. No firm conclusions can be drawn.

Dr Kelly Turner

As this post comes to an end, I am thinking back to Dr Kelly Turner’s work on spontaneous remissions of cancer. Kelly outlined how healing is based on a range of factors, only two of which were body-based (those of ‘radically changing your diet’ and ‘herbs and supplements’). By asking Daniel only about the body-based activities and treatments he had, we are missing out on finding out about the majority of his healing journey.

Dr Kelly Turner also discussed how valuable information about healing can be gained from asking the patient themselves what they believe healed them. Daniel Darkes thinks his healing resulted from the combination of his running and his diet, which is high in zinc, nuts, oily fish and vegetables.

I intend to use Daniel Darkes’ route to health as a roadmap for my own healing. However, I am hoping that I won’t need to achieve the fitness of an ultra-marathon runner to heal my Type 1 Diabetes… I dearly hope that my unique path to healing may not require such a high level of physical exertion for the same results!! Let’s wait and see.

Enjoyed this post? Check out my post on ‘MORE Spontaneous Remissions From Type 1 Diabetes!’ too.

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Allostatic Load

Re-Understanding The Development Of Type 1 Diabetes As Progression Along A Continuum

Summary: This article provides a conceptual framework for understanding the path to healing Type 1 Diabetes. Currently, the condition is seen as something that has ‘switched on’ in our bodies and remain there permanently. Perhaps instead we can use the concept of an ‘allostatic load’ to see T1D as a status that arrives when the environment of the cells has tipped towards too much toxicity or they are under too much challenge from areas such as the diet, feelings of the individual, amount of exercise, and all other life experiences. Using this concept, the focus then becomes about how to tilt that seesaw back towards health and healing.

Stress impacts the human body. We all know this! When stressed, our bodies produce a series of hormones to equip the individual to deal with a perceived or actual threat in the environment.

Hormones

There are two main types of hormones that are produced as a result of stress: glucocorticoids and catecholamines.

Glucocorticoids:

These are also known by the name glucocorticosteroids (which gives an impressive Scrabble score of 28 points!). These are part of the immune system feedback loop, which helps maintain homeostasis in the human body. One well-known glucocorticoid is cortisol, the ‘stress hormone’. Glucocorticoids have many functions, including:

1. An Ability To Stop Inflammation In The Body:

It does this by suppressing the release of molecules called proteins, which are used in the inflammatory process [1]. Glucocorticoids are therefore great at stopping the damage done by overactive immune system disorders, such as type 1 diabetes.

2. A Role In Regulation Of Glucose Metabolism:

Glucocorticoids encourage glucose production in the liver and also prevent insulin from working effectively to uptake glucose [2]. Glucocorticoids also affect pancreatic alpha and beta cell functioning [3]. This influences the amount of glucagon and insulin released into the bloodstream. The goal of glucocorticoids is to keep glucose in the bloodstream so that the brain, during times of stress, can work at maximum capacity [2].

Catecholamines:

Catecholamines (a mere 23 points in Scrabble!) are another type of hormone released during stressful life events. They are produced by my adrenal glands, which are located just above my kidneys. Examples of catecholamines are dopamine, norepinephrine and epinephrine (aka adrenalin). These hormones are sent into my bloodstream every time I get physically or emotionally stressed. Like glucocorticoids, catecholamines raise blood sugar levels, as well as heart rate, blood pressure and increased arousal of the sympathetic nervous system.

What Is Allostasis?

Both of these hormones, glucocorticoids and catecholamines, have beneficial short-term effects in the body. They prepare the body for a fight-or-flight response in times of stress or threat to life, for example. This process of adjusting the body, through physiological and/or behavioural changes, is known as ‘allostasis’ [4].

Allostatic Load

However, in the long-term, the process of allostasis can become disadvantageous and even burdensome on the body. Such a burden is known as the ‘allostatic load’ [4]. The higher my allostatic load, the more burden my body is carrying, in terms of raised blood glucose levels, higher stress levels, increased inflammation and so on. For example, chronic stress can lead to high levels of the glucocorticoid ‘cortisol’ (yes, that’s right, the ‘stress hormone’ as it’s known!). Chronically elevated cortisol levels can lead to:

- Anxiety
- Depression
- Digestive problems
- Sleep problems
- Weight gain
- Issues with memory [5]

How Is Allostatic Load Relevant To T1D?

Allostatic load is the burden the body has as a result of (ongoing) environmental stressors. It takes a toll on the system and, over time, creates a whole range of health issues [6].

Both the sympathetic nervous system and the neuroendocrine system (that’s the system that influences both hormones, like insulin, and neurons, including those in the brain) play central roles in the concept of ‘allostatic load’ [7]. In other words, chronic stress reduces insulin production and affects brain functioning. A lack of insulin production results in Type 1 (or Type 2 or MODY) Diabetes.

Dopamine is an example of a catecholamine. Insulin has been found to be strongly associated with the ‘pleasure’ centre of the brain, the striatal region, where dopamine is produced. [8]. The more insulin there is in the bloodstream, the more dopamine is released from the striatal region. Dopamine is a feel-good chemical. In a Type 1 Diabetic, when blood sugar levels are too high, the resulting mood is likely to not be a very fun one… Oh, I know that grumpiness of high blood sugars!! In a non-diabetic, I would anticipate that the reverse must be true… The more joy they experience, the more they are able to produce insulin.

In my post on Descartes and the Mind-Body Split in Western Medicine, I touched upon the research that highlights a connection between stressful life events and subsequently developing T1D. As discussed, chronic stress releases glucocorticoids and catecholamines that shut down insulin production and increase glucose concentrations in the blood. So perhaps the reverse can be true…? If I can reduce my allostatic load, it gives my system more of a chance of increasing (starting!) insulin production. It makes my bodily environment more welcoming to growing some new beta cells (as discussed in my post ‘What is Type 1 Diabetes?’).

My Take-Home Message

For me, the concept of an allostatic load is something to hold going forward. Instead of understanding my beta cells as being burnt out or broken, I am seeing them as being in an environment that stops them from switching back on.

The environmental conditions in my body are fuelled by all the factors that contribute to my allostatic load. These include my diet, my feelings of helplessness, my exercise regime, my response to my life experience, the amount of daily stress I carry with me, and so on.

In other words, Type 1 Diabetes is a multifaceted disorder. Thus, each one of these things that I can improve or eliminate, the smaller the burden of my allostatic load will be. I am therefore looking to improve all areas of my life that I feel may contribute to my allostatic load and thus fundamentally reduce it. I will watch to see what happens to my blood sugar levels (and pancreatic function) from there!

Summary

Stress produces two types of hormones in the body: glucocorticoids and catecholamines.
Glucocorticoids stop inflammation in the body and increase and/or maintain blood glucose levels, ready for the individual to respond to threat.
Catecholamines raise blood sugar levels, as well as heart rate, blood pressure and arousal in the sympathetic nervous system.
Allostatic load is a measure of the amount of cumulative stress placed on a system due to adjustments the body makes to maintain homeostasis.
Allostatic load can be used conceptually to understand T1D. Healing from T1D, using this approach, requires an overall reduction on stressors in the system that can contribute to a high allostatic load.

After-Thought…

Writing this post has also given me some food for thought on a related point… The dominant model for understanding Type 1 Diabetes is the Eisenbarth model (see my post on ‘What is Type 1 Diabetes?’ for more info on this). If researchers are using this model as their way of understanding T1D, they are going to assume that the beta cells in the pancreas are burnt out. Therefore, measuring the C-peptide, for example, once only is a sufficient indicator of the amount of insulin-producing cells left in that individual’s pancreas.

However, if that model is flawed and insulin production fluctuates with allostatic load over the course of a day, a week or a month, then measuring C-peptide would only indicate the amount of functioning beta cells at that moment in time. The C-peptide test is most often done, if at all, in the early days after diagnosis of T1D. At such a stressful time of life, when your allostatic load is likely to be huge, a low C-peptide level would almost be guaranteed. This would give an explanation for the ‘honeymoon effect’ of a lot of T1Ds since, after diagnosis, they are often looked after mentally, physically and emotionally by those around them.

References:

Barnes, P. J. (1998). Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clinical Science (London), 94(6), 557-572.
Kuo, T., McQueen, A., Chen, T. C., and Wang, J. C. (2015). Regulation of Glucose Homeostasis by Glucocorticoids. Advances in Experimental Medicine and Biology, 872, 99-126.
Rafacho, A., Goncalves-Neto, L. M., Santos-Silva, J. C., Alonso-Magdalena, P., et al (2014). Pancreatic alpha-cell dysfunction contributes to the disruption of glucose homeostasis and compensatory insulin hypersecretion in glucocorticoid-treated rats.PLoS One, 9(4), e93531.
McEwen, B. S. (2000). Allostasis and Allostatic Load: Implications for Neuropsychopharmacology. Neuropsychopharmacology, 22, 108-124.
Talbott, S. M. (2007). The Cortisol Connection: Why Stress Makes You Fat and Ruins Your Health – And What You Can Do About It. Nashville, TN: Hunter House.
McEwen, B. S. (2000). The Biological Basis for Mind Body Interactions. Progress in Brain Research, Vol 122. New York: Elsevier.
Kiecolt-Glaser, J. K., McGuire, L., Robles, T., and Glaser, R. (2002). Psychoneuroimmunology: Psychological Influences on Immune Function and Health. Journal of Consulting and Clinical Psychology, 70(3), 537-547.
Stouffer, M. A., Woods, C. A., Patel, J. C., Lee, C. R. et al. (2015). Insulin enhances striatal dopamine release by activating cholinergic interneurons and thereby signals rewards. Nature Communications, 6, 8543.

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The SHOCKING Truth About Insulin!

Hormones, Neuropeptides and… Acid!

Summary: This article discusses outlines the role of insulin in diabetes, highlighting how it is a hormone that acts on the permeability of cells. The discovery of insulin by Banting and Best is outlined, followed by a discussion of the modern-day insulins that are available. A consideration of the synthetic components contained within insulin are discussed, along with its properties of being both a hormone and a neuropeptide.

Ah, the elixir! The magic potent drug that keeps me alive and well. What would I do without you?!

Now, for me, it’s funny sitting here writing this post… For decades, I have (mostly!) diligently put insulin into my system. This has been via syringes (originally ones that were sterilised by boiling them in a saucepan!!) then insulin pen devices then an insulin pump and now syringes again. All those units of insulin, all those vials, all those bottles… But I actually know so little about this wonder drug! Is it even a drug?!

What Is Insulin?

So, to answer my first question… No, insulin is not a drug (until it is put into bottles and sold by pharmaceutical giants, anyway!). A plethora of books, articles and webpages kindly inform me that insulin is a hormone [1, 2, 3].

What Are Hormones?

Hormones are a type of molecule in the human body that are transported around the body by the circulatory system. They are taken to places in the body to stimulate specific cells or tissues to produce a predetermined action. The hormone insulin is produced in the pancreas in the beta cells. Insulin is then dispatched into the bloodstream to act on the glucose molecules found there. Insulin works by increasing the permeability of the cells in the human body. With increased permeability, each cell is able to absorb more glucose from the bloodstream, resulting in lower amounts of glucose molecules in the blood [4].

A Brief History Of Insulin

I have to admit that I’m not a great fan of learning about the past. I had a really boring history teacher when I was at school who, I think, successfully put me off history for the rest of my adult life. Saying that, I don’t mind a quick delve into the textbooks of the past when I feel there’s something to be gained. This is true for insulin.

Insulin was not discovered until 1922. Prior to its discovery, the life expectancy of children and young adults with type 1 diabetes was very poor, with deteriorating health and death always imminent. My mother’s great-grandmother was one of the early ones to suffer this fate, dying when she was just 19 years old.

Thankfully, advances have been made. In 1922, insulin was discovered by Frederick Banting and Charles Best, under the directorship of John Macleod, following their investigations into the pancreatic function of dogs [5]. They siphoned off a pancreatic extract from the dogs’ pancreases (what we now know to be insulin) and found that the dogs developed diabetes. By re-injecting this pancreatic extract back into the dogs, the dogs’ blood sugars were lowered.

Charles H. Best and Banting, c. 1924.

The insulin that was extracted from the dogs’ pancreases in these experiments was not purified. Therefore, when it was injected for the first time into a human being, that of a fourteen year old boy, the lack of purification resulted in a sterile abscess and little effect on the blood sugar levels [6]. Banting and Best, with the help of their biochemist colleague J. B. Collip, purified the pancreatic extract, resulting in the first medically viable insulin [7]. In 1923, Banting and Macleod were awarded the Nobel Prize for their discovery of insulin.

Over the following decades, procedures for extracting insulin were refined. Eli Lilly began producing insulin from animal pancreases. He found that the insulin from dead pigs and cows was particularly suited to humans.

In 1982, ‘human’ insulin was produced for the first time. Human insulin is manufactured from genetically engineering the bacterium of yeast cells to produce insulin.

On the market today, there are over 40 different types of insulin available to the diabetic consumer. The vast majority of diabetics use human insulin. However, natural animal insulins, which have no synthetic properties, are still available in some countries, including my home country of the UK. I feel this fact is important to know when considering healing from Type 1 Diabetes. I wish to make my body as healthy as I can, which I believe involves removing as many extraneous toxins as possible.

Rapid-Acting, Short-Acting, Intermediate-Acting, Long-Acting…

Today, we are blessed to have so many different types of insulin available to us. Whatever our bodily responses to food, exercise and generally just staying alive(!), there is an insulin to match it.

i) Rapid-acting
ii) Short-acting
iii) Intermediate-acting
iv) Long-acting
v) Pre-mixed

Each of these types of insulin have different profiles for how long it takes them to start to work and how long they remain effective in the human body. Rapid-acting insulins, such as Novorapid (also known as Novolog), Humalog and Apidra, all start working in 10-20 minutes and last for two and half hours to five hours (although every human body is different so I only ever take these as rough guides until I’ve seen what they do to me in practice!).

Short-acting insulin tends to have a slower onset and duration than the rapid-acting insulins. Actrapid (also known as Regular insulin) is the most well-known type of insulin in this this group.

NPH is an intermediate-acting insulin, so-called because it takes 1-2 hours to start to work but then last in the system for about half a day.

In the long-acting group is insulin glargine (the most commonly known ones being Lantus and Toujeo), insulin determir (known as Levemir) and Insulin degludec (known as Tresiba). These have a much longer onset time, somewhere between one to two hours depending on the specific type, but last up to 24 hours or longer.

The last group are the pre-mixed insulins, which consist of both short-acting and long-acting insulins.Some examples are Humulin 70/30 and Novolog 70/30, both of which take 30 minutes to onset and last up to 24 hours.

The Lesser Known ‘Amylin’

As I was reading up on insulin production, I found that the insulin-producing beta cells in the pancreas don’t just produce insulin. They also produce another hormone… Amylin.

Amylin is the hormone that helps insulin to attain optimal blood glucose levels after meals. It has many roles…

1. It slows the digestive process, which means that carbohydrates take longer to enter the bloodstream. This results in smaller blood sugar spikes after meals.

2. Prevents glucagon being secreted from the pancreas. Glucagon is a hormone that is responsible for raising blood sugar levels. That means, for me as a type 1 diabetic, I have the added joy of MORE glucagon being released when I eat a meal. So my poor body has to cope with even more free-floating glucose in my bloodstream. Consequently, I have to take more insulin; some to cover the meal itself and some to cover this additional glucagon spike.

3. Amylin increases feelings of satiety. Increasing satiety would dissuade me from reaching for that third second piece of cake after dinner or that lovely chocolate cookie between meals. But, nope, I don’t have amylin. So THAT is why I feel like I… am… always… hungry!!

There is a product on the market called Symlin, which is synthetic amylin that can be used to counteract the lack of amylin in your system.

However, for me, that is not really a choice I wish to make. I am striving to get my body back to as natural a setting as possible and focusing on getting my body to regenerate itself as much as possible. But just knowing that there is a reason why I don’t ever feel satisfied at the end of a meal (no matter how full my belly is!) lets me know that that is okay. I can make peace with that.

My Experience of Insulin

I have been on a range of insulins over the years. When I was first diagnosed, I had two injections a day of mixed Actrapid and Monotard (an old long-acting insulin). This continued until I was eight or nine years old, when I was switched to Novorapid three times per day with meals and Protaphane at bedtime. I have played about with different types since then, including taking purely Novorapid through an insulin pump for a five-year period. Currently, my insulin regime tends to take one of two approaches:

When eating a carbohydrate-rich diet (50-100 grams per day), I find that Novorapid at meal times plus one large-ish dose of Lantus at bedtime is the most effective.

When eating lower amounts of carbohydrates (usually 30-40 grams per day), I require a different regime. I find that Actrapid is more effective for meals (since the protein content of my meals gives the larger blood sugar hit and this hits in later than simple carbohydrates) and two doses of Lantus (at night and in the morning) gives me better stability in my daily blood sugars.

Always Read The Label…

Now this was a bit of a shocker for me. I had always assumed that the insulin I was putting into my body on a more-than-daily basis was just that… Insulin. Well, it turns out that I have been duping myself. I decided to read the package leaflet for each insulin to discover what I was really putting into my body.

Lantus:

At the moment, I use Lantus (insulin glargine) from 3 mL pre-filled cartridges. These contain insulin glargine, plus the following inactive ingredients:

Zinc chloride

Metacresol

Glycerol

Sodium hydroxide

Hydrochloric acid

Water for injections

Novorapid:

I use Novorapid (Novolog) vials for my mealtime injections. They contain:

Glycerol

Phenol

Metacresol

Zinc chloride

Disodium phosphate dihydrate

Sodium chloride

Hydrochloric acid

Sodium hydroxide

Water for injections

I have to admit that, whilst I’m deeply grateful for my insulins and their ability to keep me alive and well, I’m really disappointed to see how many additional chemicals I am putting into my body on a daily basis. This makes me think more deeply about using animal insulin rather than synthetic insulin. I think I need to investigate that idea further.

Insulin And The Brain

“You what?! What do you mean ‘insulin and the brain’? They have absolutely nothing to do with each other!” was my first thought on this topic. After all, I’ve never had discussions about my brain with my diabetologist. Well, it turns out that maybe I should…!

Early research believed that insulin purely existed in the pancreas and in the bloodstream. It was simply a hormone.

However, recent research is showing that insulin is in fact highly involved with the brain. It appears that insulin has several roles in the brain and is involved in multiple neural pathways [10].

Insulin was first found in the brain in the late 1970s by Jana Havrankova and colleagues [11]. This early research was conducted on rat brains but insulin has similarly been detected in human brains [12].

For this reason, researchers of today are now choosing to refer to insulin as a ‘neuropeptide’.

What Are Neuropeptides?

Peptides are protein-like molecules that are used by nerve cells (called neurons) to communicate with each other. They are made up of a string of amino acids and are usually shorter in length than proteins.

Neuropeptides are a specific type of peptide that are released from neurons (in the brain and central nervous system) and act on neighbouring neurons.

A hotly debated area in the world of neuropeptides and insulin production is whether or not insulin is made in the brain [13].

Whilst there appears to be no clear conclusion on this matter as yet [10], the latest research is strongly indicating that there is in fact insulin being produced by the brain [14].

Is Insulin A Neuropeptide Or A Hormone?

It turns out that insulin is BOTH… A hormone and a neuropeptide (see my post here for more on this topic). Insulin is produced in the pancreas by beta cells (in non-diabetics) and travels through the bloodstream to act on glucose molecules. This makes it a peptide hormone. However, as discussed above, some preliminary studies are indicating that it is also produced in the brain and acts on neighbouring brain regions.This firmly places insulin in the neuropeptide camp too.

Why Does It Matter If Insulin Is A Neuropeptide Or A Hormone?

Neuropeptides are mainly brain-focused. Hormones are mainly body-focused. Insulin is both a hormone and a neuropeptide. It has actions in both the brain and the body. Type 1 Diabetes results from a lack of insulin. So has the insulin production been disrupted in the brain or the body or both?

For me, it seems obvious that Type 1 Diabetes cannot be just a disorder of the pancreas. It is not a purely physical disease with a purely physical origin. If it acts in both the brain and the body and is produced in both the brain and the body, then both the brain and the body must go wrong at the time of the onset of T1D. Going forwards, this further underlines for me how my healing from T1D needs to involve both my mind and my body. Both of them need to be healed, not either in isolation from the other.

Summary

Insulin is a hormone that T1Ds require to regulate blood glucose control.
Insulin today comes in two types: synthetic ‘human’ insulins and natural animal insulins.
Human insulins contain, as well as insulin, multiple additional ingredients including zinc chloride, metacresol, glycerol, sodium hydroxide and hydrochloric acid.
Insulin acts on both the pancreas and the brain. It is therefore both a hormone and a neuropeptide.
T1D can therefore be understood as being associated to both the mind and the body.

References

Holt, R. I. G., and Hanley, N. A. (2012). Essential Endocrinology and Diabetes. Chichester, UK and Hoboken, NJ: Wiley-Blackwell Publishers.
Scheiner, G. (2011). Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin (2nd ed.). Cambridge, MA: Da Capo Press.
Neal, M. J. (2012). Medical Pharmacology at a Glance (7th ed.). West Sussex, UK: John Wiley and Sons.
Stryer L (1995). Biochemistry (4th ed.). New York: W.H. Freeman and Company.
Banting, F. G., Best, C. H., Collip, J. B., Campbell, W. R., and Fletcher, A. A. (1922). Pancreatic extracts in the treatment of diabetes mellitus. Preliminary Report. Canadian Medical Association Journal, 12, 141-146.
Quianzon, C. C., and Cheikh, I. (2012). History of Insulin. Journal of Community Hospital Internal Medicine Perspectives, 2(2), 10.
Bliss M. (1993). The History of Insulin. Diabetes Care, 16(3), S4-7.
https://www.iddt.org/diabetic-commonsense/the-great-debate-natural-animal-or-artificial-human-insulin
https://www.sciencedaily.com/releases/2015/10/151027074802.htm
Gray, S. M., Meijer, R. I., Barrett, E. J. (2014). Insulin Regulates Brain Function, but How Does It Get There? Diabetes, 63(12): 3992-3997.
Havrankova J., Schmechel, D., Roth, J., Brownstein, M. (1978). Identification of insulin in rat brain. Proc National Academy of Science U S A, 75(11), 5737–4110.
Dorn, A., Bernstein, H. G., Rinne, A., Ziegler, M., Hahn, H. J., Ansorge, S. (1983). Insulin and glucagonlike peptides in the brain. Anatomical Record, 207(1), 69–77.
Blázquez, E., Velázquez, E., Hurtado-Carneiro, V., and Ruiz-Albusac, J. M. (2014). Insulin in the Brain: Its Pathophysiological Implications for States Related with Central Insulin Resistance, Type 2 Diabetes and Alzheimer’s Disease. Frontiers in Endocrinology, 5, 161-182.
Molnár, G., Faragó, N., Kocsis, A. K., et al. (2014). GABAergic neurogliaform cells represent local sources of insulin in the cerebral cortex. Journal of Neuroscience, 34, 1133–1137.

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What Is Type 1 Diabetes REALLY?

The “Beta Cell Burnout Theory” May Not Be True

Summary: The Eisenbarth model explains Type 1 Diabetes (T1D) as an autoimmune disease where the immune system targets and eliminates pancreatic beta cells, cells that are crucial for insulin production. However, recent research offers hope for treatment advancements and cure. Research has highlighted the potential for beta cell preservation and regeneration, including findings on delta cell transformation and the presence of dormant and baby beta cells in the pancreas.

After 38 years with diabetes, I felt pretty sure that I was the Mastermind champion on Type 1 Diabetes (T1D)!

I knew that my pancreas had stopped functioning. I knew that I needed to take regular insulin injections (or insulin pump infusions) to replace the lost insulin that my pancreas no longer produces.

I knew that my pancreas was defunct. Irreparable. Beyond salvation. Dead as a dodo.

Life with T1D

T1D management can be tricky and, at times, onerous. I maintain my T1D through testing my blood sugar levels up to ten times per day.

I inject insulin at each meal and at bedtime (see my ‘Insulin‘ post for further exploration on this topic).

I inject varying amounts of insulin for each meal. The amount depends on the carbohydrates on my plate (or, more accurately, in my stomach!!).

Insulin dosing is a fine art. Too much, I hypo (‘hypoglycaemia’). I become listless, confused and sometimes uncooperative. Too little insulin, my blood sugars run too high (‘hyperglycaemia’). I become irritable, anxious and sometimes mean.

But I am well and I am healthy. I live a full and active life. I am a wife to a non-diabetic husband. I am a mother to a non-diabetic child. I travel. I exercise. I live. I have fun.

The Finer Detail…

But I have to hang my head and say that I don’t TRULY know what diabetes is. I’ve heard about the islets of Langerhans. But I couldn’t explain to you what they are. I know that my beta cells have been attacked by my immune system. But I can’t draw you a picture of what that looks like. And I don’t know why my immune system attacked my beta cells to start with.

Back To School

I decided that the first stage of my healing process must include improving my knowledge levels. How could I slay the beast without knowing what it looked like? How could I understand what healing from T1D required if I didn’t know what its mechanism actually was?

Understanding this process started with under the immune system. Basically, the immune system functions in two main stages. Firstly, it detects foreign bodies, known as pathogens. When pathogens are detected, the immune system sets about neutralising these pathogens.

In healthy individuals, the immune system is so advanced that it is able to differentiate between pathogens and the normally functioning cells, tissues and organs of the human body.

The dominant model to explain diabetes is the Eisenbarth model [1]. This model states that T1D is a chronic autoimmune disease where the immune system attacks the pancreatic beta cells. It mistakenly identifies the beta cells in the pancreas as pathogens and sets about eliminating them [2].

The Pancreas

So here it is, the little beauty! What strikes me most about this organ is how unnoticed AND unnoticeable it is! If you ask most healthy people, they could describe where the major organs of the brain, heart, lungs, kidneys, stomach, bladder and bowel are located. But the pancreas…?

The pancreas is part of the digestive system. It is conveniently situated behind the stomach. It has both endocrine and exocrine functions. The endocrine functions are mostly focussed on regulating blood sugar levels. It achieves this by secreting a series of hormones, including insulin, straight into the bloodstream. The exocrine functions involve supplying the stomach with digestive enzymes. These enzymes break food down into carbohydrates, proteins and fats.

What Are Beta Cells?

There are three types of endocrine cells:

Alpha Cells: secrete glucagon. Glucagon is responsible for stimulating the liver to convert glycogen stores into ready-to-use glucose.
Beta Cells: secrete insulin.
Delta Cells: produce somatostatin that inhibits the secretion of glucagon and insulin.

All three are found in the pancreatic islets. These pancreatic islets are also known as the ‘islets of Langerhans’. These were named after the German anatomist Paul Langerhans, who discovered them in 1869.

Researchers generally posit that T1D occurs when the majority (between 70-90%) of the beta cells have been destroyed [3], [4], [5], [6]. Without these beta cells, the pancreas is unable to produce enough insulin to maintain healthy blood sugar levels.

Beta Cell Mass and Beta Cell Function

Now this is where, for me, things got a bit more murky. More recent research [8] suggests that the lack of sufficient insulin in diabetes could in fact result from two different factors:

Reduced beta cell mass: there are fewer working beta cells in the pancreas due to increased beta cell death.
Reduced beta cell function: the beta cells are still alive and well in the pancreas but they are in a dormant/non-functioning state.

So which one is relevant to Type 1 Diabetes? It would appear that the answer is… BOTH! For T1D that developed before the age of 14, there appears to be a higher number of inflamed islets (suggesting a reduction in their functioning) and also a lower number of remaining beta cells [9]. For T1D developed in the teenage years, however, beta cell mass is still surprisingly high [10]. The beta cells are still there, just not working right! It is thought that the marked increase in the loss of beta cell mass in the early years of Type 1 Diabetes is due to an increased level of the inflammatory process ‘insulitis’ [10].

Why Were My Beta Cells Inhibited And/Or Destroyed?

I have millions of cells in my body that do thousands of different jobs so why on earth did my rampaging, rebellious, body-wide immune system choose to turn in on my beta cells? That’s pretty specific! Why not the cells responsible for producing nasal mucus (that’s snot and bogeys to you and me!!)? I’d prefer to do without those!

Well, now the next piece of the story unravels… It turns out that the immune system in T1D may actually be working perfectly. Instead, it is the beta cells that become dysfunctional [11]. This dysfunction causes the immune system to (quite correctly) identify them as pathogens, unhealthy to the system. It therefore sets about clearing them out.

Is All Hope Lost?

Okay, soldier, not so quick on the draw!! Despite all the gloom and doom about total beta cell loss, I have found some avenues of hope.

Firstly, some interesting findings concerning C-Peptide. C-Peptide and insulin are produced and released from the pancreas at the same time and in similar quantities. Thus, measuring C-Peptide can give a fairly good indication of the level of insulin that the pancreas is producing. It has been found that 88% of T1D still have functioning beta cells, even many years after diagnosis and therefore also still have measurable levels of C-Peptide[12]. Thus, for these lucky individuals, half the battle is won. Unfortunately, my doctor has confirmed that my C-Peptide level is so small that it’s unmeasurable… Unfortunately, I ain’t in that ‘my-pancreas-is-still-performing-pretty-well’ camp!!

Secondly, research does not seem to support Eisenbarth’s proposal that great numbers of beta cells have been destroyed by the immune system… In fact, only modest increases in beta cell death have ever been found in T1D [13]. So the beta cells might not even be dead…?!

Instead, researchers [14] have demonstrated that the pancreas of T1Ds hold a larger-than-normal number of delta cells in their pancreas. Therefore, they suggest that, instead of the beta cells dying, they have been converted from insulin-producing beta cells into insulin-inhibiting delta cells. These same authors also found that this cell transformation is reversible, meaning that the delta cells can be changed back into fully-functioning beta cells under laboratory conditions.

Thirdly, it has been found that when beta cells from Type 2 Diabetics are taken out of the ‘stressful stimulus’ provided by their bodily environment, they started producing insulin again [15].

Fourthly, cutting-edge research has found that the pancreas has its own back-up system in place! Hidden in plain sight from researchers for over one hundred years is a population of baby beta cells tucked up around the edges of healthy pancreatic cells [16]. These baby cells can already produce some insulin. I therefore wonder if it’s possible to grow these into fully-functioning ‘adult’ beta cells to restore insulin production in the pancreas.

Hope Still Exists!

These four findings give me great hope. Although I do not have any measurable C-Peptide, I may still have dormant beta cells (which therefore are not producing C-Peptide). These may just need a wake-up call to get going again. However, even if I don’t have these dormant but healthy beta cells that can go forth and multiply, I still do have a source for creating new ones… The baby beta cells in the periphery of my pancreatic cells. Furthermore, the notion that the environment of the cell may inhibit insulin production makes me think about how I might change that environment myself to encourage beta cell proliferation.

Rebooting The Pancreatic Cells

So I need to find a way to reawaken my dormant beta cells (if I have any), and/or transform my delta cells back into fully-functioning beta cells and/or grow my baby beta cells into adult form. As I have discussed above, beta cells can suddenly start producing when the environment they are in is changed. This makes sense to me. After all, how do you get a plant or an infant to grow? You provide it with the right nutrition, environment and conditions for growth to take place.

In my forthcoming blog posts, I will further support and expand upon the thoughts in this post. Furthermore, I will be exploring a whole series of factors that I believe will contribute to the (re)growth of my beta cells.

Summary

Type 1 Diabetes was originally understood to be an autoimmune disorder resulting from a misfiring immune system killing off the pancreatic cells that produce insulin (beta cells).
The beta cells are stored in pancreatic islet cells, along with alpha cells (that secrete glucagon) and delta cells (that produce somatostatin, which inhibits insulin and glucagon production).
Cutting-edge research is demonstrating that: i) the beta cells in the pancreas may not be destroyed after all; ii) beta cells have been transformed in the pancreas into insulin-inhibiting delta cells, which can be transformed back to beta cells; iii) changing the environment of inhibited beta cells can enable them to start producing insulin again; iv) the pancreas also contains baby beta cells that have the potential to develop into fully-functioning beta cells for those who do not have their own supply.
T1D appears to be more healable than the ‘beta cells have been burnt out’ theory suggests.

Glossary:

Alpha Cells: one of three types of cells found in the pancreatic islets. These are responsible for releasing glucagon to raise low blood sugar levels.

Autoimmune disease: a disease caused by the immune system attacking cells or tissues in the human body that should not normally be attacked.

Beta Cells: one of three types of cells found in the pancreatic islets. These are responsible for producing insulin, which lowers blood sugar levels.

Beta Cell Function: a measure of the ability of the insulin-producing beta cells to produce insulin.

Beta Cell Mass: a measure of the number of fully-functioning beta cells remaining in the pancreas.

Blood sugar levels: a measure of the amount of glucose in the bloodstream. In diabetes, the body’s natural ability to maintain this at an optimum level is diminished.

Carbohydrates: sugars, starches and fibres that are found in food stuffs. Carbohydrates are normally the body’s main source of energy, being utilised to increase blood glucose levels as and when required.

Chronic: long-term.

C-Peptide: an amino acid produced concurrently with insulin in the pancreas. A detectable level of C-peptide in the bloodstream is indicative of insulin production in the pancreas.

Delta Cells: one of three types of cells found in the pancreatic islets. These are responsible for inhibiting the production of glucagon and insulin from the alpha and beta cells respectively.

Eisenbarth model of diabetes: the currently dominant model of diabetes used by the majority of researchers and doctors to explain how T1D occurs. It suggests that T1D results from the immune system attacking and breaking down the beta cells in the pancreas, thus causing hyperglycaemia.

Hyperglycaemia: the presence of too much sugar in the bloodstream.

Hypoglycaemia: the presence of too little sugar in the bloodstream.

Immune System: this is a complex, body-wide system that protects a body against pathogens and disease. It consists of many cells, organs and tissues of the anatomy.

Insulin: a hormone produced by the beta cells in the pancreas. It is responsible for lowering glucose levels in the bloodstream. In T1D, insufficient insulin is produced by the pancreas. The lacking insulin is replaced with external insulin, either via injection or insulin pump.

Insulitis: a disease of the pancreas where immune cells infiltrate the pancreatic islets, causing beta cell loss.

Islets of Langerhans: also known as pancreatic islets. Each one is a specific small area of the pancreas that contains three main cells that are responsible for producing hormones; alpha cells, beta cells and delta cells.

Pancreas: an organ of the body, situated behind the stomach. It has roles to play in both the digestion of food and regulation of blood sugar levels in the bloodstream. In T1D, one small part of the pancreas, the beta cells, no longer produce insulin.

Type 1 Diabetes (T1D): an autoimmune disease that occurs when the immune system attacks and destroys the insulin-producing beta cells in the pancreas.

References:

Pugliese, A., and Skyler, J. S. (2013). George S. Eisenbarth: Insulin and Type 1 Diabetes. Diabetes Care, 36(6), 1437-1442. [Article]

Holt, R. I. G., and Hanley, N. A. (2012). Essential Endocrinology and Diabetes. Chichester, UK and Hoboken, NJ: Wiley-Blackwell Publishers. [Book]

Gepts W. (1965). Pathologic anatomy of the pancreas in juvenile diabetes mellitus. Diabetes, 14(10), 619–633. [Article]

Gepts W., and De Mey J. (1978).Islet cell survival determined by morphology: An immunocytochemical study of the islets of Langerhans in juvenile diabetes mellitus. Diabetes, 27(S1), 251–261. [Article]

Junker K., Egeberg J., Kromann H., and Nerup J. (1977). An autopsy study of the islets of Langerhans in acute-onset juvenile diabetes mellitus. Acta Pathologica et Microbiologica Scandinavica. Section A, Pathology, 85(5), 699–706. [Article]

Kloppel G., Drenck C. R., Oberholzer M., and Heitz P. U. (1984). Morphometric evidence for a striking B-cell reduction at the clinical onset of type 1 diabetes. Virchows Archiv A Pathological Anatomy and Histopathology, 403(4), 441–452. [Article]

Chen, C. et al. (2017).Human Beta Cell Mass and Function in Diabetes: Recent Advances in Knowledge and Technologies to Understand Disease Pathogenesis. Molecular Metabolism, 6(9), 943-957. [Article]

Atkinson, M. A., von Herrath, M., Powers, A. C., and Clare-Salzler, M. (2015). Current Concepts on the Pathogenesis of Type 1 Diabetes — Considerations for Attempts to Prevent and Reverse the Disease. Diabetes Care, 38(6), 979-988. [Article]

https://www.telegraph.co.uk/news/health/news/12146841/Type-1-diabetics-have-sleeping-insulin-cells-which-could-be-woken-say-scientists.html

Sims, E. K., and DiMeglio, L. A. (2019). Cause or effect? A review of clinical data demonstrating beta cell dysfunction prior to the clinical onset of type 1 diabetes. Molecular Metabolism, 27S, S129-S138. [Article]

Oram, R. A., Sims, E. K., and Evans-Molina, C. (2019). Beta cells in type 1 diabetes: mass and function; sleeping or dead? Diabetologia, 62(4), 567–577. [Article]

Butler A. E. et al. (2007).Modestly increased beta cell apoptosis but no increased beta cell replication in recent-onset type 1 diabetic patients who died of diabetic ketoacidosis. Diabetologia, 50(11), 2323–2331. [Article]

Piran, R., Lee, S. H., Li, C. R., Charbono, A., Bradley, L. M., and Levine, F. (2014). Pharmacological induction of pancreatic islet cell transdifferentiation: relevance to type I diabetes. Cell Death and Disease, 5, e1357. [Article]

Jeffery, N., et al. (2019).Cellular Stressors may alter islet hormone cell proportions by moderation of alternative splicing patterns. Available at: https://ore.exeter.ac.uk/ repository/ bitstre am/handle/10871/37184/Jeffery%20et %20al.,%20HMG%202019.pdf?sequence=1.

van der Meulen, T., et al. (2017).Virgin Beta Cells Persist throughout Life at a Neogenic Niche within Pancreatic Islets. Cell Metabolism, 25(4), 911-926. [Article]

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Natalie Leader

Category: Physical Wellbeing

References:

Recent Comments:

What can I commit to now that I will be able to continue to do in the future?

Accountability Buddies!

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Increased Risk Of Death For People With Type 1 Diabetes

What Are The Most Common Health Conditions Among People Who Die Of COVID-19?

Type 1 Diabetics Three Times As Likely To Die From COVID-19

What Is The Takeaway Message?

HOWEVER…

Easier Said Than Done…?

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Lack of Sleep Decrease Insulin Sensitivity in Type 1 Diabetes

Sleep and Inflammation

Circadian Rhythms Impact The Immune System

Not All Sleep Is Created Equal…?

How Can I Improve My Sleep?

The Effects of Blue Light on Sleep

Bonus Tip: Sleep Naked!

1. Sleeping Naked Promotes Sleep Quality

2. Sleeping Naked Helps You Lose Weight

References

Recent Comments:

Who Is Daniel Darkes?

Daniel Stops Taking Insulin

The Impossible Becomes Possible

Reactions To Daniel Darkes’ Cure

What Do We Know About Daniel Darkes’ Miracle Cure?

Daniel’s Diet

Daniel’s Vitamins and Supplements

Daniel’s Exercise Routine

What The Experts Think

What I Think

Issues With The Experts’ Explanation

Western Medicine Has Not Undertaken A Holistic Investigation

We Also Need To Be Asking Daniel About…

Dr Kelly Turner

Recent Comments:

Hormones

Glucocorticoids:

1. An Ability To Stop Inflammation In The Body:

2. A Role In Regulation Of Glucose Metabolism:

Catecholamines:

What Is Allostasis?

Allostatic Load

How Is Allostatic Load Relevant To T1D?

My Take-Home Message

Summary

After-Thought…

References:

Recent Comments:

Recent Comments:

Life with T1D

The Finer Detail…

Back To School

The Pancreas

What Are Beta Cells?

Beta Cell Mass and Beta Cell Function

Why Were My Beta Cells Inhibited And/Or Destroyed?

Is All Hope Lost?

Hope Still Exists!

Rebooting The Pancreatic Cells

Summary

Glossary:

References:

Recent Comments: