Re: Insulin and mortality

[Guest guest]

>It has been shown that injecting insulin increases the mortality of diabetics

with advanced heart problems by four times compared to that of diabetics taking

oral medication with heart problems but nobody yet knows why.<

For me, this is so counterintuitive that I would have to know everything about

this study before I would be willing to consider it.

Shown by whom? Who sponsored this study? How many test subjects were there? How

were the test subjects chosen?

For all I know it was sponsored by Glucatrol...

Dianne

__________________________________

Yahoo! for Good - Make a difference this year.

http://brand.yahoo.com/cybergivingweek2005/

[Guest guest]

>It has been shown that injecting insulin increases the mortality of diabetics

with advanced heart problems by four times compared to that of diabetics taking

oral medication with heart problems but nobody yet knows why.<

For me, this is so counterintuitive that I would have to know everything about

this study before I would be willing to consider it.

Shown by whom? Who sponsored this study? How many test subjects were there? How

were the test subjects chosen?

For all I know it was sponsored by Glucatrol...

Dianne

__________________________________

Yahoo! for Good - Make a difference this year.

http://brand.yahoo.com/cybergivingweek2005/

[Guest guest]

> Well, let's think about this. We've got a

> patient with advanced heart disease.

Not quite, Carol. There were 554 patients, not " a patient " .

> With or without diabetes and with or without

> insulin this patient is going to die, probably

> of heart disease.

It was not a question of whether they were going to die or not, it

was a matter of whether they could survive for one year after the

cardiac event. That is not a very long time. 90% of the non-

diabetics did, 86% of the diabetics being treated with oral

medication also survived the year, but only 62% of the diabetics

being treated with insulin managed it. Those are significantly worse

odds (4 times worse in fact). Care was taken to cancel out all

confounding influences. Nobody knows yet why it happens.

> We all have to die of something,

> even if it's just old age.

Sure but that is the best possible outcome! All that we are striving

for is to have the best chance of dying of old age and not to pop

off too early for some other reason.

I know that one study does not make a scientific fact but it is an

indication that Type 2s would benefit statistically by staying off

insulin as long as possible unless they are very sure that their

hearts are 100% fit, at least until the next relevant study comes

along!

Regards

T.

[Guest guest]

> So that almost sounds as though because we

> are more likely to have a heart attack that

> you are advocating changing from insulin to

> some other form of drug therapy.

I am not advocating anything, Rob, I was just

interpreting the conclusions drawn by the man in

charge of the study. He wasn't advocating

anything either except that patients at risk and

their physicians should include consideration of

the greatly increased risk of DM2s taking insulin

not making it through the one year after a heart

attack compared with non-diabetics and diabetics

on oral medication.

The study was peer-reviewed by cardiologists so

there is no really good reason to doubt its validity.

> Not much good if you can't survive without insulin

> in the first place - depends how far the DM2 has

> progressed and whether you are producing any

> insulin yourself at all.

Yeah, sure, but that is just stating the obvious!

> So that sounds like BS to me ( and I don't mean

> Blood Sugar)!!!

People believe mostly what they want to believe so

I can understand your reaction!

The study conclusion sounds convincing to me but

then I am not using insulin but I do have overweight

as an additional risk factor and hence am

automatically at higher risk for a heart attack

than a diabetic of normal weight so my personal

decision is to remain on oral medication for as

long as I can and to keep working on my cardio-

vascular health.

All the study does is confirm the truism that most

everything has a down side if you look for it, even

insulin - how could it be otherwise?

Happy New Year!

T.

[Guest guest]

> With respect, I must disagree. Until the

> study has been replicated at least

> once, there're lots of reasons to doubt

> its validity. That isn't to say the

> study should be entirely ignored.

Thanks, Bill, that is all a great help. I was not ignoring all those

points but adopting the position that we, as lay persons, are not in

a good position to cast doubt on the conclusions. A panel of

cardiologists naturally could but it is said to have been peer-

reviewed so as a lay person, I feel that I ought to take their word

for its validity such as it is.

I was interested to see that some people here reject the conclusions

on the apparent grounds that they are suspicious of all studies and

I have a vague feeling that most people are more willing to accept

findings that confirm something that they already believed than news

that runs contrary to it. I have to ask myself if that was not the

reason why I was so ready to accept this one!

Thank you for the Medscape reference. I read it right through and I

understand the reservations but a glance at the two plots, Fig. 1

and Fig. 2, convinced me as a lay person immediately, especially the

striking difference in survival between DM+,Ins+ and the other two

in the first 6 months.

If my physician were to place those two plots in front of me and

then ask me if I would like to switch to insulin, how could I make

any other decision but to refuse? He wouldn't do that but do you

know of any other investigations that are accompanied by similarly

strong graphic arguments that would encourage a decision to switch?

Put it this way, faced with those plots, I would need some very

strong evidence before I could be convinced to disregard them. It

would be like seeing figures showing that, adjusted for numbers

sold, a particular car model was four times more likely to be

involved in single-vehicle crashes than cars of any other model and

then going out and buying one of them! No way!

Regards

T.

[Guest guest]

> After all, the scientific consensus is that

> a low-fat, moderate-carb diet is appropriate

> for diabetic patients .

Yes, well I accept that, too, Bill, because it fits my case exactly!

Just because at one location there happens to be an accumulation of

diabetics who it does not fit cannot, in my view, invalidate the

worldwide medical consensus!

> Please bear in mind that the study's authors

> explicitly concede that the bad results may not

> be due to insulin. For instance, they could be

> due to good effects of oral meds. Or, they could

> be due to patients in the insulin group having

> poorer health than patients in the oral meds

> group--only certain aspects of health were

> statistically corrected for. I suggest that you

> read the Discussion section and list the possible

> causes other than insulin identified by the authors.

Yes, I did read it but that is mostly speculation on their part

since they admit that they did not do any work on those aspects.

> Yes, the statistics and tables strongly suggest

> that *something* is going on. But, a correlational

> study such as this one can't tell us what that

> thing is. Maybe it's insulin use. Maybe it's

> something else.

You will have noticed that they took 554 *consecutive* patients. I

understand that to mean that they took the first 554 who came

through the door. My guess is that from experience of a certain type

of patient dying on them within a much shorter time than others,

they decided to get some solid data to identify a commonality and

the insulin factor was the one that was inescapable from the results

they obtained. They probably felt that with 554 data points already

in, further patients of the same kind would not be likely to affect

the final result significantly so they stopped there.

> The primary significance of this study, in my view,

> is that it begs questions regarding whether insulin

> is really responsible for the adverse effects and,

> if so, what component or aspect of insulin causes

> harm. I'd anticipate that researchers will design

> experimental studies to address these questions.

Sure, but since I was facing the decision of whether or not to

voluntarily switch to insulin just to keep my wife company, it is

enough to tip the balance so that I have decided against it, at

least until some hard evidence is produced. She is not a candidate

for HF but I am!

> Here's another question to ask yourself about the

> study. Did the insulin and non-insulin groups differ

> in *any* way other than choice of medication? That

> is, were glycemic control, overall health, and

> complications equivalent between the two groups... ?

I assume that they are likely to have differed in many ways if the

study was really made on a group of *consecutive* patients.

Going back to my automobile analogy, just because a particular model

is involved in more single-vehicle crashes than any other model does

not mean that there is anything wrong with the vehicle. It could be

one that is primarily bought by younger people who might be inclined

to take more risks or it might be bought by people who prefer to

drive on minor roads which have a higher accident rate than major

divided highways. OK, but until that gets sorted out, I would not

buy one of them. Similarly, I am prepared to believe that insulin as

such is not the cause of the effect observed but I prefer to let

them clarify that first before I decide about switching!

The way I look at it, there has to be a downside to insulin use, it

cannot possibly be all good news. Almost everything else connected

with diabetes seems to involve a trade-off, why should insulin use

be an exception?

Regards

T.