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Question:

From Santa Rosa, California, USA:

My 17 year old daughter has had diabetes since early infancy, and also has acanthosis nigricans along with veins that are hard to get blood out of, and she is not prone towards ketosis. Is this due to insulin resistance since insulin is a vasodilator?

This was said by a chiropractor named Walter Schmitt in 1998:

WHEN A HORMONE CRIES "WOLF"

Insulin is produced by the pancreas when carbohydrates (CHOs) are ingested. Insulin activates cell membrane receptors to "open the cell door" for glucose to enter. Excess stimulation of a membrane receptor over a long period of time by any substance results in the membrane reducing the number of receptors to that substance. This is called down regulation of the receptors. One may think of this as a protective mechanism so that the cell does not get over stimulated by the excess substance. It is like the boy who cried "wolf" so many times that the townspeople stopped paying attention to him.

Likewise, excess insulin production from excess CHO intake results in down regulation of insulin receptors. This is called insulin insensitivity or insulin resistance. When the cell membrane pays less attention to insulin, less glucose gets inside the cell. The result is the cells being starved for glucose and the person craves even more dietary CHOs.

Another way the body can become insensitive to insulin (receptor down regulation) is with excess cortisol (associated with stress including poor diet.)

The adrenal glands produce three categories of hormones glucocorticoids (cortisol), sex steroids (DHEA, et al), and mineralocorticoids (aldosterone.) In chronic stress states the body makes cortisol preferentially, often resulting in decreased production of DHEA. Excess insulin also results in decreased DHEA and other sex steroids by blocking the enzyme (C17-20 lyase) which produces DHEA and the others.

Has it been determined that there is no insulin resistance involved in the etiology and continuance of juvenile diabetes and that cortisol and DHEA levels are normal in all respects? Could the children have stress brought about by the mother's diet while they were in utero?

Answer:

The real question is what type of diabetes does your daughter have, typeá1 or typeá2 or some combination. You should discuss this in some detail with her diabetes team/doctor since there may be some ways to determine this.

If your daughter is overweight, she could have insulin resistance from her obesity and also have classical type 1 diabetes from an autoimmune process at the same time. What you describe is a good description of receptors and regulatory mechanisms, but we do not know nearly enough about these things as we would like.

SB

DTQ-20020331035159
Original posting 21 Apr 2002
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:34
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