The increase in deaths seems to be a big surprise to most involved, eliciting a lot of handwaving explanations. But if you just think a little about the nature of Type II diabetes and the action of insulin in the body, I suspect the outcome makes perfect sense; worse, had anybody applied some logical thinking to well-established medical knowledge, the outcome would have seemed preordained. The problem here (which seems to be endemic in modern medicine) is that few people seem to be able to see the forest for the trees. Insulin and sugar have well-known physiological effects, and any hypothetical treatment for Type II diabetes should account for these. Of course, almost nobody does this, leading to the current mess.
Let's start by being clear on what Type II diabetes is. Diabetes is generally thought of as a condition where blood sugar is chronically too high; but is chronically high blood sugar the cause of the disease, or just a symptom? In Type I diabetics, the patient's immune system attacks the pancreas (the organ responsible for making insulin), destroying it's ability to secrete insulin. Insulin is one of the body's most powerful hormones, governing many aspects of metabolism, not least being blood sugar levels. Blood sugar is tightly regulated in the body, because sugar has several damaging toxic effects; but you need a little sugar in the blood to power certain cells, like red blood cells. So Type I diabetics, lacking insulin, suffer increasing blood sugar, and all of the attendant bad effects, on average having significantly shortened lives.
Type II diabetes is really the opposite condition: too much insulin. You still have the symptom of increased blood sugar, but now it occurs because your body's cells have a downgraded response to the insulin secreted by the pancreas. Since the cells don't respond as readily to the insulin signal, sugar tends to build up in the blood, so the pancreas cranks out more insulin, which further desensitizes the cellular insulin response, resulting in a vicious cycle where both insulin and blood glucose levels increase over time. Ultimately your pancreas reaches the limit of what it can do, blood sugar goes through the roof, and you're classified as a Type II diabetic.
Now it makes sense to treat a Type I diabetic with insulin, because they have a serious lack. Insulin does a lot of things besides regulate blood sugar, and if you don't have any, you're in big trouble. But insulin is a seriously powerful hormone. It has many effects beyond reducing blood sugar, and these are just as well-known as the effects of high blood sugar itself. There's a reason why, in the presence of a too much insulin, your cells lower their response: too much insulin is damaging. Insulin resistance is a protective mechanism, and in Type II diabetics, it's out of control. From an evolutionary standpoint, one could go so far as to argue that insulin is more toxic than high blood glucose, otherwise the mechanism for insulin resistance would not have evolved (but that's just speculation on my part).
Giving insulin to a Type II diabetic is like dumping water in a sinking boat. It just exacerbates the original problem by further increasing insulin resistance AND subjecting the body to further damaging effects of chronically elevated insulin levels.
Now, you might argue that the "experts" had more information, and that I am oversimplifying things. I probably am oversimplifying things, but not as much as the so-called experts. Check out these quotes from the NYT article:
“It’s confusing and disturbing that this happened,” said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,” he added.
Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.
“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”
Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.
And some insurance companies pay doctors extra if their diabetic patients get their levels very low.
The low-blood sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.
Not very scientific, wouldn't you say? Everybody just assumed that lowering blood sugar was "the right thing to do", come hell or high water. In a sense, that's true: high blood sugar definitely causes serious damage. The problem is that nobody gave any thought whatsoever to the potential downsides of the treatment, especially in light of the known cause and symptoms of Type II diabetes, and the known effects of high insulin. The result? Many people killed in an effort to prove the dogma, not to mention millions of dollars wasted. With even a little rational thinking based on well-established knowledge, those lives would have been spared, and those dollars put to much more productive use. And the scary thing is, they still don't get it:
Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.
It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.
"Clearly", Type II diabetics with low blood sugar are different from non-diabetics: they have high insulin. They knew that before the study, but chose to ignore it, and blindly continue to do so. Apparently most of the deaths in the study were from heart attacks. Should we be surprised? Below is an excerpt from an excellent article about insulin (go down to the section "Insulin and Cardiovascular Disease"):
But there are certain tissues that aren't becoming resistant such as your endothelium; the lining of the arteries doesn’t become resistant very readily, so all that insulin is affecting the lining of your arteries.
If you drip insulin into the femoral artery of a dog, there was a Dr. Cruz who did this in the early 70s by accident, the artery will become almost totally occluded with plaque after about three months.
The contra lateral side was totally clear, just contact of insulin in the artery caused it to fill up with plaque. That has been known since the 70s and has been repeated in chickens and in dogs; it is really a well-known fact that insulin floating around in the blood causes a plaque build-up. They didn't know why, but we know that insulin causes endothelial proliferation. This is the first step as it causes a tumor, an endothelial tumor.
Insulin also causes the blood to clot too readily and causes the conversion of macrophages into foam cells, which are the cells that accumulate the fatty deposits. Every step of the way, insulin is causing cardiovascular disease. It fills the body with plaque, it constricts the arteries, it stimulates the sympathetic nervous system, it increases platelet adhesiveness and coaguability of the blood.
Insulin is a part of any known cause of cardiovascular disease. It influences nitric oxide synthase; you produce less nitric oxide in the endothelium. We know that helps mediate vasodilatation and constriction, i.e. angina.
So it would seem that, given what is known about the effects of insulin on arteries, an increase in deaths from heart attack should have been the expected outcome.
Once again, do you want these people making decisions about your health? If you are a Type II diabetic, the outcome of this study should serve as motivation to find out for yourself what is known about the cause of the disease, and the treatment options available. Don't blindly follow the brain-dead dogma espoused by most physicians and scientists, apparently blind themselves to long-established knowledge about the effects of insulin. Get the information for yourself, and ask your doctor hard questions about WHY you should do what he/she recommends. If the best answer they can give is "because I said so", you might consider looking for another doctor.