Retrospective #412: “Cover” Story

With idle time in my wife’s doctor’s waiting room, I picked up WebMD Magazine’s June 2017 issue. The cover story appeared to be an article asking, “Trouble reaching your A1c goals?” Next to a photo of a middle-aged man, the caption invited the reader to: “See how Jerry does it.” I’m always interested in seeing how other people lower their A1c’s, so I eagerly and naively turned the page…to a 3-page ad for Trulicity, a product of the Eli Lilly company.

Somehow, I missed the disclaimer on the false cover. It said, on a black banner, “Special advertising section. This Trulicity promotional cover has been placed on a limited number of WebMD magazines.” – just the ones in doctor’s offices, I’d bet. It continued, “It does not constitute an endorsement by WebMD Magazine, and no endorsement is implied.” Okay, WebMD gets big bucks for the fake cover, but how about the doctor’s office? Are they not complicit in this “non-endorsement” endorsement? I think so, and they (the doctor) doesn’t even get paid for it!

I also missed the small Lilly logo at the bottom of the false cover. But it was impossible to miss the 3 full pages of information about “non-insulin Trulicity, a once-weekly injectable pen for type 2 diabetics to help [your body] release its own insulin.” They’re careful to say, as required by the FDA, that it’s not the first pharmacotherapy med for type 2s. That would be Metformin, introduced in France in 1957, the UK in 1958, and the U.S. in 199X. But Metformin works on the liver to suppress unwanted glucose production and improve to insulin sensitivity (glucose uptake), and it’s safe.

As Lilly implies, Trulicity works on the pancreas, an organ that is already overworked in type 2s, to counter the insulin resistance that is the cause of type 2 diabetes. Does it make sense to put an added burden on the one (and only) pancreas you have to secrete the insulin on which your life depends? Trulicity makes the pancreas work harder; it “helps the body release its own insulin,” to use Lilly’s own words. But Lilly’s not worried about that. When the pancreas eventually is exhausted from overwork and wears out, you will graduate to another injectable drug made by Lilly: insulin glargine. And with all the increases in the last few years, have you seen the price of insulin glargine lately?

But Lilly and all the other drug manufacturers do not intend you harm. Their drugs are all approved by the FDA for the uses intended, and the uses all conform to the American Diabetes Association's Standards of Medical Care. What’s wrong with this picture? Answer: The treatment plan! The treatment treats the most common symptom of type 2 diabetes—an elevated blood sugar – by forcing the pancreas to produce more insulin. More insulin is what your pancreas has been producing for years before and since your impaired insulin response was discovered by your doctor (by an elevated fasting blood glucose, or with an A1c test).

Your impaired insulin response, aka INSULIN RESISTANCE (IR), is the cause of your type 2 diabetes. What caused your Insulin Resistance? Answer: On the government’s advice, in order to avoid eating saturated fat and cholesterol, for 60 years you ate a diet of 55% to 60% carbohydrate, composed of simple sugars and processed, refined, “whole grain” glucose molecules, euphemistically called “complex” carbohydrates. Over time, you became Carbohydrate Intolerant.

So, what’s the best treatment plan for Insulin Resistance? That’s simple too: reduce your intake of carbohydrates, especially the refined, processed ones, and the simple sugars, of course, particularly the liquid ones. From 60% there’s lots of room for lowering. For the generic woman’s 2000kcal/day diet, 60% is 300 grams of carbs/day. Lowering it to 20% would be 100 grams/day. For a man (2500kcal/day =375 grams/day), lowering it to 20% would be 125 grams/day.

With a few more waiting-room minutes on my hands, I searched that entire issue of WebMD magazine in vain for another mention of type 2 diabetes. This is a condition that nearly a third of the people of the U. S. already have, with another quarter pre-diabetic or overweight with Metabolic Syndrome. Alas, there was not a word in the whole issue. There was, however, an article on longevity where it mentioned that Metformin was being investigated as an anti-aging agent. Hmmm. Another reason to 1) eat fewer carbs and 2) take Metformin to help manage your type 2 diabetes.