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June 1, 2002

Daily Care, Type 2

Question from Cincinnati, Ohio, USA:

My friend, who has type�2 diabetes treated with insulin, went to an internist who has a specialty in endocrinology (but is not an endocrinologist) and he wants to take her off her insulin completely for five days and have her fast for five days. If she agrees to do this, he'll have her go into the office for each of the five days. She was so stunned by this approach that she didn't ask any questions, and now her family and I are skeptical about this being good medicine. She had a quadruple bypass a number of years ago, and her regular internist took her off her Zocor due to high liver enzymes. Her cholesterol and her triglycerides are double what they should be. Is this some kind of new treatment for type 2 diabetes? Wouldn't a person with diabetes develop ketones during five days without insulin, even if they didn't eat? Is this approach safe for someone who has the makings of another heart attack brewing in her body? It seems to me that fasting for five days and not taking insulin would be a terrible shock to the body and the heart. If this is a "normal" treatment, where can I go on the Internet to get more information, or if it's experimental, where can I go on the Internet to learn more?

Answer:

I would say you and your friend are reasonable in wanting more information about this approach. In patients with very high sugars and on large doses of insulin, there is a theoretical advantage in acute weight loss and a drop in insulin requirement. However, the benefit is only temporary and is not necessarily a good long-term benefit. I would have your friend insist on more information before she commits to this.

JTL