My most important contribution to medicine is the following essay.
The word ‘diabetes’ means peeing a lot. ‘Diabetes mellitus’ means peeing a lot of sweet-tasting urine. Yummy.
This phraseology was originally used to describe ‘type 1 diabetes mellitus.’ This is an autoimmune disease in which one’s own immune system attacks and destroys insulin-secreting cells in the pancreas. It was universally fatal before the discovery that animal insulin could be injected to do the same job.
Things took a turn for the worse when a new disease emerged that also involved peeing sweet urine. This disease looked a lot like ‘type 1 diabetes mellitus’ and was thus termed ‘type 2 diabetes mellitus.’ Cue problems. Because both of these diseases have similar symptoms and virtually the same name, it was logical that the treatments would also be the same. So we gave people with ‘type 2 diabetes’ insulin and other medications to prevent high blood sugar.
This is an important point. We know high blood sugar is bad. And because we can easily measure blood sugar, we instinctively thought preventing high blood sugar was good.
I argue below that this is a catastrophic mistake. And, that we should rename these two diseases based on what we now understand about them to avoid this confusion. As it turns out, our methods have evolved beyond tasting urine.
The pathophysiology underlying ‘type 2 diabetes’ has classically been referred to as ‘insulin resistance.’ In contrast with ‘type 1 diabetes’, ‘type 2 diabetes’ is characterized by extra insulin in the blood. That is, there is a state of hyperinsulinemia. The classic story is that fat cells, which normally take the sugar out of the blood in response to insulin, have stopped listening to the insulin. And, if we just add some extra insulin, those fat cells begin to listen again.
But why did the fat cells stop listening in the first place?
Because they are full. They are stuffed to the brim with sugar and don’t want any more. There is so much damn glucose in the fat cells that instead of going inside, the glucose starts to accumulate in the blood. We can measure the sugar in the blood, and we know high blood sugar is bad, so we try to lower the blood sugar by forcing even more glucose into the already stuffed cells. This is backwards.
What is happening here is sugar overload. The proper medical term for this is ‘glucosis,’ and I propose we replace the disease name ‘type 2 diabetes mellitus’ with this new name.
Glucosis works because it describes an unnatural situation in which the cells of the body have too much glucose. And, because they are full, they stop responding to normal levels of insulin. The African American community already understands this as they call it ‘sugar.’ Glucosis is more technical, but it’s the same idea.
If this is the paradigm from which we are working, the treatment for glucosis becomes obvious; Get glucose out of the body. How does one do this? By not putting excess glucose into the body. The body will naturally burn the glucose it has and reach a healthy homeostasis.
Fasting, low-carb diets, and exercise are the treatments. Forcing more glucose into the body with medications so that the blood sugar levels look normal, is not. It probably makes things worse. Interestingly, there are some modern medications that can block sugar reabsorption in the kidney. These SGLT2 inhibitors induce a sort of artificial diabetes mellitus on purpose to get rid of excess sugar in the blood. Such a medication addresses the underlying problem because it lowers total body glucose.
So then what do we call ‘type 1 diabetes?’ Call it what it is: autoimmune beta-cell pancreatitis. Maybe beta pancreatitis for short.
Renaming diseases that are so entrenched in medicine and society presents a huge challenge. But this is not without precedence. In fact, there is an entire movement devoted to renaming diseases because of how important it is to get names right and how many times we have gotten names wrong.
This ‘diabetes’ language no longer serves us and causes harm. This is evidenced by the skyrocketing rates of glucosis around the world. Changing these names is an important step in a paradigm shift that brings integrity to Western medicine by calling things what they are. Shakespeare wrote: “What’s in a name? That which we call a rose. By any other name would smell as sweet.” It turns out, he forgot to smell his urine.
The similarity in name of these vastly different diseases has resulted in confusion and a mixing and matching of treatments. Not to mention Alzheimer’s disease is now developing the nickname ‘type 3 diabetes’ to describe neurons being unable to take in glucose.
If what I propose above is realized—the renaming of ‘type 1 diabetes mellitus’ to ‘beta pancreatitis,’ and, more importantly, the renaming of ‘type 2 diabetes mellitus’ to ‘glucosis’—the impact in terms of reducing unnecessary suffering will be beyond anything else I do in medicine.