The three "missing" principles of insulin therapy

1.- Correct a deficiency

Based on the idea that Diabetes Mellitus (current T1D) was considered a deficiency of internal secretion of insulin, the main principle of treatment was, therefore, to correct this deficiency.

2.- Layered on top of the best dietary therapy

And not the other way around, with the expectation of doing the least harm (Hippocratic oath). Physicians were using insulin cautiously while maximising the potential of what they had learned before insulin had been available.

3.- The less insulin, the better

The reasons were many, including the unknown long-term complications, the danger of hypoglicaemia and the fear of ketoacidosis.

So, what happened?

In the origins of understanding Diabetes, the few patients who presented with Diabetes Mellitus were mainly Type 1 diabetics, it wasn't until later on that the distinction between insulin deficiency and hyperinsulineamia was found (T1D vs T2D).

Many types of interventions were trialed back then in Type 1 diabetics, with very different approaches and one common goal: preventing the patient from dying within the following few days due to the incapacity to produce insulin and the severe physiological disregulations that this issue caused.

Later on, apart from the mere survival, interventions on length and quality of life started to take place. Every one of them was focused on nutrition. The discussion on which ones worked the best is probably one for another day. The truth is, though, that the arrival of insulin therapy made the importance of nutrition disappear from the frontline of interventions, allowing patients to eat freely, so long they counterbalanced, more or less, whatever the potential glucose spike with the appropriate insulin dosis.

However, somewhere along the way, physicians and diabetologists alike stopped paying attention to the potential consequences of a exogenus hyperinsulinaemia and consequential insulin resistance. Many interests play a part on forgetting the THREE PRINCIPLES FOR INSULIN THERAPY (not all of them that well intended, by the way) and nowadays we encounter cases of insulin-deficient people who have developed insulin resistance due to the constant high amounts of insulin injected to compensate for the high amount of carbohydrates in their diets.