Black Hills Health and Education Center

Diabetes Case Study Part 2 c-Peptide

Hi, I am back with a question.

Great, that is how we learn by asking questions!

How do you know I can get along without taking insulin?

Why did your doctor put you on insulin?

He said that I needed it to control my blood sugar.

Normally your pancreas makes just the right amount of insulin that you need.

Is there any way to measure how much insulin my pancreas is making?

Yes, that is what c-Peptide test is all about.

What is the c-Peptide test?

C-Peptide is a break down product of the insulin that the pancreas makes, but not of the insulin given by needle. So this is a way to find out what insulin your own pancreas is making for you.

How do you do the test?

There is the standard laboratory test and there is the provocative or test that tells you what the most insulin your pancreas can make. The difference is between taking the test fasting or 2 hours after eating. The c-Peptide is a blood test.

Why would you want to know what the maximum amount your pancreas can make is?

Because the result of the laboratory test done 2 hours after a meal tells us what chance you have of being able to get off insulin. If your c-Peptide test is 4, you have a 90% chance of being able to get off insulin. At rest (fasting), the value of your c-Peptide is not predictive about your chances to get off insulin. Your insulin demand is greatest after a meal, the maximum insulin your pancreas can make tells us what your chances are to get off insulin.

So how do I put this all together? What does this all mean?

Good questions! One way of looking at or understanding diabetes, is in relation to your pancreas and insulin. What diabetes is all about is energy supply and demand on a cellular level. We live in our cells. If we habitually supply our cells with more energy than they can store and handle, they start being resistant to receiving and using more energy. Energy in the body means glucose - sugar. So if the cells have all the sugar they can use, they start refusing to take more and the pancreas makes more and more insulin trying to get the cells to take and use more glucose. This results in a stand-off and the blood sugar rises and we call that diabetes. Eventually the pancreas gets exhausted and "burnt-out" and with less insulin production, there is less glucose used by the cells and the blood sugar builds up in the blood for that reason.

So the question is what to do? How to best treat diabetes? From the standpoint of controlling the symptoms - the blood sugar level and the symptoms which it causes (being thirsty, going to urinate more, being drowsy, tired etc) giving more insulin or other drugs to lower blood sugar is the standard approach. However, another approach is to deal with the problem at a lower level. Slow down the supply of energy (calories) to the body and give the body a rest. Eat two meals a day and eat nothing between meals. The total calorie intake will go down and the cells will have a chance to use the energy already stored and be ready for more. Exercise! This burns calories and relieves the body of its overloaded energy stores. Drink more water, this will thin down the blood and improve the circulation. This will give the pancreas a rest and may increase its ability to make insulin. With a combination of exercise and decreased calorie intake, the blood sugars will come down because the body is burning more energy at the same time as receiving less energy by mouth! There is no question that this approach works. The question is whether you are willing to eat twice a day and nothing between meals? The experience of most doctors is that this approach does not work - not because it is not effective, but because people are not willing to commit to or be consistent with a change in lifestyle.

What is at stake? What difference does it make if I eat, drink and be merry or deny myself and only eat twice a day and exercise and drink water?

The difference is plain. Eat, drink, and be merry even with medication ends up with parts being cut off of your body to save your life, going blind, and the need for increasing amounts of medication in an attempt to keep the blood sugars within limits. Exercise, eat twice a day and drink water and control blood sugars with these natural methods and save body parts, eyesight and your kidneys for many years to come. The choice is ours!

Tell me more about diet and its effect on my diabetes.

That will take some time. Come back next time and we will cover diet's influence on diabetes in part 3.