Insulin for type 2 diabetes lowers blood glucose, but these patients already run high insulin levels. The extra insulin makes insulin resistance worse. It also adds to fat storage and metainflammation. In the studies cited below, a low-carbohydrate ketogenic diet improved hemoglobin A1c more over one year than a low-fat, calorie-restricted diet.
Insulin is the most popular drug treatment for type 2 diabetes. It was once used only sparingly. Today it makes lots of money for the companies that make it. Thanks to drug company marketing and a lack of time, many physicians prescribe insulin. They do it instead of nutrition counseling or lifestyle management.
Before the 1920s, Diabetes treatment mainly aimed to control glycosuria (sugar spilling into the urine). Glycosuria happens when blood glucose goes above about 160–180 mg/dL, and it is easy to measure. The diet advice back then was “meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea” and held 5% carbohydrates, 20% protein, and 75% fat. This is much like the Low Carbohydrate Ketogenic Diet (LCKD). That advice was very different from today’s low-fat, high-carbohydrate advice for people with diabetes. Also note that people rarely ate breakfast back then, and factory-made snacks did not exist yet. That gave 2 small glucose spikes a day, compared with today’s 5-6 spikes. And vegetable oils were not widely sold before the 1940s and 1950s.
Insulin given by injection to treat Diabetes arrived in the 1920s. That began the shift from controlling diabetes with lifestyle to controlling it with drugs. It has gone so far that many type 2 Diabetic patients now eat too many carbohydrates, knowing they can chase them with insulin. Sadly, these patients already have a high insulin level. The extra insulin only makes the insulin resistance worse. On top of that, insulin tells the body to store fat. That makes the metainflammation worse, and the patient’s obesity too. This is like a fat dog chasing its tail. The glucose is the tail, the mouth is the insulin, and the fat dog is the broken metabolism.
Several recent studies have taken a fresh look at cutting carbohydrates in type 2 Diabetes. They confirmed again that the Low Carbohydrate Ketogenic Diet (LCKD) is safe and works. Over one year, hemoglobin A1c (a measure of average blood sugar) improved more on a low-carbohydrate diet. It improved less on a low-fat, calorie-restricted diet. Put simply, people’s glycohemoglobin improved more on the low-carbohydrate diet. It improved less on a eucaloric low-fat diet (one with the same calories). LCKD can be very good at lowering blood glucose. Because of that, patients on diabetes medication who use this diet should be under close medical supervision or able to adjust their medication.
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- Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF: The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004, 140: 778-785.View Article Google Scholar
- Samaha FF, Iqbal N, Seshadri P, Chicano K, Daily D, McGrory J, Williams T, Williams M, Gracely EJ, Stern L: A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003, 348: 2074-2081. 10.1056/NEJMoa022637.View Article Google Scholar
- Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004, 53: 2375-2382.View Article Google Scholar
- Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005, 142: 403-411.View Article Google Scholar
- Nielsen JV, Jonsson E, Nilsson AK: Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report. Ups J Med Sci. 2005, 110: 179-183. Google Scholar
- Yancy WS, Vernon MC, Westman EC: Brief report: a pilot trial of a low-carbohydrate, ketogenic diet in patients with type II diabetes. Metabolic Syndrome and Related Disorders. 2003, 1: 239-244. 10.1089/154041903322716723.View Article Google Scholar
So, we know that patients with type 2 diabetes have the symptom of too much glucose. But their actual disease is too much insulin, with cells that are insulin resistant. Yet we treat them with more insulin. That raises the question: why, and who benefits? (This does not in any way suggest insulin is bad. Insulin is a lifesaving drug. It means patient care should first focus on lifestyle changes, and insulin should be the rescue drug.)
Making lifestyle changes and counseling patients takes time and energy, which most healthcare providers lack. Physicians are one of the key decision makers. So they remain a main target for drug company sales. The drug industry uses many marketing and promotion efforts to shape what doctors prescribe. This starts early in medical school, even in the first years of study before patient care. This marketing goes on through a physician’s whole career. Drug companies hand out gifts and benefits, from cheap gifts to costly trips and grants. That leads to poorer prescribing choices and pushes more expensive care. One could argue that most physicians are simply a marketing tool the drug companies use to sell their products. They are a sales team that is paid indirectly.
Drug companies often launder their education efforts through patient advocacy groups. On the surface, these groups appear to be trusted authorities, such as The American Diabetes Association.
Clearly, Big Pharma will not be likely to pay for studies that cut use of its products. Those studies would favor lifestyle changes that no one gets paid for. Academics funded by the same interests are also unlikely to do that kind of evidence-based research. The whole health care industry seems built to medicalize treatment rather than improve lifestyle. Lifestyle change would radically disrupt the status quo. Big Pharma is everywhere in the academic world of policy and thought leaders. So it is no longer considered a “conflict of interest” to recommend a drug that paid that policy or thought leader. It is now simply considered a “duality of interest.”
Related reading
- Using Insulin in Type 2 Diabetes
- Anxiety and Depression: The Insulin Resistance Link
- Insulin Resistance and Chronic Pain
- Why We Care About Food and Diabetes
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 17, 2026
