🔑 Key Takeaways
- Dr. Bernstein's approach of managing carbohydrates and protein can benefit not only type 1 diabetes patients but also anyone with a functioning pancreas. Understanding diabetes basics can help support kids with the disease.
- Healthcare professionals play a crucial role in supporting patients and families dealing with the complexities of managing type 1 diabetes.
- Timely diagnosis and treatment of type 1 diabetes in children is crucial to prevent complications and ensure their well-being.
- Type 1 diabetes is a result of an autoimmune response, involving T and B cells, leading to the destruction of insulin-producing beta cells. Its increasing incidence may be influenced by environmental factors or viral exposure.
- Early diagnosis of type 1 diabetes in infants is crucial due to rapid progression and atypical symptoms, while accurately diagnosing late-onset type 1 diabetes is important for different treatment approaches.
- While targeting B cells in autoimmune diseases may not delay the onset of type 1 diabetes, there is potential in using this approach to treat other autoimmune conditions.
- Maintaining a normal BMI in children can be advantageous in preventing type 1 diabetes, but genetic factors and early detection are also important in addressing the disease.
- Having a relative with type 1 diabetes increases risk, but there's only a 3% chance your child will develop it. Hemoglobin A1C levels for managing type 1 diabetes have decreased over time.
- The HbA1c test, with a level greater than 6.5%, is now the primary diagnostic tool for type 2 diabetes, improving diagnosis accuracy and leading to better management and outcomes for patients.
- Insulin is responsible for regulating various important processes in the body, including glucose uptake, protein metabolism, and the levels of circulating androgens. Understanding its interactions with other hormones is vital for overall health.
- Banting and Best's innovative approach to treating diabetes led to the isolation of a substance that lowered blood glucose levels, paving the way for future advancements in diabetes treatment.
- The development of recombinant insulin has significantly improved patient outcomes in diabetes treatment, but the high cost remains a barrier to accessibility, emphasizing the need for market influence and government intervention in reducing prices.
- High glucose levels in diabetes can lead to various complications such as blindness, kidney disease, and amputations. Achieving tight control of blood glucose levels is challenging but necessary to prevent these complications.
- Collaboration and continuous monitoring are essential in managing blood glucose levels for patients with diabetes, as it is a complex process that requires more than just following a prescribed insulin to carb ratio.
- Interventions can reduce complications in type 1 diabetes, but conducting large-scale trials is costly. Careful consideration of resources and managing side effects, such as weight gain, is necessary for effective intervention.
- Striving for near-normal blood glucose levels can greatly reduce the risk of cardiovascular disease in individuals with diabetes, even if control later becomes less tight. However, managing blood glucose volatility is crucial in the present.
- Even short exposures to high blood glucose levels can have long-lasting effects on gene expression and cell behavior, especially in children with type 1 diabetes, emphasizing the importance of managing glucose variability and educating about carbohydrate intake.
- Living with type 1 diabetes requires vigilance in managing carbohydrate intake to maintain stable blood sugar levels, posing a significant burden for individuals and their support systems.
- Understanding the burden faced by individuals with type 1 diabetes is crucial in providing necessary support and tools to alleviate guilt, shame, and self-blame.
- Continuous glucose monitoring devices offer hope to individuals with type 1 diabetes, helping them better manage their glucose levels and experience significant positive changes in their overall well-being.
- Exercise, especially intense exercise like marathon running, can greatly enhance diabetes management by activating AMP kinase, an enzyme that promotes glucose uptake in skeletal muscles, highlighting the potential for alternative approaches to insulin-dependent pathways.
- Distance or aerobic exercise can significantly reduce insulin requirements in individuals with type 1 diabetes, providing a powerful tool for managing blood glucose levels and reducing insulin therapy's volatility.
- Dr. Bernstein emphasizes the importance of controlling carbohydrate consumption to manage blood glucose levels effectively and minimize insulin-related errors in both type 1 and type 2 diabetes.
- A low-carbohydrate diet has been proven beneficial in managing type 1 diabetes, resulting in improved health outcomes and fewer hypoglycemic events. Joining support groups can provide valuable resources and guidance for adopting a low-carb lifestyle.
- Taking the time to truly listen and support patients can have transformative outcomes, even for those considered hopeless. Building rapport and utilizing tools like continuous glucose monitoring (CGM) are crucial for effective management of type 1 diabetes.
- Low carb advocates provide valuable resources to help families manage type 1 diabetes, but caution is needed when considering a ketogenic diet due to potential risks. Research is ongoing to improve treatment options.
- Patients with type 1 diabetes using SGLT 2 inhibitors or following a nutritional ketosis diet should be aware of the risks of delayed recognition of insulin deficiency and closely monitor their glucose levels.
- The Standard American diet, particularly high-carbohydrate consumption, increases the risk of cardiovascular diseases in people with type 1 diabetes. Understanding the role of insulin in macrovascular disease highlights the need for further research in promoting cardiovascular health.
- Monitoring insulin levels and striving to lower them can have significant health benefits. Understanding the area under the curve of insulin production provides insights into metabolic function and potential interventions, such as autophagy. Self-quantification and staying connected to one's physiology are valuable in managing insulin levels for optimal health.
📝 Podcast Summary
The Impact of Diet on Managing Diabetes
Diet can have a significant impact on managing both type 1 and type 2 diabetes. Dr. Richard Bernstein's approach of managing carbohydrates and protein to regulate insulin and glucose levels has shown promising results. It is not just individuals with type 1 diabetes who can benefit from this approach, but anyone with a functioning pancreas. The conversation also highlights the risks associated with controlling blood sugar levels with high amounts of exogenous insulin. This has implications for everyone because the interchangeability of exogenous and endogenous insulin applies to insulin usage in general. Understanding the basics, history, and prevalence of type 1 diabetes can help us support kids with the disease and learn from their experiences.
The Impact of Type 1 Diabetes on Children and Families
Jake Kushner initially had different career expectations and ended up in pediatric endocrinology, where he encountered the profound impact of type 1 diabetes on children and their families. Despite expecting to work on esoteric diseases, Jake found himself interacting with newly diagnosed children and their overwhelmed families. Witnessing the emotional and physical challenges they faced, he realized the complexity and importance of managing this chronic condition. Peter Attia also shared a personal experience with a friend who was eventually diagnosed with type 1 diabetes. Both stories highlight the significant medical and human elements of treating this disease. The key takeaway is the recognition of the multi-faceted nature of type 1 diabetes and the vital role of healthcare professionals in supporting patients and their families.
Understanding Type 1 Diabetes in Children
Type 1 diabetes is a commonly misunderstood and misdiagnosed condition, especially in children. It is characterized by a state of profound catabolism, leading to weight loss, excessive drinking, and frequent urination. Many children with type 1 diabetes present with diabetic ketoacidosis (DKA), which signifies prolonged illness and a lack of proper diagnosis. Without insulin, individuals with type 1 diabetes can quickly deteriorate and face life-threatening situations. The prevalence of type 1 diabetes is significant, affecting approximately 1 in 300 people, with an onset typically around the age of 9. It is crucial to raise awareness about type 1 diabetes to prevent misdiagnoses and ensure timely treatment.
Understanding the complex nature of type 1 diabetes
Type 1 diabetes is a complex condition with both genetic and environmental contributors. The pathophysiology of the condition involves an autoimmune response, primarily driven by T cells and with some involvement of B cells. This autoimmune response occurs when beta cells in the pancreas, which produce insulin, begin to dump off antigens that provoke the immune system. This leads to the destruction of beta cells and a progressive loss of insulin production. It is important to note that there is no single virus or direct relationship with body weight that can conclusively be attributed to type 1 diabetes. The incidence of type 1 diabetes has doubled since 1960 and continues to increase, possibly due to environmental factors or viral exposure.
Importance of Early Diagnosis and Different Diagnosis for Type 1 Diabetes in Infants and Adults
Early diagnosis of type 1 diabetes in infants is crucial as the disease can progress rapidly and present with atypical symptoms. Without checking serum glucose levels, life-threatening diabetic ketoacidosis and diabetes may go unnoticed. Unlike adults, infants do not have the physiological reserve to withstand the decline of endogenous insulin production. Additionally, infants may have a more aggressive autoimmune response, resulting in the destruction of 90% of their beta cells within months. For older individuals, type 1 diabetes can smolder slowly for years, making the diagnosis more complicated. This highlights the importance of accurately diagnosing individuals with late-onset type 1 diabetes, as their treatment may differ from those with type 2 diabetes.
The Potential of B Cell Targeting in Autoimmune Diseases
Autoimmune diseases such as type 1 diabetes and autoimmune thyroid disease often have a common B cell and T cell component. Although the study discussed did not show statistically significant results in delaying the onset of type 1 diabetes with a single dose of rituximab, it highlights the potential of targeting B cells in autoimmune diseases. It is also worth noting that there is overlap between different autoimmune endocrine disorders, and patients with type 1 diabetes may be more susceptible to developing other autoimmune conditions. While there is no definitive way to completely prevent type 1 diabetes, certain factors such as body weight and diet may play a role in increasing the risk. However, it is important to consider that the environmental contribution to type 1 diabetes is smaller compared to type 2 diabetes, making it challenging to determine the exact factors influencing its development.
Promoting a healthy BMI to reduce the risk of type 1 diabetes in children.
Maintaining a healthy BMI in children may reduce the risk of developing type 1 diabetes. Peter Attia and Jake Kushner discuss the relationship between body weight and the potential risk for type 1 diabetes. They mention a study using T1D exchange data, which suggests that closer to normal BMI could provide an advantage in preventing type 1 diabetes. It is important for parents to be aware of this possibility and educate themselves and others about the dangers of undiagnosed type 1 diabetes in children. Early detection is crucial in ensuring prompt medical intervention. Additionally, the genetics of type 1 diabetes are complex, with certain alleles increasing the risk. However, the genetic contribution, though significant, is not the sole determining factor.
Risk of Type 1 Diabetes in Relatives and Hemoglobin A1C Levels
Having a direct relative with type 1 diabetes increases your risk by approximately 6 to 10 fold, but it does not guarantee that your child will also have the condition. Even with the increased risk, there is still a 97% chance that your child will not develop type 1 diabetes. However, there are some families where all children have the condition, and even in identical twins, the concordance rate is around 50-60% in the first few years, rising to 80% by adulthood. Fraternal twins also have a higher risk compared to the general population. Over time, it has become evident that the target hemoglobin A1C level for managing type 1 diabetes has decreased to around 5.7-5.9, which is lower than what was previously thought. The conversation highlights the evolution of thinking and understanding in managing the condition.
The Hemoglobin A1c (HbA1c) Test: A Key Tool for Measuring Blood Glucose Levels in Type 2 Diabetes.
The hemoglobin A1c (HbA1c) test is used to measure the average blood glucose levels in individuals with type 2 diabetes. This is done by imputing the average blood glucose based on the HbA1c levels. In the past, the diagnosis of diabetes relied on insulin or glucose levels during an oral glucose challenge. However, today, a diagnosis of type 2 diabetes is made solely based on an HbA1c level greater than 6.5%. This criterion was established after the discovery of insulin and the development of the Diabetes Control Complication Trial (DCCT). Prior to the discovery of insulin, individuals with type 1 diabetes had limited options and typically experienced significant complications and a shortened lifespan. Insulin plays a crucial role in regulating the metabolism and determining whether cells are in a state of feast or famine. It helps in storing nutrients in cells during feast times and mobilizing them during famine.
The Essential Role of Insulin in Regulating Body Processes
Insulin plays a crucial role in regulating various processes in the body. It regulates the levels of free fatty acids and triglycerides in adipose cells, promoting glucose uptake in muscle cells, and influencing protein metabolism. Insulin also affects glycogen levels and can impact lifespan and aging. It has a complex relationship with IGF (Insulin-like Growth Factor) and its binding proteins. High levels of insulin can reduce the levels of circulating androgens and can acutely decrease IGF-1. Insulin and IGF-1 have overlapping functions and can bind to receptors in different combinations, leading to alterations in metabolism. Understanding the intricate workings of insulin and its interactions with other hormones is crucial for maintaining overall health.
The Groundbreaking Discovery of Banting and Best
In the early 1900s, Banting and Best made a groundbreaking discovery in the field of medicine. Banting, a surgeon struggling in his practice, stumbled upon an article describing structures in the pancreas that might be related to diabetes. He had the brilliant idea to block the outflow of the pancreas and extract the residual muck to find a potential treatment for type 1 diabetes. With limited resources and time, Banting and Best successfully isolated a substance that lowered blood glucose levels in dogs. They then conducted an experiment on a medical student with type 1 diabetes, further proving its effectiveness in humans. Despite facing rejection, their research eventually won them the Nobel Prize. This groundbreaking discovery paved the way for advancing our understanding and treatment of diabetes.
Revolutionizing Diabetes Treatment through Insulin Discovery and Genetic Engineering
The discovery of insulin and its subsequent development into recombinant insulin has revolutionized the treatment of diabetes. Prior to recombinant insulin, insulin was derived from animals such as pigs, which led to complications and the need for higher doses. The ability to produce human insulin through genetic engineering has greatly improved patient outcomes. However, the high cost of recombinant insulin remains a challenge, preventing many individuals from accessing necessary treatment. This highlights the need for market influence and government intervention to drive down prices and ensure affordable access to insulin. Additionally, the conversation touches on the importance of clinical trials, specifically the Diabetes Control Complication Trial, in understanding and managing diabetes-related complications.
Complications of high glucose levels in diabetes
High glucose levels in individuals with type 1 or type 2 diabetes can lead to various complications. These complications include microvascular issues such as abnormal vessel growth causing blindness, damage to the vascular endothelium, and fragile new vessels that can break and bleed. Additionally, high glucose levels can alter the kidney's functioning, leading to renal failure. Amputations, particularly of toes, are also common due to altered healing caused by diabetic neuropathy and abnormal microvasculature behavior. Preventable amputation, blindness, and kidney disease are all primarily caused by diabetes. The relationship between average blood glucose levels and these complications is monotonically increasing. However, achieving tight control of blood glucose levels can be challenging due to the risk of hypoglycemia and the system's variance and sensitivity to various factors.
The Challenge of Managing Blood Glucose Levels in Diabetes
Managing blood glucose levels in patients with diabetes is incredibly difficult. Physicians often have the expectation that patients will simply follow a prescribed insulin to carb ratio, but it's not that simple. Patients can't always achieve perfect blood glucose levels, and labeling them as noncompliant is unfair. It's comparable to trying to fly a plane solely relying on instruments instead of looking at the horizon. Patients and physicians can easily become frustrated with the constant fluctuations in glucose levels, leading to high and low cycles. The DCCT trial aimed to normalize blood glucose levels, but it was challenging because there were no established best practices at the time. Through conference calls and shared best practices, they were able to reduce A1c levels from 9% to 7% over a decade. It highlights the importance of collaboration and continuous monitoring in diabetes management.
Study on Reducing Diabetes Complications
The significant findings from the diabetic retinopathy and diabetic nephropathy trial led to a groundbreaking paper in the New England Journal of Medicine. This paper proved that reducing complications in type 1 diabetes is possible through intervention. However, the resources and costs required for such studies are immense. The trial had a budget of over $100,000,000 and included only 1400 patients over 7 years. The expenses were primarily allocated to coordinating centers, care provision, and patient follow-up. Despite the positive outcomes, there were drawbacks as well, such as an increase in hypoglycemic events and weight gain due to higher insulin dosages. Additionally, the trial highlighted the issue of weight gain in type 1 diabetes, which has been linked to poor cardiovascular outcomes. Overall, the trial set a precedent for modern type 1 diabetes care, showcasing the importance of intervention in reducing complications.
The long-term benefits of tight blood glucose control for individuals with diabetes
Maintaining tighter control over blood glucose levels can have long-term benefits for individuals with diabetes. The discussion highlights how individuals who had tighter control for seven years, even if they later had less tight control, still retained some benefit from those initial years. This suggests that striving for near-normal blood glucose levels can significantly reduce the risk of cardiovascular disease, bringing it closer to that of a non-diabetic individual. However, achieving and maintaining tight control can be challenging, as demonstrated by the high variability in glucose levels experienced by those with poor control. While potential cures and advanced therapies are being explored, it is important to focus on managing the volatility of blood glucose levels in the present to support individuals living with diabetes.
The Impact of Blood Glucose Levels on Diabetes Complications and Cognitive Impairment in Children
There is a growing understanding that diabetes complications are not as simple as previously thought. Research suggests that even short exposures to high levels of blood glucose can lead to permanent and profound changes in gene expression and cell behavior. This means that intermittent exposure to very high blood glucose, whether due to volatility or absolute level, can have long-lasting effects on the body. This finding is particularly concerning for children with type 1 diabetes, as they may be at risk of cognitive impairment if their glucose variability is not properly managed. It also raises questions about the impact of unhealthy foods on blood glucose levels, highlighting the need for better education and awareness about carbohydrate intake, especially for children.
Managing Type 1 Diabetes: The Constant Battle of Blood Sugar Levels
Living with type 1 diabetes requires constant vigilance and careful management of blood sugar levels. People with this condition must be mindful of their carbohydrate intake to avoid dramatic spikes and dips in blood glucose. Even seemingly insignificant choices, like picking croutons out of a salad, can have a significant impact on blood sugar levels. This can be a challenging and frustrating reality for those with type 1 diabetes, as it involves constant monitoring, finger sticks, and potentially painful testing. It's a responsibility that both adults and children must bear, which can be a heavy burden on both the individual and their loved ones.
The cognitive load and mental health challenges of living with type 1 diabetes
Living with type 1 diabetes can create a significant cognitive load, leading to high levels of stress and mental health challenges. Parents and individuals with type 1 diabetes constantly worry about blood sugar levels, insulin dosing, and potential hypoglycemic episodes. This cognitive load can be overwhelming and affects one's ability to enjoy life fully. Studies have shown that approximately 45-50% of individuals with type 1 diabetes experience depression or anxiety, which can be debilitating. It is crucial for healthcare providers and society to recognize the immense burden faced by those with type 1 diabetes and provide the necessary tools, support, and understanding to alleviate guilt, shame, and self-blame. Blaming and shaming individuals for high hemoglobin a1c levels only reinforces the negative cycle and hampers progress in managing the condition effectively.
Transforming Lives with Continuous Glucose Monitoring
Diabetes distress and anxiety can become so ingrained in a person's life that they accept it as the norm. They may feel antagonistic towards the medical establishment for not fully understanding their condition and their loved ones may struggle to understand the complexities of managing diabetes. However, there is hope in the form of continuous glucose monitoring devices. These devices can help individuals with type 1 diabetes better manage their glucose levels and improve their overall well-being. When people have successfully used these devices, they have experienced significant positive changes in their ability to think, feel, and navigate the world around them. The discovery and adoption of these devices have the power to transform lives for the better.
Failure of First Generation CGM's and the Role of Exercise in Improving Diabetes Control
The first generation of CGM's (continuous glucose monitors) for people with type 1 diabetes was a failure due to the lack of effective solutions in managing the condition. Simply badgering patients to check their blood glucose levels and take insulin before meals was not realistic or effective. However, exercise, particularly intense exercise like marathon running, has shown to significantly improve diabetes control. This is because exercise activates AMP kinase, an enzyme that drives insulin independent glucose uptake in skeletal muscle. The difference in glucose disposal between insulin dependent and AMPK driven pathways can be dramatic. Further research is needed to understand the exact mechanisms behind this and to determine if insulin sensitivity is more influenced by insulin or AMPK.
Exercise and Insulin: A Powerful Combination for Type 1 Diabetes Management
Exercise, specifically distance or aerobic exercise, can significantly reduce the amount of insulin needed by individuals with type 1 diabetes. Marathon runners and distance athletes who engage in high-intensity, long-duration exercise have shown a remarkable ability to lower their insulin requirements. This suggests that exercise can be a powerful tool in managing blood glucose levels and reducing the volatility associated with insulin therapy. While the specific mechanisms behind this phenomenon are not well-studied, the idea of using exercise to reduce overall insulin exposure is an exciting prospect for individuals with type 1 diabetes. Additionally, the conversation highlights the importance of finding the right balance between exercise intensity and duration to maximize the benefits for blood glucose control.
Managing diabetes with a low-carb, high-protein diet and insulin control
Dr. Bernstein's core idea of carbohydrates causing blood glucose excursions is supported by the rule of small numbers: consuming more carbs requires more insulin and increases the chance of mistakes, while fewer carbs lead to less insulin and fewer errors. Dr. Bernstein's book, "The Diabetes Solution," offers practical tips for managing both type 1 and type 2 diabetes, including complications. He suggests avoiding carbs, covering protein and fat with medium and long-acting insulin, and following a low carb, high-protein diet. However, it is important to note that the impact of protein on insulin response is somewhat debatable, as it is delayed over hours and influenced by factors such as exercise. Dr. Bernstein advocates for covering protein with regular human insulin, which aligns better with the kinetics of protein absorption and glucose response compared to rapid onset insulins.
The problematic approach of relying on insulin pumps and a high-carbohydrate diet in managing type 1 diabetes.
There is a problematic approach in managing type 1 diabetes that involves relying heavily on insulin pumps and consuming a high-carbohydrate diet. This approach leads to erratic blood sugar levels, increased burden of illness, and various negative emotional and physical consequences. It is suggested that the insulin pump and insulin companies promote this approach to sell more insulin and pumps, creating a profit-driven incentive. However, a low-carbohydrate diet has been found to be beneficial in managing type 1 diabetes, resulting in better health outcomes and fewer hypoglycemic events. Although it may require giving up some pleasure in eating, the long-term benefits outweigh this sacrifice. Joining support groups like Type 1 Grit can provide valuable resources and guidance for those interested in adopting a low-carb lifestyle.
Transforming Patient Care through Personalized Approach
Changing the way doctors practice medicine can have a transformative impact on patients. Jake Kushner realized that the tight schedules in endocrinology made it impossible to provide comprehensive care to patients with type 1 diabetes. To address this issue, he decided to see patients only at the end of the day, spending as much time as needed with each individual. Despite being less efficient, this approach allowed him to truly listen, understand, and support his patients, leading to transformative outcomes. He discovered that even patients who were deemed hopeless and on a path to poor health could be helped with the right level of care, compassion, and understanding. By establishing rapport and taking the time to ask open-ended questions, patients felt more comfortable sharing and acknowledging their difficulties. This approach is especially crucial for teenagers with type 1 diabetes, who require patience, love, and suspension of disbelief to effectively manage their condition. In terms of tools for managing type 1 diabetes, continuous glucose monitoring (CGM) is essential, although unfortunately, not all insurance companies cover it.
Access to affordable healthcare and support for families of children with type 1 diabetes is a challenge, but the low carb community offers resources and information to help manage the condition effectively.
Access to affordable healthcare for families with children diagnosed with type 1 diabetes is a significant challenge. The expenses associated with managing the condition, such as insulin costs and continuous glucose monitoring, can place a tremendous financial burden on these families. However, there is a growing community of low carb advocates who are working to support individuals with type 1 diabetes. Resources such as books, Facebook groups, podcasts, and YouTube videos are available to provide information and tips on low carb diets and managing the condition effectively. It is crucial for individuals with type 1 diabetes to be cautious when considering a ketogenic diet due to the potential risks of diabetic ketoacidosis and other complications. Research and clinical trials are being conducted to address these concerns and improve treatment options.
Risks of SGLT 2 Inhibitors and Nutritional Ketosis in Type 1 Diabetes
Patients with type 1 diabetes who take SGLT 2 inhibitors may not recognize the signs of life-threatening insulin deficiency due to the effects of these medications. The SGLT 2 inhibitors can lower glucose levels by dragging glucose out into urine, which makes it difficult to monitor blood glucose levels for insulin deficiency. This can lead to a delay in seeking medical care and receiving appropriate treatment. This phenomenon of delayed recognition and cognitive dissonance can also occur in rare cases in people with type 1 diabetes who follow a nutritional ketosis diet. It is important for healthcare providers and patients to be aware of these potential risks and to closely monitor glucose levels when using SGLT 2 inhibitors or practicing nutritional ketosis.
The Impact of Diet and Hyperinsulinemia on Cardiovascular Health in Type 1 Diabetes
The Standard American diet may be contributing to cardiovascular disease in both diabetic and non-diabetic populations. The discussion highlights the impact of hyperinsulinemia on weight gain and cardiovascular outcomes in type 1 diabetes. It is observed that individuals with type 1 diabetes consuming high-carbohydrate diets are at risk for cardiovascular illnesses. This suggests that the harmful effects of the Standard American diet extend beyond just diabetes. The conversation also touches upon the role of insulin in macrovascular disease compared to glucose in microvascular disease. The uncertainties surrounding the exact mechanisms and links between insulin and cardiovascular disease reveal the need for further research and understanding. Overall, the conversation underscores the importance of dietary factors in promoting overall cardiovascular health.
Understanding Insulin Levels and Their Impact on Health
Monitoring insulin levels and finding ways to reduce circulating insulin may have significant benefits for overall health. The discussion highlights the importance of understanding the area under the curve (AUC) of insulin production, which can provide valuable insights into metabolic function and potential interventions like autophagy. While individuals with type 1 diabetes have the advantage of directly knowing their AUC through insulin injections, others must rely on indirect indicators like average glucose levels to estimate it. The conversation emphasizes the value of self-quantification and staying connected to one's physiology. Overall, monitoring and managing insulin levels can play a crucial role in optimizing health and well-being.