Too Much Insulin?

For a quarter-century, insulin has been the widely used, highly touted treatment for diabetes. This week, doctors were warned to go slow with it. Before the American Chemical Society in Atlantic City, Dr. Michael Somogyi charged that "innumerable" patients now getting large daily doses (50 to 150 units) "are actually victims of chronic insulin poisoning."

Owlish, Hungarian-born Dr. Somogyi is a biochemist in the Jewish Hospital of St. Louis. But he is not an M.D., and so is not allowed to treat patients or see them professionally unless a cooperative doctor leads them into Somogyi's office for consultation. But, "looking over the shoulders of physicians," as he puts it, Somogyi has had a hand in treating 4,000 new cases of diabetes in the last 14 years. He has also been consulted in 300 to 400 other cases which had been previously "mismanaged" (by his standards) by other doctors.

Slimmer Doses. With this mass of clinical material, Somogyi has come to a sweeping conclusion: among adult diabetics reporting for first treatment, there are less than 1% who cannot be treated so as to get along entirely without insulin.* Of the tiny fraction of more stubborn cases, nearly all can get by with 20 units of insulin a day--in the severest cases, no more than 30 units.

Doctors are always on the alert, Somogyi points out, for "insulin shock"--severe symptoms of trembling, sweating, convulsions and even coma--which follow when overdoses of insulin reduce the sugar content of the blood drastically. But, he argues, there may actually be a serious blood-sugar deficiency before these dramatic symptoms occur. Then the body's glandular forces go to work, building up the blood sugar. In such circumstances they overdo the job: soon, there is again too much sugar in the blood, and many physicians are likely to order more insulin --thus completing the vicious circle.

Slimmer Patients. The trouble with accepted theories about the cause and treatment of diabetes, says Somogyi, is that they pay too little attention to the role of the liver. Laboratory work has convinced him that in most diabetics the liver cannot metabolize fats fast enough. Physicians working with him in St. Louis reject the common idea that a patient's intake of starches must be restricted; instead, they make the patient cut down on fats, to ease the load on the liver and to get his weight down to the ideal norm for his age and height.

Dr. Somogyi's conclusion: "The scale is the judge: if the body weight rises, the fat ration must be cut ... Any diabetic whose weight is above the ideal level is definitely mismanaged."

* Children, unlike adults, nearly always need insulin at first. But even they need less than 20 units a day, Somogyi holds.

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