Diabetes Research: part 2
Edward Lichten, M.D.,PC
TESTOSTERONE is a natural hormone that is produced in both men and women. Women do not realize that all their estrogen comes from Testosterone. Understand ladies that without testosterone there would be no sex drive, no attitude, and no estrogen! In men, testosterone is everything important: sex drive, muscle mass, increased cardiac performance, weight loss and stable blood sugars!
Our discovery is that testosterone has a profound effect on stabilizing a man's diabetic blood sugar! On numerous occasions we have been able to take men off oral agents and some even off regular insulin; up to < 20 IU/day. Most find that their blood sugars are lowers and the amount of medication is reduced by 25% to 50%. That is why we are spending our time and effort in bringing our years of experience with this phenomenon to the public. And we are convinced that testosterone may be the best treatment ever for adult onset diabetes while assisting in stabilizing the fluctuations of juvenile male diabetics!!
Proof of our results are seen in the first set of data. This 73 year old man has been diabetic for 20 years.
Not only was he able to discontinue Micronase, but he felt stronger and better. Unfortunate, his advanced gangrene could not be contained and surgical intervention followed all our efforts at hormonal therapy.
But a second man was able to avoid amputation of his finger with testosterone therapy while a third saw a 2-year old foot ulcer heal completely in two months!
While a third was able to control his glycogenated hemoglobin (HgB A1c) without radical changes in diet or exercise! See graph below.
In our practice, we have treated individuals who enter using upwards of 100 units of insulin daily. This is called 'insulin resistance.' Testosterone has been able to reduce and stabilize the blood sugars and lower insulin requirements in some individuals better than RezulinŽ (precursor to Actos/Avandia).. But testosterone does not work for everyone. We only suggest that diabetic individuals with mild, moderate or severe disease consider testosterone for inclusion in their diabetic program. Strong diabetic control, that is low insulin and stable blood sugars, is most important in avoiding the terrible complications and end-stage processes of diabetes. By the time a diabetic develops coronary HEART disease, massive OBESITY, renal disease requiring DIALYSIS, amputation of extremities and neuropathies, nothing including testosterone can slow the progression of this dreaded disease. The time for intervention is NOW!
Our lectures have been focused on education for the physicians and public to the need for tight insulin control. But many individuals do not know that they are pre-diabetic or diabetic. That is why it is important for both the man and woman to insist that their treating physician measure their fasting insulin, testosterone and sex hormone binding globulin. Because even if you think "everything is OK" you may be inclined to change your diet, exercise or medication program if you find you are "sicker than you think."
Our research has established that there is a definite relationship between the amount of free testosterone and the 'sensitivity' to insulin. This is influenced by the individual's sex; male or female. The term we prefer is Gender-Specific. In men, high testosterone and low sex hormone binding globulin makes for higher free testosterone which is good. High free testosterone equals a decreased need for insulin for the man. Remember that for diabetes and all of us the goal is still excellent glucose control, but, more important is strict insulin control. A normal fasting insulin is less than 10 mIU/ml. Lower yet is proportionally much better.
For women, low free testosterone best serves her insulin sensitivity. High sex hormone binding globulin correlates to low fasting insulin and less abdominal and body fat. Just remember that you want your hormones to match that of a healty teenager or young adult. The wonder of appropriate hormonal replacement is that many of our patients report that they do feel 20 years younger, sexier and healthier!
Your doctor can use the following formula to determine how much 'active' or free testosterone is available to the male patient. Free Androgen Index (FAI) = concentration of total testosterone in mg/dl x .0347 divided by concentration of sex hormone binding globulin in nmol/L. A non-diabetic teenager may have a ratio of 2. An 80 year old man with diabetes on dialysis may have a ratio of 0.1 or so. The normal adult male's ratio is approximately 1 (0.8 to 1.2). Women have a ratio of 0.04 or less. For both genders with diabetes, we follow the testosterone, estrogen, sex hormone binding globulin, fasting insulin level and hemoglobin A1C to monitor improvement with hormonal treatment.
The individual shown below knows that he has to follow a diet low in processed carbohydrates and exercise. But in his mid-50's, he isn't going to change. He did start testosterone replacement with injections and then long-acting pellets. His fasting insulin levels dropped in half and the amount of stored sugar in his cells as related to Hemoglobin A1C improved dramatically. He has continued on this regimen for three years. His has been able to decrease his oral medication for adult onset diabetes in half while losing 20 pounds. He feels well enough to work long hours as a truck driver and enjoys his time with his wife and grandchildren. As long as his disease is stable, we feel we are positively impacting on his disease. We reinforce his need for dietary change (low carbohydrate), exercise and regular physician monitoring.
Testosterone has been used in the United States in injections since 1939 and in pellet form since 1948. We have been instrumental in developing a long-acting pellet that lasts for 3 months and a new delivery system. NOTE, there are FDA approved testosterone pellets that are prescribed for men with low testosterone levels. These are the products we use when billing your insurance company.
Many individuals seem to think that a doctor cannot use a product like testosterone for medical conditions not approved by the FDA. This is not true. It is part of the law of the United States that a physician can use any 'approved' product for any medical condition he feels is appropriate. That is why ibuprofen is used for menstrual pain and headaches along with the pain of arthritis.
There are specific protocols we follow when treating men with testosterone, men with diabetes, and women with diabetes. The men need to have specific laboratory tests including (1) PSA (prostate specific antigen). The PSA follows changes in the prostate that may predict cancerous changes. All men need a digital examination to rule out changes in the prostate. We also follow these (2) non-hormonal laboratory tests. The complete blood count follows for the development of high blood counts (the reverse of anemia). The SMA12 follows for changes in liver function (very rare) and the Lipid test follows changes in lipids (usually very mild if any). Men are seen every other week for intramuscular injections or every 6-12 weeks for the pellets. (3)Third, we follow blood tests for hormones. This includes calculation of the Free Androgen Index, (testosterone & sex hormone binding globulin), estradiol, DHEA-sulfate, and thyroid. These are followed every 3 months. Often, the FAI is kept quite high to lower insulin resistance.
For more information call Dr. Lichten at phone: 248.593.9999 to make an appointment to discuss your case in detail.
Non-healing Diabetic Ulcer leading to Amputation
Fifty Years of Diabetes
Edward Lichten, M.D. in a
1997-2002 study through Providence Hospital in Southfield,MI
RL Kraft, M.D. in 1975 showed that
diabetics have no or abnormal insulin responses to the standard glucose
Doctor Lichten repeated Kraft's
work and identified that more than two-thirds of all men on oral agents to
reduce their serum glucose were insulin requiring.