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Type 2 diabetics who receive insulin, instead of pills, to control their blood sugar levels after heart attacks live longer, on average 2 years longer. And they don't have to have continuing insulin therapy after getting out of the hospital.

In 1945, the renowned cardiologist Demetrio Sodi-Pallares made a remarkable discovery. Treating heart attack patients with a combination of potassium, glucose, and insulin sometimes brought them completely back to health. Over the years, Sodi-Pallares used his position as a professor of medicine first at UCLA, then at Michigan, and then at the Baylor School of Medicine almost as an evangelist for the simple method of treatment.

And in 1998, fifty-three years later, the American Heart Association begrudgingly acknowledged to the then 85-year-old Dr. Sodi-Pallares that his method did work, when there was no danger of its replacing bypass surgery as the treatment of choice.

The idea that insulin can be what ailing hearts need, however, has resurfaced with reports of the results of a 20-year follow-up study published in  Lancet Diabetes & Endocrinology on 13 May 2014.

The DIGAMi-1 Study of Heart Attack Survival in Diabetics

The Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) was a study conducted in 19 Swedish hospitals between January of 1990 and January of 1993. Heart attack patients who also had type 2 diabetes and high blood sugar levels, over 11 mmol/L (199 mg/dl in the American system) were randomly assigned into two groups. One group was given standard heart attack care and the usual oral medications for type 2 diabetes. The other group was given standard heart attack care and put on intensive insulin therapy for 3 months to keep their blood sugar levels low as their hearts healed.

Then both groups were followed for the next 20 years. There were significant differences in survival between the two groups.

  • One of the patients in the insulin treatment group survived another 20 years and 9 months after heart attack.
  • Half of the patients treated with oral medications lived for 4 years and 8 months or longer after their heart attacks.
  • Half of the patients treated with insulin, just for 3 months, lived another 7 years after their heart attacks.

But some patients benefited from insulin therapy a lot more than others.

  • In patients who were under the age of 70 when they had their heart attacks, who had no prior insulin treatment, and no history of congestive heart failure, the median survival time was 9.4 years with insulin treatment, compared to 6.9 years without it.
  • In patients who were over the age of 70,or who had a history of cardiovascular disease other than heart attack, or who already had diabetic complications, adding insulin therapy for 3 months did not increase longevity.

That does not mean, however, that treating type 2 diabetes with insulin over the long term would be a bad idea.

Follow-up care for heart attack patients has greatly improved since 1993. People who have heart attacks are routinely given ACE-inhibitors (drugs such as captopril, lisinopril, or ramipril) to control blood pressure.

The ACE-inhibitor lowers blood pressure, but it also prevents the formation of scar tissue in the heart.

Moreover, it short-circuits a cellular signal called mTOR, which powers the proliferation of cells that have become cancerous, and reduces the risk of diabetic kidney disease. This simple, readily available, extremely inexpensive medication not only protects the heart but also reduces the risk of cancer and kidney disease.

Continue reading after recommendations

  • Dr Viveca Ritsinger, Prof Klas Malmberg, Anton Mårtensson, Prof Lars Rydén MD, Prof Hans Wedel PhD, Anna Norhammar MD. Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20 year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial. The Lancet Diabetes & Endocrinology, Early Online Publication. 13 May 2014 doi:10.1016/S2213-8587(14)70088-9.
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