The Metabolic Classroom with Dr. Ben Bikman An Alternative View of T1DM
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Jul 13, 2025 Dr. Bikman revolutionizes the understanding of type 1 diabetes by emphasizing the significant role of glucagon. He explains how glucagon can exacerbate hyperglycemia and ketone production when unregulated. This insight challenges the traditional focus solely on insulin deficiency. The discussion introduces promising therapeutic options like glucagon receptor blockers and GLP-1 agonists. Ultimately, there's a compelling call to rethink diabetes treatment as a bi-hormonal issue rather than just an insulin-centric one.
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Bi-Hormonal Hypothesis of Diabetes
- Dr. Roger Unger's bi-hormonal hypothesis states diabetes involves both insulin deficiency and excess glucagon.
- Excess glucagon drives major diabetic symptoms even without insulin, challenging insulin-centric views.
Local Insulin Controls Glucagon
- Insulin locally suppresses glucagon within pancreatic islets via paracrine signaling.
- High insulin near alpha cells inhibits glucagon release, balancing glucose regulation.
Glucagon Unchecked in Type 1 Diabetes
- Type 1 diabetes destroys beta cells but spares alpha cells, losing local insulin suppression of glucagon.
- Alpha cells secrete glucagon inappropriately despite high glucose, worsening hyperglycemia.