Diabetes Forecast

Abracadabra: The Lessons of Insulin

Enjoying a sense of wonder about changes the “Mozart hormone” orchestrates in the body

By Dan Fleshler , ,

Nikada/Getty Images

“I am living proof that it is never too late for even the most grumpy curmudgeon to cultivate awe and wonder.”
Dan Fleshler

“The most beautiful experience we can have is the mysterious,” wrote Albert Einstein in Living Philosophies, published in 1931. “Whoever does not know it and can no longer wonder, no longer marvel, is as good as dead.”

I can count only a few occasions during my first 58 years when I felt a sense of abject, uncluttered, completely spontaneous awe and wonder: the birth of my daughter; the descent of thousands of sandhill cranes on the Platte River in Nebraska; the last three innings of the sixth game of the 1975 World Series.

So I have been quite surprised lately, not only because I am able to feel wonder but because of its unlikely source: the inner workings of my diabetic body.

The Enemy

Comments on diabetes blogs and websites indicate that many of us—with either type 1 or type 2 diabetes—think of our bodies as outright foes, cruel tricksters that fool us with unexpected, sometimes inexplicable responses to our attempts to calibrate insulin, food, and exercise. I’ve been wrestling with this condition for 51 years, but I can get as frustrated at the fluctuations of my blood sugar as any rookie who is just learning how to count carbs. Too much stress, or too few kidney beans for dinner, or a strong cup of coffee, or an infusion of insulin in the wrong flap of skin can throw everything off-kilter.

I’ve gradually learned how to stop reflexively beating myself up for blood sugar results or, for that matter, not feeling well. But I never thought of my body as anything other than an enemy agent that I was forced to outthink and outwit until recently, when I gave myself a crash course in the life sciences and began to study diabetes—including the mechanisms of insulin—for the first time in earnest.

I quickly learned that insulin prompts awe even in the most matter-of-fact scientists. One professor mentions “those mystical actions of insulin.” And this excited plaudit comes from Robert A. Bowen, DMV, PhD, a professor at Colorado State University, on his Web page introduction to the endocrine system: “Stand on a street corner and ask people if they know what insulin is, and many will reply, ‘Doesn’t it have something to do with blood sugar?’ Indeed, that is correct, but such a response is a bit like saying, ‘Mozart? Wasn’t he some kind of a musician?’ ”

Very Important Hormone

One thing that surprised me about insulin was that it has many functions besides those related to storing, regulating, and transforming sugars and fats. For example, it stimulates the uptake of amino acids (the building blocks of all proteins), potassium, and other vital chemicals into cells. It helps to regulate the amount of acid secreted in the stomach and sodium excreted by the kidneys. In the past few years, researchers have discovered that insulin even enhances learning and memory and has all sorts of other functions in the brain. Who knew?

 But it wasn’t until I developed a very elementary understanding of how insulin actually works that the sense of wonder began to take hold.

Insulin is a hormone. Every hormone has specific “receptors” in target cells, which the hormone needs in order to have an impact on the body. These receptors hang around, waiting for hormones that are meant for them, like high school kids yearning for prom dates to show up.

When insulin finds its prom date on the edges of a cell, binds with it, and activates it, this triggers a kind of wild chemical dance within the cell, a process that I’d never heard of called “autophosphorylation.” What happens is that parts of the insulin receptor receive phosphates (compounds with phosphorus) from other parts, and this sets off what scientists call a cascade of changes. As Bowen puts it: “Abracadabra, the cell has been changed!”

Abracadabra. That one word from a seemingly objective researcher made me realize that I was learning about more than dry, drab physiology; it freed me to believe there was some kind of magic within me. The actual transformations insulin induces are extraordinarily complicated, and the elixir switches many of them on and off. They are illustrated in some scientific texts with charts containing many chemicals linked by arrows that were incomprehensible to me. But I understood enough to be amazed.

For one thing, insulin makes it possible for glucose to get inside cells, with the help of molecules called “GLUT4 transporters.” Before the insulin-receptor dance begins, most of the GLUT4s linger, dormant, in the cell’s interior, while some are on the edge of the cell. But insulin helps to orchestrate the movement of more GLUT4 transporters to the edge, where they literally pry the cell open, creating a kind of corridor to allow the glucose to get through and fuel life.

Why in the world does that happen? How does the body get what Deepak Chopra has described as its innate “intelligence”? An accumulation of examples of what insulin accomplishes prompted me to go back and reread Einstein. He summed up what I was feeling in his explanation of why he was a deeply religious man, despite the fact that he, like me, did not believe in a personal god: “The knowledge of the existence of something we cannot penetrate, our perceptions of the profoundest reason and the most radiant beauty, which only in their most primitive forms are accessible to our minds: It is this knowledge and this emotion that constitute true religiosity.”

Shock and Awe

Scientists are only beginning to fathom what our Mozart hormone is orchestrating. I take surprising, newfound comfort in learning how much they don’t know. One consequence of living with diabetes for half a century is frustration with all of the “promising” research that has gone nowhere, all of the so-called breakthroughs that haven’t yielded practical benefits because so many puzzles still need to be solved. But lately, the idea that very smart researchers are constantly throwing up their hands and exclaiming, “What’s going on?!” has made me feel as if we are part of the same fellowship, respectfully observing and paying constant homage to the mysteries of insulin.

More important, I am living proof that it is never too late for even the most grumpy curmudgeon to cultivate awe and wonder. I tell myself to do a little mental calisthenic at least once a day when I inject insulin (yes, I still do it the old-fashioned way). I imagine the hundreds of different chemical cascades that are taking place within my body, including—no, especially—my brain, because of insulin.  And I whisper, “Abracadabra.” 

The blood sugar still swoops up or down wildly on occasion, taunting me. But I have finally begun to make peace with the enemy.

Dan Fleshler, who has lived with type 1 diabetes since 1962, blogs at theinsulinchronicles.com.



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