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In this Metabolic Classroom lecture, Ben challenges the conventional insulin-centric model of type 1 diabetes by introducing the “bi-hormonal hypothesis” proposed by Dr. Roger Unger.
While insulin deficiency is a defining feature of T1DM, Dr. Bikman emphasizes the overlooked role of glucagon in driving hyperglycemia, ketone production, and muscle wasting. In normal physiology, insulin from beta cells locally suppresses glucagon from alpha cells. But in type 1 diabetes, this local regulation is lost, allowing glucagon to run unchecked—even when blood glucose is high.
Ben explains how injected insulin, although lifesaving, can’t mimic the precise intra-islet insulin levels needed to suppress glucagon secretion. This mismatch helps explain why blood sugar control can remain elusive despite appropriate insulin use. Excess glucagon ramps up liver glucose output and ketogenesis, creating a more complex hormonal storm than insulin alone can calm.
The lecture also explores new therapeutic strategies—including glucagon receptor blockers and GLP-1 agonists—that may help suppress glucagon more effectively. Dr. Bikman urges a shift in perspective: instead of seeing diabetes as just a disease of insulin, it’s time to recognize its bi-hormonal nature and tailor treatment accordingly.
Show Notes/References:
For complete show notes and references, we invite you to become an Insider subscriber. You’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben after the lecture, ad-free podcast episodes, show notes and references, online Office Hours access, Ben’s Research Review Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more: https://www.benbikman.com
Translation Notes:
You can click the gear icon at the bottom of this video to auto-translate captions. For example, to translate into Polish, select Subtitles, choose Auto-Translate, then first choose English, then choose Auto-Translate again, then choose Polish.)
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Timestamps (approximate):
00:01 – Rethinking the Insulin-Centric Model
01:04 – Dr. Roger Unger and the Bi-Hormonal Hypothesis
03:15 – Glucagon: The Forgotten Hormone
05:17 – Glucagon Physiology and Liver Function
08:23 – Pericrine Regulation in Pancreatic Islets
10:36 – What Goes Wrong in Type 1 Diabetes
12:45 – Glucagon Secretion Without Insulin
13:50 – Glucagon’s Role in Ketogenesis and Protein Breakdown
15:54 – The Limits of Injected Insulin
17:58 – Why Systemic Insulin Misses the Mark
19:10 – Explaining Glucose Variability and High Insulin Needs
21:34 – Clinical Implications of Hyperglucagonemia
23:32 – Muscle Wasting and Amino Acid Shuttling
24:29 – Blocking Glucagon: A Therapeutic Strategy
25:29 – Type 2 Diabetes and Glucagon Resistance
26:21 – Drug Therapies Targeting Glucagon
28:31 – GLP-1 Drugs as Glucagon Suppressors
29:37 – Final Thoughts: A Paradigm Shift in Diabetes Treatment
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Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)
Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)
Ben’s favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)
Ben’s favorite health check-up for men: https://blokes.co/drben15 (discount: DRBEN15)
Other products Ben likes: https://www.amazon.com/shop/benbikmanphd
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Lizzo, the Grammy-winning artist known for 'Truth Hurts,' shares her weight loss journey, including her experience with Ozempic and GLP-1 drugs. She discusses why she chose to focus on dietary changes, particularly incorporating meat, to achieve her goals. Lizzo emphasizes the importance of finding what works for you and encourages understanding for those using medication to manage weight. This video explores her transformation and offers insights into her approach to health and wellness.
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How to Measure Body Fat Percentage for Overweight Children. Part of the series: How to Treat Various Child Ailments. The best way to the measure body fat percentage for an overweight child is to use a tool called the Body Mass Index. Learn how this tool is used to measure body fat with guidance from a doctor in this free video on child health treatments. Read more: http://www.ehow.com/video_5574567_measure-fat-percentage-overweight-children.html
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