Abracadabra: Why Insulin Sparks Awe and Wonder

“The most beautiful experience we can have is the mysterious,” wrote Albert Einstein. “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 uncluttered, completely spontaneous awe and wonder: the birth of my daughter; the last three innings of the sixth game of the ’75 World Series; the ascent of thousands of sand hill cranes from the Platte River in Nebraska; the time I was driving on the highway and “Hellhound on My Trail” by Robert Johnson was played by a college radio station, literally one second after I had thought of the song.

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.

Comments on the web from the diabetes on-line community indicate that many of us 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 half a century, but I can get as frustrated as any rookie who is just learning how to count carbs at the fluctuations of my blood sugar. Too much stress, or too few kidney beans for dinner, or an infusion of insulin in the wrong flap of skin can throw everything off kilter.

Over time,  I’ve learned how to stop reflexively beating myself up for blood sugar results.  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 very technical and widely published overview mentions “those mystical actions of insulin.”  And this excited plaudit comes from Dr. R.A. Bowen in an 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?’”

One thing that surprised me about insulin was that it has many functions besides those related to storing, regulating and transforming sugars and fats. It stimulates the uptake of amino acids –the building blocks of protein, of you and me–, potassium, magnesium and other vital chemicals into cells. It helps to prompt arterial walls to relax and contract. In the last few years, researchers have discovered that insulin even enhances learning and memory and has all sorts of other functions in the brain. Who knew? Check out Wikipedia for a longer list of what our Mozart hormone does.

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. (Take a deep breath and stay with me, please. I beg of you. I hated science in high school, too!)

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. Insulin’s perpetual prom date is a protein called tyrosine kinase A1.

When insulin finds its prom date on the edge of a cell, binds with it and activates it, this triggers a kind of wild chemical dance within the cell, a process called “autophosphorylation.” What happens is that parts of the activated tyrosine kinase A1 contribute phosphates (compounds with phosphorus) to other parts, and this sets off what scientists call a “cascade” of changes. As Bowen puts it: “Active protein kinase A1 `runs around the cell’ adding phosphates to other enzymes, thereby changing their conformation and modulating their catalytic activity – - – 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, way above my level of science education. But I  understood enough to be amazed.

For one thing, insulin makes it possible for glucose to get inside of cells, with the help of molecules called “GLUT4 transporters.” Before the insulin-tyrosine kinase dance begins, most of the GLUT4s linger, dormant, in the cell’s interior, while some are on the edge of the cell. But insulin recruits many more GLUT4 transporters and drives them to the edge. There, they make it possible for glucose molecules to diffuse into cells, and once there, the glucose is trapped due to phosphorylation. And then more abracadabra transforms it into energy.

Why in the world does that happen?! How does the body get what Deepak Chopra has described as its innate “intelligence?” An accumulation of more than a few examples of what insulin accomplishes prompted me to go back and re-read Einstein. He summed up what I was feeling in his explanation of why he was a deeply religious man, despite the fact that, like me, he 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.”

I am living proof that it is never too late for even the most grumpy curmudgeon to cultivate awe and wonder.  At least once a day when injecting Mozart (I don’t use a pump), I tell myself to do a little mental calisthenic–call it a blessing, if you want.  I try to 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. When I record the test results in a log, I still sometimes add question marks, angry exclamation points and “WTF? What’s going on?!” But I have finally begun to make peace with the enemy.

Comments

  1. Jeff N. says

    Thanks for the magical description of the action of insulin, Dan. I knew just a little of that, and am sure I will keep coming back to this post to let the details sink in.

    I admire your old-school approach of injecting and keeping a handwritten log. I’m trying to do the same thing with electronics–pump and CGM–but need to find the “WTF” button for my digital records. I would use it a lot, too.

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