Diabetes: Let’s not sugar-coat the pill

When talking with a friend recently who was diagnosed with Type-2 Diabetes (T2D) about a year ago, I was appalled to find out he had no idea what T2D was. His doctor never explained it to him, rather just said his blood sugar was high and wrote him a prescription for metformin.

T2D, and pre-diabetes, are serious conditions with growing prevalence. Do you have a relative or friend with diabetes? It is a complex condition with multiple risk factors The good news is that T2D can be prevented and even reversed with lifestyle modifications.

Here are the facts and what you can do to manage and prevent the disease.

The stats

According to surveys by the Center of Disease Control, the prevalence and cost of diabetes are astonishing.

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  • There are 29.1 million people in the United States that have diabetes. That is 1 out of every 11 people.

  • 1 out of 4 people don’t know they have diabetes.

  • 86 million people (that’s 1 out of 3 adults) have prediabetes.

  • However, 9 out of 10 people do not know they have prediabetes.

  • 15-30% of people with prediabetes will develop prediabetes within 5 years.

  • The total medical costs and lost work and wages for people with diagnosed diabetes is estimated to be $245 billion.

  • The risk of death for adults with diabetes is 50% higher than those without.

  • Medical costs of people with diabetes are twice as high as for those without diabetes.

  • People with diabetes have a higher risk of developing serious health complications such as blindness, kidney failure, heart disease, stroke, and loss of toes, feet, or legs.

What is Type 2 Diabetes?

Type 2 Diabetes is a condition that causes blood glucose (sugar) to rise higher than normal. High blood glucose is the result of improper use of insulin, called insulin resistance.

What is insulin resistance?

The progression to type 2 diabetes begins long before the actual onset of the disease. It begins with insulin resistance.

To understand insulin resistance, it is important to review the normal physiological process that occurs in response to eating.

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When we eat foods that contain carbohydrates (anything from pasta, bread, crackers, and cake to fruit, fruit juice, soda, and oatmeal), it is broken down in the stomach into glucose. Glucose is absorbed through the small intestine into the blood stream causing an increase in blood glucose. When glucose enters the blood stream, it triggers the pancreas to secrete the hormone insulin. Insulin is secreted from the beta cells of the pancreas. In a lock and key manor, insulin stimulates (unlocks) muscle cells to allow glucose to enter and be stored within the cell and used for energy and the concentration of glucose in the blood decreases. Glucose is also produced by the liver and released into the blood stream when blood glucose gets low. Thus, blood glucose levels are kept in a tightly regulated range.

When there’s too much sugar floating in the blood after a meal, (for example, you ate that hi-carb meal, washed it down with a soda and went back to your chair in front of the computer) the cells refuse to let insulin bring the extra sugar in. The result? Insulin production shoots up as the body tries to “muscle” the sugar into the cells. When the muscle cells don’t budge, excess sugar goes away into the fat cells, where it begins to accumulate.

In other words, over time, a sedentary lifestyle, poor eating habits, genetic predisposition, and other factors can result in insulin resistance. This occurs when the muscle cells become desensitized or resistant to the effects of insulin. The beta cells of the pancreas must then secrete more insulin to dispose of the same amount of glucose.  This is the first step in the progression of Type 2 Diabetes.

The development of Type 2 Diabetes

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1.        Insulin resistance.

At first, the pancreas compensates for insulin resistance by increasing insulin secretion, resulting in elevated levels of insulin in the blood (hyperinsulinemia). Glucose tolerance, or glucose levels in the blood, remains in the normal range because higher insulin secretion does the trick.

2.       Impaired glucose tolerance and beta-cell dysfunction.

The next progressing towards type 2 diabetes is an increase in blood glucose levels (hyperglycemia). Insulin secretion is reduced and this is reflected in blood glucose levels as insulin is no longer sufficient to dispose of glucose into the cells. The beta cells of the pancreas also begin to fatigue and stop working properly as less insulin is secreted.

3.       Type-2 diabetes

Lastly, the progression to full blown type-2 diabetes where the pancreatic beta cells fail. They secrete little to no insulin in response to blood glucose. Medications such as metformin and insulin injections are then prescribed. Symptoms include feeling tired because your cells have little glucose for energy, excess thirst. Diabetes is complex and affects multiple organ systems. It can lead to other conditions such as eye problems (retina damage), heart disease, and neuropathy or tingling/burning sensations in arms and feet.

How do you test for T2D or pre-diabetes?  There are a few ways to determine whether you have diabetes or pre-diabetes.  · Impaired glucose tolerance – This is step 2 in the development of T2D. Have you ever had a glucose tolerance test where you drink a very sugary drink then have your blood drawn before and after? This measures the glucose response to the sugar drink. If your glucose is elevated after 2 hours, depending on how high it is, you may be pre-diabetes or have T2D.  · Elevated fasting glucose – Also step 2 in the development of T2D. When you go to the doctor and they draw your blood in the morning before you have eaten anything (you are fasted). If your glucose is high, then this means you have impaired fasting glucose. Remember there are 2 sources of glucose, what you eat and your liver can make it. When you are fasted, your liver makes glucose. Insulin is secreted to keep this glucose level in a tight range. When fasting glucose is high, this means insulin is not doing its job and you are insulin resistant.  What about step one? Notice that these tests do not measure insulin levels. In these 2 cases, we miss step one. The only way to determine if you are insulin resistant but still glucose tolerant (meaning your pancreas has to secrete more insulin to get the cells to take to glucose out of the blood stream and store it) is to measure your insulin response to a glucose tolerance test. If your insulin is elevated, then you are hyperinsulinemic and insulin resistant. If you think you might be insulin resistant and on your way to prediabetes or T2D, ask you doctor about testing both your insulin and glucose response to an oral glucose tolerance test (OGTT).

How do you test for T2D or pre-diabetes?

There are a few ways to determine whether you have diabetes or pre-diabetes.

· Impaired glucose tolerance – This is step 2 in the development of T2D. Have you ever had a glucose tolerance test where you drink a very sugary drink then have your blood drawn before and after? This measures the glucose response to the sugar drink. If your glucose is elevated after 2 hours, depending on how high it is, you may be pre-diabetes or have T2D.

· Elevated fasting glucose – Also step 2 in the development of T2D. When you go to the doctor and they draw your blood in the morning before you have eaten anything (you are fasted). If your glucose is high, then this means you have impaired fasting glucose. Remember there are 2 sources of glucose, what you eat and your liver can make it. When you are fasted, your liver makes glucose. Insulin is secreted to keep this glucose level in a tight range. When fasting glucose is high, this means insulin is not doing its job and you are insulin resistant.

What about step one? Notice that these tests do not measure insulin levels. In these 2 cases, we miss step one. The only way to determine if you are insulin resistant but still glucose tolerant (meaning your pancreas has to secrete more insulin to get the cells to take to glucose out of the blood stream and store it) is to measure your insulin response to a glucose tolerance test. If your insulin is elevated, then you are hyperinsulinemic and insulin resistant. If you think you might be insulin resistant and on your way to prediabetes or T2D, ask you doctor about testing both your insulin and glucose response to an oral glucose tolerance test (OGTT).

What are the risk factors for Type 2 Diabetes?

There are both modifiable and non-modifiable risk factors for Type 2 Diabetes.

Non-modifiable risk factors are those that we have no control over:

  • Family history of diabetes

  • Age over 45 years

  • Race/ethnicity

  • History of gestational diabetes.

Risk factors we can change include:

  • Physical inactivity

  • Poor diet

  • Overweight and obesity

  • High blood pressure

  • High cholesterol

 

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Lifestyle treatments for Type-2 Diabetes

1.       First and foremost, the diagnosis must be treated with urgency.

Think back to the progression of diabetes. By the time high blood glucose (impaired glucose tolerance, high fasting glucose) occurs, you are already insulin resistant and on your way to full on diabetes. Now that you know there are factors you can modify, ask your doctor what factors (weight loss, diet, exercise) you need to focus on.

2.       Exercise

Exercise has many benefits. Exercise has numerous benefits. When it comes to diabetes, exercise works at the molecular level of our cells to increase glucose uptake and sensitivity to insulin. It also reduced harmful fats inside the cell that can promote insulin resistance and increase good fats that promote insulin resistance.

3.       Diet

Specific dietary changes should be adopted immediately when diagnosed with pre-diabetes or full on Type 2 Diabetes. The consumption of carbohydrates requires insulin. (Remember all carbohydrates are broken down to their basic molecules – glucose.) When the pancreas no longer produces or produces too little in response to glucose then insulin must be administered. This is essentially a band aid to the larger issue. Treatment with insulin as a medication (exogenous insulin) is not a cure. Reducing carbohydrate consumption, however, reduces the need for insulin. A lower carbohydrate diet is essential for reversing diabetes.

Numerous research studies have shown that even modest lower carbohydrate diets improve pancreatic beta-cell function and increase insulin sensitivity.

The take-away:

  • Diabetes and pre-diabetes are urgent diagnoses!

  • You CAN prevent and even reverse diabetes through lifestyle modifications – diet and exercise.

Lastly, consult your doctor before taking on any drastic lifestyle changes. Increases in insulin sensitivity through diet or exercise will likely change the need for medications such as insulin and metformin and should be medically supervised.

Have you been diagnosed with T2D or pre-diabetes? Do you have family history of diabetes? Want to know more about what you can do for T2D and how to prevent it? Contact SPINLab!