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...can have two underlying causes:
The
treatment for diabetes- including nutrition, exercise, and medications- all
focus on decreasing the resistance of your tissues to insulin, or helping your
body have enough insulin. This will
lower you chance of having a stroke, heart attack or other diabetes related
complications.
Insulin Resistance
is the most common condition underlying type 2 diabetes. This can be present in both obese and
lean people.
Insulin resistance is a
breakdown in the communication between insulin receptors on
cell membranes, and glucose transporters inside the
cell.
Tissue resistance to insulin
is genetic in origin, and probably started ~ 10 years before you were diagnosed
with diabetes. Getting older,
increased body weight, less physical activity, and increased abdominal girth are
all factors that can progressively make insulin resistance worse.
To
compensate for this progressive resistance, the pancreas produces more insulin
in an attempt to keep BG normal. Insulin resistance creates many changes in your body that raise your
chance for a stroke or heart attack. It is associated with high blood pressure,
glucose intolerance, damaging changes in cholesterol and triglyceride levels,
changes in the lining of vessel walls, and more clotting factors in your blood.
These conditions collectively have been termed the “ insulin resistance
syndrome”.
This process can go on for
years. Eventually the pancreas can
no longer keep up with the extra demand for insulin so blood sugar levels
rise. To add to the problem, the
liver contributes an extra source of glucose when there is too little insulin
working. Also, when blood glucose
is high, the pancreas has problems releasing insulin quickly after you have
eaten.
The end result is that
diabetes is diagnosed, or diabetes gets out of control. Once you have
diabetes—or even insulin resistance—controlling your BG, your blood pressure,
and your lipids (cholesterol and triglycerides) are the most important things
you can do to lower your chance of cardiovascular disease.
Reversing Insulin
Resistance:
The good news is, action can
be taken to reverse insulin resistance. Many
things you can do yourself. The end
result will be controlled blood glucose, blood pressure, and blood fat (lipid)
abnormalities. Many people have
more energy, feel better, and have a lower chance of health problems.
These actions include:
- Exercise is the most
powerful tool you have to reverse insulin resistance. It is effective even if weight stays
stable.
- Moderate carbohydrate, low
fat eating pattern. Eating meals and snacks
based on your nutrition needs, at least 200-400 Calories below your weight
maintenance calorie level will improve insulin sensitivity. This is true even if you are at a weight
plateau.
- Weight
loss. About 80-90% of people with
Type 2 diabetes are overweight and losing weight improves sensitivity to
insulin. A realistic goal, which has shown health benefits is a 5-10% reduction
in body weight over a six month period, and maintaining the reduced weight.
- Reducing abdominal
girth. Excess body fat located in
the abdomen is associated with insulin resistance.
Decreased Insulin
Production:
There may be several reasons
why insulin output can be reduced. The pancreas may not be able to produce enough insulin, or it may have a
sluggish release of insulin because of regularly high BG levels. Diabetes medications are
more likely to be necessary in this setting, as lifestyle factors
will not increase the output of insulin.
Lean adults who develop type
2 diabetes may have a significant problem making enough insulin. Another problem that can
raise BG levels is the liver releasing too much stored sugar when it
shouldn’t.
Correcting The Problem Areas
In Type 2 Diabetes:
- Tissue Resistance to Insulin:
- Lose weight
- Exercise
- Eat healthy foods in the correct amounts
- Shrink your abdominal girth
- Talk to your doctor about medications that help reverse insulin
resistance.
- Pancreas Problems
- Decreased insulin production by your pancreas:
You may have inherited a problem in making insulin. By controlling
the timing and amount of carbohydrate, and becoming more physically fit, you
may be able to control your blood glucose. If not, you need a diabetes
medication to get your BG into the target range.
- Sluggish release of insulin by your pancreas:
When BG levels are persistently high (200-300+ range), it usually
takes a more aggressive plan to get them down than it does to keep them down.
High BG levels cause "glucose toxicity". This means that cells can't
do their job well when they are sugar coated. This includes the beta cells of
the pancreas, which means they can't make and release enough insulin. Getting
the blood sugars down will reverse the impact of glucose toxicity on glucose
control.
- Liver Storage Problems
- One diabetes medicine decreases the excess sugar released by the liver.
- Spread out the carbohydrate you eat for the best BG control. Your food
intake needs to match your ability to produce and release insulin. If meals
are spread 4-5 hours apart, without snacks, the BG pattern may be different
than the same amount of carbohydrate eaten in three meals and three snacks.
By testing your blood glucose throughout the day, you can determine what
works best for your diabetes.
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