Sunday Q&A – Understanding Diabetes

Q: I hear about diabetes all the time, but what is it actually?

A: There are a few different types of diabetes, but there are 2 main kinds: type 1 and type 2.

Type 1 diabetes is what used to be called “childhood diabetes” but due to an increased in children getting type 2 diabetes they have stopped calling it this. This is an autoimmune condition where your body destroys it’s insulin supply. These people NEED insulin because they don’t make any/enough.

What is insulin? Here’s a quick physiology lesson.

Your cells need glucose (sugar) to function. In order for your cells to pickup glucose from the blood they need insulin to ring the doorbell on the cell and let the sugar in. Let’s pretend that a glucose of 100 triggers insulin to be released.

So if you don’t have any insulin, the sugar can’t get into the cell and the cells can’t work.

Type 2 diabetes is due to insulin resistance. This occurs when there is a steady level of too much glucose floating around in the blood for a number of years. This high level of glucose triggers lots of insulin to be released and overtime, the doorbell gets sick of being triggered all the time to open. Just like a doorbell at home, when it’s pushed too many times and the doorbell gets worn out and needs to be pushed harder and harder in order to ring.

This is a vicious cycle –

The glucose is high (let’s say 150), insulin in released and the doorbell rings. A little glucose goes in but, the glucose is still high (120) so more insulin is released. This happens over and over again. The doorbell is sick and tired of being triggered all.the.time so eventually it changes the set-point so you need to be really high for it to ring (let’s say 200).

Since the set-point is higher, the glucose in the blood rises until it gets to that point, but insulin keeps getting released when the sugar is over 100. So now you have tons of sugar and tons of insulin floating around. This leads to 2 things

  • Too much sugar damages cells. This is what leads to neuropathy (people can step on a nail and not feel it – no joke), kidney damage and blindness. 
  • Too much insulin and too much ringing causes the doorbell to continue to get worn out

Patients with type 2 diabetes eventually need SO MUCH insulin to trigger the doorbell that their pancreas can’t keep up. This is why some people with type 2 diabetes need to take insulin. Prior to this point, they usually take medications to reduce the extra sugar the body releases, tune-up the door bell a bit, spill more sugar in the urine or stool, or trigger the body to release a little more insulin.

The treatment is also lifestyle changes. Here are the 3 main things

  1. Exercise of any kind. WALKING – just plain old walking that costs no money at all – 30 minutes a day decreases insulin resistance. One reason is that when you walk your cells need glucose to keep you moving. They reduce their insulin resistance a bit to pick up more glucose so sustain the exercise.
  2. Eating a balanced diet with more fiber and less refined carbs (i.e. sugar, white bread, potatoes, juice). This prevents the glucose in your blood stream from swinging up and down and keeps a more steady state.
  3. Weight loss. Extra fat cells do release extra insulin and weight loss alone has been shows to improve diabetes. But we all know it is near impossible to have meaningful weight loss long-term unless you get bariatric surgery (which has been found to reverse diabetes all together).  This should be a more gradual goal made possible by doing #1 and # 2 above, NOT by doing a crazy fad diet or taking a medication. If you only do something for a short time you’ll only have weight loss for a short time. So unless you’re ready to take orlistat your whole life (and carry a change of clothes everywhere, just in case), don’t start it in the first place.

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