THE DOC AND CHEF SHOW EP. 12: DIABETES // SUPPORTING SCIENCE AND THE RECIPE
Diabetes has reached epidemic proportions. More than 37 million US adults have diabetes, and 1 in 5 of them don’t know they have it. Diabetes is the eighth leading cause of death and the leading cause of kidney failure, lower-limb amputations, and adult blindness in the United States. In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.[1]
There are several types of diabetes, but the two most common are:
1. Type 1 Diabetes: This is an autoimmune condition where your immune system mistakenly attacks and destroys the insulin-producing beta cells in your pancreas. As a result, your body cannot produce insulin. Type 1 diabetes usually develops in childhood or young adulthood and requires lifelong insulin therapy.
2. Type 2 Diabetes: This type is characterized by insulin resistance, where your body's cells don't respond effectively to insulin. Initially, the pancreas tries to compensate by producing more insulin, but over time, it may not keep up with the increased demand. Type 2 diabetes is often associated with lifestyle factors such as obesity, a sedentary lifestyle, and genetics. It is more common in adults, although it can also occur in children and adolescents. More than 90% of patients with diabetes have type 2 diabetes.
The main symptoms of diabetes include increased thirst, frequent urination, unexplained weight loss, fatigue, and blurred vision. If left untreated or poorly managed, diabetes can lead to serious complications, including heart disease, stroke, kidney disease, nerve damage, eye problems, and problems with the feet and skin. If you suspect you have diabetes or are at risk, it's crucial to consult with a healthcare professional for proper evaluation, diagnosis, and management. Early diagnosis and appropriate management are essential for controlling blood sugar levels and preventing or minimizing complications associated with diabetes.
Diabetes is defined by specific criteria related to blood glucose (sugar) levels. These criteria are established by various medical organizations, including the American Diabetes Association (ADA) and the World Health Organization (WHO). The primary measures used to diagnose and classify diabetes are[2]:
1. Fasting Blood Glucose (FBG): This test measures your blood sugar level after an overnight fast (usually at least 8 hours). The diagnostic criteria for diabetes based on FBG levels are as follows:
- Normal: FBG below 100 milligrams per deciliter (mg/dL)
- Prediabetes (impaired fasting glucose): FBG between 100 and 125 mg/dL
- Diabetes: FBG of 126 mg/dL or higher
2. Oral Glucose Tolerance Test (OGTT): In this test, a person fasts overnight and then drinks a sugary solution. Blood sugar levels are measured at fasting and at specific intervals afterward. The diagnostic criteria for diabetes based on OGTT are as follows:
- Normal: 2-hour post-OGTT blood sugar below 140 mg/dL
- Prediabetes: 2-hour post-OGTT blood sugar between 140 and 199 mg/dL
- Diabetes: 2-hour post-OGTT blood sugar of 200 mg/dL or higher
3. Hemoglobin A1c (HbA1c) Test: This test measures the average blood glucose level over the past 2-3 months. The diagnostic criteria for diabetes based on HbA1c levels are as follows:
- Normal: HbA1c below 5.7%
- Prediabetes: HbA1c between 5.7% and 6.4%
- Diabetes: HbA1c of 6.5% or higher
Prediabetes is an indication that a patient is developing insulin resistance. 1 in 3 adults in the US have prediabetes. Prediabetics have an increased risk for many of the complications of type 2 diabetes. Left untreated, almost 40% will develop type 2 diabetes within 4 years.[3]
So, what causes insulin resistance and type 2 diabetes?
Despite what many people perceive, the root cause is not sugar, it is the accumulation of fat in the muscle cells that makes those cells resistant to insulin. When we consume sugars (carbohydrates), we need insulin to “unlock” a door in our muscle cells to let in the carbohydrates so we can store them in the form of glycogen to use as energy. However, when we overconsume fat, some of that fat gets deposited in our muscle cells where it is not supposed to be. This fat in our muscle cells, called intramyocellular lipid clogs up the lock from the insulin, so insulin can no longer do its job, so the sugar levels in our blood start to rise and our pancreas starts to have to work extra hard to make more insulin. Over time, the pancreas can’t keep up and you develop type 2 diabetes. There are other risk factors, such as genetics and physical inactivity, but at its core, insulin resistance is a food-borne illness. [4]
Treatment approaches for type 2 diabetes may include:[5]
1. Lifestyle Modifications:
- Healthy Diet: Adopting a low-fat, high fiber diet that focuses on whole grains, legumes, fruits, vegetables, can help control blood sugar levels and can even reverse type 2 diabetes.
- Regular Physical Activity: Engaging in regular physical activity, such as aerobic exercises (e.g., walking, jogging, swimming) and strength training, can improve insulin sensitivity and help control blood sugar. Aim for at least 150 minutes of moderate-intensity exercise per week.
- Weight Management: Losing excess weight, if overweight or obese, can significantly improve insulin sensitivity. Even a modest weight loss of 5-10% of body weight can have a positive impact on blood sugar control.
2. Oral Medications:
- There are several classes of oral medications (antidiabetic drugs) available to help lower blood sugar levels in people with type 2 diabetes. These medications work in various ways, such as increasing insulin sensitivity, reducing glucose production in the liver, and improving the release of insulin from the pancreas.
- Common oral medications for type 2 diabetes include metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT-2 inhibitors, and GLP-1 receptor agonists.
- The choice of medication(s) depends on individual factors, including blood sugar levels, side effects, and other health considerations. Healthcare providers will determine the most appropriate treatment plan.
3. Insulin Therapy:
- In some cases, when blood sugar levels cannot be adequately controlled with oral medications or other therapies, insulin therapy may be necessary. Insulin can be delivered through injections or insulin pumps.
- Insulin therapy aims to mimic the body's natural insulin production and may be used alone or in combination with other medications.
- Routine checkups with healthcare providers are crucial for monitoring diabetes management, assessing overall health, and identifying any complications or changes in treatment needs.
It's essential for individuals with diabetes to work closely with healthcare providers to develop a personalized management plan and to take steps to prevent complications through healthy living practices. Diabetes management is a lifelong commitment, and successful management can help reduce the risk of complications and improve quality of life.
[1] https://www.cdc.gov/diabetes/basics/diabetes.html
[2] https://diabetes.org/diabetes/a1c/diagnosis
[3] Perm J. 2014 Summer;18(3):88-93
[4] Biophys Rep. 2015;1:90-98.
[5] BMJ Med. 2023 Sep 4;2(1):e000372
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