About 9 out of 10 people with Diabetes have Type 2 Diabetes. Type 2 Diabetes can be prevented, and Prediabetes can be reversed.
November is National Diabetes Awereness Month, a time to bring attention to the alarming facts about Diabetes. Did you know that Diabetes rates are expected to rise 50% by 2026? Diabetes is a major public health problem that is approaching epidemic proportions globally.
Today, more than nine million Canadians, or one in four, live with Diabetes or Prediabetes (a condition that, if left unchecked, is a risk factor for developing Type 2 Diabetes). In this newsletter, we dive into what is Diabetes, the signs and symptoms, and how you can protect yourself and your family.
A metabolic pandemic
Diabetes is a chronic condition that affects the human body’s ability to metabolize energy from food. Our food is primarily made up of fat, protein, and carbohydrates, which our bodies must break down or metabolize to harness energy. Under normal conditions, carbohydrates are broken down into glucose and stored in muscle and liver cells in a form known as glycogen. Although different organs require different amounts of glucose and fat for fuel, glycogen is the body’s primary energy source. When there are excess carbohydrates, and all muscle and liver glycogen stores are full, the body converts the excess carbohydrates into fatty acids, which are then stored as fat cells (1). This is the main mechanism for accumulating body fat in humans. Fat storage is essential for our survival, but excess fat storage (in adipocytes) can have adverse health outcomes, leading to obesity. An overabundance of fat accumulation can often be linked to the development of Diabetes. Diabetes and obesity are metabolic disorders with overlapping features; however, not all clinically obese individuals develop Diabetes (2,3).
With an abundance of high sugar foods and a common overuse of hidden sugars present in the food industry, we are rapidly progressing towards a metabolic epidemic. As Diabetes is generally caused by irregular glucose metabolism and is composed of multiple complex pathways, there are opportunities for problems to arise at different stages of metabolism – resulting in the classification of different types of Diabetes.
Types of Diabetes
Diabetes is primarily a disorder of the body’s insulin system. Insulin is a hormone released from the pancreas, which functions to lower blood glucose levels by sending a signal to our cells to remove glucose from the blood and telling our liver to stop releasing glucose into the blood. This system is essential for survival as a means for our cells to take in available energy after a meal or when it is required during exercise and activity. Insulin also works to ensure that our blood glucose levels stay normal throughout the day, as glucose is essential for our central nervous system to function, and therefore necessary for survival. Diabetes occurs when our insulin system does not function properly, which can happen in multiple ways.
Type 1 Diabetes, often regarded as juvenile Diabetes due to the incidence of early presentation, is characterized by the inability to make insulin at all. Many who develop Type 1 Diabetes are predisposed due to their genetics, but some individuals can develop Type 1 Diabetes later in life (4).
The majority of cases of Diabetes are in people who have developed a resistance to insulin and therefore need higher levels of insulin from their pancreas to make up for the lack of sensitivity to the signal. This is commonly classified as Type 2 Diabetes. Anybody can develop Type 2 Diabetes through overuse and exhaustion of the insulin system, most often occurring in people with low activity levels in combination with high fat and carbohydrate-based diet. Individuals with a poor diet and a sedentary lifestyle in combination with any genetic predisposition are at a much greater risk of developing insulin resistance, which can eventually lead to Type 2 Diabetes. Fortunately, there remains an opportunity to delay or completely escape disease onset with a consistently healthy diet and exercise regimen, regardless of genetic predisposition. When muscle cells no longer respond to the insulin signal, they don’t take up as much glucose from the blood and it can end up in the liver, resulting in increased production of fat in the liver, which can eventually lead to fatty liver disease.
Another case of non-permanent Diabetes exists surrounding pregnancy, also known as Gestational Diabetes. Gestational Diabetes can occur in pregnant women in the second or third trimester and is one of the most common metabolic disturbances associated with pregnancy (5). The development of Gestational Diabetes presents a great risk of health complications for both the mother and the newborn.
Signs and symptoms
The prevalence of Diabetes in Canada is astonishingly high, with nearly 30% of the population being classified as either diabetic or pre-diabetic. Pre-diabetic individuals are often screened based on their abnormally high blood sugar and HbA1c levels, which are the most common clinical markers assessed for insulin resistance. Many people live asymptomatically with some degree of insulin resistance. Insulin-resistance is seen in a large range of populations, most commonly in older people with chronic health problems, but still prevalent in young and healthy individuals.
Although some pre-diabetic individuals may present no visible signs of insulin resistance, most will have a much greater risk for developing obesity and/or Diabetes, which can often lead to increased risk for cardiovascular disease (6,7). High dietary fat and carbohydrate intake is a significant predictor as these are highly linked to the development of insulin resistance. Chronic obesity and increased visceral fat can then exemplify insulin resistance and manifest as Type 2 Diabetes. The proposed harm associated with saturated fats rests in their ability to increase triglycerides (TGs) which has been found to increase insulin resistance significantly (7,8). In addition to this, increases in TGs have a negative impact on cholesterol metabolism, which is linked to increased incidence of cardiovascular disease, stroke, and Diabetes.
The most common symptoms associated with Diabetes include high blood sugar, sustained hunger regardless of food intake, and increased frequency of infection. Although there is a significant overlap in Type 1 and Type 2 Diabetes symptoms, there are major differences in their presentation. Type 1 diabetics usually exhibit more severe symptoms much earlier in life than Type 2 Diabetes, which commonly presents much later and sometimes goes undetected until complications arise.
Type 2 Diabetes is often observed in conjunction with obesity and insulin resistance, and testing for the disease is recommended in any adult with a BMI greater than or equal to 25 kg/m2, regardless of age.
Gestational Diabetes has a lower prevalence than Types 1 and 2 Diabetes, affecting roughly 10% of pregnant women, but still has a genetic component. Those with the incidence of Diabetes amongst family members have an increased risk of developing Gestational Diabetes during their pregnancy. Additionally, obesity, high blood pressure, poor cholesterol management, or incidence of polycystic ovarian syndrome (PCOS) before pregnancy are all factors that increase the risk of gestational Diabetes (1,5).
In the scientific community, there is critical importance placed on reducing the prevalence of Diabetes in general. Unfortunately, this emphasis has not translated well to the general public, with estimates of Diabetes incidence in Canada predicted to increase by 30% for both Type 1 and 2 Diabetes by 2030 (10). With consideration of all the health risks associated with Diabetes in addition to the prevalence of comorbidities, prediction and prevention of risk must be at the forefront of the conversation.
How to protect yourself
The most effective ways to protect against developing insulin resistance and eventually Diabetes start with a balanced diet and a regular exercise routine.
Active living: Studies have shown that even one 45 minute bout of cardiovascular exercise can have a profound impact on mitigating the effects of insulin resistance (11). Cardiovascular exercise allows our cells to intake glucose independently of the insulin signalling system, completely bypassing the problems associated with insulin resistance (12). These benefits compound over time with chronic exercise and can even restore our insulin systems to working order.
Nutrition: Spikes in blood glucose levels are unavoidable, occurring as a natural biological response to eating. One of the best things we can do to protect our insulin system is to ensure that our glucose spike does not continue for a long time after eating. This can be achieved by incorporating a 10-30 minute period of brisk activity after meals, helping our blood glucose return to normal levels. We can also manage our diet to limit large glucose spikes altogether. Glucose spikes are often caused by eating foods with a high glycemic index (13). These foods have high levels of simple sugars such as glucose and fructose, which are easily available forms of energy for our body. Common examples of high glycemic index foods include processed sugars and processed grains, such as soda and white bread. Adjusting our diet to include more complex carbohydrates instead of these simple sugars can be highly beneficial. These release energy over time and do not result in as large of a spike in glucose. Complex carbohydrates also require more energy to digest and therefore have a net lower level of calories. Common examples of complex carbohydrate-containing foods include whole-grain bread, rice, and vegetables. Continuous glucose monitoring (CGM) devices are a valuable tool for this purpose, as they allow us to keep track of our blood glucose in real-time and respond according to our glucose response. As humans we all have differences in our metabolism, and using a CGM can help us understand which foods make our glucose spike and which ones do not. CGM devices can also help us realize when our glucose is high and encourage us to restore it to normal levels by doing things such as light exercise.
Another group of useful tools for maintaining a healthy insulin system includes caloric restriction and various forms of fasting. Restricting the time of feeding or the amount of food we eat have a similar function in preventing Diabetes; when we do not eat as much or as often, our body uses up any glucose available from food and recovers to normal glucose levels, giving our insulin receptors a chance to recover (14).
Healthy sleep: Finally, a healthy sleep routine is something that we repeatedly hear about and has profound effects on all aspects of health. Many studies have shown that sleep deprivation and reduced sleep can quickly compound dramatically negative effects on insulin resistance (15). Getting a night of good sleep can protect us from developing Diabetes and heart disease, help bolster our immune system to protect against infection, and positively impact mental health.
In summary, preventing insulin resistance and Diabetes is essential for maintaining good health into old age. It can be as simple as maintaining a regular weekly exercise regiment, managing our diets to limit foods high in fat and processed sugar, and taking steps to optimize our sleep. Although Diabetes prevalence is rising at a scary rate, prioritizing diet and exercise can have major positive effects on reversing and preventing insulin resistance, protecting us in this everlasting battle against metabolic syndrome.
Assess your risk of developing Type 2 Diabetes here, come in for regular checkups, and do not hesitate to contact your doctor if you have any questions or concerns. The Preventous family is here for you.
Dr. Rohan Bissoondath,