Loss of pancreas function in diabetes-Can we do something about it?
Type 2 Diabetes and Management
Thanks for reading Dr Evelyn Chang Newsletter! Subscribe for free to receive new posts and support my work.
People with pre-diabetes and type 2 diabetes have compromised pancreas function, or in more specific, compromised beta cell function to produce insulin, which then resulting the body less able to take up glucose for energy. Scientific studies showed that beta cell function has already dropped by 50% prior to disease onset and can be further reduced from 50% to 97% in type 2 diabetes. Factors contributing to compromised beta cell function include insulin resistance, inflammation, hyperglycaemia (high blood glucose level), and/or hyperlipidaemia (high cholesterol and lipid levels). There are 3 possibilities which contribute to beta cell failure, i) reduced beta cell number ii) beta cell exhaustion iii) loss of identity in beta cell.
Figure illustrates 3 possibilities beta cell fails to function. Note: islet of Langerhans- a collection of pancreatic cells producing hormone insulin and glucagon. Figure source: Wysham C, Shubrook J. Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications. Postgrad Med. 2020 Nov;132(8):676-686. doi: 10.1080/00325481.2020.1771047. Epub 2020 Jun 16. PMID: 32543261.
REDUCED BETA CELL NUMBER
Reduced beta cell number can occur due to cell death and genetic factors. When you are pre-diabetic, you may already have a 21-40% decrease in beta cell mass according to science report. The beta cell mass can further be reduced by up to 60% in individuals with type 2 diabetes. Whilst several factors can contribute to reduced beta cell mass, beta cells are most vulnerable to death when continuously being exposed with high blood glucose level (hyperglycaemia) and excessive saturated and free fatty acids. Some individuals because of genetic factors might have low beta cell mass and lack the ability to increase beta cell capacity to meet increasing demand later in life, and these could put them at higher risk for developing type 2 diabetes.
BETA CELL EXHAUSTION
Insulin resistance, inflammation, hyperglycaemia (high blood glucose level), and/or hyperlipidaemia (high cholesterol and lipid levels) can place beta cells under severe stress resulting in them failing to produce insulin, where we say that the beta cells become exhausted.
LOSS OF IDENTITY AS A BETA CELL
Insulin resistance, inflammation, hyperglycaemia (high blood glucose level), and/or hyperlipidaemia (high cholesterol and lipid levels) can also cause loss of beta cell gene expression. What this means is that beta cells can lose their identity as a beta cell and with that they will lose their insulin secretion ability.
WHAT DOES THESE MEAN TO YOU?
You may ask, would it make any difference to know about these? Definitely! First, it is very important for you to know that even though a big proportion of your beta cells may not be functioning, not all of them are dead. If your pancreatic beta cells are simply exhausted or losing their identity, you can reverse this phenomenon by lifting the factors contributing to compromised beta cell function, i.e., insulin resistance, inflammation, hyperglycaemia, and hyperlipidaemia. Secondly, if you now know that excessive free fatty acids and persistent hyperglycaemia are ‘toxic’ conditions for your beta cells, you can preserve other living beta cells by working towards achieving normal blood glucose level and lipid profiles. There is hope!
HOW EARLY TO START ACTING?
As early as you can. Pause a moment and ask yourself, are you eating more than your body needs? Are you continuously putting on weight and creeping up to more than 3kg? Do you have high or deranged lipid profile such as high triglycerides, high LDL or low HDL ? Is your fasting blood glucose level 6.1 mmol/L or more? Is your blood glucose level 2 hours after having the 75g glucose drink are 7.8mmol/L or more? If you have diabetes, how is your recent HbA1c and lipid profile result? How is your eating pattern like?
Remember, changes take courage and persistency. It takes a while to make changes but even longer to build a sustainable habit. Do get necessary support to help you keep going and achieve eating habit which gives you the optimal health outcome while allowing you still able to enjoy your food.
1. Chen C, Cohrs CM, Stertmann J, Bozsak R, Speier S. Human beta cell mass and function in diabetes: Recent advances in knowledge and technologies to understand disease pathogenesis. Mol Metab. 2017 Jul 8;6(9):943-957. doi: 10.1016/j.molmet.2017.06.019. PMID: 28951820; PMCID: PMC5605733.
2. Inaishi J, Saisho Y. Beta-Cell Mass in Obesity and Type 2 Diabetes, and Its Relation to Pancreas Fat: A Mini-Review. Nutrients. 2020 Dec 16;12(12):3846. doi: 10.3390/nu12123846. PMID: 33339276; PMCID: PMC7766247.
3. Wysham C, Shubrook J. Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications. Postgrad Med. 2020 Nov;132(8):676-686. doi: 10.1080/00325481.2020.1771047. Epub 2020 Jun 16. PMID: 32543261.
4. Lupi R, Dotta F, Marselli L, Del Guerra S, Masini M, Santangelo C, Patané G, Boggi U, Piro S, Anello M, Bergamini E, Mosca F, Di Mario U, Del Prato S, Marchetti P. Prolonged exposure to free fatty acids has cytostatic and pro-apoptotic effects on human pancreatic islets: evidence that beta-cell death is caspase mediated, partially dependent on ceramide pathway, and Bcl-2 regulated. Diabetes. 2002 May;51(5):1437-42. doi: 10.2337/diabetes.51.5.1437. PMID: 11978640.
5. Cerf, M. (2013). Beta Cell Dysfunction and Insulin Resistance. Frontiers in Endocrinology, 4. doi:10.3389/fendo.2013.00037