Type 2 diabetes is beyond having high blood glucose level: It’s time to know more behind how diabetes happens
Type 2 Diabetes and Management
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I have ventured a lot of effort and time to this post- searching and screening for lots of science evidence and piecing them into the simplest form that I can think of. I hope you find this post helpful. Let me know by dropping a comment at the end of this post, okay?
I mentioned before in the previous post titled sugar and type 2 diabetes that most diabetic clients I see have a sweet tooth. I also relate diabetic clients tend to enjoy carbohydrate such as bread or rice or pasta/ noodle. Nonetheless, there are also clients diagnosed with diabetes or pre-diabetic telling me that they neither like sweet things nor eating a lot of carbohydrate. If so, why do they have diabetes?
This is when I think to have an understanding about how type 2 diabetes is developed is important. Not only you understand the reason you have diabetes, but it also can empower you to make the right decision, take the right action, and be perseverance towards achieving the best of your health benefit.
Type 2 diabetes is a complex disease, it is never as simple as “I get rid of all sugary food and drink OR if I take medication, I expect my diabetes to go away”. Unfortunately, NO. Scientists are actively doing research to understand more about type 2 diabetes. What I have put together here today is merely based on what current science say and with time goes by, we will have more details- let us be grateful to our dedicated scientists around the world.
Type 2 diabetes is a slow onset disease, meaning that it takes years to develop. When you have pre-diabetes or type 2 diabetes, there are two parts that you need to know: i) you have insulin resistance and ii) your organ called pancreas is not producing insulin as efficient as it should be. We all know that genetic factor plays an important role, but other factors are equally important in determining the onset of type 2 diabetes.
Beta cell produces insulin
You may sometimes hear about beta cells. What’s that? Beta cells form part of your pancreas, and they are the factory to produce insulin. What I would you like to know more about this is that your pancreas also consists other cells, which is not the focus of this post.
What insulin does?
Insulin is a multi-tasking superhero. Insulin is well known by its role to lower blood glucose levels by directing glucose to be taken up by muscles and fat cells. Other roles include:
· Promotes excess glucose to be stored in muscle and the liver in the form of glycogen, think of it as your first line energy store.
· Inhibits liver from making glucose.
· Promotes fat to be stored in your fat cells, think of the fat cells as your long-term energy store.
· Promotes the making of protein by your body.
Because of insulin are such multi-tasking hormones, you will experience a series of deranged problems affecting one and another when your body becomes less capable to recognise insulin, we call it insulin resistance.
The story: how type 2 diabetes develop?
While you read along the story, I would like you to use the diagram I have created in Figure A below as a guide to get a better understanding of what happens.
1. Raised free fatty acids: When you eat more than what your body needs, the extra calorie turns into fat and stored in your fat cells. Your fat cells act as your fat closet. Every individual has different number of fat cells, some has more whilst some has less. Now, there will be 2 conditions in which fat cannot be stored in the fat cells: i) when your fat cells have no room for any more fat, ii) insulin resistance causing your fat cells to become less capable to store the fat. What happens then is that the extra fat called “free fatty acids” start to accumulate in your blood, i.e., that’s when your blood test result shows that you have deranged lipid profile.
2. Ectopic fat deposit leads to further insulin resistance: If you continuously eating too much creating long-term excess calorie intake, these free fatty acids will deposit on the organs including liver and pancreas. Excess fat deposited in the liver will result in liver to become resistant to insulin- your liver becomes less capable of recognising the presence of insulin around.
3. Fatty liver, carbohydrate break down, and sugary food consumption lead to raised blood glucose level: Because the liver receives less signal from the insulin, it starts to produce more glucose and thereby raise the blood glucose level. Now, if you are eating a lot of carbohydrate or sugary food, this will further raise the blood glucose level because very few of them end up taken up by your body cells due to insulin resistance.
4. Compensation action from your body: Your body senses the rise of blood glucose and it quickly reacts by directing beta cells in the pancreas to produce more insulin to keep up with the glucose processing.
5. Chronic elevated insulin level leads to your body no longer able to lower blood glucose level: When your body is exposed to continuously elevated insulin levels as a response to high blood glucose level, your body can get overwhelmed. What happens is that your body becomes less sensitive to insulin signal hence insulin resistance gets worse than before. This creates a vicious cycle whereby worsen insulin resistance leads to more free fatty acids being released from the fat cells, which then lead to more glucose produced by the liver.
Next, switch to using Figure B as the guide.
6. Prolonged exposure to elevated free fatty acids in the presence of elevated blood glucose level can contribute to beta-cell damage. When less and less beta-cells can produce insulin to process glucose produced by your fatty liver as well as from the food, you will end up having lots of glucose in your blood flowing throughout your body. When you consistently experience high blood glucose level not able to be compensated by your body, you develop diabetes.
There is a guideline you can use to diagnose type 2 diabetes. According to Royal Australian College of General Practitioners (RACGP), you are said to have type 2 diabetes if:
HbA1c ≥6.5% (48 mmol/mol) on two separate occasions
Fasting blood glucose (FBG) ≥7.0 mmol/L or random blood glucose ≥11.1 mmol/L confirmed by a second abnormal FBG on a separate day
Oral glucose tolerance test (OGTT) before (fasting) and two hours after an oral 75 g glucose load is taken. Diabetes is diagnosed as FBG ≥7.0 mmol/L or two-hour post-challenge blood glucose ≥11.1 mmol/L
Take away message:
1. Individual with type 2 diabetes experiences i) insulin resistance and ii) declining beta cell function.
2. Eating more than your body need starts the whole cascade of process leading to the development of type 2 diabetes, especially when you have family history.
3. People with type 2 diabetes tends to have fatty liver and fatty pancreas.
4. Type 2 diabetes does not happen overnight, it is a consequence of your body no longer able to compensate with a collection of deranged problems your body endures for many years.
5. Elevated or high blood glucose level is the outcome of type 2 diabetes but it is not the only problem diabetic individual need to work on.
6. Type 2 diabetes is a complex disease and the mechanism is still actively being explored by scientists.
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5. RACGP. Management of type 2 diabetes: a handbook for general practice. Defining and diagnosing type 2 diabetes. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/diabetes/defining-and-diagnosing-type-2-diabetes. Accessed on 25-August-2022