DIABETES How Did I Get Here?
Feb 03, 2014 01:01PM
By Les Cole, M.D.
If you have Type 2 Diabetes (T2D), you’ve probably seen a doctor and been put on medication for it. If you asked how you got it, you may simply have been told to diet, lose weight and exercise. If you’ve tried these but failed, it may not be your fault. You simply may not have had enough information. Let’s start at the beginning with how our body’s cells normally work and then how T2D begins.
Normally, your cells use glucose for energy. Glucose is the end product of 90+ percent of all the sugar and non-fibrous carbohydrates you eat. Muscle and heart cells also use mostly fat for energy, but your brain can only use glucose for energy. This total requirement of your brain for glucose means that if your glucose drops too low, you’re in trouble—you can become unconscious and even die. So, it is very important for your blood glucose or blood sugar (BS) level not to drop too low— generally not below 50. Thankfully, your body is exceedingly good at preventing this. It has five hormones that prevent this from happening: glucagon, adrenaline, norepinephrine, cortisol, and growth hormone, called counter-regulatory hormones because they “counter” the effects of insulin. There is only one hormone that lowers BS: insulin, by driving it (along with digested fat and protein) into your cells from your blood. So, if insulin isn’t working right, there’s a problem—elevated BS, which leads to all the problems associated with T2D.
How does insulin stop working in T2D? The first step occurs in food choices. If you eat a diet of processed foods (as opposed to whole foods) and don’t exercise much, then it is likely you are taking in more sugar than your body can use. Sugar, like high fructose corn syrup, is hidden in many processed foods. All carbohydrates (90+ percent) when digested, with the exception of fiber, turn into sugar and are absorbed, becoming BS. Insulin drives the BS into your cells, but when your muscle cells (the largest metabolically active part of your body) have enough, they resist insulin and stop taking in BS. Your muscle cells are now said to be Insulin Resistant (IR). This is the first step in the development of T2D. With less exercise, your muscle cells need less sugar to power them. With less exercise, your muscles grow smaller and therefore need less energy (sugar). And because they run off fat as well, the more fat stores in your body, the less sugar they use for energy. Each of these factors adds to muscle’s Insulin Resistance (IR) as you continue to take in the same amounts of sugar (non-fibrous carbohydrate).
Where then does the sugar go? Your liver and fat cells still remain sensitive to insulin. The majority of your BS is taken up by your liver cells where it is converted mainly into Triglycerides (TG), the main storage form of fat, and some into Cholesterol (C). Both your TG & C are sent back out into the blood where insulin causes them to be taken up by your fat cells for storage and you begin to gain weight. At this stage your BS, TG & C blood levels are still normal. Without a change in lifestyle or food choices, you continue gaining weight, becoming overweight or obese.
The next stage in the development of T2D occurs when your fat cells become IR and can no longer take up fat. At this stage your BS is still being converted to TG & C in your liver. Your BS remains normal but the TG & C have no place to go so your lipid blood levels increase and your doctor likely puts you on a lipid lowering medication. But many of these medications work by preventing the conversion of BS to TG & C and so this then raises your BS because it now has nowhere else to go. Your insulin is also rising in an attempt to offset the IR, but without a change in lifestyle it will not succeed. At this stage, weight gain plateaus. Also, elevated TG components, which are toxic to your pancreas, begin damaging insulin producing cells. This damage can become irreversible.
The last stage occurs when there has been sufficient damage to your pancreas that it can no longer produce enough insulin to force the liver to convert all the BS to TG & C. At this stage your BS begins to rise. You can see that elevated blood sugar is the last stage in the development of T2D, yet it is the one test used by most doctors to detect it. But at this point, the genie is already out of the bottle! At this stage, because not all your BS is being converted to TG & C, these lipid levels may drop a little and you may even lose a little weight. If you didn’t know your BS was elevating and insulin decreasing from pancreatic damage, you might think this was a good thing, but it’s not because the causes are increasing damage and disease progression.
How do the counter-regulatory hormones contribute? Constant stress causes elevation of your cortisol, adrenalin and norepinephrine, which leads to the breakdown of protein in your body. This causes muscle wasting and you then have less need for sugar for energy. The broken down proteins are used by these hormones to make more sugar that raises your BS even more. High protein diets turn on glucagon (converting protein to sugar) and worsen IR. Insulin is important for building muscle because just like it causes cells to take up sugar and fat (TG & C), it causes them to take up protein for building. And when your muscles are IR they also can’t take up protein to build muscle.
Dr. Les Cole is both Certified and a Fellow of the American Academy of Anti-Aging and Regenerative Medicine, specializing in male and female bio-identical hormones, anti-aging, weight, diabetes, hypertension, thyroid, chronic fatigue, gut health, metals, IV vitamins and nutrition. See ad page 16.
To read more of this article and learn what you can do to prevent, improve or even reverse Type 2 Diabetes, “Meet the Doctors” at the Vital Well-Being Center, 210 South Pinellas Avenue, Suite 106, Tarpon Springs, February 11, 7 p.m., RSVP 727-786-1661.