By Dr. Paul Gloe
Type 2 Diabetes will likely be the greatest modifiable risk factor for all cause mortality during the next 20-50 years, making it such an important topic for us all to understand. Today we are going to discuss insulin resistance and the dangers of excess blood sugar in the body, and how this can lead to Type 2 Diabetes.
If this article strikes a chord in you about yourself or a loved one, or about society in general, please make sure to read the follow up article next week about what you can do to decrease the risk of developing diabetes, or reversing or stopping its progression.
The story of diabetes is related to the relationship between the hormone insulin and glucose in our blood stream. Glucose is our body’s main energy currency, and it is generally found in foods high in carbohydrates and simple sugars. It is an amazing fuel — really it is the ultimate fuel.
Insulin is secreted by the pancreas and its main purpose is to allow glucose, or fuel, into the cells. Think of insulin as a key that opens the door on a cell’s surface, allowing glucose to enter cells to be used as energy.
When these cells are at maximum energy capacity, insulin turns its signaling key to fat, or adipose, cells to store this glucose as fat droplets that can be converted to energy at a later time. This energy storage process works amazingly well for a bear getting ready to hibernate, or a hunter gatherer who might not find food for a few days. Nowadays though, true food scarcity is rare and hunting and gathering is easily accessed via a refrigerator or pantry 24 hours a day. This breakdown of the glucose-insulin relationship is further exacerbated since the least expensive foods at the store, the ones that fill us up the most, and the ones that have the longest shelf life, are generally the foods that are highest in simple carbohydrates and sugars. These high energy foods are fantastic for rapid energy when running a marathon, but when we are not running a marathon, our body is exposed to a very unhealthy roller coaster of blood sugar spikes and excess that turns more and more sugar into fat.
When the blood sugar is chronically elevated, the functional cells — and even the fat storage cells — cannot keep up. The pancreas recognizes that there is still excess glucose in the blood stream, so it secretes more and more insulin trying its best to utilize or disperse this sugar. Then as a protective mechanism the cells themselves slowly stop responding to the increased insulin persuasion.
This is officially the start of the continuum called insulin resistance, or Type 2 Diabetes.
Now, for a while, the pancreas is able to keep up with this ever-increasing insulin production, but eventually the pancreas starts to wear down — and in turn, insulin production slows down. So now there is a double whammy in the body. The cells have underlying resistance to insulin and the pancreas is making less and less insulin. This is when a primary care provider might start talking about medicine to treat Type 2 Diabetes.
Medicine can be taken to force the pancreas to secrete every last bit of insulin that it can produce, or medicine can make cells more sensitive to the circulating insulin. Eventually though, the pancreas just wears out, and the cells become so desensitized to the body’s insulin production that a person needs to start injecting insulin to compensate.
Unfortunately, that is not the only problem.
Excess glucose in the body is extremely inflammatory and damages blood vessels and nerves. Not only is excessive glucose itself caustic to the body, but it also leads to the formation of triglycerides as the liver tries to repackage this excess glucose as fat.
In addition, the majority of an individuals’ bad cholesterol actually comes from carbohydrates and not fat! This may sound counterintuitive, but it is true. Carbs make most of our cholesterol, not fat. This increase in triglycerides and other cholesterol particles further increases the inflammation of the blood vessels.
All of this inflammation leads to the concerning finding that Type 2 Diabetes is one of the greatest risk factors for cardiovascular disease (heart attack and the main cause of strokes). In fact, the damage to the blood vessels with a person who has Type 2 diabetes is so severe that uncontrolled diabetes carries the same risk of having a heart attack as a prior history of heart attacks!
As discussed earlier, excess glucose is packaged as fat. This particular fat has a preponderance for finding a home in our abdomen, which is technically referred to as central obesity or visceral fat. Visceral fat can be seen with the classic “beer belly” or the “pear-shaped” figure.
Fat cells, specifically belly fat cells, are linked with inflammation in our bodies. Belly fat cells are particularly skillful at creating TNF alpha, which in excess is a very destructive inflammatory cytokine that initiates a cascade of harmful immune cell-related damage to our body, increases cancer forming cells, and further worsens insulin resistance. These belly fat cells also lead to a decreased secretion of adiponectin which, negatively affects our cholesterol profile, further increasing cardiovascular damage.
It has also been found that central obesity decreases a process called autophagy. Autophagy is a critical process in the body that acts as our cleanup system that removes old, damaged cells, or cells that are not growing properly. If that is not all bad enough news, excess insulin increases estrogen production by fat cells beyond what is healthy. This excess of sex hormones can lead to irregular menstrual cycles, infertility issues, and excessive body hair with women. And the most concerning thing is that excess estrogen (in men and women) has been linked with increased risk of breast, ovarian, endometrial and prostate cancer.
Well, this week I have given you all a lot of bad news, my sincere apologies, but it is hard to skirt the truth regarding Type 2 Diabetes and its implications for our own bodies and the public health in general.
There is much hope, though, and we all are empowered to intervene! Next week please read the second part of this series to find out what you can do to prevent, slow down, or reverse Type 2 Diabetes for yourself, your loved ones, and possibly even society.
Dr. Paul Gloe is the medical director for Cordova Community Medical Center, and a physician who sees patients both in the clinic and hospital settings.
