DEAR DR. BLONZ: Many articles on health and sugar make reference to insulin as an evil contributor to obesity. But we need insulin to live, and diabetes is when you don't make enough. My husband was diagnosed with Type 2 diabetes and now takes medication to produce more. The idea of insulin being bad is quite confusing. It seems like a simplification of a much more complex process. -- T.S., San Diego
DEAR T.S.: Glucose is the body's "instant fuel," the body is designed to always have it available in the blood and to keep it within a specific range. During digestion, complex carbohydrates get broken down into their individual unit parts -- primarily glucose -- which get absorbed and enter the bloodstream. No digestion is needed for simple sugars, such as glucose, fructose, honey or high-fructose corn syrup, so these are rapidly absorbed. Sucrose (table sugar) also enters the system rapidly, being split into its glucose and fructose parts during the process.
When the blood glucose level rises above its normal range, which usually happens after we have just eaten, the pancreas is programmed to releases insulin, a hormone that signals that the body has been fed. Insulin keeps the blood sugar level from getting too high by causing sugar to be pulled into cells where it can provide energy for work and other metabolic processes. The presence of insulin also indicates that our immediate energy needs have been met, and this causes glucose entering the cells to be converted into fat, the body's most concentrated form of energy, and sent off to the fat cells for storage.
Diabetes occurs when, for any of a number of reasons, there's insufficient insulin to do the job. It can occur when the pancreas can no longer produce insulin (Type 1 diabetes), or if the insulin being produced is no longer able to elicit the appropriate response (Type 2 diabetes). In either case, there isn't a sufficient amount, so diabetics have to take shots or pancreas-stimulating pills to help provide the needed insulin boost. In both cases the diet should to be adjusted to avoid instances that would cause rapid rises in blood sugar; sweets or soda, especially on an empty stomach, are examples of items that must be controlled.
Concerns about insulin relate to its association with obesity. Our fat cells get larger as we become overweight, and enlarged fat cells tend to be less responsive to insulin (this is called insulin resistance). If the body's normal insulin release is unable to clear surplus glucose out of the bloodstream, it creates an ongoing demand for the pancreas to release more, and this can become destructive to insulin-producing cells of this vital organ. Consider that elevated blood glucose (the source of energy) is constantly coupled with an elevated level of insulin (a signal to store energy as fat); it's a perfect recipe for weight gain and obesity. Between 80 and 90 percent of adults with Type 2 diabetes are obese. The good news is that many experience improvements when they begin to lose their excess pounds. It is not entirely correct to characterize insulin as "evil," but a diet and lifestyle that don't allow it to do its job can certainly have evil consequences.
Send questions to: "On Nutrition," Ed Blonz, c/o Universal Uclick, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to email@example.com. Due to the volume of mail, personal replies cannot be provided.