DEAR DR. BLONZ: I am 59 with no family history of diabetes, but was recently diagnosed as having Type 2. I know I have to lose some weight, but am curious about other steps to take. I read your bio online at blonz.com, and it states that you did some research on insulin and obesity. What exactly did you research, and what advice do you have about diabetes? -- F.S., Charlotte, North Carolina
DEAR F.S.: My doctoral research focused on the role of insulin in the development of obesity. I used an animal model that was genetically tweaked to get obese if fed a normal diet. As adults, these animals had an elevated insulin level (hyperinsulinemia) in addition to their obesity; I found that in this specialized animal model, the excess insulin preceded the obesity. Such research helps us better understand the relationships between obesity and insulin, and, by extension, diabetes -- but it won’t help us much in dealing with your particular situation.
During digestion, dietary carbohydrates tend to be broken down into their glucose building blocks. The glucose is then actively absorbed into the blood, at which point it is often referred to as “blood sugar.” Glucose, a key source of energy for the body, travels throughout the body via the blood. To release its energy, however, glucose needs to get into the cells where the work is done, and for this it requires insulin: the hormone produced and released by the pancreas as the blood glucose level rises. Once inside the cells, glucose can be used to provide energy for work, such as muscular efforts or cellular repair. When there is sufficient energy, the glucose gets changed into fat, the body’s most concentrated form of energy. It then gets put away in storage in the body’s fat cells.
Diabetes is present when there’s insufficient insulin to get excess glucose out of the blood and into the cells. Type 1 diabetes is when the pancreas is unable to produce the insulin. In such cases, replacement insulin needs to be provided from an external source, usually via injection. Insulin, a protein, can’t be taken orally because the digestive system would break it down before it could be absorbed. More common is Type 2 diabetes; this occurs when the pancreas is still able to produce and release insulin, but it’s unable to keep up with the demand, and the blood glucose level remains elevated. Treatments in such cases can include diet and lifestyle adjustments, or medications to stimulate the pancreas to release more insulin. Type 2 diabetes used to be known as “adult onset” diabetes because it was only seen in adults; not so anymore.
With weight gain, the fat cells increase in size, and enlarging fat cells are associated with a decreasing sensitivity to insulin. This “insulin resistance” means that the body needs more insulin to clear the same amount of glucose out of the blood. Obesity, in essence, overworks the pancreas, which is eventually unable to keep up. Between 80 and 90 percent of those with Type 2 diabetes are obese. This also helps explain why those with Type 2 diabetes often experience dramatic improvements when they lose a few excess pounds.
As there can be short- and long-term complications when one’s blood glucose remains elevated, the bottom line with any diabetic condition is to keep glucose within normal limits. Your task will be to get this done using diet, exercise, medications and/or insulin injections. I encourage you to speak with your family physician and a registered dietitian (R.D.). They can help you with mapping out strategies for weight loss and food selection. There is also a library of information at the American Diabetes Association (diabetes.org).
Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to firstname.lastname@example.org. Due to the volume of mail, personal replies cannot be provided.