On Nutrition by Ed Blonz

Managing Type 2 Diabetes

DEAR DR. BLONZ: For years, my blood glucose has been in the “high-normal” range. The last couple of checkups showed elevated levels, though, and after some other tests, I was diagnosed as having Type 2 diabetes mellitus. I am 65, a bit overweight, with no family history of diabetes. I was advised to lose some weight, change my diet and do more exercise. I’m not clear about insulin resistance and how it relates to the different types of diabetes, so I am interested in your thoughts. -- F.S., Scottsdale, Arizona

DEAR F.S.: Glucose, the building block of carbohydrates, is a primary fuel for the body. It is the brain’s preferred fuel, and the only one that red blood cells can use. Entire body systems exist to help maintain blood glucose, but these systems don’t always work perfectly.

During digestion, dietary carbohydrates get broken down to glucose, which is actively absorbed into the bloodstream -- at which point it is often referred to as “blood sugar.” Glucose has a hard time getting into cells on its own. The missing factor is insulin, the hormone produced and released by the pancreas that serves as a passport to get glucose into most cells. (Insulin doesn’t help get glucose into the brain -- that’s a different story.) Once in the cell, glucose provides energy for all work, including muscle contraction, biosynthesis and repair. Once cellular energy needs are satisfied, extra glucose gets turned into lipids (fat), the most concentrated form of energy in the body. Packaged as triglycerides, these travel to storage in our fat cells.

Diabetes is present when there’s insufficient insulin to get the glucose out of the bloodstream and into the cells. Type 1 diabetes is when the pancreas is unable to produce and release insulin. In such cases, replacement insulin is given, usually by injection. More common is Type 2 diabetes; this occurs when the pancreas can still produce and release insulin, but can’t keep up with the demand, so blood glucose levels remain elevated. Treatment 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 seen mainly in adults, but now it is prevalent in children, as well.

Here’s the connection between Type 2 diabetes and weight: As fat cells increase in size, they tend to become less sensitive to insulin. This insulin resistance means that the body needs more insulin to clear the same amount of glucose from the bloodstream. Obesity, in essence, can overwork the pancreas until it becomes unable to keep up. Between 80 and 90 percent of those with Type 2 diabetes are obese. This also helps explain why those with this type of diabetes often experience dramatic improvements when they lose some pounds and change the way they eat.

There are short- and long-term health risks if blood glucose remains elevated. The bottom line with any diabetic condition is to keep the glucose within normal limits. This can be done with diet, exercise and medication, along with regular monitoring of blood glucose levels. For more on managing diabetes, see b.link/wb6c3.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.