Diabetes / Insulin sensitivity

senecarr

This seems to be a topic worth discussing.
What things truly do impact diabetes and insulin sensitivity?
What is the relative impact of various factors: does activity, diet, sheer weight, or adiposity have the greatest impact?

I'll start out by throwing out that I see a lot of advice out there that advises weight as most important, followed by diet - often with claims of low carb, slow carb, controlled carb, or even ketogenic diets - as the biggest impact on it. I see very little claims ever given to exercise and activity level being important for the condition, so I'll throw this article out there:
http://press.endocrine.org/doi/abs/10.1210/jc.2011-0435

EvgeniZyntx

Highest risk factors seem to be weight and activity level - I remember reading a CHO consumption study that showed on significant impact when corrected to those other factors. Can't find it for the time being. If I run across it I'll post it.

LKArgh

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/causes-diabetes/Pages/index.aspx
http://www.diabetesforecast.org/2010/oct/why-me-understanding-the-causes-of-diabetes.html
Genetics, obesity, lack of physical activity.

lemurcat12

Lose weight! If you drink soda, stop. Start exercising.

tbonethemighty

I'm not diabetic and I'm not overly well-informed on the topic, but my old landlord (also a good personal friend) was; he regulated his sugars with pills, not with injections, which I gather is a relatively mild form. However, I also know that there were weeks when he was active in summer (gardening, Nordic walking) where he would not have to take his medication at all, and he/his wife always told me it was due to being an exercise-heavy week.

Takeaway: I doubt that exercise will entirely resolve the problem, but it does appear to at least be a helpful factor in regulating.

yarwell

Are we talking causal factors or treatments ? The prevailing advice to lose weight doesn't work if you're a Type 2 diabetic with a BMI of 22 for example.

Also for clarity (and so they don't throw their toys out of the pram) I assume this excludes Type 1 diabetes and other auto-immune type version.

yarwell

senecarr wrote: »

so I'll throw this article out there:
http://press.endocrine.org/doi/abs/10.1210/jc.2011-0435

"considerable controversy exists as to the importance of skeletal muscle mass on whole body insulin sensitivity in healthy and clinical populations" - See more at: http://press.endocrine.org/e-letters/10.1210/jc.2011-0435 (published comment on above article).

The "corrected" data in Table 3 shows a non-significant effect on Diabetes, in fact the least muscle reference quartile has the least Diabetes :




but bio-impedance, NHANES, etc.

LKArgh

DancingDarl wrote: »

Of course weight and activity level would be the risk factors. You would be surprised that a lot of these people have been working out and eating right and the weight does not budge. The judgements passed that just lose weight stop the pop is ignorant. Insulin resistance makes it extremely difficult losing the pounds also, the things that work people will tell you is losing the weight(ironically the hardest of all).

The things that work are metformin(didn't help with my insulin resistance but others swear by it)
Exercize light meals.
Adding healthy spices like cinnamon, saffron and turmeric.
Personally I used inositol which was great, apple cider vinegar 2 tsp with water before eating also did we'll by my insulin resitance.
There are so many things to think about, but the best advice is yes lose the weight no kidding, however I wish people who do not understand it could realise it needs to be treated at the condition level.

Hmm, considering drs believe the major contributing factors to insulin resistance for most people are inactivity and being overweight, I am not really sure about these "judgements" being ignorant.
http://www.niddk.nih.gov/health-information/health-topics/Diabetes/insulin-resistance-prediabetes/Pages/index.aspx#causes

yarwell

"Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnea; and cigarette smoking."

Yi5hedr3

Exercise is a small part, but low carb diet is the biggest impact on fat burning.

ForecasterJason

From my personal experience, I would say genetics is a significant influence. I also think that sleep and possibly gut bacteria health are other factors.

ForecasterJason

DancingDarl wrote: »

ForecasterJason wrote: »

From my personal experience, I would say genetics is a significant influence. I also think that sleep and possibly gut bacteria health are other factors.

Interesting , sleep is important for general health and wellbeing across the board. Why do you suggest gut bacteria?

Gut bacteria has been shown to be implicated in diabetes due to inflammation, although part of the explanation has been attributed to obesity.
http://care.diabetesjournals.org/content/33/10/2277.full
http://www.sciencedirect.com/science/article/pii/S2213453013000451

earlnabby

It really depends on whether you are talking about causing and worsening it, or managing it.

Risk factors (aka "causes") are:

1. Genes (both inherited and mutations that happened in your genome) that cause beta cells to burn out
2. Weight. Being overweight is the most common controllable risk factor
3. Medications. Certain ones like statins and antidepressants are known for increasing your risk
4. Age. Face it, the pancreas gets old just like the rest of your body
5. Environmental factors. There is some correlation between certain herbicides, pesticides, and the amount of arsenic in your body. This is not proven, but there is enough evidence to warrant further study.

Management:

1. Getting the weight to within the normal range is one of the biggest factors in being able to manage IR or T2Dm
2. Moderating carb intake. The exact way this is done depends on the individual. Most need to go to moderate carbs, some need low carb or even keto.
3. Exercise. Exercise increases insulin sensitivity. Generally it takes about 15 minutes of exercise to deplete the glucose in the bloodstream, then glycogen is released from the muscle stores. When you stop, any excess will get stored again, waiting for the next need. Muscles use glucose better than fat does so the more muscle you build, the better managed your glucose can be

ForecasterJason

DancingDarl wrote: »

ForecasterJason wrote: »

DancingDarl wrote: »

ForecasterJason wrote: »

From my personal experience, I would say genetics is a significant influence. I also think that sleep and possibly gut bacteria health are other factors.

Interesting , sleep is important for general health and wellbeing across the board. Why do you suggest gut bacteria?

Gut bacteria has been shown to be implicated in diabetes due to inflammation, although part of the explanation has been attributed to obesity.
http://care.diabetesjournals.org/content/33/10/2277.full
http://www.sciencedirect.com/science/article/pii/S2213453013000451

This is actually quite fascinating. Inflammation is very common in obese people I would imagine. But what of all the healthy weighted sufferers? Do you believe it just to attribute to diabetes or those who suffer insulin resistance?

The problem is that (to my knowledge), there is unfortunately very limited research on IR and diabetes in exclusively normal weight people. But given that some newer studies have shown the health of gut bacteria to be implicated in a variety of health outcomes, I would think it is certainly plausible that this also has an impact on those without obesity.

senecarr

EvgeniZyntx wrote: »

Highest risk factors seem to be weight and activity level - I remember reading a CHO consumption study that showed on significant impact when corrected to those other factors. Can't find it for the time being. If I run across it I'll post it.

That would be interesting because the prevailing sense I get from some of the board is that claims to have treated pre-diabetes / diabetes is that after agreeing about weight management is that diet matters more than physical activity. I'd be interested in seeing anything of actual substantiated evidence showing whether activity trumps diet, or diet trumps activity.

yarwell

"Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition" http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-3-16

jgnatca

I was insulin resistant for years, then T2 diabetic for another decade. My diabetes went in to remission after RNY surgery, a known side-benefit. The remission cannot be explained by weight loss alone.

• First risk factor is genetic. I have it, my sister has it, and my dad too.
• Second, weight.
• I suspect multiple pregnancies (dramatic weight fluctuations?) can increase the chances. My sister is now insulin dependent type 2 and she had three children through her maturity. By comparison I had my children when I was young and skinny.

The doctor mentions losing weight because it is easier to manage one's sugar levels at a lower weight. The person is less likely to overwork a weaker pancreas if they are carrying less weight around. Besides, I can't un-choose my parents.

One question still left outstanding; does overweight bring on T2 diabetes and insulin resistance, or does a native insulin resistance cause the person to gain weight more easily?

Nevertheless, the "cure" is the same. Careful monitoring of calories to steadily lose weight. There are other factors in play like stable sugar levels, so the diabetic must also eat on a routine and eat a balance of macros to prevent spikes and dips that people with fully functioning pancreases do not need to concern themselves with.

Where exercise plays a role is that it helps burn up the fast calories from carbohydrates, giving the insulin resistant better control.

jgnatca

One could use say, heart disease as a comparable.

• There may be family history.
• Prevention is around watching cholesterol levels to prevent build-up in the arteries and exercise to improve cardiovascular health. The person can't escape risk factor one, however.
• Post heart-attack therapy is similar; diet and exercise. Because that is something the person can do.

Now, we all benefit from watching cholesterol and aerobic exercise, but the person with a family history more so.

Now, if a person comes down with T2 diabetes, do we tell them it is their fault because of laziness or gluttony? Or how about the person who has a heart attack? Perhaps they are type A's who never took a break and never watched what they ate or went to the doctor.

We do our best to take what actions we can with our health, and perhaps we can delay the inevitable for years. But it's wrong to assume that it is a personal failure when someone falls ill.

I think this is the danger of our modern society where we are becoming ever more fastidious with what we consume, thinking we can somehow prevent all misfortune. There's a flip side. Blaming the sufferer for not doing enough, when the whole premise may be false. The person may be living pure as the driven snow, and still fall ill.

earlnabby

jgnatca wrote: »

One could use say, heart disease as a comparable.

• There may be family history.
• Prevention is around watching cholesterol levels to prevent build-up in the arteries and exercise to improve cardiovascular health. The person can't escape risk factor one, however.
• Post heart-attack therapy is similar; diet and exercise. Because that is something the person can do.

Now, we all benefit from watching cholesterol and aerobic exercise, but the person with a family history more so.

Now, if a person comes down with T2 diabetes, do we tell them it is their fault because of laziness or gluttony? Or how about the person who has a heart attack? Perhaps they are type A's who never took a break and never watched what they ate or went to the doctor.

We do our best to take what actions we can with our health, and perhaps we can delay the inevitable for years. But it's wrong to assume that it is a personal failure when someone falls ill.

I think this is the danger of our modern society where we are becoming ever more fastidious with what we consume, thinking we can somehow prevent all misfortune. There's a flip side. Blaming the sufferer for not doing enough, when the whole premise may be false. The person may be living pure as the driven snow, and still fall ill.

I liken it to the emerging evidence regarding a genetic component to substance abuse/addiction. Two people can have the same behaviors (overeating, binge drinking) but one becomes diabetic or an alcoholic and one does not. What is the difference? You can't say that it is 100% the behavior, otherwise everyone who exhibits the same behavior will have the same consequence.

The best we can do is mitigate the circumstances by maintaining a healthy weight, eating a healthy diet, and getting regular exercise. Diabetes will happen to some no matter what they do so it makes no sense to blame the person. This idea that people are diabetic because they are lazy and don't care for themselves properly is wrong and unhelpful. Does it apply to some? Yes, just as some don't do everything they can to lessen the risk of heart disease, certain cancers, etc. Tarring everyone with the brush of lazy does nobody any good.

senecarr

jgnatca wrote: »

One could use say, heart disease as a comparable.

• There may be family history.
• Prevention is around watching cholesterol levels to prevent build-up in the arteries and exercise to improve cardiovascular health. The person can't escape risk factor one, however.
• Post heart-attack therapy is similar; diet and exercise. Because that is something the person can do.

Now, we all benefit from watching cholesterol and aerobic exercise, but the person with a family history more so.

Now, if a person comes down with T2 diabetes, do we tell them it is their fault because of laziness or gluttony? Or how about the person who has a heart attack? Perhaps they are type A's who never took a break and never watched what they ate or went to the doctor.

We do our best to take what actions we can with our health, and perhaps we can delay the inevitable for years. But it's wrong to assume that it is a personal failure when someone falls ill.

I think this is the danger of our modern society where we are becoming ever more fastidious with what we consume, thinking we can somehow prevent all misfortune. There's a flip side. Blaming the sufferer for not doing enough, when the whole premise may be false. The person may be living pure as the driven snow, and still fall ill.

Which is one of the reasons I also put insulin sensitivity in the title - I would think most productive discussion would be controllable factors that can improve it, whether the person's other factors prevent them from not becoming diabetic, or not allow them to become diabetic.

yarwell

senecarr wrote: »

Which is one of the reasons I also put insulin sensitivity in the title - I would think most productive discussion would be controllable factors that can improve it, whether the person's other factors prevent them from not becoming diabetic, or not allow them to become diabetic.

Insulin Resistance and Hyperinsulinemia
Is hyperinsulinemia the cart or the horse?

http://care.diabetesjournals.org/content/31/Supplement_2/S262.full

Seems you can make rodents insulin resistant by increasing their insulin levels.

"Hyperinsulinemia in the basal state of any origin produces widespread insulin resistance. "