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Diabetes / Insulin sensitivity
senecarr
Posts: 5,377 Member
in Debate Club
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
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
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Replies
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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.0
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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.1 -
Lose weight! If you drink soda, stop. Start exercising.0
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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.0 -
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.0 -
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.0 -
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#causes0 -
"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."0
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Exercise is a small part, but low carb diet is the biggest impact on fat burning.
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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.0
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Gut bacteria has been shown to be implicated in diabetes due to inflammation, although part of the explanation has been attributed to obesity.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?
http://care.diabetesjournals.org/content/33/10/2277.full
http://www.sciencedirect.com/science/article/pii/S2213453013000451
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It really depends on whether you are talking about causing and worsening it, or managing it.
Risk factors (aka "causes") are:- Genes (both inherited and mutations that happened in your genome) that cause beta cells to burn out
- Weight. Being overweight is the most common controllable risk factor
- Medications. Certain ones like statins and antidepressants are known for increasing your risk
- Age. Face it, the pancreas gets old just like the rest of your body
- 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:- Getting the weight to within the normal range is one of the biggest factors in being able to manage IR or T2Dm
- 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.
- 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
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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.DancingDarl wrote: »ForecasterJason wrote: »
Gut bacteria has been shown to be implicated in diabetes due to inflammation, although part of the explanation has been attributed to obesity.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?
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?
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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.0 -
"Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition" http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-3-160
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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.0 -
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.0 -
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.0 -
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.0 -
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. "0 -
Many moons ago I read a Times article about a recessive genetic disorder (eye disease) that showed up in the offspring sometimes but not always. The author described the normal resistance to this disease as two sentinels (imagine a pair of the Queen's Guards).
People who carry the recessive gene for this disorder may have one sentinel or they may have none. Those with no sentinel certainly will get the disease, and those with only one sentinel may develop it if their sentinel wears out or breaks down.
This helped me put genetic disorders in perspective, and explains why some may manage to dodge the bullet whereas others, no matter how diligent they may be, still get it.0 -
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.
You have expressed the crux of the matter very well, thank you. I'm glad I used this "L" word. Just to put this all in to perspective.0 -
DancingDarl wrote: »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
Wrong wrong and wrong
Inactivity yes-but not exclusively
Overweight yes-but not exclusively
And insulin resistance resides across a variety of diseases. So your argument remains does it that they are all just fat and lazy?
Ignorance is not researching objectively, if you clearly believe everything your doctor tells you that is ignorance.
Ps your point of overweight and inactive falls with me. I was not overweight or inactive..
But still had insulin resistance.
Try metformin and if you f n hate it then research the other proven ways.
I am insulin resistant. Obviously there is a genetic factor, since I am not overweight and never have been, while others are obese and not IR. However, what I have noticed is that a low bmi and regular exercise means everything turns to normal, just as my endocrinologist said it would happen. Gain a few kilos (still well within healthy bmi range) and stop exercising, lab tests become abnormal again. Not saying this is true for everyone obviously, but it has been for me.0 -
It seems like for some people who are insulin resistant, genetics prevents exercise from exerting beneficial effects.
While I am not a type 2 diabetic, I am pre-diabetic and suspect I fall in the minority of people for whom this is the case. Over the course of a few months my long term blood sugar control actually worsened after making a substantial increase in my activity level. One caveat is that it's possible exercise intensity may play a role.0 -
It is possible that one size does not fit all. For some diet and exercise is the key for others like a friend who is tall slender(very) and runs regularly and developed type II diabetes. For women who are gestational diabetics their risk of developing Diabetes is very high later in life. I was very thin and fit when I got pregnant the second time as I have ages my HgA1c has slowly gotten higher. Genetics possibly0
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So I just last night found out about this article:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150148
and I think this is a nice write up aimed at the laymen without distorting the findings:
http://www.eurekalert.org/pub_releases/2016-03/kcl-epf031816.phpScientists tested small groups of people across a wide spectrum of glucose levels including healthy (15) athletic (14), and obese (23) people, and people with prediabetes (10) or type 2 diabetes (11) using robust analysis of glucose levels and fatty acids in their blood. Participants' diets were evaluated using a dietary questionnaire.
They found that, in the condition where glucose uptake into muscles is impaired, replacing saturated fats in the diet with polyunsaturated fats had a beneficial effect in slowing the development of diabetes. It is thought that this is because polyunsaturated fats promote uptake of glucose by the insulin receptors in the muscles.
In people whose livers were producing too much glucose, reducing saturated fat was found to be linked to slower progress of diabetes but replacing it with polyunsaturated fat was found to have no effect.0 -
I have read about diabetics who have had weight loss surgery getting their numbers down before losing weight.
http://m.care.diabetesjournals.org/content/34/Supplement_2/S361.fullStudies have shown that return to euglycemia and normal insulin levels occurs within days after surgery, long before any significant weight loss takes place. This fact suggests that weight loss alone is not a sufficient explanation for this improvement. Other possible mechanisms effective in this phenomenon are decreased food intake, partial malabsorption of nutrients, and anatomical alteration of the gastrointestinal (GI) tract, which incites changes in the incretin system, affecting, in turn, glucose balance. Better understanding of those mechanisms may bring about a discovery of new treatment modalities for diabetes and obesity.0 -
I really think it depends on the person. At least that has been my experience. I was diagnosed T2 diabetic in 2009. For ME, the biggest factors have been weight and activity level. It seems like it doesn't matter to my blood glucose level what I eat, however my activity will always determine if my glucose will be high or low the next day. Losing weight has made the biggest long-term impact for me. I have actually had "normal" A1C levels for about 2 years now.0
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My insulin resistance probably began in my late teens and twenties (with reactive hypoglycemia) but then became worse (slightly elevated FBG) after taking steroids for a health issue. Once my IR worsened I gained weight and fell into the overweight BMI category. When my IR began I was lifting and running about 6-8 hours per week, and was quite lean
Weight loss did not improve my IR. If I have (for me) a high carb meal my BG is right back up there the next day. I don't think I could ever out-exercise a soda, a pile of mashed potatoes or a plate of noodles. In my case, it makes sense to not spike BG in the first place.
Exercise does help my BG stay lower, but not nearly as much as eating low carb.1 -
So I just last night found out about this article:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150148
and I think this is a nice write up aimed at the laymen without distorting the findings:
http://www.eurekalert.org/pub_releases/2016-03/kcl-epf031816.php
Just for clarity, this wasn't an intervention study, just comparing measurements of body parameters against food intake questionnaire ? I got confused by the "replacing X with ..." dialogue but maybe it was referring to a mathematical construct not an experiment.
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