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Diabetes / Insulin sensitivity
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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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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
Tell that to my Type 2 grandfather, who was skinny as a rail at diagnosis and until he died - and who always exercised. Tell that to my mother, who was not skinny at diagnosis, is normal weight now, and has always swum for an hour at least 3x a week (pre and post diagnosis) - who eats the ADA recommended diet, who takes more medication that I do, and and whose A1c is 26% higher than mine. My mother believed the ignorant judgment - and on the strength of it lost well more than 10% of her body weight - the amount she was promised would make a difference. It made none at all. (In contrast, I control my diabetes by eating low enough carbs to avoid triggering an elevated BG response. My BG was in the normal ranges 3 days after diagnosis while I was still obese. I am moving toward a normal weight - but after losing 23% of my body weight my carohydrate tolerance remains unchanged - it is, and has been, around 20 grams in a 3 hour period both at 197.3 (diagnosis) 152.2 (currently).)
There are many T2 diabetics for whom there is a correlation between weight and disease expression. I am not one of them - nor is anyone in my family (all descendants my age or older of my maternal grandfather) - nor is anyone in my spouse's family - with a similar strain of diabetes that does not correlate well (or at all) with weight.
As the spouse of a normal weight person who was a good little patient and went to the medical professionals, where she was told (1) lose weight and (2) if that doesn't help we'll just have to medicate the crap out of you - it IS an ignorant judgment when it is spewed out without an individual determination that in this person, diabetes is connected to weight.
Not to mention that it is a barrier to attaining normal BG levels when(1) all T2 diabetics are treated identically and (2) the medical profession continues to recommend solutions (weight loss & 30-50 carbs/meal) that rarely achieve better than diabetes-normal control. I'm looking for the statistics, but I believe it was feewer than half achieve what the ADA calls "tight" control - which permits BG readings of up to 130 before meals (normal would be below 100), and up to 180 2 hours after a meal (normal rarely goes above 140 - and a 180 2 hours after eating strongly suggests a spike well above 180 at around 1 hour). This is particularly troubling, given the latest study that links elevated blood glucose (even at the high normal range) with all cancers other than liver.
Just because it is a doctor (or other medical professional) passing judgment it doesn't keep it from being ignorant.
(FWIW, even AFTER that determination, it is still not clear which (if either) caused the other - or if yet a third thing caused both.)
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@neohdiver Good point about what doctors consider tight control. What the medical profession would consider "tight BG control" I consider to be unacceptably high. Normal should be the same for those with IR and without.0
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I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).1 -
ForecasterJason wrote: »I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).
If one is active, the amount of insulin the pancreas has to push normally wouldn't be high - the person is liable to be very insulin sensitive, so the pancreas probably isn't working that hard.
And the pancreas refusing to put out insulin would be more in line with Type 1 Diabetes. Type 2 diabetes is about the muscle, liver, and to a smaller extent adipose cells becoming insulin resistant.0 -
Maybe it's fair to say that with other environmental factors (such as a slight lack of sleep, or a bit of elevated stress), insulin resistance could slowly start in the scenario I gave. I just find it hard to believe that over the long term the pancreas would still function flawlessly with a constant overload of carbs (particularly with a decent number of high GI ones). I think it would be cool though to see a future study on insulin function for people in this situation, at least 5-15 years apart.ForecasterJason wrote: »I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).
If one is active, the amount of insulin the pancreas has to push normally wouldn't be high - the person is liable to be very insulin sensitive, so the pancreas probably isn't working that hard.
And the pancreas refusing to put out insulin would be more in line with Type 1 Diabetes. Type 2 diabetes is about the muscle, liver, and to a smaller extent adipose cells becoming insulin resistant.
Also, I see some sources that seem to indicate that in T2D insulin secretion is impaired.
http://www.ncbi.nlm.nih.gov/pubmed/18640585
http://diabetes.diabetesjournals.org/content/50/suppl_1/S169.full.pdf
http://bmcbiol.biomedcentral.com/articles/10.1186/s12915-015-0140-6
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T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.0
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lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.1 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
Because introduction of diet is the only western import that ever happens in these scenarios. Sedentary time never goes up for these people.
Your best bet would be look up whatever study Eades quotes to claim Aborigines are more sedentary in the Bush than in cities and their traditional diet supposedly fixes T2D.0 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
Because introduction of diet is the only western import that ever happens in these scenarios. Sedentary time never goes up for these people.
Your best bet would be look up whatever study Eades quotes to claim Aborigines are more sedentary in the Bush than in cities and their traditional diet supposedly fixes T2D.
You are saying the Chinese may be more sedentary now than in the past, or that they are more sedentray than Americans are?
Sure. They might be.
Obesity rates in China are somewhere between 5 and 20%, with 20% being in urban areas. Obesity in the USA is what? Around a third? The Chinese's rate of diabetes is higher. So you are saying it is (in part) because the Chinese are more sedentary than Americans? They walk less, watch more TV and play more video games or computer than Americans, and drive everywhere? I dunno. It's possible.
Sure, Activity level can play a part in T2D. I don't know if being inactive plays a large part in this situation.
I'm afraid I don't know what you are refering to with Eades and Aboriginals. The Aboriginals ate a traditional diet and were more sedentary and that helped reverse their T2D?0 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
It doesn't seem to be grains or starches. Such societies often include decent amounts of them without T2D or other modern diseases. (One reason I think paleo is wrong, as well as the fact they were part of the human diet even during the paleo period.) China has traditionally had a high rice consumption, as has Japan -- their protein consumption has likely increased more than grain. Overall I think it's a more modern or wealthier diet, which is hard to separate from other factors, such as less activity, higher amounts of sat fat, and just more calories in general. I personally do suspect there's a contribution from all of the above, including more high cal, low nutrient, low fiber foods, like many high sugar processed products (vs. fruit), as well as less fruits and veg as part of the overall diet, but I don't think it's easy to sort out and I am not sure that that's more than my own prejudice. There are some articles I've read that the in some ways horrible British diet during WW2 and rationing was actually positive for health, because of limited ability to have some of the more luxurious foods (both sugar and sat fat), despite more starchy stuff (like potatoes, which were encouraged), and lots of awful-sounding processed stuff (again, contra the idea that "processed" always means the same thing). I will not be at all surprised if there are more studies that do show a contribution of food type. As you know, I tend to buy into the Michael Pollan/David Katz articles that are sometimes presented, so that is my bias/interpretation of the evidence.0
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