Down And Dirty With Diabetes

Recently I was talking with an individual who had been newly diagnosed with Type II Diabetes, and I was cringing in disbelief at what her doctor had told her to do in regards to her diet.  "Stay away from carbs!  Those will cause your blood sugar to spike and send you into a diabetic coma!" was exactly what he had told her to do.  With two thirds of our country classified as overweight and one third of that classified as obese, Diabetes is on the rise, particularly Type II Diabetes.  So what can you do to manage it once you get it?  Let's talk Diabetes.

There are three types of Diabetes: Type I, Type II, and Gestational.  About 90% of diagnosed cases are Type II, with the other 10% a mix between Type I and Gestational.  All three have different etiologies and nutrition therapy that corresponds with them, so knowing which kind you have is key. 

Type I Diabetes
Type I Diabetes is most typical in individuals younger than 30 years of age.  The peak age of onset for Type I Diabetes is 10 to 14 years old.  In Type I Diabetes, the body attacks and destroys the beta-cells in the pancreas.  Now, these beta-cells are very important because they secrete the hormone insulin.  Insulin is the hormone that takes the glucose from the food we eat from our bloodstream and pulls it into our cells, so our body can use that food for energy.  In the case of a Type I Diabetic, whether it be an immune system response or an unknown etiology, the body destroys those beta-cells and therefore, is unable to produce and secrete insulin.  This means, no matter how much an individual eats, their cells will starve because they are not able to absorb those nutrients. 

The only way a person with Type I Diabetes can manage the disease is to give themselves insulin.  No amount of nutrition-related changes can jump start the body to start producing insulin again.  That being said, they still need to monitor the amount of carbohydrates they are ingesting at a given meal and adjust their dose of insulin appropriately.

Type II Diabetes
Type II Diabetes was formerly known as "Adult-Onset Diabetes", mostly due to the fact that there were no diagnoses of Type II Diabetes in individuals younger than 50 about twenty years ago.  Now, we are seeing children as young as 9 being diagnosed with Type II Diabetes.  This type of Diabetes is related to poor nutrition, sedentary lifestyles, and being overweight or obese.  In Type II Diabetes, there are three steps in the process: insulin resistance, beta-cell failure, and glucose production in the liver. 

Step One: Insulin Resistance
In order for insulin to draw glucose from the bloodstream into the cells, it needs to find a receptor to hook up to on the outside of the cell.  Think of it as a lock-and-key type of situation.  In an individual who is overweight or obese, these cells are stretched out and larger than in an individual who is normal weight.  This causes the receptor, or keyhole, to change shape as well and stretch.  When this happens, the insulin either doesn't recognize the receptor as one it can hook up to, or insulin tries to hook up to the receptor, but it doesn't quite fit in the hole anymore.  Without insulin hooking up to the cell, the cell cannot take in glucose from the bloodstream.

Step Two: Beta-Cell Failure
So, now we have a lot of glucose running through our bloodstream.  The pancreas notices this, and thinks that we need more insulin.  The pancreas is not aware that there is actually enough insulin being produced, it just can't get hooked into the receptors.  So the beta-cells on the pancreas are working overtime trying to produce more and more insulin.  And as everything that works overtime all the time, the beta-cells get burnt out and ultimately they fail.  At this point, the Type II Diabetic is not producing hardly any insulin, if any at all.  This is when the pathophysiology of a Type II Diabetic starts looking more like the pathophysiology of a Type I Diabetic.


Step Three: Glucose Production in the Liver
OK, so now the insulin receptors on the cells are stretched out and not hooking up with insulin, the beta-cells in the pancreas are burnt out and not producing insulin, so your body is on overdrive thinking you are not making/eating enough glucose because your cells are starving.  So what happens?  The liver starts going on a glucose-making rampage.  Why is this so bad?  Well, lets stop and think about this.  You are still eating a normal (or normal for you!) diet, and the food is still getting broken down into glucose for your cells to use, but that glucose isn't getting absorbed into the cells.  So, we have the glucose we are already getting from food in the bloodstream at a very high concentration because its not going anywhere.  And now, the liver is producing a lot more glucose that isn't getting absorbed into the cells either.  When this happens, an individual can have fasting blood glucose levels in the 400s (normal range = 70-100 mg/dL).  This is one intense sugar-high!

Gestational Diabetes

Gestational Diabetes occurs when there is any degree of glucose intolerance (the cells not absorbing glucose out of the bloodstream) with the onset or first recognition during pregnancy.  Usually this appears in the second or third trimester.  Gestational Diabetes is reported in about 2 to 10% of pregnancies, and is resolved once the baby is born.  Gestational Diabetes is caused by an increase in the hormone levels in the mother, particularly the hormones that suppress insulin.  With all those extra hormones running through Mom's body, it can get a bit confusing for them and sometimes it ends up that there are adverse effects, one being insulin suppression and glucose intolerance.  Women who have Gestational Diabetes do have a 35 to 60% chance of developing Type II Diabetes in their next 10 to 20 years.

So you were diagnosed with Diabetes...now what?  Well, lets talk about it.  I'm going to focus on Type II Diabetes, just because that is the one that can be primarily controlled through lifestyle changes, as in diet and exercise. 


Let's Talk About Carbs...
When people think of Diabetes, they immediately think...NO CARBS!  It seems even health professionals are under this impression.  Well, today I am going to tell you the opposite...EAT CARBS!  The key to controlling a Diabetic diet is not cutting carbs out of the picture, its about consistent carbs.  What do I mean by that?  Having consistent amounts of carbohydrates throughout the day.  Don't have eggs and bacon for breakfast, a salad for lunch, and then load up on pasta, bread, and potatoes for dinner.  That's not very consistent. 

OK, consistency, that seems easy enough.  But what is a carbohydrate?  When we are talking about Diabetes, there are four food groups that are considered "carbohydrate foods".  Those are: starch, fruit, milk, and sweets.  Starches include anything from pastas, breads, crackers, tortillas, and even starchy veggies like corn, potatoes, and beans.  Fruit is pretty self-explanatory, but don't forget fruit juice!  Milk also includes yogurt.  Sweets can be anything from a candy bar to ice cream to gummi worms. 

Additionally, we want to aim for more complex carbohydrates, meaning going for more whole grains, whole wheat, and alternative grains instead of the refined carbohydrates and simple sugars.  Replacing your white rice and pasta for brown rice and whole wheat pasta.


Physical activity is also a focus when treating individuals with Type II Diabetes.  One of the major causes of Type II Diabetes is being overweight or obese.  Adding regular physical activity to your everyday routine will improve insulin sensitivity to the receptors on the cells, reduce the chance of you getting high blood pressure or high cholesterol (also risk factors of having Type II Diabetes), it will help control your weight, and may even improve your well-being.  When Type II Diabetes is diagnosed early, some individuals have actually been able to alter their lifestyle so much by changing their diet and beginning an exercise regimen, that they reversed the diagnoses.  It takes dedication, but it is absolutely possible, if your health is worth that much.

So, lets work the other way now.  So you were diagnosed with Diabetes, but have no intention of changing your lifestyle.  You love eating all that fried chicken, steak, and ham.  And don't forget that beer every night.  And exercise?  Forget about it.  So what happens in a situation like this?

Every now and then you will find an individual that has no interest in changing their lifestyle.  Eventually that individual will end up with hyperglycemia (high blood glucose), hypertension (high blood pressure), and hyperlipidemia (high blood lipids, or fats).  That individual will end up taking oral insulin medication followed by insulin injections prior to each meal and once in the morning and once in the evening.  At the end of the road, that individual will end up on dialysis and die.  Doesn't sound too fun, does it?

But lets face it, this could all be avoided by doing two very simple things: include a little physical activity in your life and having a sensible and nutritious diet.  Its your life, your choice.