Diabetes question

Factual Questions
1

I have known I have had diabetes for almost a year now. I am on no meds and control my sugar with excercise and curbing my carb intake. I test several times a day. My most recent A1C was 5.5, so all seems pretty well.

Question - one factor in diabetes is that your cells become insulin resistant. Wouldn’t this only be the cells you currently have? Wouldn’t the cells your body produces in the natural course of repair/replacement not have this resistance to insulin, so long as the resistance is not genetic? If you have your blood sugar under control, so your poor, wee pancreas is not working triple time squirting insulin into your blood, shouldn’t the newly formed cells have your original level of insulin tolerance/resistance?

Thusly, if your pancreas is not too worn out, couldn’t you effectively reverse diabetes by keeping your blood sugar at a level where the newly formed cells do not become resistant?
(I know there are many places online and elsewhere that claim to reverse diabetes. I realize most of these plans are bogus.)

2

I’m not a doctor, but I’ve spent the last year or so studying diabetes pretty thoroughly, after my own diagnosis a little over a year ago.

You seem to be thinking that the reason you become insulin resistant is because you produce too much insulin, saturate the cells, and they become resistant. I don’t think that’s the case, and I don’t think it’s true that newly-formed cells are not insulin resistant to begin with. Otherwise your question - “couldn’t you effectively reverse diabetes by keeping your blood sugar at a level where the newly formed cells do not become resistant?” - would have been proven to be true at some point in the last 3000 or so years.

I don’t think we know what causes insulin resistance; there’s a lot of theories, but nobody knows exactly why one person becomes insulin resistant under the same condition that someone else does not. Obviously diet & exercise has some effect on it, but it’s not the only thing, otherwise every overweight person would be diabetic, and that’s not the case.

3

I have type II and I know that fat cells are most resistant to insulin. I lost 40 lbs and now I take less medicine and my numbers are better.

My Dr. told me you never stop being diabetic and that agrees with everything I have read and heard. If you don’t take medicine or insulin and your sugar numbers are very good you are still diabetic.

4

I think you ask an interesting question, the answer to which has a few parts (and probably more that I’m not aware of having been out of the diabetes field for some years now).

As you alluded, some portion of insulin resistance is genetic. Indeed, in certain populations (e.g. Pima Indians), it’s a very potent effect and quite pervasive. But, even in other, less closed groups, genetics plays a significant role.

Your question is based on the very reasonable thought that cells are being replaced in the various tissues where insulin resistance occurs. Although that is literally true, the rate of replacement is not very great. So, even if some new cells are produced that are insulin sensitive, they will still be greatly outnumbered by the older, insulin resistant ones.

Along those lines, fat cells tend to expand and shrink in size, as opposed to dieing off and new ones produced. Again, this minimizes the creation of new, potentially insulin sensitive cells.

Finally, a key factor in diabetes, and the factor that changes the insulin resistant state to a frankly diabetic one, is “exhaustion” of the insulin producing cells of the pancreas (i.e. diabetes is not simply due to an increasing degree of insulin resistance).

The situation becomes very complicated (at least to me) when one realizes that whatever the original cause of high blood sugar, once it’s occurred the high sugar causes both a “poisoning” of the insulin producing cells (thereby lowering insulin levels further) and increased insulin resistance. The converse is equally true and plays a large role in the treatment of diabetes - namely that however blood sugar is lowered, whether by diet, pills, or insulin, both the insulin producing cells get “detoxified” and make more insulin and the body’s cells become more sensitive to insulin.

5

I don’t have any good answers for you, just wanted to congratulate you on keeping your blood sugars in control.

6
  1. What she said. Boy do I miss spaghetti. :frowning:

FWIW, my endocrinologist said to me that in Europe more thin people than overweight people have diabetes.

7

But - do you experence the same cumulative damage to other parts of the body (kidneys, eyes etc.) if you’re staying within normal blood sugar / A1C levels?

8

As a teacher, not as someone trying to be patronizing, I don’t think that’s quite correct.

Muscle cells are typically more insulin resistant than fat cells. One way to look at it is to think about someone who’s very overweight and insulin resistant, and/or even frankly diabetic. Their obesity, i.e. large fat mass, is telling you that their fat cells are continuing to take up fat despite the fact that they are insulin resistant. This is because the term “insulin resistance” is usually taken to mean resistance of muscle cells to insulin. If someone’s fat cells were as resistant to insulin as their muscle cells were, they’d be breaking down their fat and lose weight as the insulin resistance came into being, and certainly when it progressed.

It also pays to keep in mind that the biggest (potential) user of sugar in the body are the muscle cells. When they are resistant to insulin, the body loses its biggest “sink” for sugar, or at least part of it.

9

newscrasher, think of how are new cells produced. It’s called mitosis, if you want to run a search on it there’s tons of info on the web.

They aren’t formed in some little factory and carried to their destination in cute little trucks. They’re formed in the spot where they’re needed by splitting up an old cell (except for blood cells and reproductive cells, most cells don’t get to travel). DNA in the old cell makes a copy of itself, then the cell splits in half, with the nucleus also splitting (and, if everything has gone right, an exact copy of the original DNA in each new nucleus) and other organules being split more or less evenly, “one mitochondria for you, one for me…”

The daughter cells are “new”, but their parts aren’t. The organules, the proteins in the membrane that serve as the cell’s communication system with the rest of the body (including insulin receptors), the fatty acids in the membranes, etc. are reused. Everything gets replaced eventually, but - eventually. And if what’s broken down is not the final product of a production chain (for example, an insulin-receptor membrane protein) but one of the organules that form that production chain… it will be making “bad” end product for as long as it doesn’t get replaced. Not “bad” enough to get discarded, not “bad” enough to kill the cell outright, but bad enough that once enough cells have the problem (which gets inherited during mitosis) you need to watch your sugar levels.