I was perusing the 'net to look up information on diabetes. Specifically, Type 2 Diabetes as someone close to me was just diagnosed with Type 2.
I came across this website: http://www.phlaunt.com/diabetes/14046739.php
which states that it’s all genetic and that obesity etc. is simply a result of the diabetes in the first place.
Is this merely semantics or does the article have a point? My understanding is that lifestyle absolutely has a role to play in the onset of Type 2 Diabetes.
Specifically overeating doesn’t tend to cause diabetes, and exercising and eating well won’t necessarily prevent it. There is a genetic component, but I’m not sure whether it is (as this article claims) a simple weakness in the body’s ability to do stuff or (as I’ve read in other places) that diabetics (or potential diabetics) are predisposed to a bug which attacks the islets of langerhans, which are the outlet ports on the surface of the pancreas which generate insulin. The body develops a way to kill off the bug and then proceeds to kill off the islets, thus adopting a “scorched earth” policy which, prior to the advent of insulin injections, was invariably self-defeating.
Your cells have receptors which insulin binds to. There are different things that factor into diabetes. One is that, due to genetics, you don’t have as many open receptors available, so there is a genetic component that can factor into all of this. The second thing is that if you are overweight, for whatever reason, fat particles can block the insulin receptors. Either one or both of these together can make your pancreas work harder to regulate your sugar. If you overstress and kill some of the cells in your pancreas, they don’t grow back. Voila, you now can’t produce enough insulin and you have type II diabetes (compared to type I diabetes which is where the cells in your pancreas can’t produce enough insulin to start with).
That article seems to be a big load of hooey. Obviously genetics can be an important factor. If you don’t have as many insulin receptors to start with you are much more prone to diabetes. However, just fat alone can block the insulin receptors and overstress your pancreas. So you can overeat yourself into type II diabetes.
There is a point to be made, and that is that if you have type II diabetes it is possible that you didn’t overeat yourself into it. It’s also possible that you did, though, and that’s where the article is flat out wrong.
Losing weight gets rid of the fat that blocks your insulin receptors, so if you lose weight and follow a strict diabetic diet (count carbs) you can significantly help to regulate your blood sugar, and if the cells in your pancreas haven’t been too badly damaged, it’s possible for you to be “cured” (not needing diabetic medications). It’s not really a cure though since the cells in your pancreas will never grow back. It’s probably better to say it is managed rather than cured.
If there is too much damage to your pancreas though, you will probably be stuck on diabetic meds for the rest of your life.
ETA: Also, it is important to note that if you do lose weight, you free up the fat from your insulin receptors, and even if you do have to be on diabetic meds, you ease the load on your pancreas and stop yourself from doing even more damage to it. If your pancreas gets worse, it can be much more difficult, even with meds, to keep your blood sugar properly regulated.
(IANAD, but I have diet and exercise managed (not “cured”) type II diabetes)
A theory I’ve heard (no idea how valid it is) is that things like obesity and type II diabetes are side effects of metabolic adaptations that helped us survive thousands of generations ago, rather than a linear progression of conditions. So it isn’t as simple as obesity precedes and causes diabetes. They could just both be symptoms of a similar underlying metabolic condition. Both insulin resistance and obesity help people survive periods of famine.
But yeah, genetics aside, lifestyle has a strong role in prevention and maintenance of type II diabetes.
This study found a 58% reduction in development of type II diabetes when lifestyle changes were enacted.
FWIW, other things like magnesium levels and vitamin D levels play a role in the onset of type II diabetes too.
There are a lot more diabetics now than there were 20 years ago. But I have heard a criticism that part of that is that the diagnosis of diabetes is laxer (you now need fasting blood sugar of 126, it used to be 140) and more people are monitoring their blood sugar so more people are aware they have the condition. So it seems like a complex issue. More people are diagnosed with diabetes because testing supplies and public awareness are more present, and the diagnosis is easier to get since you need a lower blood sugar level. As a result the number of diabetics rise. I have no idea how much is an actual diabetes epidemic.
Another person who takes a grain of truth and runs with it beyond any sense whatsoever.
Most people withe type 2 diabetes need to have both some degree genetic predisposition to it and a lifestyle that includes obesity. Most with the genetic predisposition would not develop diabetes if they had a lifestyle that included better nutrition, more exercise, and a normal or near normal BMI. There are a few individuals however who do develop type 2 diabetes without being overweight. And there are many who are overweight who do not have diabetes. Obesity is a major part of the story; genetics is a major part of the story; and even both together do not tell the whole story.
The easiest way to dismiss the website claims that it is “all genetic” is to point to this article. The genetic make up of the United States did not change all that dramatically between the 1970s and the 1990. Obesity increased dramatically. A wide variety of poorer nutritional options proliferated and exercise levels decreased. And the rate of type 2 diabetes increased dramatically. Genes are the hand you have been dealt and those hands are still pretty much the same now as they were 30 to 40 years ago when type 2 diabestes was less common (age group for age group), but the pot is won or lost based on how we play those cards.
And Wesley’s cite is excellent.
Well… sometimes yes and sometimes no.
My spouse, for instance, is diabetic due to an infection that physically destroyed quite a bit of his pancreas. As there are functional cells left they produce some insulin, but not enough. Thus, he doesn’t need to inject insulin but he is diabetic and a Type II (which may advance to insulin dependence as he continues to age). It had nothing to do with his lifestyle, it was bad luck.
In other cases, yes, poor dietary choices lead to obesity which is a known risk factor for Type II diabetes.
So while lifestyle is often a signficant factor it isn’t always so.
Like many conditions that plague modern life, the exact cause is not known. Genetics, lifestyle, random chance all seem to play a part.
MS, Parkinsons, Alzheimers, Diabetes I and II, various cancers, hypertension, even heart problems - you cannot look at a healthy someone’s vitals or other details and say “you will get this” with 95% certainty, nor can you say “do this and you will not get it” with 95% certainty.
Type 2, really? Type 2 typically means that your cells have become resistant to insulin. Seems like damage to the pancreas that resulted in it not producing enough insulin is more like Type 1.
He’s classified as Type 2 because he does not require insulin injections.
Really, he doesn’t fit either of the two “classic” diabetes as he’s not so due to auto-immune destruction of the islet cells (Type 1) and he’s not insulin resistant (Type II), he simply doesn’t have sufficient islet cells left to fulfill his body’s need for insulin.
Keeping his weight under control does have a positive effect, but mostly it’s managed by diet and typical Type II diabetes medication. Thus, “Type II” even if it’s not the usual way to get it.
Does that make it clearer?
My doctor claims that my insulin levels are high, but my body resists it. The high insulin levels make it easy to store fat, but I was always obese (not any more, although still somewhat overweight) and my blood sugar was normal until a few years ago. So while I wouldn’t exclude genetic factors (which may have been positive when starvation, not overweight was the biggest issue facing humankind), it seems clear that lifestyle is and remains important.
Another thing to remember is that until recently few people lived long enough to experience these diseases of age and, in any case, things that happen after reproductive age are unlikely to drive evolution. (Yes, I am aware of the “grandparent” effect, but it cannot be very important.)
The grandparent effect might be sufficient to make a difference, but it may not require all four grandparents. If just 1 grandparent is sufficient to provide a survival advantage to the young then you can have 75% of grandparents die early with minimal effect, yet still retain the benefit of having one, Thus, not a lot of incentive to improve health post-reproductive years. This would fit with a minority of elders retaining good health into their 70’s-80’s but most dying in their 40’s.
A hunter-gatherer society doesn’t need a LOT of elderly folks to benefit from elder’s wisdom. Just a couple will do.
Depends what you mean by “require.” I have type 2, and take a high dosage of insulin twice a day. If I discontinued it, my blood sugar would skyrocket, with disastrous consequences. So do I “require” insulin injections?
Not really. I mean, I get it that he’s not really a “classic” diabetic because he got that way through an infection. But like panache45 said, whether or not someone needs insulin injections isn’t the determining factor between Type 1 and Type 2. If he’s not insulin resistant, I don’t see how he’s Type 2.
But really, maybe it’s silly to even try to categorize him. He’s not either type, really.
Okay, let’s clarify the definitions.
Not sure if that helps classify Broomstick’s husband though. Does he have an absolute deficiency in insulin secretion, albeit in his case not of an autoimmune cause, or is it a relative one, with pancreatic damage resulting in inadequate compensation for some insulin resistance that he can modify with diet, exercise, and type 2 sort of meds? Does it matter what it is called?
The factors that contribute to developing insulin resistance include as both independent and interacting factors:
And as that website breathlessly promotes, the degree of insulin resistance is only part of whether or not an individual develops diabetes; the other part is how much capacity the pancreas has to compensate … and for how long. For which a host of other factors may contribute.
I’ll use myself to express the bottomline: I have a strong genetic predisposition to Type 2 diabetes. I cannot change my genes. I cannot change what my Mom ate while she was pregnant with me. But the I can and do control my lifestyle. Doing that does not give me a 100% assurance that I won’t develop diabetes as I age, but it does make my odds much much better.
Not all diabetes cases fit neatly into types 1 and 2. Pancreases that are scarred by infection or other causes such as alcoholic pancreatitis or CF (to name but 2 non-infectious causes) tend to produce inadequate amounts of insulin, but insulin resistance frequently isn’t present. These people get called type 1 a lot of the time, but they don’t tend to get ketotic because they still produce some insulin. Some can even be controlled by low carb diets, or supplemental long-acting maintenance insulin only. Others need insulin pumps or frequent doses of short-acting insulin just like the type 1s do.
My spouse unquestionably has an ethnic risk factor, being at least half Native American. Most, if not all, of his relatives over 60 either are pre-diabetic or full blow diabetic.
In his case, the infection that caused the damage precipitated diabetes. Is he Type I or II? As pointed out, he doesn’t fit neatly into either. The medical types around here usually call him Type II for whatever reason. However, as he ages he might well (might even be likely to) develop insulin resistance, if he doesn’t have some already. Thus, the doc says that while at present his is controlled by diet, weight control, and medication in the future things might get worse.
In other words, he might wind up with a diabetes state with multiple causes. Because it’s not confusing and frustrating enough, I guess. :rolleyes: I don’t think he cares much what it’s called so long as it can be controlled. He always figured he’d get diabetes eventually because of his family history, it just happened about 10 years earlier than expected. He also thinks he’ll eventually wind up on insulin, too, but he’s trying to put that off for a bit. Although, like he told the doctor, he’d FAR rather do the self-injecting thing than go blind or lose limbs or wind up on dialysis. I don’t think he’d have a problem with the needles, unlike some unfortunates. I know he’s talked about the possibility with his doctor already.
Anyhow, it was intended as an illustration that there’s more than one way to wind up diabetic, a person might be diabetic for more than one reason, and it’s certainly not always the “fault” of the person in question.
I don’t know how this fits in, but both his regular doc and my sister the MD have both cautioned that he is prone to both high and low blood sugar, something about the regulatory mechanism having also been damaged. Fortunately, these swings haven’t been debilitating but he’s probalbly had as many significantly low blood sugar episodes as high, especially while he was recovering from the precipitating illness and learning to manage all this.