Among the 3 diseases in our 3 "high" series, I would argue that type 2 diabetes is the most complicated disease but probably the most preventable one. If we eat healthily, exercise regularly, and keep our BMI (body mass index) normal, we can delay the onset and slow down progression of type 2 diabetes! In this blog, my cousin, Charmain, and I will discuss what we can do to prevent type 2 diabetes.
What is high blood glucose?
Glucose, which is the end product of sugar, is a source of energy for the cells in our body. Foods, particularly carbohydrates, are digested and broken down into glucose for absorption in the small intestines.
As you all probably know, blood glucose levels are different before and after a meal, which is why most people fast for at least 8 hours before getting a blood test. The body has a very intricate system to prevent blood glucose from being too high or too low, and the pancreas is the main organ responsible for producing the hormones that control it. Insulin is secreted when glucose levels are too high, and glucagon when they are too low. Insulin signals a lot of organs, mainly the liver, muscle and fat cells, to increase glucose uptake, thereby reducing the level of blood glucose. In the liver, glucose is stored as glycogen, in fat cells as triglycerides. In the muscle, glucose is metabolized and used up. Glucagon, on the other hand, tells the liver to break down glycogen and produce glucose. In diabetes, the blood glucose level is high, a term called hyperglycemia. Persistent hyperglycemia is the cause of most diabetic complications.
What is Hemoglobin A1C (HbA1C)?
HbA1C, also known as glycosylated hemoglobin, is a blood test that physicians order for the screening of diabetes. It is the percentage of glucose attached to walls of the red blood cells. Glucose in the blood sticks to the red blood cells, which generally circulate in the blood for about 90 days. The more glucose in the blood, the more glucose is “stuck”. Therefore, the amount of glucose on the red cells indirectly measures the level of blood glucose circulating in the blood stream for the last 2-3 months. Normally, less than 5.6% of the red blood cell wall is glycosylated. When the percentage is persistently over 6.5, the diagnosis of diabetes is made. Unlike fasting glucose that can be “cheated” by eating healthily for the few days prior to the blood test, the HbA1C cannot be “cheated”. The blood glucose level has to be persistently less than 140mg/ml (7.8mmol/l) to have a normal result of <5.6%.
What is type 2 diabetes?
Diabetes Mellitus has type 1 and type 2. Type 1 diabetes is not preventable, and is usually diagnosed in childhood or young adulthood. Patients with type 1 diabetes need to be on insulin and are closely monitored by their doctors, so we will concentrate on type 2 on our blogs.
Type 2 diabetes results from insulin resistance. As we grow older and gain weight, the body stops responding to the insulin produced. The liver, muscles and fat cells are not as responsive and need more “push” to do their work. The pancreas, trying to keep the blood glucose normal, then secretes more insulin to “push” the liver, muscles and fat cells to work harder. Leading to a state of insulin resistance. At this stage, the blood glucose is high and the insulin level is also high! The problem is the body not knowing how to respond to the insulin anymore. Without intervention, the pancreas will become “exhausted”, unable to produce enough insulin to reduce the amount of blood glucose. As blood glucose continues to rise, insulin resistance will lead to pre-diabetes and eventually diabetes. However, with diet, exercise, and weight loss, all of this can be prevented! Insulin resistance can be reversed!
How do we reverse insulin resistance?
Insulin resistance is mainly a result of aging and weight gain. The aging process cannot be reversed yet as of 2021, but we can definitely work on weight gain. As we age, the fat distribution when we gain weight also changes. It is the intra-abdominal visceral fat which is metabolically active, and that is the culprit for insulin resistance. Here, genetic predisposition comes to play a role. Asians tend to gain weight centrally. There is actually a term, TOFI - Thin Outside Fat Inside, to describe the propensity for asians to store fat intra-abdominally! In general, a BMI of >25 is considered overweight, triggering the screening for diabetes. For Asians, a BMI of >23 is already considered overweight and at risk for diabetes! So, at the early stage when glucose is only slightly elevated, diet and exercise has the most impact. Even with just a 5 lbs weight loss, the course can be reversed and diabetes can be prevented!
To reverse insulin resistance, it is also important to:
- stop smoking
- drink less alcohol
- sleep more
For most people, it is easy to gain weight but very hard to lose it. Weight gain is something that we cannot allow ourselves to do once we reach adulthood! A lot of diseases, besides the 3 ”high” that we have been discussing, can also be avoided by not gaining weight. Diseases that range from arthritis to cancer, like breast cancer! One of the methods that I find helpful is not allowing myself to purchase larger size clothes. When the pants are feeling tight around the waist, that means I need to eat less and exercise more and get rid of that belly fat! Staying on a strict diet and exercise regimen is difficult, but we all have to strive and work hard on it. Starting with portion control and eating less, the stomach (the organ) will eventually shrink! Feeling 75% full is more than sufficient. Whatever diet you decide on, it has to be a forever diet. For more on what to eat, please visit Charmain dietitian.
This blog is already long enough, but we have only touched on the surface of diabetes. I hope you understand the role of insulin and the significance of insulin resistance. We will discuss more on the complications and treatment of diabetes in our next blog.