Type 2 Diabetes
What is type 2 diabetes?
A simple explanation of type 2 diabetes (or to use its full name, type 2 non-insulin dependent diabetes mellitus) is having too much sugar in the blood and either insufficient or ineffective insulin.
Type 2 diabetes is often known as late onset diabetes as it tends to affect people over the age of thirty-five, although it is becoming increasingly common in younger people due to increased sugar consumption.
Type 2 diabetes is the most common form of diabetes, affecting 90 to 95% of sufferers, and should not be confused with type 1 diabetes, where sufferers are insulin dependent. With type 1 diabetes the body’s own immune system attacks the beta cells that produce insulin, whereas type 2 diabetes is often a self-inflicted condition, where the body’s ability to control its own blood sugar has been hampered by years of eating the wrong foods and often living a sedentary life (though it’s worth noting that there are exceptions to this, about 10% of type 2 sufferers are not overweight).
Diabetes is now commonly seen in children and it’s thought that the number of people with diabetes across the world will increase to 300 million in the next generation. Over 2 million people in the UK have late onset diabetes, costing the NHS 6 billion pounds a year, and it is the fourth leading cause of death.
What causes it?
There are a number of factors affecting the likelihood of developing type 2 diabetes, those being diet, weight, race, age, lack of exercise and hereditary factors. It is frequently found in overweight people (90% of cases). In many cases the condition can be controlled without the need for insulin or other drugs, instead purely by making dietary changes. Additionally, people eating a diet high in refined food (which is full of sugar), refined carbohydrate (such as white bread, white pasta and pre-packaged convenience meals), high in stimulants (tea, coffee, alcohol, chocolate and confectionery), too much meat and dairy products and too little fibre are more susceptible. Sometimes there are no symptoms, instead it may be noticed by a routine urine test (glucose present) or blood test at the doctor. Symptoms can include extreme thirst, increased hunger, and increased urination.
Dehydration can occur due to large amounts of water being drawn from the body to help dilute the high amount of sugar in the blood and help the kidneys remove it. This causes a large amount of water loss, which in turn increases dehydration.
Insulin, which is secreted by the pancreas, is the only hormone in the body that reduces blood sugar levels. When we eat a snack or meal high in refined carbohydrates and sugar, the level of glucose in the blood will rise above normal levels. Insulin is released quickly, which reduces the levels too far, causing symptoms of hypoglycaemia or low blood sugar (causing hunger, dizziness, irritability, lack of concentration, brain fogginess, palpitations, and numbness or tingling of the lips). The adrenal glands will then release adrenalin in response to this drop that will increase blood glucose levels again. This is the cause of diabetes. Over time, this constant load on both the pancreas and adrenal glands will impair their correct functioning. The insulin receptors on cells fail to respond to the hormone (insulin resistance), and the adrenals and pancreas become exhausted and their function slows reducing their output, which can lead to diabetes.
Some type 2 sufferers may be secreting some insulin but not in sufficient amounts, and may therefore require regular insulin injections to correct the imbalance. Frequently, however, sufferers do have sufficient insulin but the body’s insulin receptors cannot process it efficiently. If that’s the case, then it can be controlled by diet and lifestyle modifications.
What are the early warning signs?
The following short section gives a more detailed explanation of the what happens within your body when you become insulin resistant, for those ‘geeks’ who like to understand the scientific details.
After we eat food is digested and broken down into its smallest forms. Glucose is the simple form of sugar that passes through into the blood. This increase in blood sugar initiates the release of Insulin. Insulin is a hormone produced by the beta cells from the islets of Langerhans located in the pancreas. Insulin then binds to the sugar, transporting it to the cells to either be used for energy, stored as glycogen or stored as fat. Insulin is required for cell regulation and growth. It is also essential in the metabolism of sugar (carbohydrates), lipids (fat), and amino acids (protein). Insulin resistance is a condition in which the body cells have become resistant to effects of insulin, creating a need to release more insulin to remove the toxic levels of sugar from the blood. The more insulin produced the more resistance the cells become. Eventually the pancreas cannot produce enough insulin to cope with the body’s demands. This is caused by a chronic high sugar (or high glycaemic) diet, were large amounts of insulin are constantly being produced. Insulin resistance is related to a condition known as metabolic syndrome, which increases the risk of developing heart disease and diabetes. Insulin resistance can be due to both genetic and/or lifestyle factors. Medical conditions such as fatty liver, arteriosclerosis, skin tags, female reproductive problems and the skin condition acanthosis nigricans are all associated with insulin resistance. Although not exclusively, people with insulin resistance are more likely to be obese. While genetic factors can be the cause, the majority of insulin resistance cases can be managed through nutrition, exercise and, in extreme cases, medication. High resting blood glucose and insulin levels are a predictor that you could have insulin resistance, and this is a precursor to developing type 2 diabetes.
Insulin is also known as the ageing hormone; it has a detrimental effect on every cell in the body speeding up cell deterioration. At the end of our chromosomes we have a protective cap known as telomeres. These telomeres are a biomarker of ageing, when they get short they stop dividing and die. It has been shown that high blood sugar shortens the telomeres in white blood cells, increasing a person’s biological age.
Increased insulin also decreases fat oxidation (burning). When insulin is circulating in the blood the body is in an anabolic storage mode and this blocks the breakdown of fat for energy.
Other associated health factors
Generally, type 2 diabetes is preventable with diet and lifestyle modifications. When we know that diabetes can be a risk factor for having heart disease (the risk is 3 times higher in a diabetic), kidney failure, blindness, nerve damage to the limbs and internal organs and free radical damage in the body, it makes sense to do what we can to prevent its onset.
There are several related conditions leading up to type 2 diabetes including insulin resistance and metabolic syndrome (syndrome X). High levels of sugar in the blood can lead to artery, eye, kidney and nerve damage. Ultimately this damage, left unchecked, can create complications such as blindness, amputations, severe heart disease and even death.
Metabolic syndrome is a term used for those who are obese and also have diabetes and high blood pressure. While these conditions can be damaging enough on their own, in combination there is an even greater risk of suffering from heart disease, strokes and diabetes.
Risk factors for being diagnosed with metabolic syndrome include insulin resistance, obesity (particularly having a large waist circumference), a family history of type 2 diabetes, high LDL cholesterol and low HDL cholesterol, high blood pressure, skin tags and darkened skin (especially under the arms and back of neck).
More and more people are developing metabolic syndrome on a western diet, with the chances also increasing as we age; around forty percent of people in their sixties and seventies have this collection of risk factors.
Diabetes is preventable and has been shown to be reversible with the correct exercise and diet plan. The first step in tackling diabetes is to learn how to balance blood sugar. It’s important to recognise which foods cause a quick spike in blood sugar and which foods and food combinations cause a slow gentle rise in blood sugar. If we can understand this, we are half way there.
Breakfast is an important meal for anyone, but especially for a diabetic as breakfast kick starts the metabolism. At first it may be hard to eat breakfast if you are not used to it, but over time it will become easier. Generally, skipping meals will cause a drop in blood sugar, create cravings and make it much harder to stick to a healthy blood sugar diet.
Ensure that you are eating complex carbohydrates rather than refined - this means wholegrain foods such as wholewheat pasta, wholewheat bread, wholegrain brown rice, beans, lentils, peas and lots of vegetables especially broccoli, spinach, kale, french beans, cabbage and brussel sprouts. Look for words such as wholegrain, unrefined and high in fibre when shopping. These foods will have a lower glycaemic index than their refined contemporaries. Avoid white bread and pasta and processed foods that are low in nutrients, lacking in fibre and high in sugar, these disrupt blood sugar levels. It’s important when trying to balance blood sugar that you do not go to the other extreme and cut out carbohydrates completely, this will down regulate thyroid output, which creates its own set of problems. The secret word is “balance”.
Reduce stimulants such as tea, coffee, alcohol, chocolate and sweets that stimulate the adrenal glands to raise blood sugar levels. Replace these instead with herbal teas, rooibosch tea, dandelion coffee or fruit teas. Always drink around 2 litres of purified or bottled water daily, tea's and coffee are diuretics. It is worth noting that even decaffeinated tea and coffee still contain some stimulants, but they are useful if you need to ‘wean’ yourself off the real thing slowly! Cutting down on sugar can be hard as sugar has been shown to be addictive. It’s a better idea to gradually cut it out rather than replace with sweeteners or alternatives as this simply perpetuates the sugar cravings.
Certain cooked vegetables such as parsnips and baked potatoes have an effect on blood sugar. Raw or lightly steamed vegetables are better choices. Peas, carrots, cauliflower, broccoli are good choices and all contain soluble fibre. All vegetables have antioxidants, which are very beneficial, and a good variety should be eaten daily.
A diet high in fibre helps to balance the digestion of carbohydrates and control blood sugar release. Fibre rich foods are beans, lentils, oat bran, nuts, seeds, psyllium husks (available in health food shops), peas and apples.
Although fruits contain sugar, it is in the form of fructose, which has to be turned into glucose in the liver, thereby slowing down sugar release. Contrary to popular belief fruits are not an enemy, they are encased in a fibrous, vitamin, mineral and antioxidant filled matrix which slow its sugar release, however they should still be eaten in moderation. Apples, pears and berries are the best, eaten raw and unprocessed. Grapes tend to have the greatest effect on blood sugar as well as pineapple, watermelon and bananas, whilst apples, berries and pears have the least effect. All other fruits are excellent choices.
A diet high in saturated fats found in red meat, dairy products, cakes, ice cream and crisps increases the level of triglycerides (fats) in the blood, which is another risk factor for developing diabetes. Conversely, eating oily fish found in salmon, mackerel, sardines, and tuna as well as nuts and seeds (almonds, sunflower seeds, pumpkin seeds, walnuts) all contain essential Omega 3 and Omega 6 fats. The body cannot make these fats, they are essential for many bodily functions and help to lower triglyceride and insulin levels.
Balance blood sugar levels by eating a meal or snack containing protein and carbohydrate. A portion of fish, portion of wholegrain rice, two portions of vegetables, or a piece of fruit and a handful of nuts.
Do not go for too long without any food. Eating little and often is a good strategy, ideally no longer than 2 to 3 hours without some food.
Try to avoid convenience foods, as they often contain hidden sugars, as well as often being high in saturated fats. Saturated fats make cell membranes less permeable, effecting the transportation of glucose into the cell. Studies have shown that people with diabetes have an increased risk of having cardiovascular disease. Saturated fat will increase the amount of low-density (bad) cholesterol in the blood, further increasing the risk.
Fish oils have been shown to improve symptoms of pre-diabetics and insulin resistance. Polyunsaturated fatty acids found fish oils have been shown to increase levels of adiponectin (a marker for insulin sensitivity). It is thought that adiponectin can increase insulin sensitivity, making blood sugar regulation more efficient. Human studies have however not been as consistent as animal studies, although higher levels of this hormone are associated with lower risk of both diabetes and heart disease. The fact that cell membranes that have a higher proportion of polyunsaturated fatty acids are more permeable may also have a beneficial effect on glucose transportation from outside to inside the cell.
Important vitamins and minerals
There are concerns that diabetic patients on a calorie restricted diet may not be eating enough important fruit and vegetables, which are essential to getting enough vitamins, minerals and antioxidants. It may be wise to supplement with a good quality multivitamin to ensure adequate consumption.
Vitamin E, C and beta-carotene are important antioxidants and have been shown to reduce the risk of heart disease (which can evolve from diabetes). These antioxidants delay the oxidation of LDL (low density lipoproteins), which would subsequently lead to hardening of the arteries. Vitamins E and C are also beneficial in reducing damage to proteins of the eyes and kidneys. Commonly found damaged in chronic diabetic patients. Vitamin E’s protective properties also extend to preventing oxidative damage to the pancreas, where insulin is produced.
People with diabetes are more susceptible to eye problems, due to the combination of high blood sugar, high blood pressure and cholesterol, which damages blood vessels around the eyes. Vitamin E is a powerful antioxidant and has been shown to be useful in AMD (age related macular degeneration). There have also been some studies that show it can play a role in the prevention of cataracts. Vitamin E can be found in soya beans, raw wheat germ, seeds, avocados, green vegetables, eggs and unrefined nuts (especially almonds and hazelnuts).
Chromium has been shown to help blood sugar balance, and therefore is beneficial to diabetics. A substance called glucose tolerance factor is made in the body from absorbed dietary chromium. It enhances the role of insulin, which is essential to control blood sugar levels.
Magnesium is another important mineral they may be beneficial to diabetics. It has been shown that people with poor glucose tolerance are low in magnesium. It is not known whether low magnesium causes poor glucose tolerance or if poor glucose tolerance creates low magnesium levels, but it’s important to get enough in your diet. Foods high in magnesium include green leafy vegetables, avocado and bananas, nuts and seeds and seafood, such as salmon and tuna.
One of the most important ways of avoiding diabetes is by maintaining the correct body weight and, if you’ve already been diagnosed, then exercise is essential. Exercise will help to reduce cholesterol, reduce the need for insulin, reduce weight and improve insulin sensitivity and subsequently glucose management. Obese people tend to have difficulty in processing insulin correctly. As well as following the above dietary guidelines, you should take some regular exercise, which raises your pulse rate, at least three times per week. Suitable options are cycling, brisk walking, joining in an aerobics class – whatever activity you will enjoy and, most importantly, do on a regular basis! try to build up to 30 to 60 minutes aerobic activity and resistance training three or four times per week. If you are a smoker, then you need to try and stop since cigarette smoke encourages free radical damage as well as having an effect on blood sugar levels.
Quick easy guide to combating type 2 diabetes
Maintain a healthy weight
Eat between 4 to 7 portions of vegetables a day and 1 to 2 pieces of fruit
Eat high-fibre whole grain foods
Reduce/avoid refined carbohydrates