The Causes and Progression of Type 2 Diabetes
Many people are born with a genetic predisposition to developing diabetes at some point in life – though this does not necessarily mean that they are destined to develop diabetes. We explore why and how type 2 diabetes develops in some people, and not others.
First comes love…then comes marriage…then comes a baby - wait. That's not the progression we are talking about. We're talking about the progression of a disease. A very deadly disease at that, with type 2 diabetes being the 7th leading cause of death, according to the Centers for Disease Control and Prevention.
How does Type 2 Diabetes Develop?
Many people are born with a genetic predisposition to developing diabetes at some point in life - though this does not necessarily mean that they are destined to develop diabetes. It does, however mean that you they are more likely to develop diabetes than someone who is not genetically predisposed. Even if you don't have diabetes running in your family - you can certainly still develop it.
After conception, your genes are all planned out and locked in for life, you might say. After this point, lifestyle takes over and plays the biggest role in whether you will develop type 2 diabetes in your lifetime. It's the classic nature vs. nurture argument, and we must consider both genetics and environment to explain how you get type 2 diabetes.
As you grow and develop as toddler, how you eat can begin to influence the progression of type 2 diabetes. If you consume lots of sugary drinks and fruit juices, candy, and simple carbohydrates like crackers, cookies, and chips, then you are already increasing your risk, as a child, for type 2 diabetes. These kinds of foods cause your pancreas to begin working overtime to produce insulin in order to process all that sugar.
So when you consume lots of simple carbohydrates, simple sugars, and sugary drinks over a lifetime, then your body works hard to produce plenty of insulin to handle it. And over the course of a lifetime, this can really wear out your organs, and is one of the main ways you get type 2 diabetes.
Type 2 Diabetes Develops Over Time
Exhausting your pancreas takes a long time, and is usually the last step in the progression of type 2 diabetes.
So what happens first when you get type 2 diabetes? It starts at the cellular level.
All of your body's cells are surrounded by a membrane, and embedded in this membrane are special receptors where insulin can 'plug in'.
Over time, cellular membranes can become damaged by oxygen, free radicals, and pro-oxidants. This can change their shape and function, as well as their sensitivity to signaling from hormones like insulin. Damaged cellular membranes and dysfunctional insulin receptors can reduce your sensitivity to insulin, which is where the term insulin resistance comes from.
When cell membranes become damaged and less sensitive to insulin signaling, then less glucose is able to enter cells, trapping extra glucose in the bloodstream. This phenomenon is known as prediabetes and can lead to moderately elevated glucose levels. When your fasting blood glucose is above 100mg/dL, your physician will likely diagnose you with prediabetes. Once that level goes above 125mg/dL, you could be diagnosed with type 2 diabetes.
Sometimes, repeated fasting insulin levels will rise over time and when this happens, it's another red flag that the progression to type 2 diabetes is well on its way.
Some of the main reason that individuals progress from prediabetes to type 2 diabetes include:
Elevated fasting glucose and increasing fasting glucose levels
High plasma insulin
High BMI – Body Mass Index
Dyslipidemia-elevated triglycerides, LDL or 'bad' cholesterol, and low HDL or good cholesterol levels
Hypertension – high blood pressure
Decreased insulin response to glucose - indicating your pancreas is no longer able to handle larger glucose load
Poor Beta-cell function - indicating pancreatic health issues
Preventing Prediabetes from Becoming Type 2 Diabetes
Left untreated, and if you choose not to make any changes after being diagnosed with pre-diabetes, then you are at an increased risk for high blood pressure, cancer, type 2 diabetes, heart disease, and stroke. People with uncontrolled type 2 diabetes have a greatly increased risk for eye problems, blindness, kidney failure, and amputations. All that sugar trapped in the body does major damage over time. But you don't have to get type 2 diabetes. You have a say in whether or not you allow your body to progress to type 2 diabetes.
One of the best things you can do to help slow the progression to type 2 diabetes is to be active for at least 30 minutes every day, achieve normal body weight, and reduce your intake of simple sugars and simple carbohydrates. Getting adequate sleep every day and finding ways to manage stress can go a long way to slowing the progression to type 2 diabetes as well.
Vivian A. Fonseca, MD. Defining and Characterizing the Progression of Type 2 Diabetes Diabetes Care. 2009 Nov; 32(Suppl 2): S151–S156. doi: 10.2337/dc09-S301 PMCID: PMC2811457 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811457/