Understanding Type 2 Diabetes & the Causes
Some people are born with a genetic predisposition for developing diabetes, though this does not mean they are destined to a diagnosis. We explore why and how type 2 diabetes develops in some, and maybe not in others.
One out of every three people in America are living with diabetes and the number is only expected to grow. This is especially true as obesity rates continue to rise in the United States and across the world.
But what exactly is type 2 diabetes and what causes it? Learn how the disease progresses and steps to take to prevent a diabetes diagnosis.
Understanding Type 2 Diabetes & The Causes
Diabetes is when the body is unable to use glucose as energy following carb intake. This is mostly related to the absence or resistance of insulin.
There are two types of diabetes, including types 1 and 2 diabetes. Type 1 diabetes is when the body's own immune system destroys the cells that produce insulin. Blood sugars rise mostly related to insulin resistance in type 2 diabetes, which accounts for about 90 percent of all cases.
Unlike type 1 diabetes, type 2 diabetes can be delayed in progression and delayed. If diagnosed with diabetes, though, high blood sugars increase the risk of diabetes complications, including heart disease and nerve damage.
But these complications do not occur overnight. The progression of diabetes takes time.
Progression of Type 2 Diabetes
Diabetes progression is primarily characterized by a decline in beta cells (or β-cells) function and worsening of insulin resistance.
Beta Cell Decline
Beta cells produce, store, and release the hormone insulin. They are located in the pancreas.
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 insulin sensitivity, which emerges the concept of insulin resistance.
Worsening of Insulin Resistance
Insulin is a fundamental hormone required for glucose utilization, as it assists in glucose entry into the cells following carbohydrate intake.
Insulin resistance is when cells do not respond well to insulin. This means they cannot sufficiently take up glucose from the blood.
Ultimately, when beta cells decline and cells are resistant to insulin, blood sugars start to rise. This is also known as hyperglycemia. Clinical tests are used to identify blood sugar levels and the presence of hyperglycemia. These include hemoglobin A1c, fasting plasma glucose, and postprandial (after meal) glucose levels.
Take, for instance, hemoglobin A1c (HbA1c). This diabetes diagnostic test measures average blood sugar up to three months. A HbA1c of 5.6% or less is considered normal, while 5.7 to 6.4% indicates prediabetes and hyperglycemia. A HbA1c of 6.5% or greater, is diagnostic for diabetes.
Nature vs. Nurture
People can be born with a genetic predisposition to developing diabetes at some point in life. But this does not necessarily mean they are destined to develop diabetes.
It does, however, mean they are more likely to develop diabetes than someone who is not genetically predisposed. Even if diabetes does not run in the family, though, one can certainly still develop it.
After this point, lifestyle takes over and plays the biggest role in the development of type 2 diabetes. It is the classic nature vs. nurture argument. Both genetics and environment must be considered to explain the progression of type 2 diabetes.
Environmental factors that can lead to diabetes include a poor diet filled with sodas, juices, and processed snacks and pastries. These kinds of foods cause the pancreas to begin working overtime to produce insulin in order to process all that sugar.
Physical inactivity, poor sleep, and chronic stress can also increase diabetes risk.
Health Risks that Lead to Diabetes
Again, if diabetes runs in the family, there is an increased risk of being overweight and developing diabetes.
There are also certain races and ethnicities that are more susceptible to diabetes than others. These include African Americans, Hispanics, American Indians, Asian Americans, and Pacific Islanders. Aging is also a fixed risk factor for diabetes, particularly for those aged 45 and older.
However, there are additional health risks and lifestyle factors that can lead to diabetes beyond genetic makeup and age.
• Weight: Being overweight or obese increases the risk of type 2 diabetes and other comorbidities. This is based on body mass index (BMI), in which overweight is classified as a BMI over 25. Obese is classified as having a BMI over 30.
• Fat distribution: Waist circumference is a stronger predictor of diabetes than BMI, predominantly based on a fat distribution. Fat stored mostly in the abdomen places a greater risk of diabetes. Men and women are advised to keep waist circumferences under 40 and 35 inches, respectively.
• Physical inactivity: Lack of exercise may increase the risk of diabetes, primarily contributed to an increased potential for weight gain. Additionally, physical activity can also improve insulin resistance and improve blood glucose levels.
• Gestational diabetes: Gestational diabetes is a condition diagnosed in some pregnant women, often related to changes in hormones. If gestational diabetes arises in pregnancy, women are more at risk of developing diabetes after the baby is born. Women who birth a baby over nine pounds are also at elevated risk.
• Polycystic ovary syndrome (PCOS): Women with PCOS have a greater risk of developing gestational and type 2 diabetes. Polycystic ovary syndrome is a hormonal disorder common among women of childbearing age.
• High blood pressure: Also known as hypertension, having high blood pressure (140/90 mm Hg) is linked to an increased diabetes risk.
• High Blood Lipids: Individuals with low HDL or "good" cholesterol and high triglyceride levels raise their risk of diabetes.
Type 2 Diabetes Prevention
Remember, some diabetes risk factors cannot be changed, including age and family history. However, there are things ones can do to lower their risk of diabetes.
The National Institute of Diabetes and Digestive and Kidney Diseases recommend a number of preventative strategies. These include losing weight and keeping it off, being physically active, and eating healthy foods most of the time.
Making diet modifications can help with weight loss and lowering diabetes risk. General diet recommendations include reducing the intake of overly processed foods rich in a refined sugar, flour, oil, and salt. Also incorporate more wholesome food sources.
Research in PLOS Medicine also found individuals' diets rich in monounsaturated (MUFA) and polyunsaturated (PUFA) fatty acids experienced lower blood sugars. They also improved insulin sensitivity compared to diets high in saturated fat and carbohydrate.
Specifically, increasing PUFAs and reducing carbs and saturated fats had the most consistent benefits. Up until this point, research lacked in understanding how dietary fats and carbs influence blood sugar and insulin.
Based on the present study, eat more and less of the following to prevent type 2 diabetes using food:
• Nuts and seeds
• Fatty fish
• Vegetable oils
• Refined grains and starches
• Refined and added sugars
• Saturated, animal fats
One can also adopt a plant-based diet for the prevention and treatment of type 2 diabetes. Plant-based diets are eating patterns that emphasize legumes, whole grains, veggies, fruits, nuts, and seeds. Animal products are reduced or avoided completely dependent on personal preference.
Not only can regular exercise manage weight, but uses up glucose as energy and makes the cells more sensitive to insulin.
But how much is enough? The American Heart Association recommends at least 150 minutes of physical activity each week, or 30 minutes most days. Also incorporate at least two or three strength training sessions.
Especially if new to exercise, though, begin slowly and increase activity in small increments. This best 4-week workout for beginners can also get newbies started.
Ultimately, any movement is better than doing without. Swap the TV for a post-dinner walk and wake up earlier for a quick morning workout.
The combination of a balanced diet and regular exercise may facilitate weight loss, in turn reducing diabetes risk. Research even suggests one cuts the risk by more than half by losing seven percent of body weight!
If those numbers seem unattainable, start small. Losing even some weight is beneficial not only for decreasing diabetes risk, but for improving overall health. And with bistroMD, achieve weight loss goals whilst ensuring adequate intake of essential nutrients.
Additional Type 2 Diabetes Preventative Measures
Additional preventative measures include sleeping seven to nine hours of sleep nightly and relieving stress. Controlling health risks, including high blood pressure and cholesterol, can also protect from a diabetes diagnosis.
Regularly meeting with a primary care provider is advised to develop a safe and customized plan. A Registered Dietitian can also ensure nutrient needs are met for any goal, including minimizing the progression of type 2 diabetes.