Monthly Archives: May 2015

Insulin resistance causes type 2 diabetes–part 2

This is the follow up post of my previous post about insulin resistance ,  much inner detailed view of insulin resistance that insulin itself causes insulin resistance i.e. the levels of insulin resistance goes up and up. This is a protective mechanism and a very good thing, which is why the body does it.

not-functioning-insulin-receptor1

If the body did not develop resistance to insulin, the high levels of insulin would rapidly lead to very, very low blood sugars.  This severe hypoglycemia would quickly lead to seizures and death.  Since we don’t want to die, the body protects itself by developing insulin resistance.  This is a good thing but the bottom line is – high levels of insulin cause insulin resistance ,Taking away the high insulin levels reverses the insulin resistance

What is driving up insulin?

insulin levels are way up the body gains weigh, reducing calorie intake doesn’t matter since the body only further reduce caloric expenditure to match and make the body gain weight. The carbohydrate-insulin hypothesis assumes that carbohydrate intake drives insulin but insulin itself will drive insulin resistance which will increase insulin in a self reinforcing cycle which will be like fat get fatter

vicious-cycle2

 

central part of treating diabetes should be more on how do we reverse that patient from insulin resistance. lets see insulin reaction to macronutrients as follows

glucose-insulin-reaction-to-macronutrients

as you can see clearly when we take carbohydrate insulin spikes which is not we want all we want was to reduce the resistance and utilize the insulin.  Based on the above both insulin and carbohydrate are toxic to the body but dietician will prescribe 1500 calorie diet to Type 2 diabetic patient what a strange.

HbA1C test reliable enough to diagnose T2DM

Red blood cell was the most common type of blood cell , its principal work was to delivering oxygen to body tissues via blood flow through the circulatory system, its structure as shown below

cell-structure-and-organisation-23-728

 

Life time : 100 to 120 days after that new cells will be developed from bone marrow

Hemoglobin : iron containing oxygen transport protein in red blood cells

Glycated Hemoglobin:  Due to non-enzymatic glycation pathway  by hemoglobin’s  exposure to plasma glucose . As average amount of plasma glucose increases  the fraction of glycated hemoglobin also increases in predictable way so to measure average glucose level over 3 months this will be useful to find out the control of blood glucose level in type 2 diabetic patients.

Hb_HbA1c_Comparison_2

 

Is HbA1C is good candidate to diagnose T2DM ?

The answer might be sometimes false positive due to various reasons or other conditions people might face that might require additional test such as Post prandial blood sugar might be needed to confirm.

Given below were some of the cases HbA1c may be spuriously elevated or depressed

  • Recent transfusion
  • Hemolysis or blood loss
  • asplenia
  • Anemia
  • Hemoglobin C disease
  • Chronic alcohol [Skew]
  • ingestion of large amount of vitamin C & E [Skew]

since HbA1c measurement was crucial one so its good to be familiar with factors affecting the test  in general and limitations.

HbA1c was the gold rule to find out the control mechanism of diabetes in that no one has doubt but when it comes to diagnose new diabetic patients that test might interfere with other conditions which will falsify the test result so if there was skewed / elevated result of HbA1c its worth to measure PPBS to confirm or diagnose Type 2 diabetes.

Are we treating type 2 diabetes right?

I am planning to write series of blog posts on what is diabetes , how do we get , prevention, treatment and so on . In this blog post lets see what is Type 2 diabetes and its consequences

Diabetes Mellitus Type 2 or adult on-set diabetes is a metabolic disorder that is characterized by hyperglycemia i.e. high blood sugar in the context of insulin resistance. Pictures worth more than words given below picture will explain difference between normal people and people with diabetesim-1

Symptoms

im-2

Diabetic Epidemic

Due to urbanization and fast moving world diabetic become epidemic due to following reasons

  • Fast food / high sugar items accessibility at ease and cheap
  • Lack of physical activity
  • environmental and other economic factors
  • Genetic i.e. family history

home

  • Diabetes, heart disease and stroke cost $237 Billion in loss on national income during 2005 –2015 (WHO)
  • 25% family income devotes to diabetic are for single diabetic family member
  • Premature deaths +5 million / year
  • diabetic patient dies every 6 sec while 2 new patients are diagnosed
  • Accumulated lifetime cost of diabetes
    • 20-30% – control & monitor
    • 70-80% – Complications
    • Medicines – ???

so based on above picture now you will understand the magnitude and public health crises we are facing .

How do we get diabetes?

  • Change in standards of diagnosis[1997 ADA lowered the per se standard for diagnosing diabetes from a fasting blood glucose level of 140 mg/dL to 126 mg/dL]
  • Insulin resistance
  • Obesity
    • too much deposit of white adipose tissue associated with obesity
    • insufficient mass of functional beta cells
    • glucagon
  • gastric emptying
  • Genetic family tree

in my next blog post we can see how do we get diabetes in detail.

Insulin resistance causes type 2 diabetes

As per my previous post here I am writing follow up post on how people will become diabetes.

Insulin resistance was the most important factor people will become diabetes, lets dig deeper how and why treatment of diabetes might be wrong. lets run through simple case for example if get hurt in leg and you will get swelling around that area and you also get little fever so to treat this case what will be treatment option i.e. you will take pills for hurt or reduce swelling or fever the correct treatment will be to understand the root cause and treatment. so have to take treatment for hurt not for fever !!! 

bottom line was that treatment for real cause not for symptom

since the body auto immune system fight against all hurts we get into via various means.

how this will resonate into treatment of diabetes ?

real culprit for diabetes was Insulin resistance nothing else, so lets find out more on this.

Insulin is peptide hormone produced by beta cells in pancreas, its regulates the metabolism of carbohydrates and fats by promoting the absorption of glucose from the blood to muscles and fat tissues, this also causing fat to be stored rather than used for energy.

Insulin resistant [IR] is a condition in which cells fail to respond to the normal actions of the hormone insulin 

insulin-resistance

    • exposure to excess nutrients causes cells to produce excess reactive oxygen species which in turn shutdown insulin signaling
    • Mitochondria were overloaded with energy i.e. excess nutrients , particularly free fatty acids causes IR
    • suppressing free fatty acids levels restores insulin sensitivity in obese & T2DM
    • if cell takes up more energy than it burns energy accumulates typically in the form of fatty acid metabolites in cytoplasm this causes IR

Hormonal-Obesity-theory-step-2

The bottom line is this – high levels of insulin cause insulin resistance.

 

how do we get excess nutrients to tissues ?

Consuming energy in excess of what the body can constructively use

Fat tissue main work was to accumulate circulating energy excess to keep away from damaging other tissues , once it started accumulating  over the period of time it begins to do its job less efficiently

Increase in energy in cause IR in parallel with fat gain so to speak the weight gain  that’s the very reason for type 2 diabetic patients hard for them to loose weight .

so from the above to treat the diabetic patient should target how to reduce  insulin only not to reduce the blood sugar , people who practice long term calorie restriction for life extension have very low fasting insulin & glucose  suggesting high insulin sensitivity