According to the CDC, 1 in every 10 Americans has diabetes. Of that number, over 90% have Type 2 Diabetes (1).
Although the rates of diabetes are continually rising in America, many people don’t know much about the condition. If you’d like to learn more, keep reading below!
Diabetes 101
Generally speaking, diabetes is a condition in which your body cannot properly process carbohydrates. In order to better understand this, lets quickly review how the body should process carbohydrates.
When you digest a carbohydrate-containing food, the carbohydrate portion is converted into a sugar, called glucose, which is released into the blood stream. In response to glucose entering the bloodstream, the pancreas releases a hormone called insulin. Insulin then helps the glucose move into different cells of the body, for use as an energy source.
However, in the case of diabetes, insulin cannot properly move glucose out of the blood, and into the cells. The exact mechanism preventing insulin from working depends on wether someone has type 1 or type 2 diabetes.
Type 1 Diabetes
Type 1 diabetes (T1DM) is an autoimmune disease. The exact cause of T1DM is unknown, but it may develop as a result of an environmental trigger (ex. extreme stress) and genetics (1). T1DM usually develops in childhood, but it can occur at any age. Generally speaking, this form of diabetes occurs when someone’s immune system attacks the pancreatic cells that create insulin. As a result, someone with T1DM cannot create insulin.
Therefore, when someone with T1DM generates glucose, the glucose will remain in their blood, and will not be used by their cells as an energy source. If blood glucose rises to high levels, a condition called hyperglycemia, or high blood sugar, may result. Hyperglycemia can have serious negative health implications, which we will discuss more below.
Due to the risk for hyperglycemia, anyone with T1DM must release exogenous (chemically made) insulin into their blood, especially if they are consuming carbohydrates (which they should be!). There are many types of exogenous insulin available, so type 1 diabetics work closely with their doctors to determine an individualized plan.
Type 2 Diabetes
Type 2 diabetes (T2DM) is a chronic disease. It occurs as a result of several risk factors, and generally develops over time. These risk factors commonly include insulin resistance, being overweight, having a large amount of abdominal fat, being physically inactive, having a family history of diabetes, and having a condition called polycystic ovarian symptom, among others (2). Unlike T1DM, T2DM is generally preventable, by reducing the number of risk factors listed above.
T2DM commonly occurs in adults, but can occur at any age. This form of diabetes generally occurs when a persons cells have become fully resistant to the action of insulin. In other words, their cells no longer recognize insulin, and cannot utilize carbohydrate for energy.In some cases, a person with T2DM may also stop producing insulin. In these situations, they may have to administer exogenous insulin as well, similar to the case of those with T1DM.
As is the case with T1DM, if someone with T2DM consumes too much carbohydrate (without proper disease management), they may experience hyperglycemia. As a result, people with T2DM are often put on medication to improve their insulin resistance, aka to help them better respond to glucose in the blood. However, in some cases, T2DM can also be managed by diet!
Complications Related to Diabetes
Hyperglecemia
As mentioned above, a condition called hyperglycemia can result in the case of either T1DM or T2DM. Hyperglycemia is a condition in which the body’s blood sugar levels rise to higher than normal levels. Common signs of hyperglycemia include increased thirst, blurry vision, fatigue, headache, and frequent urination (3).
People with T1DM must regularly check their blood sugar; therefore, they can quickly address hyperglycemia, and manage it with the administration of insulin (as directed by a doctor or diabetes specialist). However, life threatening conditions, such as diabetic ketoacidosis can result if hyperglycemia is left untreated in T1DM, and blood sugar levels become very high.
In the case of T2DM, hyperglycemia may go undetected for longer periods of time (especially if someone is undiagnosed), and may result in more serious health conditions. If blood sugar levels are chronically elevated to moderately high levels, diabetes will continue to progress, and kidney damage, as well as damage to the nerves (potentially causing blindness and need for amputations) and even the heart, may result. In fact, T2DM is currently the number 1 cause of Kidney Disease in the US. In extreme cases, where blood sugar is very high in T2DM, hyperglycemia can lead to a life threatening condition called a hyperosmolar hyperglycemic state. (Note: people with T2DM should also check blood sugar regularly, but sometimes this doesn’t happen.)
Hypoglycemia
Contrary to hyperglycemia, something called hypoglycemia, or low blood sugar, can also occur in T1DM or T2DM. In either case, signs of hypoglycemia include shakiness, anxiety, sweating, chills, confusion, fast heart rate, dizziness, and hunger (5). Typical advice for correcting low blood sugar is to eat 15 grams of carbohydrate every 15 minutes until blood sugar levels normalize. If blood sugar does not normalize within 30 minutes, consult a doctor.
Insulin Resistance
Insulin resistance occurs as the body begins to develop an immunity to insulin. Diagnosis occurs when someone’s fasting blood sugar is above the “normal” value, but below the criteria for a diabetes diagnosis. In some cases, someone with insulin resistance may be diagnosed with a condition called “prediabetes”. If not managed, insulin resistance often leads to diabetes.
Insulin resistance often develops as a result of overweight status, physical inactivity, genetic predisposition, cardiovascular disease, or polycystic ovarian syndrome (PCOS) (4). As you may have noticed, the risk factors are similar to those for diabetes.
While there is much debate as to how much diet can improve diabetes itself, there is a general agreement that diet and lifestyle changes can help to reverse insulin resistance in some cases. Someone with PCOS, an endocrine disorder, may require serious changes and/or medicine to improve insulin resistance. However, someone who experiences insulin resistance as a result of diet and lifestyle can likely improve their condition via small changes over time. In general, it is believed that weight loss of as little as 5% of someone’s body weight may have a positive impact on insulin control (6)!
Diabetes Management
Ok, so now that we know what diabetes is, how do we take care of it?
T1DM requires medical management. However, you can can manage T2DM through diet and lifestyle. The easiest way to manage T2DM is to prevent it. Therefore, if you think you may be at risk for developing T2DM, weight loss of at least 5% may be a good first step to reducing risks.
Diet is also an important factor in diabetes prevention and management, especially when it comes to carbohydrate intake. There are two main types of carbohydrate: simple carbs, and complex carbs. Simple carbs digest quickly, and have an immediate effect on blood sugar. However, complex carbs contain something called fiber; as a result, they are more slowly digest and have a more gradual effect on blood sugar. Therefore, one of the easiest ways to manage diabetes and/or its risk factors though diet, is to replace simple carbs with complex carbs. Refined (white) grains, baked goods, candy, juice and soda, contain simple carbs while whole grains, fruits and vegetables contain complex carbs.
You should also consider the amount of carbohydrate you consume. One way to help the body maintain constant blood sugar levels throughout the day is to feed it constant blood sugar levels! Therefore, you should aim to consume the same approximate amount of carbohydrate at each meal, if you have diabetes or are at risk. A dietitian can help you determine the right amount of carbohydrate for yourself!
In addition to the carbohydrate considerations above, also consider sugar and fat intake. Limit the amount of sugar sweetened foods and beverages, and saturated fat, in your diet, to help manage T2DM.
Summary
Woah, that was a lot of information- let’s review!
There are two primary types of diabetes: T1DM and T2DM. In either case, the body cannot properly digest and absorb carbohydrates. T1DM is an autoimmune disease which prevents the pancreas from creating insulin. T2DM is a chronic disease that occurs when the body no longer responds to insulin.
To recap- T1DM requires medical management. However, you can can manage T2DM through diet and lifestyle. One way to manage or prevent T2DM is to lose at least 5% of your current body weight. Another way to reduce the risk of development or progression of diabetes is to choose complex carbohydrates over simple carbs. You should also eat a consistent amount of carbohydrate throughout the day.
Diabetes, especially T2DM, is a serious chronic disease in the US. The prevalence is increasing, possibly as a result of our changing diet and lifestyles. T2DM can have serious complications, such as developing kidney disease, heart disease, loss of vision or even amputations. Therefore, it is important to be aware of diabetes and how to manage and prevent the condition!
