What is Diabetes?

Simply put, diabetes is a disorder of blood sugar (glucose) and insulin. In diabetes, something is wrong with the way a person makes and/or uses insulin, a pancreatic hormone that lowers blood sugar by moving it out of the bloodstream and into the body’s cells.

Type 1 diabetes results when, for autoimmune or other rare reasons, the pancreas becomes damaged and fails to produce insulin. This form of diabetes is most often diagnosed in childhood but can occur in adults.

In type 2 diabetes, there are defects in both the production of insulin by the pancreas (insulin deficiency) and the use of insulin by the body (insulin resistance). When damage to the pancreas’ insulin-producing cells progresses to the point where the pancreas can no longer spontaneously release enough insulin to overcome the body’s resistance to it, blood sugar levels rise.

Excess glucose in the blood is a problem because it can damage blood vessels. What’s more, the body’s tissues can’t effectively use glucose for energy because too much of it stays in the bloodstream instead of entering the cells.

It is important to recognize that high glucose levels are a consequence of an underlying process that has been going on for years before blood sugar becomes high. To explain: early on the road to developing high blood sugar and getting diagnosed with type 2 diabetes, an insulin-resistant person usually has too much insulin in the blood. This is due to the pancreas reacting to the death and/or dysfunction of its insulin-producing beta cells.

Essentially, the pancreas realizes that it has two problems: its overall ability to make insulin is getting worse, and the insulin that it is able to make isn’t working very well. So, the pancreas cranks out more insulin to flood the body’s insulin receptors and overcome the resistance. This works to keep blood sugars normal, until so much beta cell function is lost that the pancreas can no longer crank out excess insulin.

Other than its implications for blood glucose and the progression of type 2 diabetes, why is it bad to have high insulin levels?

Insulin increases the storage of fat and reduces the body’s ability to use fat for fuel. This can lead to weight gain, which plays an integral role in the development and worsening of insulin resistance. Left unchecked, you can see how this will lead to a vicious cycle: insulin resistance leads to high insulin levels, which make it easier to gain weight by accumulating fat, which increases insulin resistance, which leads to high insulin levels, which leads to more weight gain, and so on goes the cycle.

The good news is that diet and exercise can help decrease insulin resistance and its associated weight gain, which may help prevent or even reverse diabetes.

Testing Blood Sugar

How do you know if you have too much sugar in your blood? If you don’t know already, it’s simple to test in a few seconds, either in your doctor’s office or with your own inexpensive blood glucose meter.

If you are testing your blood sugar at home, read and follow the directions that come with your blood sugar meter. For most meters, the general procedure goes like this:

With clean hands, place a test strip in your blood sugar meter.
Prick the side of a finger with the lancet to draw a drop of blood.
Place the tip of the test strip on the drop of blood.
After a few seconds, the blood sugar meter will give you a reading.

Compare your own blood sugar reading with the ranges below:

Normal blood sugar: Less than 100 mg/dL (5.6 mmol/L ) after fasting overnight, and up to 140 mg/dL (7.8 mmol/L ) two hours after a meal
Prediabetes: Between 100-125 mg/dL (5.6-7.0 mmol/L) after fasting overnight
Diabetes: 126 mg/dL (7.0 mmol/L) or higher after fasting overnight, or higher than 200 mg/dL (11.1 mmol/L) at any time

Keep in mind that glucometer readings are not considered accurate enough to make a diagnosis of diabetes or prediabetes. If your blood sugar is high on a glucometer, ask your doctor to run a regular blood test to confirm the diagnosis.

The Science of

Diabetes Reversal

In 2019, the American Diabetes Association (ADA) stated that reducing carbohydrate intake was the most effective nutritional strategy for improving blood sugar control in those with diabetes.

Research shows that low-carb diets are a safe and effective option for treating type 2 diabetes. This body of evidence includes systematic reviews and meta-analyses of randomized controlled trials.

A meta-analysis from 2017 found that low-carb diets reduced the need for diabetes medication and also improved certain bio-markers in people with type 2 diabetes. This included reductions in hemoglobin A1c (HbA1c), triglycerides, and blood pressure; and increases in high-density lipoprotein (HDL) cholesterol, sometimes called the “good” cholesterol.

Additionally, in a non-randomized trial from Virta Health, the intervention group of subjects with type 2 diabetes followed a very low-carb diet and received remote monitoring by physicians and health coaches. After one year, 94% of those in the low-carb group had reduced or stopped their insulin use. Furthermore, 25% had an HgbA1c in the normal range without needing any medications, suggesting their disease was in remission, and an additional 35% did the same with only metformin. At the two-year mark, a high proportion of subjects continued to demonstrate sustained improvements in glycemic control.

This evidence suggests that type 2 diabetes does not have to be a progressive and irreversible disease. It is clearly a treatable disease when an effective lifestyle intervention is used.