No Diabetes is not a disease. Diabetes is at least two diseases, maybe three. They revolve around insulin and glucose.
Insulin is a messenger that tells most every cell to take in glucose. Simple as that.
Glucose is a sugar that is used as energy currency in the body- every cell can use it to make all cellular processes go.
The first disease we call Type 1 Diabetes, or DM1 for short. It happens when the cells that produce insulin get killed by an autoimmune response by your body. Usually this happens in childhood. So literally no insulin would be in the blood without it being injected, or a pancreas transplant happening. In 1923 Banting and received the in Medicine for discovering insulin. This was a huge discovery because before insulin, type one diabetics (and maybe poorly controlled type 2 diabetics) could only be treated by a starvation diet- almost no carbohydrates (All carbs get turned to glucose by our metabolism, which causes lots of problems for a type 1 diabetic without any insulin) and mainly protein and fat. Below is a picture of pre-insulin in DM1 with a small child on starvation therapy, and post insulin treatment in DM1 – same kid! Insulin is magic for type 1 diabetics. Without it energy in the form of glucose goes right through the human body (causing lots of problems first).
So no, unless you want to look like the child on the left, only diet control and no insulin is a poor idea in DM1. Some patients will riskily stop some or all insulin to lose weight (usually in the teenage years). This usually results in life and limb threatening high blood sugar, and ketoacidosis which will make you very sick (ICU sick). In Diabetic Ketoacidosis (DKA) your body is in a sea of glucose floating in your blood stream, but there is not a drop to drink. The body shifts metabolism to ketosis (this is “starvation mode”) where muscle is broken down to make a little sugar and fat is broken down and you end up with ketones and the blood becomes very acid and normal life cannot go on. High sugar pulls water with it and the kidney loses this over time so severe dehydration also occurs at the same time. DKA is unique to DM1 and perhaps the rare third type of diabetes called secondary diabetes because in these types absolutely no insulin is present.
Nutrition is still one of the most important issues in type 1 diabetics. The above is to show that nutrition alone will not work very well in DM1. Nutrition is often seen rather coarsely in medical science. Instead of talking about the quality of food and how it was grown or what is added, which is difficult to study and assess, we stick to what we are certain of and that is the macronutrients- Carbohydrates, Protein, Fat. It would be silly for me as a medical doctor to be completely dismissive of different nutrition or supplements or properly grown and prepared food of organic or biodynamic quality- but it may go beyond this question. I would actually highly entertain that these things may help completely answer this question.
Basically carbohydrates are the key thing to watch. Typically 45 grams to 60 grams of carbohydrate should be eaten per meal in conventional recommendations. The less simple carbohydrates like sugar and sweet things like fruit, the better as these will spike blood sugar faster than complex carbohydrates. A typical diabetic (of any type) can usually be well controlled with a good regimen of diet and or medicine. With type 1 and secondary diabetics this is always and medicine.
There is something unique about DM1. In all types of diabetes mellitus (through high blood sugar) two types of bad things happen:
Microvascular disease– this includes changes to small blood vessels affecting mainly the eye, kidney, nerves.
Macrovascular disease– predisposes to stroke, heart attack, and diseases of other large blood vessels.
Having reasonably well controlled blood sugar helps all diabetics avoid the microvascularcomplications. We have strong evidence that Type 1 Diabetics will have better odds to avoid the macrovascular complications if their blood sugars are well controlled.
Somehow, we are stumped with Type 2 Diabetics (DM2)– though we are certain good control helps the microvascular issues, we don’t have good evidence that it helps avoid the macrovascular issues at all. So more evidence that we are dealing with at least two different diseases. We have a lot more diabetics that are DM2 and heart attacks and stroke are really bad things e would like to prevent in them (that is why we stress other methods like cholesterol).
What is Type 2 Diabetes? Mostly it develops during life as several problems with the metabolism occur. These problems all create a high insulin resistance. Your body cells still have insulin telling them to take in glucose but they need a whole lot more insulin to actually respond to the message.
High insulin resistance has three main causes.
Overweight– the more extra weight you carry, the higher your insulin resistance Under active– exercise is the best non-pharmaceutical for reducing insulin resistance, at least equivalent to drugs. Genetics– some people can be hugely active and relatively trim and still get DM2, others can be obese and not exercise and go for years without DM2. Please pick good parents!
(Some medicines may increase insulin resistance too but I left that out for simplicity sake).
At least at first in DM2, the pancreas works fine making insulin. As it produces more and more to keep up with insulin resistance it eventually will start to self destruct slowly over time, it also may just stop producing insulin. Perhaps with a human organ it is proper to anthropomorphize a little- the pancreas gets pooped out, gives up, is frustrated. Eventually many with DM2 will need insulin.
There is no doubt that eating a lot of carbohydrates as a diabetic will accelerate this process. But to reduce sugar and control carbs alone (as in the question) only might affect one part of the triad of genetics, overweight, and underactive– it may eventually reduce weight. It does affect the amount of fuel on the fire- with less glucose to deal with, the metabolism that does not deal with glucose well won’t be totally overwhelmed. Blood sugars will be better, and if done early enough, especially with regular exercise and weight loss you may never need medicine for blood sugars.
It is a good question- what if you did any of the low carb/no carb diets as a diabetic? Many type 2 diabetics do this. They do lose weight. But these diets may not be completely harmless in the long run. There is controversy here. It looks beneficial. For instance here is results for the Atkins Diet showing good short term results in blood sugar control:
A recently published meta-analysis in the American Journal of Clinical Nutrition reviewed 20 randomized control trials on the effect of various diets on glycemic control, lipids and weight loss in individuals with type 2 diabetes. The results found that a low-carb diet, like the Atkins Diet™, showed greater improvements in glycemic control biomarkers for type 2 diabetics and should be considered in the overall strategy of diabetes management. “We are very encouraged by the findings of the meta-analysis in that it demonstrates the beneficial effects of a low-carb diet among type 2 diabetics. This is critical, considering that the World Health Organization estimates that approximately 347 million people worldwide have diabetes with the majority of those having type 2 diabetes,” said Colette Heimowitz, vice president of education and nutrition at Atkins Nutritionals, Inc. “This steady stream of new research validates the efficacy and safety of low-carb diets, and it continues to supportthe belief that the Atkins Diet is a valid option for people who are looking to address their type 2 diabetes.” In type 2 diabetes, the most common form of the disease, the body either does not produce enough insulin or cells ignore the insulin produced. Several trials documented the benefits of carbohydrate restriction on glycemic control and maintaining weight loss. Most impressively, there was a high level of improvement in the marker for longer term blood sugar readings, which measure the level of glucose, or sugar, in the blood stream (HbA1c). The more glucose that is in the blood, the higher the HbA1c levels will read for patients. Data from eight studies compared low-carb diets with controlled diets and found a significant decrease in the percentage of HbA1c in subjects who consumed low-carbs compared to other diets. These reductions were significant. The researchers (Olubukola Ajala, Patrick English and Jonathan Pinkney) included randomized controlled trials with interventionsthat lasted over six months that compared low-carb, vegetarian, vegan, low-glycemic index (GI), high-fiber, Mediterranean, and high-protein diets with control diets including low-fat, high-GI, American Diabetes Association, European Association for the Study of Diabetes, and low-protein diets. The 20 studies included 3,460 patients with final analyses in 3,073 patients. All participants were over 18 years old and 19 studies included both sexes.
This excerpt from a study showed many side effects though, and we have just not studied these diets for a very long time to look at other more important side effects.
Longer studies have since shown that when dieters are followed for a year, the total weight loss ends up almost the same with the two approaches. The long-term effect on cholesterol has not been studied yet. Experts have suspected that the weight loss on a low-carb diet may be largely due to water loss, because lots of fluid is bound up in the body’s carbohydrate stores that are depleted. However, Astrup said body composition studies indicated the weight loss is a real fat loss, not just water. The most frequent complaints with low-carb diets are constipation and headache, which are readily explained by the lack of fruit, vegetables and whole grains, Astrup said. Also, bad breath, muscle cramps, diarrhea, general weakness and rashes are more often reported on low-carb diets than on low-fat diets, Astrup found.
The third type of diabetes is called Secondary Diabetes. You get diabetes secondary to something that destroys your whole pancreas. A surgeon took out your whole pancreas, or it self destructed by having recurrent pancreatitis. Effectively you are like a Type 1 Diabetic with a handicap. You must have insulin, but because the cells that make glucagon are gone, and glucagon steers the body away from low blood sugar, you are more prone to have low blood sugar ( hypoglycemia). Though anyone can be a brittle diabetic, many people with secondary diabetes are brittle diabetics. Again, diet is important here, but insulin is necessary for life.
, Hospital physician
(Visited 5 times, 1 visits today)
Tags: , , , , , ,
