Diabetes mellitus refers to a group of metabolic disorders characterized by high blood sugar levels. It is estimated that over 530 million adults worldwide have diabetes, and incidence is rising in children and adolescents as well. In this article, we will explore what diabetes is, what causes it, how to reduce the risk of developing it, and whether it can be cured.
Overview of Diabetes
Diabetes is often classified into two main types:
Type 1 Diabetes
- Also called insulin-dependent diabetes
- Pancreas stops producing insulin due to autoimmune destruction of beta cells
- Accounts for 5-10% of diabetes cases
- Usually occurs in childhood or early teen years, but can happen later in life
Type 2 Diabetes
- Also called non-insulin dependent diabetes
- Pancreas still produces insulin, but cells become resistant to its effects
- Accounts for 90-95% of diabetes cases
- Usually occurs in adulthood
In both types, the end result is elevated blood glucose levels, also known as high blood sugar. But what exactly is happening in the body to cause this?
The Role of the Pancreas and Insulin
To understand diabetes, we must first understand the role of the pancreas. The pancreas has both exocrine and endocrine functions. Its exocrine role involves secreting pancreatic enzymes into the small intestine to aid digestion. But in relation to diabetes, we are mostly concerned with its endocrine function.
The endocrine pancreas consists of cell clusters called the islets of Langerhans. These islets contain beta cells that produce the hormone insulin. Insulin plays a key role in blood glucose regulation by enabling cells throughout the body to take up glucose from the bloodstream and use it for energy.
After a meal, glucose levels rise as carbohydrates are broken down and absorbed into the bloodstream. In response, the pancreas secretes insulin. Insulin allows cells to take up glucose, thereby lowering blood sugar levels.
Now let’s look at how insulin dysfunction contributes to the two types of diabetes:
Type 1 Diabetes: Autoimmune Destruction of Insulin-Producing Cells
In type 1 diabetes, the body’s immune system attacks and destroys the insulin-producing beta cells of the pancreas. This leaves the body unable to produce any insulin at all. Without insulin to shuttle glucose into cells, blood sugar levels climb dangerously high.
Type 2 Diabetes: Insulin Resistance
In type 2 diabetes, the pancreas still produces insulin. However, cells throughout the body become resistant to insulin’s effects. This means insulin is less able to stimulate glucose uptake. With glucose uptake impaired, blood sugar levels rise.
Initially, the pancreas tries to compensate by producing more insulin. But over time, insulin production declines as pancreatic beta cells weaken and die off. Ultimately, many type 2 diabetics also require insulin injections.
What causes this cellular resistance to insulin in type 2 diabetes? Research suggests excess body fat plays a major role.
The Role of Body Fat in Insulin Resistance
People with more body fat, especially abdominal fat, have a much higher risk of developing type 2 diabetes and insulin resistance. But why?
Fat cells release hormones called adipokines. As body fat increases, so do levels of adipokines in the bloodstream. These adipokines make cells resistant to insulin’s effects.
When people with type 2 diabetes lose weight and reduce body fat, their insulin resistance and diabetes often improve significantly. This strongly supports the link between excess fat and insulin resistance.
While a genetic predisposition does play a role, lifestyle factors like diet and exercise also have a major influence on body fat levels. This means we have some power to reduce diabetes risk through lifestyle changes.
Risk Factors for Type 2 Diabetes
Unmodifiable risk factors:
- Family history of type 2 diabetes
- Certain ethnic backgrounds
Modifiable risk factors:
- Overweight/obesity
- Physical inactivity
- Unhealthy diet
Genetics load the gun, but lifestyle pulls the trigger when it comes to type 2 diabetes. Let’s look at lifestyle changes that can help prevent or manage this disease.
Lifestyle Changes to Prevent and Treat Type 2 Diabetes
While no “perfect” diet exists, certain eating patterns have been shown to reduce diabetes risk, including:
- Emphasizing whole, minimally processed foods
- Limiting added sugars, refined grains, and unhealthy fats
- Ensuring adequate intake of produce, lean proteins, healthy fats, and fiber
Beyond nutrition, physical activity may be the closest thing we have to a “magic bullet” for diabetes prevention and treatment.
Here’s why exercise is so beneficial:
Increases Insulin Sensitivity
- Exercising muscles can take up glucose without needing insulin
- Muscles become extra sensitive to insulin immediately after exercise
- With regular exercise, insulin sensitivity improves long-term
Enhances Metabolic Flexibility
- Increases number of glucose transporters and metabolic enzymes
- Grows more mitochondria (“powerhouses” that burn fuel)
- Allows cells to become “metabolically flexible” in utilizing carbs and fats
Reduces Body Fat
- Increases calories burned through higher metabolic rate
- Helps create calorie deficit needed for fat loss
- Loss of body fat improves insulin resistance
For those already diagnosed with type 2 diabetes, medications are often used alongside lifestyle changes. Common drug classes include:
- Biguanides (Metformin)
- Sulfonylureas
- Meglitinides
- Thiazolidinediones
- SGLT2 inhibitors
- DPP-4 inhibitors
- GLP-1 receptor agonists
But can diabetes ever be fully cured? Let’s explore this next.
Can Diabetes Be Cured?
For type 1 diabetes, the short answer is no. Because the insulin-producing cells have been destroyed, type 1 diabetics will always require insulin injections to survive.
But for type 2 diabetes, remission is possible in some cases. Remission means blood sugar levels can be maintained in the normal range without medication. This is sometimes achieved through:
- Substantial weight loss
- Significant lifestyle changes in diet and exercise habits
- Bariatric surgery procedures like gastric bypass
However, remission does not necessarily mean diabetes is “cured” long-term. Lifestyle lapses or natural aging may cause blood sugars to creep up again. Some experts argue remission should be viewed as diabetes being in a state of dormancy rather than eradicated.
But the possibility of remission does provide hope and underscores the importance of lifestyle in managing type 2 diabetes. Even if not cured, the disease can often be effectively controlled through diet, activity, and medication.
Diabetes Managed Through Lifestyle Interventions
While no true “cure” exists, diabetes can often be prevented or managed successfully through lifestyle interventions. Eating well, staying active, and maintaining a healthy body weight go a long way in reducing diabetes risk and improving outcomes in those already diagnosed. Medicine provides additional tools for glycemic control.
Although diabetes prevalence is rising, awareness and education give us the power to blunt its impact through smart lifestyle choices and vigilant monitoring. Taking charge of risk factors within our control provides the best defense against this disease.
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