Functional Health Services for Your Well Being

Diabetes – Part I

by Alex Boersma

From the Canadian Diabetes Association:

Today, more than 9 million Canadians live with diabetes or prediabetes – a condition that, if left unchecked, puts you at risk of developing type 2 diabetes.  This means that nearly 1 in 4 Canadians either has diabetes or prediabetes.  More than 20 people are diagnosed with the disease every hour of every day.

The serious complications
Diabetes can lead to serious complications and premature death:

  • 80% of Canadians with diabetes die from a heart attack or a stroke;
  • 42% of new kidney dialysis patients in 2004 had diabetes.
  • Diabetes is the single leading cause of blindness in Canada;
  • 7 of 10 non-traumatic limb amputations are the result of diabetes complications;
  • 25% of people with diabetes suffer from depression;
  • The life expectancy for people with type 1 diabetes may be shortened by as much as 15 years; and
  • The life expectancy for people with type 2 diabetes may be shortened by 5 to 10 years.

The cost of diabetes in Canada
Not only is diabetes a personal crisis for people with the disease, it is also a tremendous financial burden for the Canadian healthcare system and society as a whole.  The cost of diabetes for 2010 is approximately $12.2 billion, which is nearly double its level in 2000.  The cost of the disease is expected to rise to $16.9 billion by 2020. Now the country is doing the best possible to allow the use of  CBD UK oils to treat diabetes, it has shown a highly improvement regarding appetite, energy balance and insulin sensitive among others, plus CBD oils can be easier to afford than other treatments.    

Type II Diabetes Mellitus (T2DM) is unquestionably the most pernicious and calamitous disease of the 21st century.  The underlying dysregulation of blood sugar is devastating to both our health and our health care system.  If we are unable to control blood sugar, we will remain impotent in the battle against obesity, heart disease, or probably even cancer.  Oh, and don’t forget blindness, kidney disease, fatty liver disease and depression!  The cost to our vitality as we age will be monumental.  To our health care system, it will be disastrous.

How best to control this emerging epidemic is the subject of considerable debate.  On the one hand, national health institutions such as the Canadian Diabetes Association contend that this is a disease governed by abnormal fat regulation.  These institutions declare that a change in dietary fat consumption is the key to regulating blood sugar, and that carbohydrate consumption is only a minor part of the problem.  On the other hand, there are numerous established clinicians like Drs.  Mary Vernon and Richard Bernstein, who have had great success in controlling and even reversing diabetes by rigorously curtailing carbohydrate consumption and enthusiastically endorsing a high fat diet.

WHAT GIVES?

In order to make an educated decision about how best to avoid becoming diabetic, it is essential that we understand the basics of blood sugar regulation in the human body.  So here goes:

BLOOD SUGAR 101

How much sugar should there be in your blood?

Your body is designed to transport approximately 4 or 5 mmol/l of glucose diluted within the blood.  Since mmol/dl don’t mean much to most of us, let’s use something we can relate to.  5 mmol/l of glucose is equivalent to about a teaspoon of sugar.  So there you have it.  Your body likes to have about a teaspoon of sugar in circulation.  It doesn’t like to have much more, and it doesn’t like to have much less.  In fact:

  • If you have a little more than a teaspoon of sugar in your blood (6 – 7 mmol/l), you start doing damage to your retinas, your kidneys, your arteries and your nerves.
  • If you have a little  less than a teaspoon of sugar in your blood (2 – 3 mmol/l) you will become light headed, dizzy, and unable to think clearly
  • If you get much lower than 1/2 teaspoon, you risk coma and death.

Moral of the story is:  Regulate your blood sugar well or else it will make you very sick or even kill you!  This is why it is so important to understand and prevent diabetes.

You are meant to have this much sugar in your blood.

Not this much!

What makes your blood sugar go up?

Carbohydrate consumption makes your blood sugar go up!  Protein and fat consumption do not make your blood sugar go up.  Unless you are suffering from some fairly advanced metabolic dysfunction, the only thing which will make your blood sugar go up significantly is the consumption of carbohydrates.  It is fair to say that most people would never have blood sugar issues if they spent their entire life on a low carbohydrate (less than 20% of calories from carbohydrate) diet.  Their chances of becoming diabetic would be low, and they would be much less likely to develop heart disease, kidney disease, nerve disorders or sight disorders.

Of course, the chances that you have spent your entire life at less than 20% carb in our carb centric, fat phobic, sugar addicted, grain imbrued world are slim.  For those of us who have spent the bulk of our lives consuming 60% to 80% of our calories in the form of breads, cereals, cookies and granola bars, things are not so simple.  Read on.

Hormones make your blood sugar go up.  In case you didn’t know, your brain needs some glucose to keep functioning.  This is why, when your blood sugar gets too low, you get light headed… that’s your brain needing sugar.  The coma and death part…that’ s your brain without sugar for too long.  Fortunately, you don’t have to eat carbohydrates to provide your brain with sugar.  When your blood sugar drops below about 3/4 of a teaspoon (4mmol/l) your pancreas starts sending out a hormone called glucagon.  Glucagon tells your liver to start turning glycogen (the storage form of glucose) back  into glucose, which it does rather efficiently.  If the liver runs out of glycogen, it starts turning protein into glucose, which it also does rather efficiently.  It uses dietary protein first, but if you haven’t eaten for a while, it will take protein out of the muscles and even (under starvation circumstances) the various organs.  Just so you know, the liver can also turn fat into ketone bodies, which can be used to provide the brain with about half of it’s energy.  Cortisol, the stress hormone, also makes your blood sugar go up, which is why highly stressed people are much more likely to suffer from blood sugar issues. Bulk cbd isolates are rare to find but are well known to help fight stress and similar conditions.
Epinephrine and Growth Hormone also have mechanisms designed to bring blood sugar up.

Just so we’re clear…if your metabolism is working properly (a big if in most North Americans) hormones never bring blood sugar to dangerous levels.  The hormones which regulate blood sugar are designed to protect your brain from starvation and provide you with quick energy in a stressful situation.  They are not designed to turn you into a glucose burning machine long term.

What makes your blood sugar go down?

Insulin.  Although your body has a number of complex hormonal systems designed to keep a small supply of glucose constantly streaming through your brain, it has only one hormone designed to bring your blood sugar down.  That one hormone is called insulin.  Insulin is secreted by the pancreas (as long as the pancreas is still working properly).  Type I Diabetics have a pancreas which is incapable of producing insulin.  If they eat carbohydrates, their blood sugar will go up and stay up….not good.  Type II diabetics have a dysfunctional pancreas.  It may still be capable of producing insulin, but it can not keep up to the extraordinarily high levels of insulin required to make up for the fact that their tissues are resistant to insulin.

How does insulin work?

 

The diagram above provides a simplified example of how insulin works.  The most helpful way to think of insulin is as a key.  Most human cells have receptors to insulin, which we can think of as locks.  When we activate the receptor, we open the lock.  When we open the lock, the cell “opens the door” to glucose.  Insulin is the key (hormone) which opens the lock (receptor) which opens the door (the cell membrane) and allows glucose to enter the cell.  The primary tissues involved in blood sugar regulation are the liver, the muscles and the adipose tissue (fat cells).  If we are to maintain a blood sugar level of about 1 teaspoon in the face of a high carbohydrate diet, it is imperative that we don’t change the locks on the doors in these tissues.

Exercise.  Exercise has a unique effect on blood sugar.  Exercise can open the door to blood sugar in the absence of insulin.  There are some other ways for glucose to enter cells in the absence of insulin, but the effect of exercise is by far the most pronounced.  Basically, when your muscle cells start to run out of glycogen (the storage form of glucose) they send little carrier molecules (called Glut 4) out to the cell membrane in search of more glucose.  These little carrier molecules don’t seem to care whether the  door has been unlocked by insulin or not.  If the door isn’t open, they break through the cell membrane and pick up any glucose molecules that happen to be passing by in the blood stream.  This is very important, especially for people who have changed their insulin receptor locks so that insulin no longer opens them.

The role of exercise in blood sugar regulation is not limited to glut4 molecules breaking through the cell membranes though.  Exercise also improves insulin sensitivity in the muscle cells.  So if you have changed a bunch of your locks, exercise changes some of them back again!  This affect can last for up to 24 hours after a single bout of exercise

How does it all come together?

 Now that we know a little about how each of the components work, let’s take a look at how they cooperate to regulate blood sugar.  It all starts with the pancreas.  The pancreas is full of little sensors which detect blood sugar levels.  When blood sugar gets above about 1 teaspoon, the pancreas starts pushing insulin into the blood.   If the pancreas senses a rapid rise in blood sugar, it will send out a whole bunch of insulin.  If it senses a gradual rise in blood sugar, it will only send out a small dose.  Then it waits to see what happens.  If the dose was appropriate, blood sugar will go down quickly and no more insulin action will be required.  If, however, the keys (insulin) aren’t opening the locks (receptors), blood sugar stays high.  In this case, the pancreas will respond with ever-increasing doses of insulin until blood sugar finally goes down.  This whole process can take less than 10 minutes in the case of a small dose of glucose being consumed by a person who is highly sensitive to insulin (someone who hasn’t changed the locks).  It can also take more than 4 hours if the dose of carbohydrate is large and/or the person absorbing it is highly resistant to insulin (someone with way too much access to a locksmith!).  Remember that the higher the blood sugar gets and the longer it stays high, the more likely it is to do some serious damage!

Presuming your locks are working, it is important to know what happens to all that blood sugar.  In the liver, insulin stimulates the conversion of glucose to glycogen.  The liver is capable of storing about 100 grams (20 teaspoons) of glycogen.  Once the liver is full of glycogen, it will continue to take up glucose, but instead of converting it to glycogen, it turns it into fat.  Some of this fat will be stored by the liver, but most of it will be sent back into the blood stream to be used for energy or stored in the fat cells. (Important caveat – in healthy people, this conversion of sugar to fat – called de-nov0 lipogenesis – contributes only minimally to fat accumulation.  The bulk of dietary carbohydrate is either stored as glycogen or burned preferentially for energy)  In the muscles,  glucose will be burned as fuel or converted to glycogen and stored as potential fuel for future energy requirements.  Depending on how much muscle you have, you can store 300 to 400 g of glycogen (60 to 80 teaspoons) in your muscles.  Once your muscles are full of glycogen, they will become resistant to insulin and will not absorb any more glucose.  In the fat cells, glucose can be absorbed and converted to fat for storage.  (Again, in healthy people eating normal levels of carbohydrate, this doesn’t happen very much)  Insulin helps the fat cells absorb blood sugar, but the fat cells can also take up glucose in the absence of insulin.  As we all know, the fat cells have an almost infinite capacity for storage, and even when they do get full, insulin seems to help the growth of new fat cells.  In the brain, glucose will be used directly for energy.  The brain has no capacity to store glucose, which is why it requires a constant supply.

When blood sugar drops below 1 teaspoon, the body goes into glucose preservation mode.  Your pancreas knows that your brain cannot afford to run out of glucose…bad things will happen!  So your pancreas begins to secrete glucagon.  As we described above, glucagon starts turning glycogen and protein into glucose so that the brain won’t run out of energy.  Glucagon also stimulates the release of fat from the fat cells so that they can be used as energy.  This is an essential piece of the puzzle, since the release and use of fat for energy will spare glucose so that it can be used primarily by the brain.

One other essential part of the puzzle is that insulin inhibits glucagon secretion.  This makes sense, because the presence of insulin means there is plenty of glucose in the blood.  No need for the liver to make more glucose and exacerbate the issue of having damaging levels of sugar in the blood.  Likewise, no need to release fat from the fat cells, since we want the body to burn glucose for energy to help get the blood sugar levels down.  Putting more fat in the blood will only slow down this process.

Summing up:

  • Eating carbohydrates makes blood sugar go up
  • Insulin acts to store blood sugar in liver, muscle and fat tissues
  • Insulin also prevents fat from being released from the fat cells
  • When blood sugar levels drop, insulin levels go down and glucagon is secreted
  • Glucagon tells the liver to make glucose
  • Glucagon also allows the fat cells to release fat for energy

At least that’s how it goes when everything is working properly!

INSULIN RESITANCE – WHO CHANGED THE LOCKS?

 Type II Diabetes is a disease caused by insulin resistance.  The locks have been changed!  The pancreas continues to make plenty of insulin, but the liver, muscle and (eventually) fat cells are reluctant to open the door and let glucose in.  Blood sugar gets high – really high – and stays that way for a long time.  The pancreas tries to keep up by secreting ever higher doses of insulin, which works for a while.  At this point you are not yet diabetic…just insulin resistant.  If you were born with a genetically gifted pancreas, you can keep punching out high doses of insulin for quite some time.  If not, you get to become a diabetic much earlier.  Either way, the pancreas eventually loses it’s ability to produce enough insulin to keep up with demand.  Now you are insulin resistant and insulin deficient…that makes you a type II diabetic.  Congratulations!  You get to move up the date on your death certificate!

The unfortunate truth is that a confirmed diagnosis of type II diabetes, at least within the confines of accepted conventional treatment plans, predicts a shortened life span and practically guarantees early onset of debillitating diseases.

Part II of this series will address the issues of diagnosing, preventing and/or reversing insulin resistance.  Our medical establishment sucks at preventing or diagnosing insulin resistance before serious damage has already been done.  We can and must do better if we expect to live long vibrant lives. 

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