Want to prevent diabetes? What you need to know about the disease and your health – Courier Journal

A topic I have often written about is insulin resistance. My goal is to draw attention to a devastating condition that is growing by leaps and bounds with no end in sight for Americans. What’s more, it’s preventable and if you do the right things, it’s very likely you will improve and ultimately can remove this huge risk to your health.
So here’s what you need to know about insulin resistance and Type 2 diabetes:
When glucose comes out of digestion and into the bloodstream, it is supposed to enter the cells of the body to provide energy. However, to enter cells, glucose must have an escort, and that escort is the hormone, insulin. When there is insulin resistance, insulin is released from the pancreas gland as expected and in a timely fashion; however, it is prevented from doing its job because the cells resist its efforts.
Picture a molecule of glucose floating in the bloodstream escorted by insulin. Normally, insulin attaches to receptors on the cell wall, announcing the delivery of glucose, and the glucose is permitted to enter. However, with insulin resistance, glucose is denied entry and instead stays in the bloodstream, accumulating and eventually causing damage.
To avoid confusion, let’s consider Type 1 vs. Type 2 diabetes. In both cases, blood glucose levels are much too high, but for different reasons. Insulin resistance is the cause of elevated glucose levels in Type 2 diabetes, in approximately 90-95% of all cases. Ample insulin is produced and released, but it is not effective.
In contrast, only approximately 5-10% of diabetics are Type 1. In Type 1 diabetes, the pancreas gland is damaged and cannot produce and release insulin, so insulin resistance is not the problem. Lack of insulin in Type 1 means you must take insulin shots every day.
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As fasted blood glucose concentration increases beyond a healthy level of 70-100 mg/dl, it increasingly attaches to proteins. One of the proteins is in hemoglobin, the principal component of a red blood cell. This allows for an easy and important blood test called the Hemoglobin A1c test, which reports the amount of glucose attached to the protein in hemoglobin. Since this process takes a while, the A1c test is an indication of how much glucose you have had in your bloodstream on average over the previous three months. This is much more valuable information than a typical blood glucose test that is like a snapshot of what is happening at the moment, which could be impacted by many factors.
Currently, it is estimated that one in three adult Americans has prediabetes, and one in 10 has Type 2 diabetes. However, since prediabetes is likely to progress in severity over the years, morphing into Type 2 diabetes, the projection is for the incidence of Type 2 diabetes to double in the not-too-distant future.
Wow! That’s really bad news for our healthcare system.
Why is diabetes so devastating? When there is excess blood glucose for a prolonged period of time, it prevents blood vessels from being able to relax and expand (dilate). This can lead to high blood pressure, plus it reduces blood flow through vessels, denying oxygen to tissues, resulting in damage and possibly death. Amputation of the toes, feet and lower leg are examples of the progression of denying oxygen. Another example is the destruction of tissues in the eye, leading to blindness.
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The exact cause of insulin resistance in prediabetes and Type 2 diabetes is uncertain but a major contributing factor is too much body fat, especially deep belly (visceral) fat located beneath the layer of abdominal muscles. Therefore, step one is to engage in responsible weight management. Unfortunately, for the millions of afflicted Americans, when the choice is to either lose body fat or take a pill, the pill almost always wins. But taking a pill only addresses the symptoms of excess glucose in the blood and doesn’t solve the problem.
Reducing body fat is a long-range approach because fat stores a highly concentrated amount of energy, with a whopping 3,500 calories (kcals) per pound. This means, all things being equal, you have to walk briskly about 35 to 40 miles to lose one pound of fat. And ironically, if you did that, and walked all those miles to a fast-food restaurant, you could immediately replace nearly half of the calories you expended in one sitting (double burger with cheese 550-700 calories, fries 300-500 calories, milkshake 400-550 calories).
Thankfully, much can be accomplished before losing all that body fat. Exercise causes an acute effect to decrease insulin resistance and increase insulin sensitivity. However, you must exercise daily to renew the effects. Moderate exercise like brisk walking is highly effective, but you get a bigger bang for the buck with more intensive exercise. Either way, daily exercise is the antidote with two benefits. One, it exerts an immediate positive effect on insulin resistance on the first day, and two, it contributes to the long-term goal of reducing excess body fat.
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If you are an insulin-resistant Type 2 diabetic, please understand your condition is reversible, and you can change things dramatically with a change in lifestyle. Unfortunately, the vast majority of Type 2 diabetics are unaware of this because when they were diagnosed, they were handed a prescription for pills and sent on their way.
If you are in the prediabetic stage, wake up and take steps to stop the process before it progresses to full-blown Type 2 diabetes.
Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.

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