First let's clear up the Type I and Type II diabetes story. Although they share similarities, the 2 types of diabetes differ significantly.

Type I Diabetes Explained
Type I diabetes typically only occurs in children and young adults - in fact, when I was in medical school it was called juvenile-onset diabetes. Those with type I diabetes need insulin treatment to survive, hence the other previous name, insulin-dependent diabetes. In type I diabetes the body’s immune system attacks the pancreas (the body’s insulin factory) leaving the cells of the pancreas unable to make insulin.

The causes of type I diabetes are not clearly understood, we don’t know what causes the immune system to attack the pancreas, but we do know it is NOT caused by lifestyle, or obesity. Having said that, controlling body weight and exercise are important parts of the treatment.

And Now on to Type II

Type II diabetes was once called adult-onset diabetes, because it once began only later in life. However, starting some 15 years ago, as more children became heavier at earlier ages, type II diabetes has become epidemic in children, adolescents and teenagers.  Of all people with diabetes, 90% have type II diabetes.

Why Does Abdominal Fat Cause Type II Diabetes?

The primary cause of type II diabetes is a phenomenon called insulin resistance. Insulin resistance happens when abdominal fat cells secrete chemicals that literally obliterate the bodies insulin receptors. Understanding why this happens will help you understand why lifestyle changes in eating and exercise, changes that anyone can make, have enormous power to both prevent and/or treat and eliminate type II diabetes!

Normally the insulin receptor sits on tissue such as muscle tissue, and insulin circulates in the blood. The insulin molecule normally fits into the insulin receptor just like a key fits into a lock, opening up the tissue to allow sugar to enter as it leaves the bloodstream. Fat cells in the abdomen, or visceral fat, as I have mentioned in previous blogs, is a unique fat. These fat cells secrete chemical called Adipokines that cause inflammation throughout the body, initiating the changes that lead to the near entire spectrum of obesity related diseases including heart disease, stroke, type II diabetes, high blood pressure, osteoarthritis, breast cancer, colon cancer and gallbladder disease to name a few.

In the case of type II diabetes, the process can be broken easily into three stages:

1. Pre-pre type II diabetes. In this stage, the inflammation caused by the chemical adipokines secreted from the abdominal fat cells causes the insulin receptor to wilt like a flower in the fall, and the insulin (key) that is circulating normally in the blood stream fits less well with the misshapen receptor (lock).  Here the body says, “No problem, because the insulin fits less well, I will just make more insulin”.  The pancreas operates at a fraction of it’s maximum output of insulin. The body turns up the insulin production, the blood sugars stay normal and no one is the wiser. Not the individual and not their doctor, yet the sinister and disease causing effects of type II diabetes have already begun.
2. Pre type II diabetes. In this stage the individual has gained more weight, and more inflammation causing visceral fat. The insulin receptor (lock) has become so misshapen that it has outstripped the body’s capacity to produce more insulin. The factory cannot be pushed past capacity and the blood sugar levels start to rise. This is normally when the individual’s doctor says that your blood sugars are rising and you have now entered the stage called pre- diabetes.
3. Type II diabetes. This stage is really just a higher degree of insulin receptor collapse, whereby the blood sugars now rise to a degree above pre diabetes in to the diabetes range.

That’s the bad news. The rest of this blog is the good news. If you understand how this process happens you can understand how it can be reversed!

How You Can Stop Type II Diabetes

At any of the above stages, weight loss, specifically loss of abdominal fat reverses the whole process. In most cases, when a type II diabetic loses weight, the insulin receptor (lock) returns to its original shape, blooming like a flower in the springtime, accepting insulin (key) normally again. This allows for the transfer of sugars into tissue, reversing and eliminating the disease. Studies have shown that by losing as little as ten percent body weight, pre-diabetes and diabetes may be eliminated.

But be warned. Somewhere around ten years of pancreas running at maximum insulin production, the pancreas will burn out and no longer create insulin. At this stage, weight loss and lifestyle change will not be effective and medication will be needed for life.

Type II diabetes if infamous for deadly and quality of life depleting complications, including heart disease, stroke, amputations, blindness, kidney failure and impotence. This all means that a disease notorious for lethal complications is in most cases reversible through weight loss. If this doesn’t serve as motivation to eat well, exercise and maintain a healthy weight, I don’t know what does.

David A. Macklin MD CCFP