Diabetes and weight – what is the link?

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Dear Dr. Mo: What is the link between being overweight and developing Type 2 diabetes? Can diabetes be prevented or cured somehow?

Dear reader: First of all it is worth pointing out that diabetes is a chronic condition. For most types (except gestational type) this chronicity means that once it occurs, it stays for life – this is not a disease we can effectively cure with our present knowledge but we can quite successfully manage it.

Before I go into your question, let me first explain the diabetes landscape and basic mechanisms behind it as Type 2 is not the only game in town.

Diabetes occurs either when the pancreas no longer produces enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.
The danger of diabetes lies in a condition called Hyperglycaemia – raised blood sugar level – which is a common result of uncontrolled/undiagnosed diabetes, which over time causes serious damage to the body, especially to blood vessels and nerves.

Food choices affect our health

Diabetes has its types and these differ in both the ways they start and the ways in which we manage them.

Type 1 Diabetes

This type had previously been known as insulin-dependent, juvenile or childhood-onset diabetes. Here, our pancreas gland becomes deficient in insulin production and there is simply no longer enough of it to properly regulate our blood sugar levels. Management requires daily administration of insulin and this type cannot be prevented with our current understanding as the cause is not known although we do think it is due to the self-inflicting damage to pancreas (process called “auto immune response”).

Symptoms may occur suddenly and include excessive thirst, excessive urination, weight loss, constant hunger, fatigue and changes in vision.

Type 2 Diabetes

This one was previously called non-insulin dependent or adult-onset type and it happens when a body ineffectively uses available insulin – the cells become resistant to this hormone. This type comprises 90% of people with diabetes in the world and this is mostly because of the excess body weight and (total) lack of physical activity.

Symptoms could be similar to Type 1 but because of Type 2’s nature and slow development, they are often undetected and remain under our radars for long until they cause serious damage, irreversible at times.

Before I address your question further, let me just mention another type:

Gestational diabetes

This type has its onset or first detection during pregnancy. Symptoms are similar to Type 2 (like Type 1 only milder). The trick with this one is that it may disappear after pregnancy and never come back or it may stay. In case it goes away, it increases the chances for that woman to develop it later in life by 50% and so she needs to take extra care of her lifestyle.

Now, the relationship between your weight and Type 2 is strong. Type 2 is a preventable disease in most cases.
Whatever the type, some of the common consequences are:

  • Heart disease and stroke – 50% of people with diabetes die of a cardiovascular disease
  • Diabetes could shut down kidneys – up to 20% of people with diabetes die of kidney failure
  • Diabetes causes retinopathy via long term damage to small blood vessels in the retina. 15 years into the disease, 10% will develop severe visual impairment and 2% will become blind
  • Damages to blood flow and to nerves in the feet often result in foot ulcers which are slow to heal and gangrene ending with eventual limb amputation

The list goes on but these are the most common complications of diabetes to be aware of.

Life style corrections have been proven to prevent or delay the onset of this most common Type 2.

What’s crucial is to attain and maintain your healthy weight.

Being overweight or obese dramatically increases the risk for Type 2.
Extra kilograms coupled with hypertension (which is common in overweight people) and raised cholesterol levels in the blood lead to what’s known as Syndrome X or Metabolic syndrome – the antechamber of Type 2. Your waist circumference is the biggest predictor for this condition and consequential Type 2 onset – read about it in my post on Syndrome X.

Polycystic ovary syndrome (PCOS) can also over time induce symptoms of the metabolic syndrome and eventually lead into Type 2 as a complication. PCOS is a common hormonal disorder among women of reproductive age. Infrequent or prolonged menstrual periods, painful menstrual bleeding, excess hair growth, acne and obesity can all occur as symptoms in women with PCOS. If you suspect you may have this condition, speak to your doctor about ways to test for it, diagnose it and if confirmed, manage it.

Physical inactivity fatigues your cardiovascular system and accelerates weight accumulation so it is paramount to have at least 30 minutes of regular, moderate exercise on most days (minimum 5 days a week) – speak to your doctor about what types of exercises are right for you and your health status – do not undertake it on your own.

Healthy diet is a corner stone of our overall health and especially in preventing the metabolic syndrome and subsequent Type 2 diabetes. I’ve written a lot about it so browse my posts and acquaint yourself with the types of food that are good for you. It is not only important what you eat but also how and when you do it and what’s your attitude towards it.

Since smoking increases the risk for cardiovascular diseases, avoid tobacco in any shape or form. If you are a smoker, speak to your doctor about ways to try and quit.

Our modern times have given us abundance of food choices and have suspended the evolutionary necessity to accumulate calories (sadly, this is not the case everywhere and hunger is still present in the world). In such conditions of abundance we tend to eat and drink more than we need and excess calories are turned into fat – our genes have not yet evolved to respond to such food abundance, which almost happened over night, and are still prone to storing the calories for a rainy day. This means that we tend to be increasingly overweight and that diabetes is on the rise.
By investing a mental effort to adjust our diets and increase physical activity in our lives we can do wonders in curbing this epidemic of causality between extra kilograms, diabetes and premature health impairment and death.

Yours in health,

Dr. Mo