Type 2 Diabetes
•Last Updated: July 14, 2023
Type 2 diabetes (T2D) is a disease in which blood glucose levels are too high. It is characterized by insulin resistance in muscle, fat, and pancreas cells and an inability of the pancreas to manufacture enough insulin to control blood glucose levels. T2D is strongly associated with excess body fat, and weight loss induced by lifestyle changes is extremely effective for treating T2D.
Type 2 Diabetes falls under theDiabetes & Blood SugarandHealthy Aging & Longevitycategories.
Last Updated:July 14, 2023
Type 2 diabetes (T2D) is a disease in which blood glucose levels are too high. It typically starts with insulin resistance: a condition where cells don’t respond appropriately to insulin. The pancreas then produces more insulin to try and get the cells to respond, but it’s unable to sustain this heightened production over time, resulting in chronically high blood glucose levels.
Most people with T2D do not present with symptoms initially because symptoms develop slowly over several years. People who do present with symptoms may report increased thirst, urination, or hunger, fatigue, blurred vision, and/or numbness or tingling in the feet or hands.
Initial pharmacotherapy generally starts with metformin, which is an older, safe and relatively inexpensive drug. Frequently, other medications are required to control glucose levels, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1 RA). These medications can be particularly beneficial in people at an increased risk of or with established cardiovascular or kidney disease.[2] Up to 35% of people with T2D eventually require insulin to achieve their glycemic targets. Besides glucose-lowering medications, medications or procedures (i.e., metabolic surgery) that facilitate weight loss are also effective for improving glycemic control.
Long-term excess energy intake leads to the accumulation of fat in the liver and pancreas that causes T2D, and calorie restriction can decrease intra-organ fat and put the disease into remission.[5] There is some evidence that high intake of added fructose, in particular, raises the risk of T2D.[6] However, any dietary pattern can be effective for treating and preventing T2D as long as it facilitates an energy deficit and promotes sustained weight loss.[7]
An increase in physical activity is recommended alongside dietary changes to achieve significant weight loss. A combination of aerobic and resistance exercise seems to be best to maximize improvements in glycemic control and health benefits.[8] In people with prediabetes, exercise and weight loss can reduce the risk of progression to T2D by 58%. Psychological interventions, like cognitive behavioral therapy and motivational interviewing, can also improve glycemic control.[9]
The cause of T2D is multifactorial, based on genetic predisposition and environment. Obesity, inflammatory diet, and sedentary lifestyle all contribute to the risk of developing T2D. Abdominal obesity is a strong risk factor for T2D, and leads to the accumulation of more fat in the liver and pancreas than a person can tolerate, which results from long-term excess energy intake.[5]
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Exercise frequently (resistance training and aerobic training are both beneficial), eat better (in this regard, less processed carbohydrates and more vegetables), and lose weight. Supplements can help, but are better when the diet and exercise are in order.
What is insulin sensitivity?
Definitions
Insulin sensitivity is a general phenomena in the body, and can be measured a few ways through studies.
The pancreas (an organ that regulates blood sugar) secretes insulin in response to high blood sugar, and cells (like muscle or fat cells) can absorb blood sugar when stimulated by insulin.
Insulin sensitivity is the relationship between how much insulin needs to be produced in order to deposit a certain amount of glucose. You are insulin sensitive if a small amount of insulin needs to be secreted to deposit a certain amount of glucose, and insulin resistant if a lot of insulin needs to be secreted to deposit the same amount of glucose.
Insulin sensitivity is seen as good as the opposite, insulin resistance, is a major risk factor for the development of Type II diabetes.
Types of Insulin Sensitivity
There are three main types of insulin sensitivity; peripheral insulin sensitivity, hepatic insulin sensitivity, and pancreatic insulin sensitivity.
Peripheral insulin sensitivity is how readily body cells in your periphery tissue, such as muscle and fat, can absorb glucose; either on their own (muscle can absorb glucose when contracted) or when insulin stimulates them. It is the most well-known form of insulin resistance.
Hepatic insulin sensitivity is related to the process of gluconeogenesis, the production of new blood sugar. Usually inflammatory factors prevent insulin from acting in the liver via inducing insulin resistance, and insulin's actions are unable to tell the liver to 'stop' producing glucose.[37][38]
Pancreatic insulin sensitivity is the functioning of the cells that secrete insulin, the beta-cells. If these are damaged or cannot function, insulin resistance can develop. This is more of a concern in disease states like Type I diabetes (insulin insufficiency)[39][40] or Cystic Fibrosis (where the function in physically hindered).[41]
Insulin sensitivity is how effective the body is as using insulin to reduce elevated blood glucose levels, with a greater efficacy being more 'sensitivity' and poorer efficacy being more 'resistant'. When the body becomes too poor at using insulin to reduce blood glucose levels, type II diabetes ensues
Lifestyle
Non-modifiable factors
It seems that insulin sensitivity is negatively associated with age[42] although these may be related more to lifestyle than to age per se.[43] The ability to reverse insulin resistance with exercise does not appear to be different between young and old.[42] Exercise tends to be recommended to older individuals to improve glucose metabolism.[44]
Modifiable factors
There is an association with obesity and insulin resistance, with insulin resistant individuals usually having more body fat. However, this also appears to be lifestyle related as increases in insulin sensitivity can occur without weight loss.[45] Some studies do note more drastic benefits in insulin sensitization in obese individuals, which is probably due to worse baseline statistics.[45]
Exercise
Aerobic Exercise (Ex. Jogging)
Aerobic exercise, or exercise that you can maintain for a prolonged period of time, seems to be able to acutely improve insulin resistance by increasing uptake of glucose into cells. It can increase insulin sensitivity immediately, as a session of 25-60 minutes (at 60-95% VO2 max) for 3-5 days.[46] Improvements can also be seen after a week of aerobic training, when doing mostly 2 short sessions of 25 minutes of walking at 70% VO2 max.[47] Interestingly, the opposite is also true. Voluntary restriction of activity or a drastic increase in sedentary activity can reduce insulin sensitivity in as little as 2 weeks.[48]
Over the long term, aerboic exercise done routinely can preseve beneficial changes in insulin sensitivity.[49]
Insulin sensitivity as a result of exercise can occur independent of weight loss.[45][50] This is not to say that aerobic exercise will not lead to weight loss, as it may.[51] The function of weight loss seems to be a blend of activity and diet, whereas insulin sensitivity increases could occur without changes in the diet.
In regards to hepatic insulin resistance, it has been seen over time periods of 12 weeks light aerobic activity[52][45] but studies lasting 1 week have sometimes noted no difference.[47]
Anaerobic Exercise (Ex. Weightlifting)
Strength exercises (lifting weights usually) is also associated with increasing insulin sensitivity as well as increased muscle mass.[53]
In persons with impaired glucose tolerance, more sets of an exercise tend to be more effective than single sets and higher intensities better than moderate.[54]
The general idea of exercise is that you want to have lean (muscle) mass, and you want it to contract somewhat regularly so it can take up glucose. The more properly functioning muscle mass one has, the better peripheral insulin sensitivity is
Supplementation
Supplements may be either supplements that directly act upon cells to induce insulin sensitizing effects (like resveratrol or carnitine) or may inhibit or otherwise delay carbohydrate uptake (like green tea catechins and perhaps chlorogenic acid)
Using some of these compounds in conjunction with diet/exercise techniques conducive to regaining insulin sensitivity would be advisable.
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