What is diabetes?

A big part of my day is explaining diabetes to patients. It's easy to get lost in the medical jargon. When you keep it simple, it's easier to understand what you can and cannot control (video below!)

Whenever you eat foods that have the chemistry of carbohydrate, that becomes blood sugar (aka, blood glucose). Not just sugar becomes blood sugar - "sugar" is just 1 type of carbohydrate. Blood sugar is not evil - it's what the body uses for energy! Our muscles, brain, and organs all use it for energy. 

Once the body converts the carbohydrate to blood sugar, it travels throughout our body via the blood stream. The blood stream is like a highway that deliver nutrients and fuel to our muscles. On the muscle, there is a door that controls whether or not (and how much) blood sugar gets inside. That door is the problem in pre-diabetes and type 2 diabetes - it's not opening as well as it used to. People with pre-diabetes and type 2 diabetes have the key to the door (insulin) but the door itself isn't working well. 

So the more carbohydrate you eat, the more blood sugar you have trying to through the door, inside the muscle. Because the door isn't working well, it spends more time in the blood stream, waiting to go where it belongs. 

(You can also think about the blood stream like a highway with exit ramps delivering to various neighborhoods. Blood sugar are the cars. When you close an exit ramp, traffic still moves, but far slower than when the ramp was 100% open. If you put a LOT of cars on the highway (such as rush hour) it takes even longer to get where you want to go).  

Our goal is to 

1. Fix the door
2. Reduce the amount of blood sugar waiting to get inside the muscle

There's a lot we do and do not know about type 2 diabetes. We do not have any hard and fast answers about why the door closes, but we have some information about what makes it more likely that the door will close.

What most commonly affects the door...

• Genetics
  • We know genetics can play a role in whether or not someone develops diabetes but it's not a factor for everyone. But we can't control our genetics. What's more, some people are the first in their families to develop type 2 diabetes while others can name a number of immediate family members affected. 
• Physical activity and muscle mass
  • The more muscle you have, the more doors there are! Strength training is a great way to reduce blood sugar long term
  • When you move, the muscle demands more energy so it forces the door open and welcomes blood sugar inside where it belongs. The more intense the physical activity, the longer the door is open in the hours that follow
• Alcohol and tobacco
  • Excessive alcohol (>1 drink / day for women and >2 drinks / day for men) has been shown to increase the risk of developing type 2 diabetes
  • Tobacco has been shown to increase the risk of developing diabetes. There's no safe / recommended amount to smoke
• Saturated fat 
  • Saturated fat is a type of fat most commonly found in animal based foods. The higher the fat content of that animal based food, the more saturated fat it has. Reducing the amount of butter, bacon, sausage, cheese, fried foods, desserts, salami, pastrami, bologna has been found to be helpful to reduce insulin resistance. Animal products like low fat dairy and lean proteins (chicken, turkey, fish, lean beef, lean pork) have been found to be less of a problem

So what creates blood sugar?

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Stay tuned for part 2!