Many healthcare providers believe that type 2 diabetes is irreversible, and once diagnosed, medications are necessary for life. However, naturopathic doctors and holistic practitioners understand the connections between body systems which allows us the opportunity to help patients come off their diabetes medication.
Diagnosis of Type 2 Diabetes
Type 2 Diabetes is most commonly diagnosed through blood work. HbA1C stands for hemoglobin A1c. An elevated HbA1c above 6.5% indicates that blood sugar has been elevated for at least 3 months. Hemoglobin is an important part of the red blood cell. When blood sugar remains high for a long period of time, red blood cells become covered in sugar. We can calculate the percentage of red blood cells in a sample that are covered in sugar, and this is called HbA1c. Because the life of a red blood cell is about 3 months, a high HbA1c indicates that blood sugar has been elevated for at least this amount of time. This time frame also means that in order to accurately see the effects of treatment, blood sugar should not be tested again for a minimum of 3 months after starting a new treatment.
Developing Insulin Resistance
A hallmark of Type 2 Diabetes is also the development of insulin resistance. Insulin is the hormone that takes sugar out of the blood and put it into organs and tissues. When blood sugar remains high, the body begins to protect itself by minimizing the amount of insulin receptors on the surface of the organs. This puts a limit on the maximum amount of sugar that can be brought into a tissue and protects it from damage. But this also means that the body becomes less sensitive to insulin overall.
Insulin resistance is not something that can be directly measured through a blood test, but by a combination of other factors. Fasting blood sugar, fasting lipids, blood pressure and waistline measurements all go into determining the risk of insulin resistance.
Stress Creates Insulin Resistance
It’s no secret that a poor diet, lack of exercise and weight gain can contribute to the development of diabetes. What does a sugar-free diet look like? While obesity is steadily on the rise in Canada, there remains a large population of “skinny” people reporting very high blood sugar levels. Therefore, we know that weight gain alone cannot be the only risk factor. So what’s missing in this picture?
Stress. High stress, excessive anxiety and lack of sleep cause a rise in cortisol throughout the day. Feeling stressed? Read my tips on finding balance. Cortisol is a stress hormone that effectively prepares the fight or flight response after a danger signal. This means elevating blood sugar in order to prepare the muscles for immediate action – to run away. The response is great, but is usually out of context for the situation. As a result of high blood sugar, insulin is released to remove the sugar and store it. When this same phenomenon happens on a daily basis, the constant rising and falling of blood sugar can also trigger insulin resistance. In clinical practice, these are generally the individuals with normal body weight, normal fasting lipids, but very high HbA1c.
Is Insulin Resistance reversible?
Many healthcare practitioners believe that insulin resistance can never be reversed. Working with a single modality, such as diet changes alone, would definitely prove to be difficult. However, a highly motivated individual can reverse insulin resistance with a combination of strict diet, exercise and stress management techniques. How to work out when you really don’t feel like it.
Exercise scientists have been studying the management of blood sugar during exercise for decades. They have looked at walking vs running, walking vs no walking, and the results were the same. Exercise of 150 minutes per week significantly reduces the risk of type 2 diabetes.
When an individual begins to exercise, the demand for oxygen and muscle fuel increases to meet that demand. Muscles use sugar to fuel their contractions. This means, the more you move, the more sugar you use! First, a muscle will use its own stored sugar as fuel. Depending on the intensity and duration of the exercise, insulin will help to bring in circulating sugar from the bloodstream (1). When this fuel runs out, the body will switch to burning adipose tissue and lipid stores.
This makes perfect sense in someone with an efficient insulin metabolism, but theoretically, if a person is insulin resistant, how can they get sugar into their muscles? Exercise scientists explained this too!
Exercise Science in Diabetes
In 2004, a group of researchers studied the use of sugar in women with Type 2 Diabetes during exercise. They found that muscles of insulin resistant women were able to take and use blood sugar just as effectively as those without insulin impairments. It was attributed to a class of exercise-induced proteins called GLUT4 (2). These proteins were found to transport sugar into the muscle, in a completely separate pathway than insulin.
Furthermore, any type of exercise was found to lower insulin resistance for up to 48 hours after (2). This proved that insulin resistance was not permanent and could be reversed with regular exercise at least every 48 hours.
So there you have it! Don’t let anyone ever tell you that diabetes is permanent. The science shows that it can be reversed and insulin sensitivity can return. The hard part is actually doing the work! Reversing diabetes can take a few years of patience and dedication. After all, the development of diabetes usually takes decades. But don’t give up, the proof is in the blood work. Within a matter of months, those numbers can come down. Every small drop in HbA1c percentage will translate into steady weight loss, increased energy and other improvements on a daily basis.
Recipe for Sugar-Free Flourless Banana Bread
References:
(1) Colberg, Sheri R et al. “Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement.” Diabetes care vol. 33,12 (2010): e147-67. doi:10.2337/dc10-9990
(2) Braun B, Sharoff C, Chipkin SR, Beaudoin F: Effects of insulin resistance on substrate utilization during exercise in overweight women. J Appl Physiol2004;97(3):991–7