Type 2 Diabetes

Unlike Type 1 Diabetes, Type 2 Diabetes is initially not due to an insulin shortage, but rather to the body's cells inability to use insulin and glucose. The hormone insulin is like the key to a lock that opens the door of the cell to let glucose, the cell's fuel, into the cell. Long before blood sugar rises, the lock mechanism becomes dysfunctional. Insulin is not as able to easily unlock it, and glucose cannot get into the cell as easily. The pancreas reads this slight rise in blood sugar and puts out more insulin to "flood" the locks with keys. But the locks are no longer perfect and the extra insulin only helps a little bit. In time, as the locks become more dysfunctional, blood sugar rises more and the extra insulin isn't enough. Once the fasting blood glucose passes 126, a diagnosis of Diabetes is made.

This dysfunctional lock and key analogy is known as Insulin Resistance, and it is the underlying disorder in Type 2 Diabetes.

Why cells become insulin resistant is not fully known. Certainly heredity is a factor in many people. One way to tell if you may have the insulin resistance gene or genes is to look at your body type. The type known as "apples", big middles but thin arms and legs, usually have this predisposition. Apples, unfortunately, cannot afford to carry even 20 lbs of extra weight, partly because all the weight goes right to the abdomen, and much of it is under the abdominal wall. This "omentum" - meaning in the abdomen - fat is all around the internal organs, a dangerous place for fat to be. My husband is an apple, and works at keeping Diabetes away.

Obesity is a known cause of insulin resistance, as is a sedentary lifestyle. Remember the Pimas, whose ancestors did not develop Type 2 Diabetes in spite of having the genetic predisposition. The combination of obesity and a sedentary lifestyle is a double whammy. It's where I was at age 48, with a fasting blood glucose of 115. Now,many pounds lighter and quite fit, it is usually 80. I think we need to consider Type 2 Diabetes, and other disorders as well, as lifestyle diseases.

At the same program at Baylor that I mentioned earlier, Dr. Garber told us the most potent treatment for insulin resistance is exercise. How intense? I asked. Hmmm. Let me make it easy, he said, you gotta sweat. Recent research has quantified the intensity issue, which I'll explain later. But weightlifting, or resistance training in some form needs to be part of the solution. Personal trainers who train people to help them lose weight emphasize the importance of weightlifting 2 to 3 times a week. Even if you don't need to lose weight per se, but want to help your body overcome insulin resistance, weightlifting must be part of your routine. A very recent discovery may reveal part of the reason why its so important. The cells in our bones that build bone are known as osteoblasts. Osteoblasts are stimulated when they are "pulled on" by muscles working against resistance. So weightlifting helps prevent and treat osteoporosis by stimulating osteoblasts. But the recent discovery is that osteocalcin, which is a hormone produced by osteoblasts, directly lowers blood sugar. A Pharmaceutical Company is probably trying to figure out how to make osteocalcin and test whether it can be administered orally to lower blood sugar. But a Personal Trainer will explain to Diabetics and Pre-diabetics that weightlifting lowers blood sugar. The other benefit of weightlifting is building of more muscle, metabolically very active tissue, to help you burn more calories even when you are doing nothing!

Merry, I'm almost finished answering your question! The practical "how to" stuff is next.