Preventing and Managing Diabetes

By: Jennifer Darby, PT, DPT, GCS, CPAHA, CEEAA

Diabetes mellites (translated literally means sweet urine) is a metabolic disease that causes high blood sugar.  Consistent high blood sugar affects various parts of the body including kidneys, eyes, the nervous system and other organs.  Insulin, a hormone made by the pancreas, regulates blood sugar.  For the body to convert sugar and/or carbohydrates into energy, first the digestive process breaks the sugar and/or carbohydrates down into glucose and then transfers the glucose into the blood to be absorbed by the cell.  It is in the cell where the glucose can be converted into energy.  Insulin serves as the key that allows the glucose to be brought into the cell.  Without the presence of insulin, the body cannot bring the glucose into the cell, allowing it to remain in the blood.  So, blood sugar rises and stays high.  The body needs to get rid of the excess glucose that is floating around in the blood causing damage.  This happens through the urine, thus its name, diabetes mellites, or as its most often referred to, diabetes.

There are several types of diabetes.  The most common is type 2 diabetes.  Before we dive into the most common form, let’s get familiar with the other types.

Type 1 diabetes is an autoimmune disease that causes the body’s own immune system to attack and destroy the cells in the pancreas that make insulin.  It’s unclear what causes this attack, but about 10% of people have this type of Diabetes.

Type 3 diabetes is associated with Alzheimer’s patients. This type of diabetes occurs when the neurons in the brain become unable to respond to inulin.  Although this type is not yet completely understood, some researchers believe it is related to the cognitive decline that occurs in the disease process.

Type 4 diabetes is the type used to describe age-related insulin resistance that occurs in lean, elderly people.  Thus, although type 4 is like type 2, it is associated with older age, rather than diet and lifestyle.

Type 2 diabetes, the most common type, is caused by diet and lifestyle and to some degree genetics plays a role as well.  Type 2 diabetes arises when the cells become resistant to the insulin.  This occurs when there is a constant bombardment of high blood glucose levels from eating high glycemic index foods.  The pancreas needs to dump a high amount of insulin into the blood, in response to this sudden influx of glucose.  Blood sugar suddenly drops as the high amount of insulin gets all the glucose into the cells.  When blood sugar drops, the person may feel light headed and hungry and reach for a sugary snack which the body begins to crave due to the sudden spike, and then this sudden drop in blood glucose levels.  The sugary snack causes the blood glucose to spike again, pancreas dumps high amounts of insulin into blood and the process continues.  After this process ensues over time, the cell begins to create a resistance to the insulin.  The sudden spiking and then down swinging of blood glucose levels at great amounts in short periods of time create this lack of sensitivity.  Then over time less and less glucose is absorbed into the cell and the metabolism begins to get rid of the excess blood glucose through the urine and type 2 diabetes process has begun.   Genetically some of the population contains genes placing them at a greater risk of developing this condition, however diet and lifestyle play a larger role on weather or not these genes will be turned off or turned on.  So, although some have this genetic predisposition, diet and lifestyle are the key factors in developing this disease.

Now that we know the process of why type 2 diabetes occurs, let talk about the main causes being diet and lifestyle.  Diet is a major player on whether a person will develop type 2 Diabetes.  The food we eat all contain various amounts of sugars.  We assign the sugar content a number that we call a glycemic index.  Glycemic index is a value assigned to foods based on how slowly or quickly those foods cause increases in blood glucose levels.  Remember the quicker the blood sugar increase, the higher the spike in blood glucose and the lower the drop and the higher chance to cause decreased insulin sensitivity over time.  Thus, eating foods that have a lower glycemic index have a much gradual blood glucose change and allow for less insulin to be released and leave the blood sugar levels steadier over a period of time without those large spikes and dips.  A level blood sugar with a gradual rise and gradual drop allows the person to feel satiated for a longer period and reduces the craving for sugary foods, since blood glucose levels do not drop suddenly.  Insulin does not get pumped into the blood in high amounts and the cell remains sensitive to the low levels of insulin and easily absorbs the glucose out of the blood.  Glycemic index tells the person how quickly their body will convert the food they are eating into glucose.  The quicker the conversion the greater spike in blood sugar.  Foods that are considered 55 or less on the glycemic index are considered slow glucose converters and will not spike blood glucose as fast as foods that are higher than 55 on the glycemic index scale.  Regular table sugar is considered a 59 on the glycemic index scale.  Hybridized wheat (Including white or whole wheat flour, white or whole grain breads, pizza, pasta, and cereals) are rated at a level 69 on the glycemic index scale.  Eating these types of foods will not only spike blood sugar levels, they will also not allow the person to feel satiated for very long, thus creating the need to eat more high glycemic index foods.  It becomes a viscous cycle that over time leads to weight gain and type 2 diabetes. 

Exercise is also a key component in preventing and managing diabetes.  Although any aerobic exercise can help lower blood glucose levels, high intensity short interval training programs appear to have a greater influence in not only decreasing weight, by reducing fat storage in the body, but also in decreasing blood sugar levels over a longer period.  Strength training has also been shown to have great long-term effects for both decreasing the chances of developing diabetes as well as controlling blood sugar levels in diabetics.  Specifically, strength training at an 80% of one repetition maximum twice a week for all major muscle groups has been shown to have great effects on long term blood glucose levels.

Type 2 diabetes can be a very debilitating disease, causing nervous system and organ damage.  However, type 2 diabetes is also very preventable and curable in many cases.  Diet and lifestyle play a key role including nutrition and exercise and understanding the disease process is the first step in preventing and/or treating the disease. 

If you would like more information, please check out my webinar, “Nutritional Considerations for the Diabetic Patient,” coming in June on the Summit Professional Education website.