Nutrition

There are several medications used in the treatment of diabetes. The oldest of these medications is insulin. Insulin is a hormone produced by the pancreas – a gland just below the stomach. Insulin has several functions, but it primarily signals the body to store excess glucose. It does this by helping the body move glucose from the blood into the cells. In type 2 diabetes, there is too much insulin – a response to excess carbohydrate consumption over time. The body’s receptors to insulin become desensitized and the effects of insulin are reduced. The body compensates by releasing even more insulin. Oral medications work by increasing insulin production from the pancreas, increasing the body’s sensitivity to insulin, or reducing how much glucose the liver makes. 

The long-term use of medication for diabetes will eventually fail. In the short-term, they can be a life-saving tool to keep a diabetic from experiencing unsafe blood glucose levels. Over the long-term, however, the goal should be to reduce and eventually eliminate dependance on medication for the treatment of type 2 diabetes. It must be stressed to all diabetics that discontinuing diabetes medication on your own is dangerous. Never alter the doses or stop taking medication without first consulting your doctor. Inform your doctor you are making important changes to your diet and you expect a need less medication as your diabetes improves. This often requires more frequent testing.

All diabetics share one common characteristic – they cannot properly control blood sugar levels. Type 1 diabetes involves an underproduction of insulin, whereas type 2 diabetes involves an overproduction of insulin. Essentially, they are polar opposites. 

Type 1 diabetes is caused by damage to the cells in the pancreas that make insulin. The most common cause is an autoimmune reaction that destroys the insulin producing cells. The details behind that are complex and beyond the scope of this discussion. Type 1 diabetics will always require insulin because their body does not make enough or doesn’t make any at all. Their dependence on insulin can be limited when carbohydrates are limited. How much insulin is required is dictated by how much sugar and carbohydrates are eaten. It’s important to reduce how much insulin is needed because too much insulin will create insulin resistance in a type 1 diabetic. Sadly, they have type 1 diabetes and develop type 2 diabetes over time. This is called double diabetes. 

Although calorie restriction can improve diabetes in the short-term, it will not reverse the disease in the long-term. The calorie in/calorie out model assumes all foods can be reduced to a basic unit of energy – the calorie. It also assumes that our metabolic response to all calories is the same. This is simply not true. And perhaps most significant, we don’t absorb everything we eat or drink. Some of what we eat passes through us every time we go to the bathroom. We also release energy in the form of heat. We’re not a closed energy system. Therefore, there is not a one-to-one relationship with our food and what our body does with that food. 

The body has an interesting response when we reduce our calorie intake – it lowers our basic metabolic rate (BMR). This metabolic rate can change by as much as 40%. So, simply lowering how many calories we eat will not lead to the long-term health benefits that we seek. Also, our metabolic rate is not constant and changes depending on several factors including what we eat, how much we eat, and how active we are on any given day. Changing WHAT you eat, not HOW MUCH you eat is the key.