Photo: portrait. Caption: Peter J. Nebergall, Ph.D.
Diabetes Mellitus is not one, but two different conditions,
that share the symptom of elevated blood sugars. Type 1 diabetes arises from
insulin deficiency, from the absence of the hormone, and thus type 1 diabetics
need to inject insulin, to preserve life. Type 2 diabetes arises from a body's
inability to correctly and completely use the insulin it is producing, and we
call that initial condition insulin resistance.
What is "insulin resistance?" What do we know about it? How can we
change it? Insulin resistance is a serious condition, closely correlating with
obesity, heart disease, and high blood pressure. We do not know the exact mechanism
of insulin resistance, only that it is a measurable lessening in the body's
ability to metabolize glucose, even though an otherwise adequate supply of insulin
may be present. We don't know what the root cause is, but we suspect it is genetic
(which would explain why type 2 diabetes so much seems to run in families).
Although there is close correlation between obesity and insulin resistance,
it is not simple "cause and effect." Being overweight does not cause
insulin resistance -- even though losing weight does indeed reduce insulin resistance.
There are many overweight people who are not insulin-resistant, and these folks
may never develop type 2 diabetes.
It appears that if a person carries the genetic trait for insulin resistance,
but follows a healthy lifestyle (good diet, not too much of it, plenty of regular
exercise), they may show little or no overt insulin resistance. If that same
person slips into overeating and under-moving, one may expect the insulin resistance
to become overt (obvious and apparent), and perhaps type 2 diabetes to appear.
Taking it further, if such a person, overweight, under-active, takes control
of their lifestyle, loses the weight, and commences a regular exercise program,
the insulin resistance should drop, perhaps even into insignificance. This "diet
and exercise" approach is the core of all good blood glucose self-management
programs. There is no better argument for living a healthy lifestyle.
Insulin resistance as a syndrome cross-correlates with a number of potentially
damaging conditions, most cardiovascular in nature. Although we cannot say which
conditions cause insulin resistance, which are caused by it, and which are merely
covalent, we know that aggressively reducing it, by lifestyle change and/or
by medication, can both improve general health and lessen the severity and likelihood
of diabetes complications.
Talk to your doctor. If you have it, your health care team can help you keep
it under control. If you have progressed to full blown type 2 diabetes, your
doctor can help you treat it, both with lifestyle change and medications, like
Metformin, Actos, and Avandia, that reduce insulin resistance. There is much
that can be done.
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