Do you think type 2 diabetes (T2D) is a condition only obese people need to be worried about? Unfortunately not. Even if you’ve had a blood test and not heard back from your surgery, you’re not necessarily in the clear. There are about 5 million people with diabetes in the UK, 90% of which is type 2 diabetes. A further 13.6 million are estimated to have prediabetes, meaning around 27% of the UK population has elevated blood sugar levels.

How do you know if elevated blood glucose is a problem for you?

Elevated blood sugar (glucose) can progress under the radar for years before meeting the clinical definition of pre-diabetes. Even before we see elevated levels on a blood test, the hormone insulin has been chronically elevated in a last-ditch attempt to keep blood glucose under control. Many people only start paying attention to their blood glucose when it goes above the clinically “normal” range, which is too high anyway in my opinion.

One way of assessing your levels is by using a continuous glucose monitor (CGM). This constantly tracks your blood glucose for two weeks giving valuable insights into which foods and other factors (sleep, stress) most impact your levels.

Without a CGM however, we can get a good idea whether someone is insulin resistant by asking ourselves few questions:

• Do you crave carbohydrates?

• Do you crave something sweet after a meal?
• Are you quick to get ‘hangry’?
• Do you have frequent energy crashes?
• Are you weeing more often, particularly at night?
• Do you feel extremely thirsty?
• Do you have abdominal obesity? – defined as a waist of greater than 40” for men and 35” in women. This is not your trouser waist size, it’s the measurement of your waist at the belly button with a relaxed stomach. I actually prefer the waist-height ratio, where you take your height and divide it by your weight (in the same units) I like to see < 1 for men and <0.85 for women.

This isn’t an exhaustive list nor is it saying if you have one or more of the symptoms you definitely have insulin resistance, however the more you experience, the higher the likelihood you are suffering with some degree of insulin resistance and are on the path to type 2 diabetes.

One of the problems with clinical diagnosis of T2D is that by the time you’ve reached the threshold, the condition has been steadily getting worse for years and is well into the disease progression.

What is type 2 diabetes?

Type 2 diabetes is a condition where the body struggles to keep the level of sugar in the blood within a healthy range. If this goes unchecked it can lead to amputations, blindness, and neuropathy (nerve damage). These are just the direct results of chronically elevated blood sugar. Due to the damage elevated blood sugar levels can cause to our blood vessels, T2D is one of the main drivers of cardiovascular disease (heart attacks, strokes). Research suggests impaired glucose metabolism is a leading cause of Alzheimer’s Disease so really the toll of T2D is much larger than the official statistics suggest.

When we eat carbohydrates, particularly refined carbs (think sugar, baked goods, bread, pasta), the food is quickly broken down via digestion and absorbed into our bloodstream. In people with good glucose control, the pancreas responds by secreting a hormone called insulin to move glucose (blood sugar) into the body cells. Someone that is diabetic struggles with this, and glucose stays in the blood for longer than usual, causing damage to the inside of the arteries. Why does this happen? The condition preceding pre-diabetes and T2D is insulin resistance (IR). IR is a state when the body’s cells refuse to respond to the hormone insulin. Instead of glucose entering the cell, it struggles to get in. Imagine a bouncer on the door of a club stopping people entering as they’re already at capacity; the people have to wait in a queue outside. This is the glucose waiting around in your blood vessels, causing damage.

People become insulin resistant for two reasons;

1. There’s already too much glucose in the cell – it’s full
2. The pancreas is not producing enough insulin to shuttle the glucose into body cells.

Glucose is essential to life; it is the primary fuel source for the brain. So much so that even if we don’t eat glucose in the form of carbohydrates, the liver can make glucose. This would’ve been vital from an evolutionary perspective when our ancestors were struggling to forage food and were going through periods of hunger. But now, with our overabundance of cheap, ultra processed, highly palatable food, it’s very easy to overeat and for our cells to become full. Coupled with being sedentary, this becomes a fast track to insulin resistance and type 2 diabetes.

T2D is a condition of civilisation and fortunately in the vast majority of people, changes in diet and lifestyle can fully reverse the condition and it’s not as complicated as you might think.

How do we prevent insulin resistance and type 2 diabetes?

The good news is for most people this is completely reversible. We have a few powerful tools we can use.

1. Diet

T2D is essentially an inability to manage carbohydrate levels. Whilst it can be addressed using different diets, the first approach I like to use is carbohydrate restriction. The chief offenders being sugar sweetened drinks and refined carbohydrates, e.g. chocolate, cakes, sweets, ice cream, sugary drinks. These foods will almost unanimously raise blood glucose sky high.

2. Exercise

Exercise is great for our health for many reasons. When we look at blood glucose management, muscles we train through exercise become more insulin sensitive, meaning less insulin is required to shuttle glucose into our cells. Secondly, the bigger our muscles, the more ‘space’ there is to put glucose.

3. Sleep

Sleep is another incredible, free performance enhancer. Again, specifically for glucose management, we are more insulin sensitive when we’ve had a good night’s sleep. Plus, if we’ve had a poor night of sleep, generally, we make worse dietary choices – we tend to eat more calories than we otherwise would, and those calories skew towards the refined carbohydrates and fats that we want to steer clear of.

4. Stress management

Cortisol, our chief stress hormone, works against insulin meaning we need more insulin to help dispose of the same amount of glucose than we would if cortisol levels were at baseline. Managing stress, particularly before and during eating (avoiding eating at your desk as you’re answering emails, for example) can support healthy blood glucose levels.

5. Gut health

Research has discovered that our gut microbiota, the community of bacteria that live in our intestines, influences our blood glucose and vice-versa. An imbalance of gut bacteria is linked to the development of T2D. Eating a wide variety of coloured vegetables and fruit can support our beneficial bacteria.

Summary

The diagnosis of pre-diabetes and type 2 diabetes is the culmination of years of elevated blood glucose and insulin.

The gold standard that is most widely available is a continuous glucose monitor (CGM), which constantly tracks your blood glucose for two weeks giving valuable insights into which foods and other factors (sleep, stress) most impact your levels.

Exercise, a low energy diet (often in the form of a low carb), adequate sleep (most people require between 6-8 hours) and stress management can all contribute to improved insulin sensitivity and therefore reverse and/or prevent prediabetes and type 2 diabetes.

If you’d like personalised nutrition and lifestyle support for type 2 diabetes prevention, or any other condition you’re concerned about you can book a free discovery call by clicking here. I’d love to welcome you to the clinic in Market Harborough, or if you’re based further afield, I see people via video call.

Photo by Blake Carpenter on Unsplash