Diabetes In A Nutshell

In order to understand type II diabetes, you have to understand metabolic syndrome. 

Metabolic syndrome is caused by abnormal blood glucose regulation. Though many things can interfere with proper blood glucose control, including certain medications and/or chronic conditions, 90% of the metabolic syndrome we see in modernity is lifestyle related. Diet and exercise are the main lifestyle factors that contribute to this condition. Metabolic syndrome is not a true "disease". It is a metabolic adaptation towards "starvation". This means metabolism is now adapted to behave as if you are starving. People with metabolic syndrome break down their bodies and everything they eat into glucose (hyperglycemia) and they store and spare body fat (obesity). This is exactly what would occur if you were starving. But why is this happening if you aren't truly starving?

The abnormal blood glucose regulation which causes this "starvation" response is initiated by large disparities between high (postprandial) and low (fasting) blood glucose. When you eat a high carbohydrate diet, postprandial blood glucose has an abnormal rise. This causes a prolonged overexpression of insulin in order to clear it. Because insulin had to be overexpressed, blood glucose clearance continues into the fasted state, dropping it too low. It is these lows that trigger the "starvation" mechanism. Low blood glucose is always interpreted as starvation by the body. The body likes to keep its blood glucose well regulated, within a narrow range, so these fluctuations are detrimental to that goal. Hyperglycemia causes heart disease, kidney damage and neuropathy. Hypoglycemia causes type II diabetes.

These disparities in blood glucose deteriorate insulin function (insulin resistance) over time, causing metabolic syndrome and ending in type II diabetes. Type II diabetes is the end stage of metabolic syndrome. At this stage, the body tries to keep its blood glucose as high as it can, fasted or not, as a protective mechanism against lows. So in essence, type II diabetes is an adaptation towards hyperglycemia and insulin resistance is what helps perpetuate this goal. Insulin resistance occurs in multiple tissues to varying degrees and rates. This includes glucoregulatory systems including the hypothalamic/pituitary/adrenal axis (stress response) and energy utilization (ability to burn body fat). This is why people with metabolic syndrome create excess blood glucose and have excess body fat. 

That’s it. That’s the basics without all the unnecessary filler. Anything else is just plain BS. Everything you need to know is written above. If you want to prevent metabolic syndrome, you have to prevent blood glucose disparities. If you want to reverse metabolic syndrome or put your type II diabetes into remission, you have to lessen blood glucose disparities and then wait and see if you can regain proper insulin function over time.

How much disparity is too much? This is one of the most highly contested topics, when it comes to diabetes. You will get multiple different answers, depending on who you ask. In fact, many cannot even agree on what normal blood glucose is. Because of this, the current guide is pathology. This means that the blood glucose number with the least pathology is considered "normal". A lot of diabetics fall in that range. They simply have high blood glucose without any current pathology. This is why what's considered "normal blood glucose" keeps rising yearly, just like what's considered normal cholesterol keeps dropping.

So, since no one truly knows, let's guide ourselves by the most common consensus. The current consensus states that "normal" blood glucose is between 70 - 99 mg/dL, while fasting, and postprandial blood glucose, at the 2 hour mark, should be less than 140 mg/dL. This means that there should not be a persistent disparity in blood glucose, between fasting and postprandial numbers, of more than around 40 points. This is if you start with the lowest fasting blood glucose number of 70 mg/dL.

What we know, for a fact, is that healthy individuals have a fasting blood glucose of around 84 mg/dL and a postprandial blood glucose, at the 2 hour mark, of guess what? Around 84 mg/dL. This means they have no persistent disparities in blood glucose at all. Their blood glucose returns to baseline before 2 hours and it doesn't go lower than 84 mg/dL after 2 hours.

But most importantly of all, their fasting blood glucose does not go much lower than 84 mg/dL at any time, not just around meals. People with metabolic syndrome have much lower dips in blood glucose, sometimes all the way to the 60's and even 50's mg/dL, particularly during the night time fast. This is why they wake up with raging "Dawn Phenomenon".

This is very important to note because in the healthy, insulin does not continue clearing blood glucose while fasting. This means their insulin release was never above normal postprandially because their blood glucose never went above normal. This preserves normal blood glucose regulation and that is the key to remaining metabolically healthy.