Friday, December 20, 2019

Type 2 Diabetes - an immune connected disorder?

Personally, I've known that type 2 diabetes was super complicated for many years.

 Type 2 .. while it's suspected that the pancreas doesn't produce insulin or that there's a problem with the organ, research has shown that this isn't the case for everyone and more and more research is starting to find that Type 2 Diabetes is a "symptom" of a larger issue or a secondary issue to something else.

 There's been research connecting it to immune disorders.. which is why I'm posting about it here.

For instance: Diabetes.Co.UK:
"The immune system also plays a part in type 2 diabetes Researchers have linked insulin resistance to high levels of cytokines, which are released in response to inflammation in the body. The immune’s system’s response to inflammation leads to fat cells being unable to respond well to insulin and sees the fat cells releasing fatty acids into the blood, leading to higher than normal levels of cholesterol."
Not to get too technical, but Cytokines are released by various cells including T Cells and Mast Cells (here and here). Mast Cells are triggered to release or degranulate by the immune system (as well as other cells).. this happens when diseases are detected or when exposed to an allergen. For those with any MCAD disease (Mastocytosis or MCAD or Hereditary Alpha Tryptasemia), insulin resistance is going to be hard to avoid.

And this study also linking Type2 to the immune system:
"Our findings provide evidence that an immunometabolic crosstalk between islet-derived IL-33, ILC2s, and myeloid cells fosters insulin secretion."
So if you already have an immune related disease, your chances of developing Type 2 aren't insignificant and you may not be able to entirely avoid it without taking some medical, medicine, or other action.

But you can help yourself a little by investigating just how your body deals with sugars/carbs.

Not too long ago, there was a research study that showed that 1 sugar + 1 sugar did not always equal 2, and it differed from person to person.

Here's the CBS article on it: CBS News: "Huge" differences even though people ate the same foods
Here's one by Science Daily: Science Daily: Blood sugar levels in response to foods are highly individual

One of the reasons it's taken so long for a cure for Type 2 Diabetes, is that it's not a one size fits all disease. What works for one person doesn't always work for the next. (You know, just like there's not a perfect diet that works for everyone.)

If you've been warned that you're heading to Type 2 Diabetes and you have food allergies or autoimmune issues, you're going to want to listen and start NOW with figuring out what works for you and what doesn't.

- Please note.. this is not intended as a replacement for medical advice, but simply as a data gathering method to help inform YOU and YOUR DOCTOR of what is actually going on in your body in relation to sugar consumption, absorption, and processing. -

Many many years ago, I wrote an article here about the best food diary (food journaling) for figuring out your allergens/intolerances. This is still a good method for Type 2 as well.

I explain more in that article about the ins and outs of what to do daily and charting it, but just to explain here as well.

For blood sugar testing, you will want to record the following items.

Your Fasting Blood Sugar (every morning before you eat or drink. Test your BS.)
Your Blood Sugar after every meal (Test 2 hours after every meal.)
Your Weight (same time every day, preferably after waking before eating or drinking)
Water Consumption (this is optional, but if you're not getting enough water it can affect your blood sugar levels and readings)

- If you're wanting to be super anal about this, you can also test your blood sugar before going to sleep as well as if you wake up in the middle of the night with insomnia. Over-testing for BS isn't really a thing so you can test as much as you want, just note that your fingers will get very sore so you'll want to spread the testing around to different fingers or even parts of the body as your meter allows. (To clarify, you can over-test and cause damage if you're using the same spot on your body too much. This can cause nerve damage over extended time. So switch it up.)

Reading the testing.

Normal Blood Sugar Ranges for those without Diabetes

  • Fasting Blood Sugars: 72-99mg/dL
  • Before & After Eating: 80-130 mg/dL
  • High Blood Sugar: 140 mg/dL or greater


Diabetic Blood Sugar Ranges:

  • Fasting Blood Sugar: 80 -130 mg/dL
  • After Eating: less than 180 mg/dL (about 1-2 hours after)
  • High Blood Sugar: greater than 180 mg/dL

See also: American Diabetes Association

If you are not diabetic yet, you should be using the "normal" of blood sugar scale:

If you're not seeing any jumps in your blood sugar no matter what you eat, and your fasting blood sugar is constantly in the normal zone, and your A1C is in the safe zone. Congratulations! You can stop testing and go on with your merry little life. Keep with your current diet, just be mindful about keeping hydrated and exercise.

If you're not seeing any jumps in your blood sugar no matter what you eat, and your fasting blood sugar is constantly in the normal zone, but your A1C is still high (over 6). Then you're missing a piece of the puzzle somewhere. You may want to try testing at 1 hour after eating as well as at 2 hours or possibly before eating AND after eating. There may be issues with gastroparesis or something else causing delays in your sugar processing outside of meal times (aka testing at 2 hours isn't catching it), or you're having sugar dumps (this happens with fight/flight triggers and allergic reactions).. Basically something is going on and you'll want to discuss this with your doctor.

If you're not seeing any jumps in your blood sugar no matter what you eat, BUT your fasting blood sugar is occasionally high.. Congratulations! You're on your way to figuring things out. Note which days your fasting is high, and try to replicate it by eating similarly again, including eating at the same times of day. If you cannot replicate it, and it continues to be randomly occuring.. there may be something else going on. Start writing down symptoms. Did you wake up that night with insomina? Did you drink less water? Did you go some place different?  If you really cannot replicate it (and I don't mean the exact BS number, I mean replicate it being high or low.. aka control it) then you're stuck. Do your best to eat a balanced diet and get some exercise. You can always return to this type of testing/food journaling if things get worse.

If you're seeing some blood sugar jumps with some meals and not others, or every meal, you're going to want to look at your diet.

If jumps are happening every meal, are you eating the same foods every meal? Milk? Wheat? Eggs? Corn? Soy? Are you eating too much or too little protein? Too much carbs or not enough? You're going to want to vary things up to see if removing or adding things makes any difference. Eat simple foods with simple ingredients so you can help narrow this down a bit.

If jumps are happening some meals but not others, you're on your way to getting answers. Make note of the meals that caused the jump. Start removing and adding foods based on that data. Can you replicate the jump? Does it happen every time with the same food? Or only when two foods are eaten together?  (Personally, my biggest jump was pizza. I could eat the cheese fine. The sauce fine. The crust fine. But if I ate them together in the same meal.. Blood sugar jump.)

With this whole process, you're looking to keep your blood sugars steady or even keel. Jumps often come with lows, and if you're not cognizant of this.. you can easily find yourself on a blood sugar rollercoaster as you crave foods during your lows that often can cause spikes.. followed again by lows.. followed by spikes.. and so on. This is not awesome for your body.

Foods that help stabilize blood sugars are fats and proteins.

If you're eating a low fat diet, you should stop. Most low fat diets have more sugar or the carbs in the diet are often just carb with very little to keep blood sugars steady. Moderation is key as well as making sure you're eating good fats. So eat some avocado, not french fries.

There is also several studies out now that eating too low-carb can also be dangerous.

When eating carbs, try to make sure those carbs aren't just easy digestible empty calorie carbs. You're going to want to make sure you're getting adequate dietary fiber (roughage), fats, and proteins with every snack/meal. You don't need to give up items like ice cream or cookies (or at least not yet), but you should go for the full-fat whole milk or heavy cream ice cream.  The fats can help curb sugar jumps/lows, but whole milk/cream ice creams also tend to be less sugar per ounce and the fats in it will make you feel more full quicker so you'll eat less. Cookies made with protein in them or whole grains will also help lessen the sugar spike and keep you going longer.

It's also best to make sure if you're eating something high carb, that it's with a meal and that you're eating protein often with each meal.

Results with diet changes will vary greatly from one person to the next. Diabetes is not a one-size-fits-all kind of thing. Which is why I suggest doing the testing and food journaling to help you figure out what works best for you.

Anyway, I hope this helps. Consult your doctor if you have any questions.

******

As a side note, MUCH of the literature around Type2 Diabetes blames fat for the issue. IMO this is cart/horse. Leading research today is more about inflammation and the immune system, but prejudices abound around fat so it'll be awhile before medicine catches up (if it ever does).

While excess fat can complicate Type2, and heavy excess of fat isn't great for anyone, I believe fat is the symptom of the cascade from the actual problem.

I believe that the immune related issue causing the inflammation, causing the insulin issues.. that that core issue causes a cascade of problems resulting in weight gain BEFORE the inflammation issue or insulin issues are bad enough to be clinically detected.

Should you attempt to lose weight healthily? Should you exercise? Yes. Please do.

But if you're beating yourself up for not being the size/weight you think you should be.. Please don't. The added stress is not helping any of this, and may actually be worsening your inflammation.

Focus on eating right, exercising right, and being healthy. If your immune system is buggered, you may never get the weight off.. but you can make yourself the healthiest and fittest and happiest you can be.

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