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Why does diabetes occur?

By Jenna Miles, Mom, Dietitian, Author, Bitch.

According to the best-quality research we currently have access to, eating sugar and carbohydrate does not directly cause diabetes.

Type 1 diabetes, which used to be called juvenile diabetes but can actually occur at any age, is caused by the autoimmune destruction of the insulin-producing beta cells of the pancreas. Insulin is like that key that unlocks your body’s cells, allowing blood glucose (a.k.a. blood sugar) to come inside. The cell then uses that blood glucose as fuel to do the work it needs to do, kind of like a car uses gasoline for fuel.

So in type 1 diabetes, if you don’t have any insulin, blood glucose is unable to enter your body’s cells. The type 1 diabetic must take insulin in order to allow blood glucose to enter the body’s cells. Otherwise, blood glucose piles up in the bloodstream, rapidly leading to diabetic ketoacidosis (DKA), coma, and death.

Type 2 diabetes happens for a different reason known as insulin resistance. Initially at least, the beta cells are still alive and well, and the pancreas is still producing insulin. But for complex reasons that we still don’t fully understand, the body’s cells have become resistant to that insulin, meaning they are not responding to the insulin. It’s as if the key doesn’t fit into the lock anymore. The body’s cells don’t seem to recognize the insulin anymore, so they’re unable to take up and use blood glucose as fully as they’re supposed to. Once again, blood glucose piles up in the bloodstream. In the long-term this leads to damage to the tiny blood vessels and nerves throughout your body, and that’s what causes the horrible complications of diabetes you hear about — kidney failure and dialysis, wounds that don’t heal, amputations, blindness, nerve damage and nerve pain, and so much more.

Also, in type 2 diabetes, the pancreas is working overtime, trying to put out more insulin in a fruitless effort to lower the amount of blood glucose in the bloodstream. I say “fruitless” because it doesn’t matter how much insulin you put out if the key just flat-out isn’t working anymore. But anyway, since the pancreas is working double-time, eventually it gets burned out. It’s like it blows out your pancreas’ beta cells, and as a result, they stop producing insulin altogether. In this way, uncontrolled type 2 diabetes eventually becomes almost exactly like type 1 diabetes, and the type 2 diabetic winds up requiring insulin injections to replace the lost insulin.

But it’s not eating carbohydrate and sugar that causes either type 1 or type 2 diabetes — at least, not directly. Carbohydrate and sugar (which is just a highly-concentrated form of simple carbohydrate) are the nutrients that naturally raise your blood glucose (a.k.a. blood sugar). This is just as true in people without diabetes as it is in people with diabetes.

Healthy people’s bodies are able to recognize the presence of blood glucose, and then send out insulin which enables the organs to use the blood glucose as fuel. In this way, your body maintains your blood glucose at perfect levels that don’t cause damage.

But remember, people with diabetes are unable to take up and use that blood glucose normally anymore. So it piles up in the bloodstream, causing that condition known colloquially as “high blood sugar.”

So there are a few different ways that a person with diabetes can manage their blood glucose. One is by taking any diabetes medications or insulin exactly as prescribed. Many diabetes pills help the body to decrease its resistance to insulin — meaning they help the body’s cells recognize the insulin “key” once again, so the “key” can work. Insulin injections replace the insulin that the body is no longer producing.

The second way is by watching the amount of carbohydrate (including simple carbs like sugar) that you’re eating. Remember, carb is the nutrient that raises your blood glucose. So if you’re diabetic eat too much carb (including / especially sugar), it raises your blood glucose too high. And remember, chronic high blood glucose causes the complications of diabetes.

But probably the most helpful way that people with diabetes can manage their blood glucose and thereby prevent the complications of diabetes is by getting as close as possible to a healthy body weight for their height.

Why? Because insulin resistance correlates very strongly with being overweight. The higher you are above a healthy body weight, the more insulin resistant you become.


We don’t yet fully understand why this is. It may have something to do with the fact that excess body fat causes increased levels of systemic inflammation all throughout the body. We’re learning more and more about how inflammation lies at the root of so much chronic disease, including diabetes.

But in the meantime, the most effective way to lower inflammation, insulin resistance, and blood glucose levels is to get closer to a healthy body weight. And a very effective way to do that is to manage your portion sizes of carbohydrate-containing foods.

Why? Because carbohydrate-containing foods are relatively more calorie-dense than some other foods. For example, 1/2 cup of cooked rice contains approximately 80 calories, while 1/2 cup of cooked non-starchy vegetables, such as broccoli, contains only 25 calories. So the calories from carbohydrate-containing foods an add up quickly, if you don’t manage their portion sizes.

And ultimately, it’s your calorie intake that has the biggest effect on your weight. If you eat too many calories during the day, you store the excess as fat and gain weight. And remember — fat is inflammatory, and excess body fat is strongly associated with insulin resistance and, ultimately, type 2 diabetes.

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