Hi, welcome to Type two, where we discuss everything about Type
two diabetes in a way that everyone can understand.
I'm Dr.
Vladmir Carvalho, and I'm an endocrinologist.
I'm going to answer a very important question that I get a lot.
Why do people with type 2 diabetes lose weight?
Aren’t they supposed to gain weight?
Now, these are very important question, because we know that being overweight
or obese is one of the risk factors for type 2 diabetes.
Right.
And a lot of people, especially in rich countries
that have type 2 diabetes, are obese.
But we also know that unexpected weight loss
is one of the classical signs of type 2 diabetes.
Now, today, I'll explain to you clearly why both of them are true.
First, we need to understand why we have to eat, right.
I'm not talking about why we want to eat.
Maybe we want to eat because the food tastes good, you know...
But I'm talking about why we have to eat.
We have to eat because all of the trillions of cells
that we have need energy so that they can produce work,
so that they can do what they're supposed to do, right.
Just like when you put gas in your car so that you can drive it.
I know some of you might say, no, we don't do gas, we're green,
but you still need electricity for your car so that you can drive it.
The same thing happens to our body.
The cells need energy and they get energy from the food that we eat.
Now, for some of you following this channel,
you know that when you eat, your blood, sugar goes up.
Right?
And you also know that it's not your blood that needs the glucose.
It's the cells inside of your body.
But glucose cannot cross the membrane of the cells.
You know that.
And they have special transporters called glucose transporters.
That can take glucose inside the cells.
Now, let me ask you a question.
Which cells give you the weight that we're talking about?
Which cells in your body make you big
or small, you know, overweight or underweight?
Are we talking about brain cells or
muscle cells or fat cells or liver cells or other cells?
Which ones do you think give you the weight
that we are going to talk about?
Your muscle cells and your fat cells.
You know, even if you have a big brain,
it doesn't change your weight too much, right?
Well, it changed a little bit, but, you know, not enough.
But your muscle cells and your fat cells,
they can give you the size, right?
They can make you big or small.
But the problem with these cells is that they are dependent on insulin
because they don't have the transporters on the membrane.
They have the transporters inside the cells, and they need insulin
to come and attach to the cells
and tell them to bring
the transporters to the membrane so that they can get glucose.
So these cells, your muscle cells and your fat cells,
they have glucose transporters 4
that are dependent on the insulin.
They are dependent on your pancreas, you know.
Inside of your pancreas,
there are some cluster of cells called islets.
Now, these islets, they have different types of cells,
including the beta cells that release insulin.
Now, as I told you last time, at the time of diagnosis of type 2
diabetes, most people, half of their beta cell
function is gone.
But I also told you that this is enough.
If you change your lifestyle and put less glucose.
Right?
But many people don't do that.
And as time goes by, you keep getting less
and less beta cell function,
which means that at some point you will not have enough insulin
to come and attach
to the cells and call the transporters to the membrane to get glucose.
So even though you are eating, you are still not eating.
I mean, you are technically eating, but your cells are not eating.
They are starving
because you are putting food in the blood, but you don't have enough insulin
to bring the transporters, to get the food, to get the glucose.
So that means that you're eating and glucose is staying in your blood.
That means your’re eating.
Your blood is getting the food, is getting the glucose, but
your muscle cells are getting nothing and your fat cells are also not eating.
Or maybe they're eating, but not, you know, a lot
and they're starving, which means you will lose a lot of weight.
Now, this is why I think we should never be mean when we talk to people
that have type 2 diabetes, because sometime we think that they eat too much.
But, you know, some of them, their cells are really starving
and they crave food, especially sugar.
You know, sometimes they can't control it.
So we should, you know, be considerate.
Now, another thing that happens is that when you lose muscle,
you lose a lot of water because muscles store glycogen and they retain water.
So when you are shrinking, your muscles are shrinking,
you are also losing water and you lose even more weight.
Now, the third one is that when your cells are not getting enough energy,
your body will start using this fat and muscle to produce energy.
So your body will start using the storage of fat
that you have around and your muscles to produce energy.
And number 4, you know that a lot of glucose is still here.
Right?
And as I mentioned before, this glucose will pull water from the cells.
And beside the cells to the blood.
And if the glucose is high enough, higher than 180,
the glucose with water will go out
as urine, will leave the blood as urine.
So today we have seen that if you have type 2 diabetes long enough
and you lose a lot of beta cell function,
you will not have enough insulin to put glucose inside the cells.
So even though you are eating, the cells that really need the glucose
are not eating, are starving, and you will start losing a lot of weight
and your body will go for plan
B, which is using your fat and your muscles for energy.
And then we know that as glucose stays in the blood, glucose will pull
water to the blood and both of them will leave the blood as urine.
They'll go to your kidneys and get out as urine.
So have a blessed week by.