When I was back in college, I had a physiology professor that said, "If you live long enough,
you're going to get diabetes."
Well, it is estimated that over 530 million adults worldwide have diabetes and those numbers
are also increasing in children and adolescents.
So, was this professor onto something or is there something else going on here?
So, in today's video, we'll definitely utilize the cadavers behind me to talk about what
diabetes is and what causes it.
We'll also talk about things that you can do to reduce your risk of developing diabetes
and if you already have it, is there a possible way to cure diabetes?
It's going to be an interesting one.
So, let's do this.
[Intro]
Diabetes or diabetes mellitus is often classified into one of two types.
Now, there is gestational diabetes but we're going to mostly discuss type 1 diabetes and
type 2 diabetes and we'll talk about the various differences but whenever you have a conversation
about diabetes, you have to talk about the pancreas.
So, let's take a look at a real human pancreas and just to orient you, we're going to be
looking in from the left upper abdomen.
So, you can see coming in from the left side here.
Here's the liver.
We'll reflect that away and then you can also see the stomach - we'll reflect that in posterior
or behind the stomach you can see how amazing this pancreas is.
Now, this is the head of the pancreas the body and then moving on to the tail down here
and I can lift that up so you can see that a little bit better.
Now, the pancreas is amazing for multiple reasons but one of the cool things about it
is that it is both an endocrine gland as well as an exocrine gland.
Endocrine gland secrete hormones into the bloodstream but the exocrine portion if we
were to look at this or look at it under the microscope, we'd clusters of exocrine cells
that will produce pancreatic enzymes and those would be secreted into the small intestines
specifically the duodenum right here and that's going to help aid in digestion but the endocrine
portion of the pancreas is where we're going to focus on.
We'll talk about the exocrine pancreas in another video but the endocrine portion or
those endocrine cells within the pancreas, those are going to produce various hormones
and secrete them into the bloodstream and one of the main hormones that we're focused
on in this case is insulin.
Now, insulin various functions but the function we're going to mostly focus on is that insulin
lowers blood glucose levels.
What many simply just refer to as blood sugar levels.
Now, we need to go into a little bit more detail on how this insulin applies to the
different types of diabetes and in order for us to do that, we're going to utilize my whiteboard
picture.
So, full disclosure, I technically traced this pink pancreas as well as the first part
of the small intestine.
When I don't trace things, you guys get stuck with me creating human cells that look like
smiley faces but for our purposes this diagram, this will suffice but you can totally tell
the outside of this is representing the cell membrane and we even have surface receptors
here.
These green receptors are representing insulin receptors which will be important in just
a second.
So, when we eat or ingest carbohydrates, our digestive tract will break that down and eventually,
those carbs will get absorbed into the bloodstream as glucose and we have a blood vessel represented
here and these black dots are representing glucose molecules which contribute to the
blood sugar levels.
Now, the pancreas in response to blood sugar levels increasing after the meal will release
insulin and insulins represented in this blue triangle.
This will get into the bloodstream and so the insulin can then circulate and go to the
various cells throughout the body and the insulin will bind to these insulin receptors
and essentially will tell the cell this - Eat the sugar in other words take the sugar
in and the cell obliges and that glucose goes into the cell.
So, you can see how insulin would therefore lower the blood sugar levels by getting the
sugar to go from the bloodstream and into the cells but what does this have to do with
diabetes?
Type 1 diabetes, which is also often referred to as insulin dependent diabetes and that's
because the pancreas is no longer creating insulin.
We get this autoimmune destruction of the beta cells and the beta cells are the specific
cell type within the pancreas that actually creates the insulin.
So, we no longer get this insulin and no longer can create this effect of the cell and so
you can see we are not going to be able to shuttle that glucose from the bloodstream
and into the cell and we might as well fix this part of the picture as well, get this
unhappy cell here.
Now, with type 1 diabetes it actually only accounts for about 5 to 10% of the overall
cases of diabetes and it typically happens in children and sometimes in the early teenage
years.
It can also sometimes happen later in life but most commonly in the younger years of
life.
Now, what's interesting is we are going to talk about potential risk factors or things
that you could do to reduce your risk of getting diabetes.
With type 1 diabetes, we don't get a lot of control with that.
Remember, I mentioned this autoimmune destruction of the beta cells.
So, essentially getting this combination of genetics and bad luck which is causing type
1 diabetes.
However, that is a bit different when we talk about type 2 diabetes but before we go into
the details of type two diabetes, I want to take a second to say thank you to the sponsor
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So, back to two diabetes which is also often referred to as non-insulin dependent diabetes
and that's because the pancreas still is actually producing the insulin.
So, in other words we do have this insulin here.
Let's get that back in there and so therefore insulin will still continue to have its effects
on the cell here.
It's just in the case of (if I can draw that triangle in there), in the case of type 2
diabetes what happens is that the cells actually become insensitive or resistant to the effects
of insulin.
So, we have this insulin trying to get the cell to take in the glucose and the cell might
do something like this and say to the insulin - which is not very nice of the cell but you
can see that because of this, we get a very similar result that we saw in type 1 diabetes
and that is the blood glucose levels will increase and get too high.
Now, what's interesting about type 2 diabetes in the initial stages, the pancreas will actually
secrete more insulin or almost overcompensate in efforts to almost kind of think of it as
trying to wake up the cells especially with our cartoon drawing here, you could think
of it as trying to convince the cell to take the glucose in if it pushes it with more insulin
but over time with diabetes, especially type 2 if it's not well managed, the pancreas will
eventually start to wear out if you think of it that way and will not be able to secrete
as much insulin to the point where this continues and someone doesn't manage their type 2 diabetes
well, they may have to start taking insulin similar to what someone with type 1 diabetes
would have to do.
But back to this whole idea about this insensitivity or this resistance to insulin -what is causing
this?
Well, we're going to find that there are some things that you don't have any control over
but some things that you do have some control over.
So, the risk factors that we don't have any control over mostly center around genetics.
So, things like family history and even certain ethnicities have been shown to have a higher
risk of developing type two diabetes.
So, for example, say you had a first-degree relative, so, a parent or a sibling that had
type 2 diabetes, that would increase your risk of developing type 2 diabetes by as much
as two or three fold.
Now, it doesn't mean someone with a family history or certain ethnicities that are at
higher risk are just doomed to get type 2 diabetes because there are some other risk
factors that we do have control over.
One of those being the amount of adipose tissue.
As adipose or fatty tissue increases, this strongly correlates with an increased risk
of developing insulin resistance and therefore, type 2 diabetes but you might be thinking,
well, why?
What is it about this increase in adipose tissue that leads to an increased risk of
type 2 diabetes caused by this insulin resistance?
Well, there's data in research that suggest that the adipose cells release these chemicals
called adipokines and as adipose tissue increases, we also get an increase in these chemicals,
the adipokines and these adipokines or these chemicals tend to make the cells throughout
the body more resistant to that insulin.
What also strongly correlates or supports this correlation between an increase of adipose
and type 2 diabetes is that someone with type 2 diabetes, as they decrease their adipose
or fatty tissue or in other words lose weight, their type 2 diabetes and insulin resistance
often improves.
So, based on all this information, you can probably see that yes, we definitely can help
prevent and reduce our risk of developing type 2 diabetes and you probably even have
some ideas on how we can do this.
Now, some may simply just want to say, "Hey, lose the fat or the adipose tissue" and yes,
that is true but there's a bit more to it than just saying, hey, lose the fat.
One, easier said than done and two, we do have to acknowledge that there are is a genetic
component to how much adipose tissue one has but we also have to acknowledge that we definitely
have some control over this and most of us will think, well, we control this by the two
things that we always hear about and that is diet and exercise.
Now, one of the interesting things about diet is that us humans sometimes fall into this
quest if you will.
This quest for the "Perfect diet".
Maybe you got all excited and gung-ho about a keto diet, vegetarian, maybe the Mediterranean
diet.
Whatever the diet was, you were so excited to be ingesting all of this healthy food,
you're going to be so healthy and be able to resist virtually any health condition.
Cancer, please, diabetes, get out of here.
Oh and World Peace, we've got you covered too because everyone throughout the world
is going to be so happy about your diet.
Rant over but the key point is there's not one magic bullet diet out there for everyone.
There are plenty of people that live long, healthy lives, reduce and mitigate their risk
for things like diabetes with a variety of different diets.
Are there general principles?
Absolutely.
One being that the majority of our food should come from whole food source - whole food sources.
Two, whatever those food choices are, we want to make sure that we get all the proper vitamins
and minerals to have proper physiological function and then also the macronutrients,
we want to make sure we have the proper proportions of those.
The macronutrients being carbohydrates, proteins, and fats and of course, those proportions
would have the ceiling of a total caloric intake and we'd want that total caloric intake
to be what we'd refer to as a calorie deficit.
Meaning, we're burning more calories than we're taking in especially if part of our
goal here is to reduce weight or reduce the adipose tissue.
Now, I do want to acknowledge again that I did just go on this rant saying there's no
magic bullet when it comes to diet but this is also true for our overall health and wellness.
There's no diet magic bullet or treatment option that's a magic bullet or whatever it
may be but if you made me pick a magic bullet or if we thought of it as what's the closest
thing we could get to a magic bullet for our health and wellness, that would have to be
exercise and let me explain what I mean by that.
Exercise is going to pay more dividends than just helping us decrease or lose adipose tissue
when it comes to this type 2 diabetes discussion.
Think of type 2 diabetes as this dysfunction of metabolism.
We have these cells that are resistant to insulin and so therefore, cannot bring the
glucose or the carbohydrates in.
So, therefore, the cells aren't processing, utilizing, metabolizing those carbohydrate
properly and because of that dysfunction metabolism, it's also going to trickle into how our body
metabolizes the fats as well as the proteins but exercise changes our metabolism.
Now, one of the things that changes with exercise is that metabolic rate increases with exercise
and that would mean we burn through more calories in that case which has its obvious benefits
but you've probably started to gather that there's more to metabolism than just how fast
we burn through carbohydrates or fats.
It also includes how effectively we process or utilize those carbohydrates, fats, and
even the proteins.
Let me give you some examples of how this improves with exercise.
We know that the majority of cells throughout the body need insulin to bring the glucose
in, including say like a resting muscle cell but say that resting muscle cell starts to
exercise and the overall muscle begins to exercise, your exercising muscles can bring
in glucose without the need of insulin which is pretty amazing to think about.
Also, there's this window directly after exercise where the muscle tissue becomes highly sensitive
to the effects of insulin.
Again, remarkable to think about especially when we're comparing that to type 2 diabetes
where the cells are less sensitive or resistant to the effects of insulin and it makes sense
that an exercising muscle or a muscle post exercise would be sensitized because it's
trying to replenish its glycogen stores which glycogen is just a storage form of glucose
and those muscle cells are also ready to bring in protein for that rebuilding process.
Now, this is just looking at it from one isolated incident like meaning 1 day of exercise.
What about consistent exercise over the long term?
If you consistently exercise, further changes will occur.
For example, the number of mitochondria within the muscle tissue will increase and you might
remember from biology class that the mitochondria was nicknamed the powerhouse of the cell because
this help create the energy currency of the cell called adenosine triphosphate or ATP.
We'll also see that the number of enzyme involved in metabolism will increase within the muscle.
We'll see cellular transporters increase.
All of these things are essentially going to help us to process more carbohydrates and
fats as well as to process and metabolize them more effectively.
This is kind of like the opposite of the metabolism that's occurring with type two diabetes and
this is what I was talking about as far as exercise paying more dividends.
We see more effective metabolism, even increased insulin sensitivity within the muscle tissue
and with that increased metabolism, that can often trickle into just from frequent exercise
to decreasing that adipose tissue which was contributing to insulin resistance and if
that goes down, insulin resistance often improves.
And finally let's talk basics of treatment as well as this idea of can you possibly cure
diabetes?
Let's start with the treatment of type 1 diabetes.
Now we haven't talked as much about type 1 because remember, we didn't have as much control
of reducing the risk of type one diabetes and because the pancreas isn't secreting insulin
with type 1 diabetes, we're left with one main treatment option and that is replenishing
the insulin through injection and the amount of insulin corresponds with carbohydrate intake.
Now, type 2 diabetes, we've actually talked a bit about a treatment option because that's
similar to prevention which is diet and exercise but on top of diet and exercise, people will
often get initiated on a diabetic medication.
Metformin is the most common medication.
Now, we could do a video on multiple different type of diabetic medications so instead we'll
just put some of the most common in the description below and kind of jump to this idea of can
you possibly cure type 2 diabetes because people have come off of their diabetic medications
through diet exercise and weight loss or sometimes people have done it through say like a gastric
bypass surgery.
So, you might be thinking "Well, their insulin resistance has improved, their blood sugar
levels are where they need to be, they're no longer on their diabetic medication, they're
cured".
Well, not so fast.
We don't usually use the word "cure" when it comes to type 2 diabetes.
The word that is used is remission and I think that's fair because we're talking about remission
because this could come back.
Say like adipose tissue came back or increased again, diet and exercise started to falter
on that and even aging can make us a little bit more at risk for developing this and so
in that case, remission is typically the word that is used but I think that's still really
remarkable to think about, that a person can improve so much, they can come off of their
diabetic medications and maintain this with diet and exercise.
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