Do you know what diabetes is?
Are you aware of the biggest risk factors you might have for the disease?
Would you know what changes to your diet and lifestyle to make to better manage your weight and blood sugar?
If you don’t know the answer to these questions, you’re not alone. The vast majority of people know very little about blood sugar, type 2 diabetes or the grave impacts it has on long-term health.
So we have answered the 14 most common questions people have about diabetes so you can take back control of your health.
1. What is type 2 diabetes?
Type 2 diabetes is a chronic disease that leads to dysfunctional metabolism, marked by high blood sugar and insulin levels. Left untreated, type 2 diabetes can cause blindness, diabetic ulcers, high blood pressure, among other serious health conditions. Type 2 diabetes is a symptom of metabolic dysfunction, which also includes increased risk for cardiovascular disease, heart attack and stroke.
2. What causes type 2 diabetes?
The ‘twin cycles hypothesis’ proposes that once the body has exhausted its storage capacity in subcutaneous fat sites, it deposits fat around vital organs (known as visceral fat) such as the liver and pancreas. Whereas storing fat under the skin does not require high levels of insulin, increased levels of visceral fat around your vital organs causes insulin to spike to supra-normal levels. Research demonstrates that excess visceral fat causes metabolic disruption, elevated glucose production, dysfunctional insulin-producing cells, and negative health outcomes.
Equally, excess body fat is nearly always accompanied by insulin resistance, triggering an increase in blood sugar levels. While there may be a small genetic component to type 2 diabetes, for the most part it is a preventable disease caused by lifestyle factors, including diet, stress and sleep.
Visceral fat stored around your vital organs is shown to cause metabolic disruption and elevated glucose production that leads to negative health outcomes.
3. How do I know if I have type 2 diabetes?
Unfortunately, there are no obvious type 2 diabetes signs and symptoms. Despite this, there are several clinical risk factors for type 2 diabetes, including:
- A BMI of 25 and over
- A sedentary lifestyle
- Polycystic ovary syndrome
- A family history of diabetes
- A history of heart disease or stroke
- Ageing (above 45)
- High blood pressure
- Poor blood lipids (specifically, low HDL levels, high LDL levels and high triglycerides)
Some ethnic groups are at increased risk for diabetes, including black, Hispanic, Native American, Asian, and Pacific Islander genetic backgrounds.
If you are overweight and fall into several of these categories, it might be a good idea to visit your doctor for a check-up.
4. Does obesity always cause diabetes?
Research shows that while two people may be obese, one may be diabetic, and the other may not. The main reason for this is the ‘personal fat threshold’. The personal fat threshold theory states that every individual has a threshold for storage body fat under the skin.
Once your body exceeds this threshold, it becomes resistant to storing additional fat subcutaneously and turns to muscle tissue and organs like the liver and pancreas.
Every person has a different threshold, which means that some people will develop type 2 diabetes earlier than others. However, think of it more like a ticking time bomb. So if you’re very overweight, it could be that you simply haven’t developed diabetes yet.
5. What is the difference between type 1 and type 2 diabetes?
Type 1 diabetes is an auto-immune disease in which insulin is entirely or almost absent from circulation, meaning that glucose in the blood cannot be appropriately managed or stored in tissues.
Type 2 diabetes, however, is considered a ‘lifestyle’ disease, as it predominantly results from a combination of lifestyle factors, such as poor diet, lack of activity, and poor sleep and stress management.
Unlike type 1 diabetes, it is more than possible to reverse type 2 diabetes with healthy lifestyle modification.
6. If diabetes runs in my family, does that mean I’ll become diabetic?
Diabetes is known to originate from both nature and nurture. For example, multiple factors may not be ‘genetic’ but are related to your family and home life, such as how your parents reinforce diet, exercise, and generally healthy lifestyle habits.
Equally, your ‘personal fat threshold’ plays a significant role in your risk of developing diabetes. However, while some factors are out of your control, the main thing to remember is that type 2 diabetes is largely avoidable through lifestyle and behavioural choices.
7. If my BMI is within a healthy range, should I be concerned about diabetes?
While BMI is a common diabetes risk predictor, it is only a surrogate marker for body composition. Body composition is the amount of body fat and muscle mass relative to your weight.
While BMI predicts body composition with a reasonable degree of accuracy in the general population, it can misrepresent specific sub-groups. For example, it is more common for older adults to have low muscle mass levels due to a condition known as sarcopenia (age-related declines in muscle size and strength).
As a result, if you are older, your BMI could fall within a healthy range, but you may have a high body fat percentage. Therefore, it is your overall body composition that is a more accurate predictor of type 2 diabetes.
8. Do I need to take insulin with type 2 diabetes?
Treatment packages for type 2 diabetes depend on the severity of your diagnosis and your healthcare provider. Left untreated, diabetes can progress to a stage where the pancreas’ insulin-producing cells become dysfunctional, hampering the body’s ability to produce insulin.
At this point, insulin injections may become necessary. However, if you can manage or reverse diabetes symptoms through lifestyle change, it’s unlikely that you would need insulin injections.
9. Should I follow a particular diet if I have diabetes?
Research shows that reaching a healthy body composition through weight loss is the most important factor in managing and reversing type 2 diabetes. The only requirement for weight loss is a calorie deficit, which, alongside a high protein diet and resistance training, will allow you to burn body fat and not muscle tissue.
Beyond total calorie and protein intake, the evidence shows that the remaining distribution of calories among fats and carbohydrates makes little difference in overall health outcomes. As a result, there is no ‘best’ or special diet for diabetics, so pick a method that allows you to be most adherent for long enough to see results.
10. Should I avoid carbohydrates if I am diabetic?
The diet that you can stick to most of the time and for the longest is likely to be your best bet when it comes to managing and reversing diabetes.
While there may be some benefits to following a low-carb diet initially, in the long-term, adding in high-quality, single-ingredient sources of carbohydrate can be beneficial for improving your energy levels, mood, and adherence.
Carbohydrate sources such as fruits, vegetables and whole grains tend to contain high amounts of fibre, which is also highly beneficial for balancing blood sugar levels.
11. Does eating sugar increase my diabetes risk?
Research shows that sugar doesn’t directly impact weight loss as long as you control total energy intake. Weight loss through a calorie deficit is the key driver in reducing diabetes risk, not the specific breakdown of the foods you eat. However, foods that contain the most sugar tend to be highly processed, nutrient-poor, and low in hunger-suppressing qualities.
As a result, consuming high amounts of these foods may make it harder to achieve fat loss in the long run. By focusing most of your food intake on single-ingredient, nutrient-rich foods, you’re likely to feel fuller and find it easier to lose weight. However, once you achieve a healthy body composition, there’s no reason you can’t include some sugar-containing foods in moderation as part of an overall healthy diet.
12. Is fruit bad for my blood sugars levels?
There is no substantial evidence to show that diabetes risk increases if you consume fruit as part of a balanced diet. Fruit has several qualities that may be helpful if you follow a calorie-controlled diet, including being relatively satiating and high in fibre. Fruit can therefore be a valuable means to keep your diet varied and enjoyable.
13. Do I need to quit alcohol if I’m worried about diabetes?
One of the main things to remember about alcohol is that it has no nutritional value. As a result, when you drink, your body has to burn the calories from alcohol before it can tap into energy from food, meaning that fat storage becomes much more likely. At seven calories per gram, alcohol can also significantly increase your daily calorie intake. Alcohol also temporarily lowers testosterone in men and oestrogen in women, thereby decreasing insulin sensitivity.
While it is possible to diet and incorporate alcohol in moderation, it’s important to bear in mind that, beyond its inherent caloric content, alcohol lowers your inhibitions around food, increasing your likelihood of overeating. However, once you achieve a healthy body composition, there’s no reason you can’t enjoy alcohol in moderation as part of a balanced diet.
14. If I’m diabetic, should I avoid exercise in case my blood sugars drop too low?
The primary tool for managing and reversing type 2 diabetes is weight loss, which typically requires a combination of dietary modification and increased activity to create a calorie deficit. Alongside this, protein intake and resistance training are two requirements for improving body composition.
It’s not uncommon for type 2 diabetics to experience the sensation of low blood sugar when they exercise. However, this can often be due to a feeling of lower blood sugar rather than low blood sugar. If you are diabetic, don’t feel like you have to go hell-for-leather straight off the bat. Accompanying this approach with low-impact activity, such as walking, has proven beneficial effects for increasing energy output and providing benefits for mental health, sleep and stress management.
