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I was looking at diabetes the other day, and I noticed something strange. Lower amounts of lipase are a symptom of diabetes, as is overweightness. However, since lipase is the enzyme that breaks down fats, shouldn't a lack of it mean that less of it enters your blood stream and is simply excreted instead? In that case, how come diabetic people are often overweight?
This question has been bugging me for ages, does anyone know why?
How are diabetes and obesity connected in light of low lipase activity?
Short answer: There's more than one type of diabetes. (And to complicate things, there's also more than one type of lipase. It's unclear from the question which type were mentioned in what you read.)
Diabetes mellitus is usually divided into Type 1 (insulin-deficient) and Type 2 (insulin-resistant). Obesity is a risk factor for Type 2 diabetes, but not all diabetics are overweight. In fact, people with Type 1 are often lean.
Decreased lipase activity is not a major symptom of diabetes. However, these two articles suggest that plasma lipase activity may be lower in cases of Type 1 diabetes but not Type 2.
Junglee, D. et al., Low pancreatic lipase in insulin-dependent diabetics, 1983.
Dendona, P. et al., Exocrine pancreatic function in diabetes mellitus, 1984.
Source : Tortora and Derrickson Principles of anatomy and physiology
I read in the section on diabetes that " The breakdown of stored triglycerides causes weight loss". I assume that diabetic people are often overweight not simply because they have diabetes but because they also have many other disorders associated with it.
Please feel free to correct me !
People with type 1 Diabetes have a heritable defect in their genes. People with type 2 Diabetes eat too much. The prevalence of type 2 diabetes has increased by a factor of 2 since the 1970's. This means more patients for the endocrinologists and more insulin sales for the pharmaceutical companies.
Type 2 Diabetes
Type 2 diabetes, the most common type of diabetes, is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes mainly from the food you eat. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Too much glucose then stays in your blood, and not enough reaches your cells.
The good news is that you can take steps to prevent or delay the development of type 2 diabetes.
‘Obesity Paradox’: Why Being Thin with Diabetes Is a Dangerous Combo
Being overweight or obese is a risk factor for developing Type 2 diabetes, but it turns out that these heavier patients may have an advantage: people who are overweight when they are diagnosed with diabetes live longer than their thinner peers.
The so-called obesity paradox, in which being overweight appears to be protective against early death, has been seen before in heart failure and chronic kidney disease.
But, says study author Mercedes Carnethon, associate professor of preventive medicine at Northwestern University, that doesn’t necessarily mean that gaining excess weight is a healthy strategy rather, it may be that people who are thin when they develop diabetes are already be vulnerable to worse health. “We hypothesized that their diabetes may be different,” she says. “They may have developed diabetes for reasons unrelated to obesity.
Overall, about 85% of people with diabetes are heavy. Gaining too much weight is a major contributor to Type 2 diabetes, since excess fat cells can affect the way the body breaks down glucose and produces insulin, but some normal weight individuals can develop the disease as well. The elderly and people of Asian descent are more likely to be at normal weight when diagnosed, for example.
For the new study, published in the Journal of the American Medical Association (JAMA), Carnethon and her team reviewed data on five previous studies that were tracking people for heart disease risk factors. The studies, which were conducted between 1990 and 2011, included 2,625 people who were recently diagnosed with diabetes, about 12% of whom were at normal weight.
The lean patients looked metabolically similar to those who were obese, with the exception of their weight, the researchers found. But they were twice as likely to die at any point than their heavier counterparts. Even after adjusting for other risk factors known to contribute to diabetes, such as high blood pressure, high cholesterol levels and smoking, the higher mortality rates remained. Further, to account for the possibility that the normal weight patients could have been losing weight due to other underlying illnesses, the researchers excluded people who died within two years of their diabetes diagnosis. The doubling of early death risk persisted.
Overall, the death rate in overweight and obese people with diabetes was 1.5% per year, compared with 2.8% in thin patients.
So, what sets the disease apart in normal weight people? More studies are needed to figure that out, but the authors have a few guesses. Genetic predisposition to improper insulin production may be part of the problem, says Carnethon. “We need to explore the genetic variations related to insulin secretion,” says Carnethon. “It’s possible that genetic factors could be promoting insulin resistance, and influencing something else related to mortality. We really don’t know.”
It’s also possible that body fat may still play a role. The studies measured the participants’ body mass index (BMI), a ratio of their height and weight, but it wasn’t able to take into account their body fat composition, or how much of their overall body weight was made up of fat versus muscle. Many seemingly thin people carry more fat than muscle, making them trim on the outside, but fat on the inside. Even with a healthy BMI, for example, such people may harbor a lot of visceral fat, deep in their abdomen, a type of fat that is particularly dangerous to health, since it secretes hormones and substances that can hamper insulin’s ability to break down sugar. Because many of the thin diabetes patients included in the new study were elderly, they likely had less muscle mass and more fat.
The findings raise the alarm that diabetes isn’t just a disease of the overweight or obese, says Carnethon, and that physicians should be looking for signs even among their leaner patients, particularly those who are elderly. “Doctors’ concern about normal weight people with diabetes should potentially be even higher than that for their counterparts who develop diabetes at a heavier weight,” she says.
Why are diabetic people often overweight? - Biology
Diabetes is a disease that causes a person to have high blood sugar. Over time, high blood sugar can damage organs such as the kidneys and heart. Nerve and blood vessel damage can lead to blindness and even the need for amputation of extremities such as the toes.
High blood sugar is a result of the body not getting enough insulin or not responding to the insulin it is getting.
Insulin is a hormone produced by an organ called the pancreas. Insulin takes the sugar in our blood (also called glucose) and helps it get absorbed into our cells. Our cells then use the glucose for energy.
Why is insulin important?
When there isn't enough insulin in the blood two things happen. First, the glucose level in the blood increases. As the body continues to eat food, carbohydrates are turned into glucose and absorbed into the blood stream to be used for energy. If there is no insulin, the glucose can't be absorbed by the cells and used up. Second, the cells are starved of energy. They end up getting their energy from fat.
Type I or Juvenile Diabetes
Type I diabetes is caused when the body's own immune system decides to attack the pancreas and destroy the cells (called beta cells) that make insulin. Doctors aren't sure what causes the immune system to do this, but, once all the beta cells are destroyed, the pancreas will stop producing insulin.
Type I diabetes is often referred to as juvenile diabetes. This is because most people are first diagnosed with the disease while they are still young. However, some people do get the disease later in life. Also, once a person has the disease they will have it for their entire life. There is no cure.
Type II diabetes is when the pancreas doesn't produce enough insulin for the body or that the insulin isn't working right. When the insulin isn't working right, this is called "insulin resistance."
Type II diabetes is different than Type I. Type II tends to occur in older people who are overweight. Losing weight, eating a healthier diet, and exercising can all help in avoiding and slowing down the onset of Type II.
Although Type II is associated with being overweight, not all people who are overweight get Type II and not all people who have Type II are overweight. Doctors aren't sure what causes Type II diabetes, but in addition to weight, factors such as race, age, and family history also contribute to the risk of getting the disease.
Common symptoms of diabetes include increased thirst, frequent urination, weight loss, bad breath, and nausea. Not everyone who has diabetes will show symptoms right away, especially those with Type II.
Although diabetes (especially Type I) can cause death if untreated, people are able to live long and normal lives with the disease. The key to living with diabetes is monitoring and controlling the body's blood sugar level. Some people with Type II can control the disease through exercise and a healthy diet. Others may need to take pills or inject insulin. Since people with Type I diabetes produce no insulin they have to inject insulin on a regular basis.
An Example of Type I Treatment
- Test their blood sugar - This is done by pricking their finger and testing their blood with a blood sugar tester.
- Count the carbohydrates in their meal - They need to know how many carbohydrates they eat to adjust their insulin dose.
- Inject insulin - They then inject a certain amount of insulin based on how many carbohydrates they eat plus their current blood sugar.
- Insulin was discovered by Dr. Frederick Banting and John Macleod in 1921. Prior to this, diabetes was a fatal disease.
- The first person to receive an insulin injection was a fourteen year-old boy in 1922.
- Many people are able to use insulin pumps to automatically deliver insulin. They still have to test their blood sugar and give the pump instructions, but they don't have to have shots all the time.
- Macleod and Banting won the Nobel Prize in 1923 for their discovery.
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*** This page is not to be used as medical advice in any way. Please immediately consult your doctor if you have medical concerns.
Understanding Obesity and Type 2 Diabetes
This educational brochure is made to help you gain knowledge about type 2 diabetes and obesity. Excess weight, obesity and severe obesity are all risk factors for developing type 2 diabetes. Often times, people are not aware of the health risk of excess weight until they are diagnosed with pre-diabetes or type 2 diabetes.
In this brochure, we will cover various topics, such as:
- Type 2 diabetes
- Defining excess weight and how it impacts the body
- Managing diabetes and excess weight through diet, exercise and medications
- The impact of excess weight on type 2 diabetes
What is Excess Weight?
Excess weight and obesity can affect a person’s health in many ways. Many methods of measurement can be used to evaluate how much excess weight a person has. One of these methods is calculating body mass index (BMI). BMI is a number calculated by dividing weight in kilograms by height in meters squared. There are four weight status categories (underweight, normal weight, overweight, and obesity).
Obesity increases a person’s risk of developing:
- Hypertension (high blood sugar)
- Type 2 diabetes
- Certain types of cancer
- Osteoarthritis (the breaking down of cartilage and bone)
- Dyslipidemia (this consists of high blood cholesterol and triglycerides, a type of fat)
What is Type 2 Diabetes?
Type 2 diabetes is a long-term, potentially crippling, and often fatal medical condition. This disease requires regular monitoring of an individual’s blood sugar level and treatment. In type 2 diabetes, the body either does not properly produce or use insulin. Insulin is a hormone produced by the pancreas that helps move sugar into cells. The body becomes resistant to insulin if it is not properly producing or using it. This resistance causes high blood sugar levels.
Difficulties of high blood sugar and insulin resistance include:
- Increased risk of heart disease and stroke
- Neuropathy (nerve damage, especially in extremities)
- Nephropathy (renal impairment, kidney failure)
- Retinopathy (vision problems, blindness)
- Cardiovascular disease (heart disease and increased risk of stroke)
- Erectile dysfunction in men and decreased sexual desire in both men and women
How does Excess Weight Impact Type 2 Diabetes?
Excess weight can greatly affect your health in many ways, with type 2 diabetes being one of the most serious. People who are categorized as “overweight,” according to body-mass-index (BMI), are three times more likely to have type 2 diabetes compared to people who are “normal weight.”
When a person predisposed to diabetes has excess weight, the cells in the body become less sensitive to the insulin that is released from the pancreas. This can end up causing insulin resistance. Insulin resistance is when the insulin ratio is higher than the blood sugar level. This means the body’s insulin is not effectively reducing its sugar levels. People affected by type 2 diabetes, who exercise, appear to reduce the severity of insulin-resistance. Exercised muscles are able to use the extra sugar found in the blood. Therefore, the body does not produce insulin and the sugar is no longer redirected to excess fat cells.
People affected by excess weight, especially obesity and severe obesity, are more likely to develop type 2 diabetes as a related condition of their excess weight.
Obesity and severe obesity greatly increase your risk of having:
- Heart disease
- Type 2 diabetes
- Certain types of cancer
- Sleep apnea (repeated stopping and starting of breathing)
How Does the Body Manage Excess Glucose?
After we eat a meal, the processes of chewing and chemical digestion produce glucose (sugar). This is the most readily available form of fuel for our organs- especially muscle and brain tissue. In a normal state, the glucose produced from these digestive processes enters our cells to help with other metabolic processes. The metabolic process is the making and breaking down of food. Insulin acts as a key that unlocks the door to let glucose in to feed our cells. When insulin is present, it also turns off the process of using glycogen from the liver. This ensures that the glucose levels do not rise further after a meal. Insulin reduces blood glucose by collecting any excess glucose that is present in the bloodstream so that it can be stored as glycogen for future use.
However, if not enough insulin is available, then this glucose is unable to enter cells. Instead, the glucose remains in the bloodstream in a higher than usual amount. This condition is referred to as elevated blood glucose or hyperglycemia.
Are You at Risk for Type 2 Diabetes?
What you eat/drink throughout your day and how active you are affects your risk of developing type 2 diabetes. Being “overweight” (BMI of 25-29.9), or affected by obesity (BMI of 30-39.9) or severe obesity (BMI of 40 or greater), greatly increases your risk of developing type 2 diabetes. The more excess weight you have, the more resistant your muscle and tissue cells become to your own insulin hormone.
In addition to excess weight, there are many other facts that increase your risk of developing type 2 diabetes, such as:
Inactivity and having excess weight go hand-in-hand with a diagnosis of type 2 diabetes. A person can decrease insulin resistance by exercising and can lower blood sugar levels.
Unhealthy Eating Habits:
Too much fat in your diet, not enough fiber, and too many simple carbohydrates all contribute to the development of type 2 diabetes.
Family history and genetics:
People who have family members with type 2 diabetes are at a greater risk of developing it themselves. People who have a higher rate of diabetes include:
- Pacific Islanders
- American Indians
- African Americans
As we age, the risk of type 2 diabetes becomes greater. The pancreas ages right along with us and doesn’t pump insulin as accurately as it did when we were younger. As our cells age, they become more resistant to insulin as well.
High Blood Pressure and High Cholesterol:
Not only do these two factors do damage to heart vessels, but they are two key components in metabolic syndrome. Having metabolic syndrome increases the risk of heart disease, stroke and type 2 diabetes.
History of Gestational Diabetes:
Women affected by obesity are more insulin resistant when compared to women of normal weight. When pregnant, gestational diabetes generally lasts the length of the pregnancy. Roughly 5% to 10% of females with gestational diabetes will continue to be affected by diabetes after delivery.
Symptoms that you may be developing or have type 2 diabetes:
- Frequent urination
- Increased thirst
- Unplanned weight-loss
- Weakness and fatigue
- Numbness or tingling in hands, legs or feet
- Blurred vision
- Dry, itchy skin
- Frequent infections
- Slow healing of cuts and bruises
*If you are experiencing these symptoms seek medical advice from a healthcare provider.
How do you test for type 2 diabetes?
There are a variety of blood tests that may indicate whether you have type 2 diabetes. Let’s take a look at each test and see what different results could mean for you and your health.
Fasting Blood Sugar Test
The amount of sugar in your blood naturally fluctuates but stays within a normal range. The preferred way to test your blood sugar is after fasting overnight for at least eight hours. A fasting blood sugar level less than 100 milligrams of sugar per deciliter of blood is considered normal.
If your blood sugar level measures from 100 to 125, you have impaired fasting glucose, and this may be an indication that you have pre-diabetes. If your blood sugar level is above 200 mg/dL, with symptoms of diabetes, a second test may not be necessary to reach the diagnosis.
Random Blood Sugar Test
This test is done without any special preparation, such as fasting overnight. Even if you’ve recently eaten and your blood sugar level is at its peak, the level shouldn’t be above 200 mg/dL. If it is and you also have symptoms of type 2 diabetes, you can expect a diagnosis of type 2 diabetes.
Oral Sugar Tolerance Test
(2-hour Post-Glucose Challenge)
This test requires you to visit a lab or a healthcare professional after at least an eight-hour fast. At the office or lab, you will drink about eight ounces of a sweet liquid that contains a lot of sugar (about 75 grams). Your blood sugar level will be measured before you drink the liquid, then after one hour and again after two hours. If your blood sugar level is 200 mg/dL or above after two hours, you may have diabetes.
What Can I Do to Manage Type 2 Diabetes?
Healthcare professionals utilize a combination of medications and lifestyle modifications to treat type 2 diabetes. After being diagnosed with type 2 diabetes, expect to see a healthcare professional to create a treatment plan. It may be necessary to take on daily action steps, such as self-care behaviors, in order to manage diabetes. This also helps healthcare professionals know when the treatment plan needs to be updated.
Blood sugar testing is an important part of taking care of type 2 diabetes. The frequency of testing may vary from daily to before and after every meal, and may change after the addition of a medication. It is important to record your blood sugar reading in a reading log.
In addition to daily blood sugar testing, periodic testing of blood pressure, blood levels of lipids, as well as the measurement of hemoglobin A1C (HbA1C or A1C) levels may be needed. A measurement of hemoglobin is a test that estimates average blood sugar levels during a period of three months. In general, the preferred ranges for a person with diabetes are:
- A1C: less than 7.0%
- Blood pressure: less than 130/80 mmHg
- LDL “bad” cholesterol: less than
- 100 mg/Dl (less than 70 mg/dl of cardiovascular disease is present)
- HDL “good” cholesterol: greater than 40 mg/dl for men and greater than 50 mg/dl for women
- Triglycerides: less than 150 mg/dl
As with blood sugar goals, these ranges may vary based on your healthcare professional’s diagnosis. Your healthcare professional will create specific goals to meet your needs.
Healthy Eating and Exercise:
Adopting a healthy lifestyle that maintains a calorie-controlled diet and average intensity exercise are two ways people with type 2 diabetes and excess weight can shed pounds.
HEALTHY MEAL PLAN:
Weight-loss occurs when people burn more calories than they consume. A calorie deficit of 500 calories a day can result in weight-loss of roughly one pound per week. Writing down the food, portion size, and calorie amount in a food diary can help people become aware of what they consume and can provide evidence of calorie intake.
Someone with excess weight and diabetes may benefit from limiting carbohydrates in their diet.
Carbohydrates raise blood sugar more than other foods and will cause the body to make more insulin which can result in weight gain.
Foods that are high in carbohydrates include:
Regular exercise helps maintain weight-loss and prevent regain. It also improves glycemic control and reduces the risk of cardiovascular disease and blood glucose levels. Glycemic control is the measurement of the effects of carbohydrates on sugar level.
A goal of 30 minutes of average exercise most days per week should be set. Exercise does not need to occur in a single session to be beneficial. Dividing the activity into multiple, short episodes produces similar benefits and is often more achievable.
Achieving the recommended weight loss is a feat that brings great joy to people with diabetes. People noticed a decrease in their insulin requirement and a decrease in weight circumference. However, this is just the beginning. Maintaining the new, lower weight is a different battle. Several studies suggest that 60 to 75 minutes of moderate activity (walking) or 35 minutes of intense activity (jogging) daily is needed to maintain a desirable weight loss.
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The Surprising Truth About Prediabetes
Amazing but true: approximately 88 million American adults&mdash1 in 3&mdashhave prediabetes. What&rsquos more, more than 84% of people with prediabetes don&rsquot know they have it. Could this be you? Read on to find out the facts and what you can do to stay healthy.
Prediabetes Is a Big Deal
Don&rsquot let the &ldquopre&rdquo fool you&mdashprediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.
Prediabetes Flies Under the Radar
You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems show up. That&rsquos why it&rsquos important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:
- Being overweight
- Being 45 years or older
- Having a parent, brother, or sister with type 2 diabetes
- Being physically active less than 3 times a week
- Ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds
Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.
Ready to find out your risk? Take the 1-minute prediabetes risk test and be sure to share the results with your doctor.
Diabetes Is Harder to Live with Than Prediabetes
Though people with prediabetes are already at a higher risk of heart disease and stroke, they don&rsquot yet have to manage the serious health problems that come with diabetes.
Diabetes affects every major organ in the body. People with diabetes often develop major complications, such as kidney failure, blindness, and nerve damage (nerve damage can lead to amputation of a toe, foot, or leg). Some studies suggest that diabetes doubles the risk of depression, and that risk increases as more diabetes-related health problems develop. All can sharply reduce quality of life.
Prediabetes = Pre vent diabetes
Think of prediabetes as a fork in the road: Ignore it, and your risk for type 2 diabetes goes up. Lose a modest amount of weight and get regular physical activity, and your risk goes down. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity. That&rsquos just 30 minutes a day, five days a week.
The CDC-led National Diabetes Prevention Program (National DPP) has been proven to help people make the lifestyle changes needed to prevent or delay type 2 diabetes. Through the program, participants:
- Work with a trained coach to make lasting lifestyle changes.
- Discover how to eat healthy and add more physical activity into their day.
- Find out how to manage stress, stay motivated, and solve problems that can slow progress.
If you&rsquore told you have prediabetes, ask your doctor or nurse if there is a National DPP lifestyle change program offered in your community. The best time to prevent type 2 diabetes is now.
Many people don&rsquot realize that type 1 and type 2 are different kinds of diabetes.
Does Fat Cause Insulin Resistance?
For decades now, we have been told that fatness (or “obesity”) is a major cause of diabetes. Health “experts” have warned about this, but they could never say how being overweight could cause insulin resistance (IR). Without IR, you can’t have Type 2 diabetes, so the whole “blame fat” theory has been suspect.
Well, now they have a plausible explanation. Obesity may cause inflammation, causing IR, leading to diabetes. But is this theory true? Does adipose (fat) tissue really create inflammation? Or do both obesity and inflammation come from some other cause? Get ready for some science as I try to explore these questions.
In a new report in the Journal of Leukocyte Biology, two Japanese scientists report that “obesity is associated with a state of chronic, low-grade inflammation.” They explain that as fat cells get larger, they seem to attract immune cells called macrophages. These cells produce inflammatory chemicals called cytokines that help cause insulin resistance. Chief among these chemicals are interleukin-6 and tumor necrosis factor-alpha.
In animal models, insulin resistance doesn’t occur until after macrophages invade the fat cells. So the question remains, which comes first, the inflammation or the fatness? What draws the immune cells into adipose tissue?
Remember that most overweight people never develop diabetes. And some overweight people have much more inflammation than others. (The same is true of thin people, of course.) Why do some develop this fat-related inflammation and some don’t?
Some think that weight itself provokes inflammation. According to French scientists writing in the journal European Cytokine Network, weight loss is associated with reduced “macrophage infiltration” and reduced inflammation. Also, another chemical, adiponectin, protects against insulin resistance and blood vessel damage. Adiponectin levels are often reduced in obese people for some unknown reason.
But researchers at the University of Tennessee found that most of the inflammatory chemicals released by adipose tissue do not come from fat cells, but from other cells (probably the macrophages) that have invaded. The fat cells themselves produce more leptin and adiponectin, chemicals that should reduce insulin resistance.
What Is Going On?
Why should increasing the size of fat cells cause inflammation? Inflammation is the body’s response to a threat (like an infection) or an injury. I can’t see why fatness should cause this reaction.
One possible answer is stress. Microbiologist Paul Black, MD, at Boston University writes that “repeated acute or chronic psychological stress may cause [inflammation seen in diabetes and cardiovascular disease].” He thinks that it may be the combination of stress and increasing fat levels that leads to insulin resistance and diabetes.
In another paper, Dr. Black reported that the liver and fat tissues are two of the biggest sources of cytokines, and that stress often activates cytokine production. So it looks as though fatness creates a potential risk of inflammation (because fat can produce more cytokines), and stress may be the actual cause (by telling the fat cells to actually produce these chemicals.)
Of course, there are many causes of inflammation besides stress. And there are many causes of stress besides psychological stress. Cold, heat, infection, fatigue, pollution, certain chemicals, and many other factors can create stress and/or inflammation. Yet the “experts” are convinced that fat is the only significant cause. I doubt it.
Obviously, as the scientists like to say, more research needs to be done. But since sustained weight loss is so difficult, I think the priority for heavy people should be to reduce inflammation, not to lose weight. Reduce stress, take an anti-inflammatory like salsalate, take care of your gums. (Gum disease is a major source of inflammation.) Relax, get out in nature, things like that.
Note: I loved the outpouring of responses to the blog entry on reasons to live. I think it would be great to do a book on reasons to live. (I have a chapter on it in The Art of Getting Well, but I’d like to expand it into a book.) I could use your help. If you have any stories about reasons to live, the benefits of having them, or the effects of not having them, please send me an e-mail at [email protected] .
Disclaimer of Medical Advice: You understand that the blog posts and comments to such blog posts (whether posted by us, our agents or bloggers, or by users) do not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs. The opinions and other information contained in the blog posts and comments do not reflect the opinions or positions of the Site Proprietor.
Managing body weight by bariatric surgery
Health benefits of bariatric surgery, determined largely from nonrandomized studies, are being increasingly recognized. These benefits include substantial and sustained weight loss (32), resolution of comorbidities such as diabetes, hypertension, and dyslipidemia (33, 34), and reduced myocardial infarction, cancers, and associated mortality (35). For extreme obesity, surgery is now the preferred and currently only effective treatment modality. Acute morbidity and mortality of surgical approaches have been dramatically reduced, enabling widespread use of these procedures. Furthermore, over the long term, bariatric surgery might reduce aggregate health care expenditures (36). There is also a growing movement toward using surgery to control diabetes, independent of severe excess weight, but there are currently few scientifically valid data to support this clinical path.
Bariatric surgery falls into two general categories: purely restrictive procedures such as the laparoscopic adjustable gastric band devices, which appear to improve diabetes via weight loss, and procedures bypassing the proximal gut, such as the Roux-en-Y gastric bypass (RYGB) or newer gastric sleeve procedures. The latter approaches (“metabolic” surgery) appear to produce unique effects on enteroendocrine hormones and neuronal signaling pathways and produce more weight loss and diabetes remission than banding alone (34, 37). Metabolic surgeries are associated with increases in anorexigenic and decreases in orexigenic hormones, changes largely absent in band or restrictive procedures, and may explain the differential outcomes (38). Although mechanisms leading to weight loss and diabetes remission are only beginning to be understood, the above endocrine, peptide, and neural effects may mediate these benefits because of structural changes including isolation of the gastric cardia exclusion of the distal stomach, duodenum, and proximal jejunum exposure of the distal intestine to undigested nutrients and partial vagotomy. Longer duration of diabetes and insulin use, both typically associated with decreased β-cell function and possibly surrogates for reduced β-cell mass, are associated with reduced postsurgical remission rates, thus suggesting that residual β-cell function may be a critical factor for metabolic benefits (39).
Known differences in mechanism and efficacy, along with risks and patient priorities (e.g., weight loss vs. metabolic/diabetes goals) already inform the choice of surgical procedure. However, many questions remain, including the following: How much weight loss is required for health benefits? What is the effect of different interventional methods on long-term outcomes? What mechanisms underlie the heterogeneous responses? Further, regarding diabetes, Is the optimal timing for treatment the same or different from obesity? Are β-cells preserved or do they even grow? Why do not we see the same efficacy and durability of response for other obesity-related pathologies (e.g., hypertension) as for glycemic control? Ongoing randomized clinical trials (40) promise to answer many questions regarding patient selection, optimal procedure, when to intervene, and where initial and chronic care should be delivered.
Not Sure About Your Shape? Measure Your Waist
Some people can tell by sight if they are apple- or pear-shaped. But if your risk of diabetes isn’t clear from a glance in the mirror, one important measurement can help you determine your risk of diabetes and heart disease: your waist. If you're a woman and your waistline is greater than 35 inches, you're at increased risk for type 2 diabetes. For a man, the magic number is 40 inches. If your tape measure reveals you're at or above these numbers, it’s time for a little waist whittling.
What are Obesity Types?
Obesity and Type 2 Diabetes
There are many risk factors for type 2 diabetes, including age, race, pregnancy, stress, certain medications, genetics or family history, and high cholesterol. However, one of the best predictors of type 2 diabetes? Being overweight or obese. Almost 90% of people with type 2 diabetes are overweight or obese.
Well, obesity causes increased levels of fatty acids and inflammation, leading to insulin resistance, which in turn can lead to type 2 diabetes. Type 2 diabetes, known as non-insulin dependent diabetes, is the most common form of diabetes and accounts for approximately 90% of diabetes cases. People with type 2 diabetes can produce some of their own insulin, but it’s often not enough or the body’s cells don’t respond to it. As a result of this insulin resistance, glucose (blood sugar) builds up in the body, leading to high blood sugar.
Patients with high blood sugar will typically experience frequent urination, increased thirst, and increased hunger. Fatigue may also result from dehydration. Untreated or poorly controlled diabetes can cause other health concerns like vision problems, nerve damage, infections, heart problems, high blood pressure, mental health issues, ketoacidosis, and stroke.
Since there is an association between type 2 diabetes and being overweight, treatment for type 2 diabetes often focuses on diet and exercise. Oral medications can also help the body use its own insulin more efficiently. In some cases, insulin injections are necessary to normalize blood sugars.
Living with Obesity and Type 2 Diabetes
Living with obesity and type 2 diabetes is not without its risks, but there’s a lot you can do to take charge of your health. Managing diabetes includes eating healthy foods, exercising regularly, reducing stress, maintaining a healthy lifestyle, and, at the advice of your doctor, using medications.
While Type 2 diabetes can be treated, it is largely preventable. Lifestyle changes and small amounts of weight loss can help reduce the risk of developing diabetes by 40-60%.
Interested in learning the optimal diet, exercise, and supplementation for diabetes? Order a Health + Ancestry Report and learn how to diet, exercise. and supplement right for your DNA and lifestyle.