Let's review basics of insulin resistance, metabolic syndrome and type II diabetes.
Diagnosis of Insulin Resistance:
Oral Glucose Tolerance Testing:
Glucose and Insulin response over 2 hours following consumption of 75-gram glucose drink.
Insulin Resistance present when at 2 hours:
Plasma Insulin: >30 uU/mL
Serum glucose: >200 mg/dL
Metabolic Syndrome Diagnosis:
*Present when 3 or more criteria are present:
- Waist circumference: Men >40 inches, Women >38 inches
- Serum Triglycerides: >150mg/dL
- Serum HDL: Men <40mg/dL, Women <50mg/dL
- Blood Pressure: >130/85 mmHG
- Fasting Blood Glucose: >110 mg/dL
Type II Diabetes Diagnosis:
Fasting Blood Glucose: >126 mg/dL *confirmed on two separate measurements, or one measurement with symptoms of diabetes (frequent urination, intense thirst)
"Casual" Blood Glucose: >200 mg/dL *confirmed on two separate measurements, or one measurement with symptoms of diabets (frequent urination, intense thirst)
Blood Sugar Imbalance to Diabetes Type 2:
Now that you have an idea of the criteria used in diagnosis of blood sugar disorders. Here's a quick rundown as to how they progress into one another:
1.) Reactive Hypoglycemia/early Insulin Resistance:
“Roller coaster ride” after high-sugar meals or as a result of skipping meals such as breakfast. Clients are typically irritable if meals are missed, and often “crash” late mornings or mid-afternoons between 3-5pm.
Those with reactive hypoglycemia offten drink caffeine throughout the day to stay focused and awake. They may also skip breakfast, or simply eat a high-sugar breakfast such as bagel and coffee or a processed yogurt.
You do not necessarily have to be overweight to be having problems with blood sugar regulation.
Fasting glucose: <85mg/dL (Medical hypoglycemia <64 mg/dL)
Triglycerides: >100 mg/dL is one of the earliest signs of insulin resistance (can be related to other causes too such as hypothyroidism). May also be indicated by <1:1 ratio of triglycerides to Total Cholesterol. Those with a 1:1 ratio and greater may be demonstrating early insulin resistance.
3.) Metabolic Syndrome & Pre-Diabetic State:
Fasting blood sugar should fall in the healthy range of 85-100 mg/dL.
Values higher than 100mg/dL put you at higher risk for insulin resistance/dysglycemia & pre-diabetes (101-126 mg/dL).
Metabolic syndrome is partly indicated by a fasting glucose measurement of 110-126 mg/dL with other criteria.
As mentioned earlier, values <85 mg/dL can be indicative of reactive hypoglycemia, but beyond skipping meals and eating too much sugar, this can also reflect a pattern of stress imbalance.
Fasting glucose measurements <64 mg/dL can be indicative of medical hypoglycemia which puts you at risk for more serious complications and can reflect more progressed adrenal problems, medication reactions, or poorly controlled diabetes.
4.) Transition to Type II Diabetes:
Type II Diabetes is diagnosed when fasting blood sugar is above 126 mg/dL on two separate measurements, or a measurement is also associated with diabetic symptoms such as increased thirst and frequent urination.
Any glucose measurement above 200 mg/dL on two separate measurements can be diagnosed as type II diabetes. Type II Diabetes is a state where the body requires increasing amounts of insulin to keep sugar levels balanced.
Complications of Chronic Dysglycemia:
Those meeting criteria of Pre-Diabetes and Metabolic Syndrome are at higher risk of early complications such as damage to nerve tissue (especially the retina), and also to blood vessel walls which may initiate the process of atherosclerosis and heart disease!
This process often begins before a diagnosis of diabetes ever takes place; early development of cardiovascular disease can even begin in the womb!
Sometimes it is these more serious symptoms that bring you to your doctor in the first place. For those meeting criteria for metabolic syndrome, the question is not if these individuals will develop diabetes or not, it is a matter of when if their poor diet and lifestyle patterns persist.
If allowed to persist:
The pancreas begins to shut down insulin production of insulin all together as pancreatic beta-cells are destroyed. Irreversible kidney damage can also occur as the body finds it increasingly difficult to flush out extra sugar (despite increased urination).
Many individuals with diabetes must undergo dialysis to purify toxins from their blood which is a process that can severely restrict the quality of your life.
An individual can become “insulin-dependent” to manage their blood sugar and must time meals and snacks appropriately. Sometimes you can also develop autoimmune complications .
When blood sugar becomes this high, there is significant risk of (and correlation with) further diabetic complications such as obesity, neurodegenerative disease (such as Alzheimer’s disease), cardiovascular complications, kidney damage, fatty liver disease, pancreatic disease, muscle weakness, loss of eyesight, increased susceptibility to viral, bacterial, and fungal infections, and irreversible nerve & tissue destruction that may lead to amputation.
Once again the question is not if these complications will occur, it’s when.
Is Diabetes Reversible?
Please forgive my serious tone in this article which is unlike the style of the more positive articles that you are accustomed to reading. Many individuals still take diet concerns lightly when it comes to their health and I feel that gentle reminders are warranted from time to time!
On a more positive note, just because your condition is given a "title" does not mean that it is not reversible. There are numerous accounts of diabetic states being reversed, or many more are well-managed once a diagnosis is given.
I've been told personally by at least one patient that being diagnosed with Type II Diabetes was the best thing that ever happened to him. It forced him to open his eyes to what he was doing to his body.
What might you be doing to yours?
In Part I: I reviewed some basic relationships between stress, cortisol and blood sugar management.
In Part III: I will explore how stress aggravates the diabetic state, and how it can be both a contributing cause and an indirect effect of uncontrolled diabetes!
Failing to address stress can make diabetes management extremely difficult, and I hope to outline why.