Overview

Type 2 diabetes is a chronic metabolic disorder that affects the way the body processes blood sugar (glucose). In this condition, the body either resists the effects of insulin, which is a hormone that regulates blood sugar levels, or doesn’t produce enough insulin to maintain normal blood sugar levels. As a result, glucose builds up in the bloodstream and can cause damage to various organs and tissues in the body over time. It is the most common form of diabetes and affects millions of people worldwide. According to the International Diabetes Federation, the global prevalence of diabetes among adults was estimated to be 9.3% in 2019, with type 2 diabetes accounting for 90-95% of all cases. In the United States, an estimated 34.2 million people have diabetes, with 90-95% having type 2 diabetes.

Type 2 diabetes is most prevalent among older adults, although it is becoming increasingly common among younger individuals as well. Certain populations, such as African Americans, Hispanic/Latino Americans, Native Americans, and Asian Americans, are at a higher risk of developing type 2 diabetes. Other risk factors for type 2 diabetes include obesity, physical inactivity, poor diet, and genetics.

Etiology

The combination of insulin resistance and beta-cell dysfunction are the key underlying factors that causes type 2 diabetes.

Insulin resistance refers to the body’s inability to use insulin properly, which results in high blood sugar levels. This can be caused by a variety of factors, including genetics, obesity, physical inactivity, and certain medications. Over time, insulin resistance can lead to beta-cell dysfunction, which occurs when the cells in the pancreas that produce insulin become damaged and can no longer produce enough insulin to maintain normal blood sugar levels.

Genetics also play a role in the development of type 2 diabetes. Some people may be genetically predisposed to developing the condition, and certain genetic mutations have been linked to an increased risk of type 2 diabetes. However, lifestyle factors such as poor diet and physical inactivity are the main contributing factors to the development of type 2 diabetes, even in individuals with a low genetic risk.

As type 2 diabetes progresses, it can lead to a range of symptoms such as increased thirst and urination, fatigue, blurry vision, and slow healing of cuts and bruises. In some cases, complications such as nerve damage, kidney disease, and cardiovascular disease can also occur.

Insulin Resistance

Insulin and glucagon are the two hormones that play key roles in the regulation of blood sugar levels in the body. Insulin is produced by beta cells in the pancreas in response to high blood sugar levels, and helps to transport glucose from the blood into cells to be used for energy. Glucagon, on the other hand, is produced by alpha cells in the pancreas in response to low blood sugar levels, and helps to release stored glucose from the liver to raise blood sugar levels.

In individuals with type 2 diabetes, insulin resistance occurs, which means that the cells in the body become less responsive to insulin. This results in high blood sugar levels, as glucose is unable to enter cells and can’t be used for energy. Over time, the pancreas may struggle to produce enough insulin to compensate for insulin resistance, leading to hyperglycemia.

In addition to insulin and glucagon, cortisol, a hormone produced by the adrenal glands, can also play a role in the development of type 2 diabetes. Cortisol helps to regulate blood sugar levels by increasing glucose production in the liver and decreasing glucose uptake by cells. However, chronic stress and elevated cortisol levels can contribute to insulin resistance and impaired glucose metabolism, potentially increasing the risk of developing type 2 diabetes.

Beta-cell Dysfunction

Beta-cell dysfunction, which occurs when the cells in the pancreas that produce insulin become damaged, can lead to impaired insulin secretion and further contribute to hyperglycemia. This dysfunction can be caused by a variety of factors, including oxidative stress, inflammation, and mitochondrial dysfunction.

Clinical Manifestations

The clinical manifestations of type 2 diabetes can vary from person to person, and some individuals may not experience any symptoms at all. However, common signs and symptoms of type 2 diabetes include:

1. Increased thirst and urination – As blood sugar levels rise, the kidneys may attempt to flush out excess glucose by producing more urine, leading to increased urination and thirst.
2. Fatigue – The body may struggle to convert glucose into energy, leading to feelings of fatigue and weakness.
3. Blurred vision – High blood sugar levels can affect the lenses in the eyes, leading to blurry vision.
4. Slow healing of cuts and bruises – High blood sugar levels can impair the immune system’s ability to fight off infections, leading to slower healing of wounds.
5. Numbness and tingling in the hands and feet – Prolonged high blood sugar levels can cause nerve damage, leading to numbness and tingling sensations in the extremities.

If left untreated, type 2 diabetes can lead to serious health complications such as heart disease, stroke, kidney disease, and nerve damage. Additionally, insulin resistance and hyperglycemia can contribute to the development of other health conditions such as high blood pressure, high cholesterol, and inflammation.

The expected progression and prognosis of type 2 diabetes can vary depending on the individual and the severity of the condition. However, with proper management and treatment, many individuals with type 2 diabetes are able to live healthy and fulfilling lives. By addressing the underlying mechanisms of insulin resistance and hyperglycemia, healthcare providers can help individuals with type 2 diabetes manage their blood sugar levels and prevent or manage complications associated with the condition.

Diagnosis

The diagnosis of type 2 diabetes typically involves a combination of clinical evaluation, blood tests, and other diagnostic criteria. The American Diabetes Association recommends the following diagnostic criteria for type 2 diabetes:

1. A fasting plasma glucose (FPG) level of 126 mg/dL or higher. Fasting is defined as no caloric intake for at least 8 hours.
2. A 2-hour plasma glucose level of 200 mg/dL or higher during an oral glucose tolerance test (OGTT). This test involves drinking a sugary drink and having blood sugar levels measured two hours later.
3. A random plasma glucose level of 200 mg/dL or higher in the presence of classic symptoms of hyperglycemia, such as increased thirst and urination.

In addition to these diagnostic criteria, healthcare providers may also order additional blood tests to assess blood sugar control over time, such as a hemoglobin A1c (HbA1c) test, which measures average blood sugar levels over the past 2-3 months.

It is important to note that some individuals may not meet the diagnostic criteria for type 2 diabetes but may still have impaired glucose tolerance or prediabetes, which can increase the risk of developing type 2 diabetes and other health complications.

Factors to Consider

There are several inputs that can affect the development and progression of type 2 diabetes, including diet, exercise, and environmental exposures.

Diet plays a critical role in the development and management of type 2 diabetes. High intake of simple carbohydrates, such as refined sugars and processed foods, can lead to rapid spikes in blood sugar levels and contribute to insulin resistance. On the other hand, diets rich in fiber, healthy fats, and lean proteins can help to stabilize blood sugar levels and improve insulin sensitivity. Specific nutrients that have been shown to be beneficial in the management of type 2 diabetes include omega-3 fatty acids, magnesium, and chromium, which can improve insulin sensitivity and glucose uptake.

Exercise and movement are also important inputs that can affect the development and progression of type 2 diabetes. Physical activity helps to improve insulin sensitivity and glucose uptake, which can help to regulate blood sugar levels and prevent complications associated with type 2 diabetes. Additionally, exercise can help to reduce inflammation and oxidative stress, which are contributing factors to the development of insulin resistance and beta-cell dysfunction.

Environmental exposures, such as exposure to toxins and pollutants, can also play a role in the development and progression of type 2 diabetes. Chemicals such as bisphenol A (BPA) and phthalates, which are commonly found in plastics and personal care products, have been shown to disrupt insulin signaling and contribute to the development of insulin resistance. Pesticides and other environmental toxins can also impair glucose metabolism and increase the risk of developing type 2 diabetes.

Integrative Solutions

Nutritional and integrative health recommendations can play a critical role in the prevention and management of type 2 diabetes. Some dietary interventions that may benefit individuals with type 2 diabetes include:

1. Adopting a low-glycemic diet – A low-glycemic diet is rich in fiber, healthy fats, and lean proteins and can help to regulate blood sugar levels and improve insulin sensitivity. The Ketogenic and Paleolithic Diet are two options.
2. Reducing refined sugar and processed food intake – High intake of refined sugars and processed foods can contribute to insulin resistance and hyperglycemia.
3. Increasing consumption of antioxidant-rich foods – Antioxidants can help to reduce inflammation and oxidative stress, both of which are contributing factors to the development of insulin resistance and beta-cell dysfunction.

Ketogenic Diet

The ketogenic diet is a high-fat, low-carbohydrate diet that has gained popularity in recent years for its potential benefits in managing type 2 diabetes. The goal of the ketogenic diet is to induce a metabolic state called ketosis, in which the body primarily uses fat for fuel instead of glucose.

Studies have shown that the ketogenic diet can be effective in improving blood sugar control and reducing insulin resistance in individuals with type 2 diabetes. By limiting carbohydrate intake, the ketogenic diet can help to regulate blood sugar levels and improve insulin sensitivity. Additionally, the high fat intake in the diet can help to promote feelings of fullness and reduce overall caloric intake, which can aid in weight loss, a key component of managing type 2 diabetes.

However, it is important to note that the ketogenic diet may not be appropriate for everyone with type 2 diabetes. The high fat content in the diet can increase cholesterol levels and may exacerbate pre-existing conditions such as liver disease or gallbladder issues. Additionally, the ketogenic diet requires careful monitoring and adjustments to insulin and medication dosages, which should be done under the supervision of a healthcare provider.

Paleolithic Diet

The paleo diet, also known as the caveman diet, is a dietary approach that emphasizes whole foods such as lean meats, vegetables, fruits, and nuts while avoiding processed foods, grains, legumes, and dairy products. The paleo diet has gained popularity in recent years for its potential benefits in managing type 2 diabetes.

Studies have shown that the paleo diet can be effective in improving blood sugar control and reducing insulin resistance in individuals with type 2 diabetes. The focus on whole, unprocessed foods and elimination of refined sugars and grains can help to regulate blood sugar levels and improve insulin sensitivity. Additionally, the paleo diet can aid in weight loss, which is a key component in managing type 2 diabetes.

Supplements

1. Alpha-lipoic acid (ALA) – ALA is an antioxidant that can help to reduce inflammation and improve insulin sensitivity in individuals with type 2 diabetes.
2. Chromium – Chromium is a mineral that can help to regulate blood sugar levels and improve insulin sensitivity.
3. Magnesium – Magnesium is a mineral that can help to improve insulin sensitivity and reduce inflammation.
4. Omega-3 fatty acids – Omega-3 fatty acids can help to improve insulin sensitivity and glucose uptake.
5. Vitamin D – Vitamin D plays a role in insulin sensitivity and can help to reduce inflammation.
6. Probiotics – Probiotics can help to improve gut health and may also improve insulin sensitivity.

Integrative therapeutic strategies such as stress management techniques, regular exercise, and improving sleep quality can also be beneficial in the management of type 2 diabetes. These strategies can help to reduce inflammation, improve insulin sensitivity, and regulate blood sugar levels.

Exercise

Regular exercise is an important component of managing type 2 diabetes. Exercise can help to improve insulin sensitivity and glucose uptake, reduce blood sugar levels, and promote weight loss.

The American Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic exercise per week, spread over at least three days per week with no more than two consecutive days without exercise. Examples of moderate-intensity exercise include brisk walking, cycling, and swimming.

Resistance training, such as weightlifting, can also be beneficial for individuals with type 2 diabetes as it can help to increase muscle mass and improve insulin sensitivity.

It is important to note that individuals with type 2 diabetes should work with their healthcare provider to develop an exercise plan that is appropriate for their individual needs and health status. Monitoring blood sugar levels before, during, and after exercise is also important to ensure safe and effective exercise.

Common Medications

While there is increasing interest in integrative and holistic approaches to healthcare, conventional medical treatment remains a mainstay in the management of many chronic conditions, including type 2 diabetes. By working with a traditional doctor and following recommended treatment protocols, individuals with type 2 diabetes can achieve better blood sugar control and prevent complications associated with the condition. However, it is important to note that medications can have potential side effects and may not address the underlying causes of insulin resistance and hyperglycemia. As such, individuals may also choose to incorporate integrative approaches alongside conventional medical treatment to achieve optimal health outcomes.

Common medications used to treat type 2 diabetes include:

1. Metformin – Metformin is a medication that helps to lower blood sugar levels by reducing glucose production in the liver and improving insulin sensitivity.
2. Sulfonylureas – Sulfonylureas stimulate insulin secretion from the pancreas and can help to lower blood sugar levels.
3. Insulin – Insulin injections may be necessary for individuals with type 2 diabetes who cannot adequately control their blood sugar levels with oral medications alone.