NURUM GUIDE

Understanding Type 2 Diabetes

Type 2 diabetes is a complex, chronic condition that affects millions of people worldwide. In this guide, we'll discuss its causes, symptoms, complications, and management approaches to help you better understand the condition and lead a healthier life.

Understanding Type 2 Diabetes

Type 2 Diabetes: A Growing Health Crisis in Hong Kong and China

The prevalence of type 2 diabetes and its antecedent state, prediabetes, is mounting alarmingly in regions such as Hong Kong and the Greater Bay Area of China, signalling a dire need for public health attention.

Approximately 12.5% of adults in Hong Kong are diagnosed with type 2 diabetes.
Roughly 13.8% are identified as having prediabetes.
In the Greater Bay Area, diabetes affects an estimated 7.8 million individuals, with prediabetes impacting close to 8 million.
Three out of every ten Hong Kong adults are confronting diabetes or its precursors.

Several cases remain unidentified largely due to insufficient testing, suggesting that the actual numbers may be even higher.

The Science Behind Type 2 Diabetes

Prediabetes marks the stage of insulin resistance where glucose levels are heightened yet not to the extent of a diabetes diagnosis. About 70% of those with prediabetes might progress to diabetes, and a staggering 90% may be unaware of their condition, owing to the subtle nature of symptoms.

Type 2 diabetes, constituting approximately 95% of diabetes occurrences, is typified in its initial stages by an incongruous presence of elevated insulin and glucose in the bloodstream. Ordinarily, such insulin levels would normalise glucose, but the hallmark insulin resistance in type 2 diabetes curtails this response, complicating glucose regulation despite medication.

Recognising Symptoms of Type 2 Diabetes and Prediabetes

Signs of Type 2 Diabetes:

Persistent fatigue
Excessive thirst and dryness of the mouth
Frequent urination
Recurring infections in the urinary tract or genital area
Impaired sexual function
Constant hunger
Sensory issues such as tingling or numbness in extremities
Blurred eyesight
Prolonged healing of wounds
Weight fluctuations

Indications of Prediabetes:

Chronic tiredness and hunger
Disrupted sleep patterns
Concentration difficulties
Sensory disturbances in the feet and hands
Darkening of the skin around the neck area
Proliferation of skin tags
Weight changes

Detecting Type 2 Diabetes and Prediabetes

Medical diagnosis of diabetes or prediabetes is essentially based on specific blood tests:

For Type 2 Diabetes:

Any of these test results could indicate diabetes:

Fasting glucose levels repeatedly at or above 126 mg/dL
HbA1c values at 6.5% or more
Glucose levels reaching 200 mg/dL or more in an oral glucose tolerance test after two hours

For Prediabetes:

One of these test readings could mean prediabetes:

Fasting glucose levels between 100–125 mg/dL on different occasions
HbA1c numbers ranging from 5.7% to 6.4%‍
A two-hour post-glucose load level of 140 mg/dL or higher in a glucose tolerance test

Understanding Blood Sugar Dynamics

Blood sugar or glucose is a constant in our circulatory system, serving as the primary energy source for various bodily functions from cognitive processes to muscle activity during intense physical exertion.

Predominantly, carbohydrates from the diet are responsible for blood glucose. Carbs are found in everyday food items like grains, starch-rich vegetables, fruits, and sweetened beverages. The digestive process simplifies these into glucose, thus spiking blood sugar levels post-consumption.

Navigating the relationship between diet and blood sugar is a cornerstone in managing type 2 diabetes and prediabetes effectively, underscoring the importance of dietary choices in long-term health outcomes.

Understanding Insulin's Role

When food is consumed, particularly carbohydrates, the digestive system breaks it down into glucose, which enters the bloodstream. To deliver the glucose to cells, where it serves as an energy source, insulin plays an indispensable role as a regulatory hormone.

By facilitating glucose's journey from the blood into cells, insulin helps maintain optimal blood sugar levels. Consuming carbohydrates causes a spike in blood sugar, and insulin functions to ensure this increase is under control. Basically, each intake of carbohydrates stimulates the release of insulin, permitting glucose to infiltrate the cells. However, when cells become resistant to insulin, glucose fails to penetrate the cells and instead accumulates in the bloodstream, resulting in elevated blood sugar.

Insulin Resistance Complications

Insulin resistance leads to type 2 diabetes. This condition makes cells resistant to insulin, hindering its function and leading to a build-up of glucose in the blood. While the exact causes of insulin resistance are yet to be fully understood, we know that introducing more insulin doesn't rectify the underlying issue. Hence, in spite of heightened insulin levels following carbohydrate intake, insulin resistance inhibits efficacious glucose transfer into cells, keeping both blood sugar and insulin levels high.

In the long term, this constant effort to counter high blood sugar forces the body to over produce insulin, putting tremendous stress on insulin-producing cells in the pancreas. Adult bodies struggle to regenerate these cells once they are lost, explaining why chronic type 2 diabetes can result in a significant reduction in natural insulin production, a state referred to as pancreatic burnout. At this juncture, insulin injections become necessary to supplement the body's vanishing insulin supply.

Insulin resistance is linked with varied health predicaments including, but not limited to, type 2diabetes and prediabetes, metabolic syndrome, polycystic ovary syndrome (PCOS),coronary artery disease, and fatty liver disease.

High Blood Sugar is a Sign of Carbohydrate Intolerance

Broadly accepted normal blood sugar ranges lie below 100 mg/dL when fasting and between 70-140 mg/dL two hours post mealtime. This range corresponds to roughly one teaspoon of sugar flowing in the bloodstream.

High blood sugar levels may inflict serious damage on blood vessels and organs, potentially causing the severe complications linked with type 2 diabetes, such as kidney failure, blindness, and limb amputations. Consequently, the body significantly amplifies its insulin secretion when blood sugar rises beyond the normal range, enabling excess sugar to be transported into cells.

If a high-carbohydrate food, such as a bowl of white rice or noodles is consumed, it swiftly elevates blood sugar, as the carbs are rapidly converted to glucose. Given that just a cup of rice contains approximately 45 grams of carbs, it virtually injects 9teaspoons of sugar into a system that perpetually tries to maintain a sugar level of around 1 teaspoon.

For some individuals, managing their blood sugar post a high-carb meal is relatively simple, owing to their heightened sensitivity to insulin. This reflects a high carbohydrate tolerance, as their body can efficiently control blood sugar even after consuming a high-carb meal.

However, the situation is trickier for those with prediabetes or type 2 diabetes. Their low tolerance to carbohydrates makes it arduous for their bodies to reduce blood sugar levels after a high-carb meal as insulin resistance impedes the successful transfer of glucose into their cells, keeping blood sugar high.

Everyone has a Unique Carbohydrate Tolerance

Each individual has a unique carbohydrate tolerance. In a person who is carbohydrate-intolerant, such as someone with type 2 diabetes, a much higher level of insulin is required to regulate their blood sugar level than someone without carbohydrate intolerance. Thus, being carbohydrate intolerant means that much more insulin is needed to maintain stable blood sugar levels, even for an equivalent amount of carbohydrates consumed.

If we imagine cells as small storage lockers, insulin acts as the key that opens these lockers. In a person with type 2 diabetes, already grappling with high blood sugar levels due to insulin resistance, the lock becomes faulty, making it harder to effectively use the insulin 'key'. This is the picture of carbohydrate intolerance.

Inflammation and Type 2 Diabetes

Type 2 Diabetes is often synonymous with high blood sugar, but there's another silent contributor to its development and progression: inflammation. Beyond merely elevated glucose levels, understanding and addressing inflammation is key in the fight against this chronic disease.

The body's inflammatory response comes in two forms – acute and chronic, each with distinct causes and implications for health.

Acute Inflammation:

This immediate, short-term response signifies the body's defence against injury or infection, causing fever, swelling, and pain. It serves as a necessary part of healing and quickly dissipates once the threat is neutralised.

Chronic Inflammation:

Unlike acute inflammation, chronic inflammation lingers and can occur absent of any obvious injuries or infections, often underlying numerous health issues. Notably, individuals with type 2 diabetes have been found to have elevated markers of chronic inflammation compared to non-diabetic individuals of similar bodyweight.

These persistent inflammatory markers are not merely associated with existing type 2 diabetes; they're also predictive of who might develop the condition. Hence, inflammation is both a precursor and a consequence of insulin resistance, further aggravated by the consistent high blood glucose levels that characterise type 2 diabetes.

Approaches to Treating Type 2 Diabetes

Treatment of type 2 diabetes aims for more than just lowering blood sugar levels— it also targets the inflammatory processes underlying the disease. When selecting a treatment plan, consideration must be given to potential side effects, such as hypoglycaemia, as well as implications for weight, costs, and overall health impact.‍

Path of Standard Care

Initially, individuals with type 2 diabetes may be advised to focus on lifestyle changes, including diet and exercise. Should the need for medication arise, first-line therapies not involving insulin come into play. Subsequent treatments may include medications that either stimulate insulin production or introduce insulin externally.

Diabetes Reversal vs. Diabetes Management

The Perspective of Reversal

Type 2 Diabetes reversal, a concept built on stringent lifestyle modifications, sparks ongoing discussions across the medical community. Though not universally accepted, growing evidence supports its potential. Numerous cases, published in peer-reviewed journals, reveal instances of enduring success in reverting affected individuals to healthy blood glucose levels off medication.

Despite diabetes being a non-curative condition, this signifies the potential of disciplined lifestyle changes in controlling and even reversing the disease to a significant degree.

The Strategy of Management

In contrast, management techniques focus on contending with the symptoms, primarily through blood sugar level regulation. It's a continuous commitment to ensure symptoms do not escalate, with an understanding that this approach doesn't address the issue's root cause.

Paradigm Shift: Reversal over Management

The possibility of reversing diabetes marks a significant departure from traditional approaches that focus more on managing symptoms. While management aids in the short-term control of blood sugar levels, it does not actively counter the root cause underlying Type 2 Diabetes. Reversal, on the other hand, aims to hit at the very core of the disease—insulin resistance and chronic inflammation—determined to wrest control from these underlying issues.

Though the reversal approach may pose some challenges, it presents a greater possibility for long-term health improvement. Facing this ongoing debate concerning diabetes reversal, specific lifestyle changes and discipline emerge as potential game-changers in tackling this chronic condition.

Personalising Treatment in Hong Kong

Hong Kong's diverse health landscape calls for tailored approaches like those provided by Nurum. The mission at Nurum is to go beyond symptom management and target the disease at its core by integrating personalised plans that address blood sugar control and inflammation management to tackle type 2 diabetes more comprehensively.

Nurum's methods are designed to align with an individual's lifestyle and long-term health objectives, ensuring a sustainable and pragmatic approach that fits the unique cultural and environmental context of life in Hong Kong.

References:

Item added to your cart