Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
27 Jun

The Definitive Guide to Insulin, Blood Sugar & Type 2 Diabetes (and you’ll understand it)

BITE ME, ADA

We all know by now that type 2 diabetes is an epidemic. We’re seeing words like crisis and runaway all over the news and in the journals. Heart disease rates have been cut in half since the staggering margarine days of the 1980s, but diabetes has swiftly risen to fill that gaping void and meet the challenge of Completely Unnecessary Disease Epidemic.

Here’s my ultra-simple explanation of the entire insulin/blood sugar/type 2 diabetes mess. Big Agra could really care less about you. That’s just business. The pharmaceutical industry is not in it for the love of life. If that were the case, drugs would be much cheaper. The FDA has to think about public health, but it also has to think about treading carefully on the toes of corporate interests, because that’s how it works when you’re the biggest economy in the world.

Print this explanation out, stick it on your fridge, email it to your aunt. And put down the pasta.

When you eat food, the body digests the macronutrients: carbohydrates, proteins – actually many different amino acids – and fats. (Anything it can’t digest, like alcohol or fiber or toxins, either passes right on through or, if it makes it into the bloodstream, gets filtered by your liver, a beast of an organ if there ever was one.) We measure these macronutrients in grams and calories, but your body operates in terms of fuel. If you eat more fuel than your body needs – which most people do – the body is forced to store this excess. This ability to store excess fuel was an evolutionary imperative in a world that was in a state of constant “feast or famine” 50,000 years ago. In terms of Primal Health and our DNA blueprint, humans became very efficient fuel storage specialists and were able to survive the rigors of a hostile environment and pass those very same genes down to you and me. Thanks a lot, Grok!

caveboy

Bear in mind that every type of carbohydrate you eat is eventually converted to a simple form of sugar known as glucose, either directly in the gut or after a brief visit to the liver. The truth is, all the bread, pasta, cereal, potatoes, rice (stop me when you’ve had enough), fruit, dessert, candy, and sodas you eat and drink eventually wind up as glucose. While glucose is a fuel, it is actually quite toxic in excess amounts unless it is being burned inside your cells, so the body has evolved an elegant way of getting it out of the bloodstream quickly and storing it in those cells.

It does this by having the liver and the muscles store some of the excess glucose as glycogen. That’s the muscle fuel that hard anaerobic exercise requires. Specialized beta cells in your pancreas sense the abundance of glucose in the bloodstream after a meal and secrete insulin, a peptide hormone whose job it is to allow glucose (and fats and amino acids) to gain access to the interior of muscle and liver cells.

But here’s the catch: once those cells are full, as they are almost all the time with inactive people, the rest of the glucose is converted to fat. Saturated fat.

Insulin was one of the first hormones to evolve in living things. Virtually all animals secrete insulin as a means of storing excess nutrients. It makes perfect sense that in a world where food was often scarce or non-existent for long periods of time, our bodies would become so incredibly efficient. How ironic, though, that it’s not fat that gets stored as fat – it’s sugar. And that’s where insulin insensitivity and this whole type 2 diabetes issue get confusing for most people, including your very own government.

If we go back 10,000 or more years, we find that our ancestors had very little access to sugar – or any carbohydrates for that matter. There was some fruit here and there, a few berries, roots and shoots, but most of their carbohydrate fuel was locked inside a very fibrous matrix. In fact, some paleo-anthropologists suggest that our ancestors consumed, on average, only about 80 grams of carbohydrate a day. Compare that to the 350-600 grams a day in the typical American diet today. The rest of their diet consisted of varying degrees of fat and protein. And as fibrous (and therefore complex) as those limited carbohydrate foods were, their effect on raising insulin was minimal. In fact, there was so little carbohydrate/glucose in our ancestor’s diet that we evolved four ways of making extra glucose ourselves and only one way of getting rid of the excess we consume!

Today when we eat too many carbohydrates, the pancreas pumps out insulin exactly as the DNA blueprint tell it to (hooray pancreas!), but if the liver and muscle cells are already filled with glycogen, those cells start to become resistant to the call of insulin. The insulin “receptor sites” on the surface of those cells start to decrease in number as well as in efficiency. The term is called “down regulation.” Since the glucose can’t get into the muscle or liver cells, it remains in the bloodstream. Now the pancreas senses there’s still too much toxic glucose in the blood, so it frantically pumps out even more insulin, which causes the insulin receptors on the surface of those cells to become even more resistant, because excess insulin is also toxic! Eventually, the insulin helps the glucose finds it way into your fat cells, where it is stored as fat. Again – because it bears repeating – it’s not fat that gets stored in your fat cells – it’s sugar.

sugar

Over time, as we continue to eat high carbohydrate diets and exercise less, the degree of insulin insensitivity increases. Unless we take dramatic steps to reduce carbohydrate intake and increase exercise, we develop several problems that only get worse over time – and the drugs don’t fix it.

Ready for this? Let’s go:

1) The levels of blood glucose stay higher longer because the glucose can’t make it into the muscle cells. This toxic glucose is like sludge in the bloodstream clogging arteries, binding with proteins to form harmful AGEs (advanced glycated end-products) and causing systemic inflammation. Some of this excess glucose contributes to a rise in triglycerides, increasing risk for heart disease.

2) More sugar gets stored as fat. Since the muscle cells are getting less glycogen (because they are resistant), and since insulin inhibits the fat-burning enzyme lipase, now you can’t even burn stored fat as easily. You continue to get fatter until eventually those fat cells become resistant themselves.

3) It just gets better. Levels of insulin stay higher longer because the pancreas thinks “if a little is not working, more would be better.” Wrong. Insulin is itself very toxic at high levels, causing, among many other maladies, plaque build-up in the arteries (which is why diabetics have so much heart disease) and increasing cellular proliferation in cancers.

4) Just as insulin resistance prevents sugar from entering muscle cells, it also prevents amino acids from entering. So now you can’t build or maintain your muscles. To make matters worse, other parts of your body think there’s not enough stored sugar in the cells, so they send signals to start to cannibalizing your precious muscle tissue to make more – you guessed it – sugar! You get fatter and you lose muscle. Woo hoo!

5) Your energy level drops, which makes you hungry for more carbohydrates and less willing to exercise. You actually crave more of the poison that is killing you.

6) When your liver becomes insulin resistant, it can’t convert thyroid hormone T4 into the T3, so you get those mysterious and stubborn “thyroid problems”, which further slow your metabolism.

7) You can develop neuropathies (nerve damage) and pain in the extremities, as the damage from the excess sugar destroys nerve tissue, and you can develop retinopathy and begin to lose your eyesight. Fun.

8) Eventually, the pancreas is so darn exhausted, it can’t produce any more insulin and you wind up having to inject insulin to stay alive. Lots of it, since you are resistant. Congratulations, you have graduated to insulin-dependent Type 2 diabetes.

That’s the bad news. And it’s seriously bad. But the good news is that there is a way to avoid all this. It’s all right there in your DNA blueprint. First off, exercise does have a major impact on improving insulin sensitivity since muscles burn your stored glycogen as fuel during and after your workout. Muscles that have been exercised desperately want that glucose inside and will “up regulate” insulin receptors to speed the process. That’s one reason exercise is so critical for type 2 diabetics in regaining insulin sensitivity. It’s also the reason why endurance athletes can eat 400 or 600 grams of carbs a day and stay lean – they burn it all off and make room for more.

Resistance training seems to be as effective as aerobic activity, but a mix of the two is the best. And because you are now “insulin sensitive”, you don’t require as much insulin to store the excess, which “up regulates” all the fat burning enzymes, so you burn your stored fats at a much higher rate throughout the day. Important amino acids and other vital nutrients have access to the cells when insulin sensitivity is high, so you’re building or maintaining muscle and losing fat weight. Go team.

Second, cutting back on carbohydrates, especially the obvious sugars and refined stuff is absolutely essential. Make fresh vegetables the base of your food pyramid. I get rip-roaring furious when I see our government suggesting that we get 60% of our calories from carbohydrates. That’s ridiculous, bordering on criminal. Think about what is optimal for human health from a “primal” perspective. Look at the genetic blueprint. Look at the statistics and studies if you like – or simply observe what’s going on around you at restaurants, movie theaters and school cafeterias – and you’ll begin to understand the implications of a diet out of whack with our design. The evidence is nothing short of overwhelming: carbohydrate intake of the refined, sugary sort is enormously stressful to the body.

Not only should diabetics limit carbohydrate intake – everyone should. We are all, in an evolutionary sense, predisposed to becoming diabetic.

Mainstream opinion is, of course, partly correct in that sugar does not necessarily “cause” diabetes – increasingly, scientific evidence is showing that genetic susceptibility plays a huge role in individuals’ potential for developing diabetes. Well, no kidding! The entire mainstream argument boils down to this: sugar does not cause diabetes; it’s genetic. I couldn’t agree more. I would simply say that our shared genetic susceptibility to insulin resistance, inflammation, cardiovascular disease and obesity shows that any sort of refined sugar or grain is the last thing humans should be eating. Our genetic “primal blueprint” indicates that we are not meant to consume sugar.

Next week, I’ll be discussing cortisol, stress, and the adrenals in light of our “primal” blueprints. See you then. I welcome your comments and questions as always.

Further reading:

What I eat

My Carb Pyramid

More Primal Health columns

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. It’s worth passing on to the universe.

    bilgi işlem wrote on April 30th, 2010
  2. All of this makes sense and sure does reveal a lot of truths about the diabetes problem. I was searching the internet on insulin resistance, though, and found some sites claiming that fat leads to insulin resistance. This is obviously contradictory to what you have said, and I was wondering if you could shed some light on this.

    Once site says that “Obese people have been found to harbor proteins called branched-chain amino acids (BCAAs) at far higher levels than non-obese people. The suspicion has been that these amino acids, in combination with a high-fat diet, contribute to insulin resistance . . . Because obese humans tend to ingest high-fat diets, the combination of high-BCAA and high-fat intake might contribute to insulin resistance in obese humans, but additional studies are needed. BCAAs constitute as much as 25 percent of amino acids in dietary protein, and are particularly enriched in diets high in animal (meat) proteins. . . Rats on a high-fat diet gained substantially more weight than rats that ate BCAAs with high-fat chow or those that ate standard chow. However, the rats eating the high-fat diet with BCAA became as insulin resistant as rats fed a high-fat only diet, even though they weren’t eating as much. . . Studies showed clear insulin resistance in the high-fat and high-fat with BCAA groups, but not in the rats eating less of the high fat chow or those eating standard chow. This proved that moderate fat intake was not a cause of insulin resistance.”

    Here is the link for the full article: http://www.emaxhealth.com/2/23/30380/too-much-protein-fat-lead-insulin-resistance.html

    I know the study was done on rats, lol, but I just wanted to make sure that eating fat doesn’t make you fat, or become insulin resistant. I totally agree with the excess amount of carbs doing just that, but can fat do that too? Sorry for the long post, and thank-you for your time and all of your great articles.

    Brandon wrote on May 8th, 2010
    • umm…. I’m no expert here, but did that abstract just say that they fed rats animal fats/high-fat diets? Hmmm… could the reason why they had problems be because rats don’t normally eat that much fat in their native diets? Maybe those rats need to get on a Primal Blueprint plan too!

      Besides, just read the “Success Stories” on this site – many stories come from T2 diabetics who now have healthy blood glucose levels.

      It just doesn’t make sense for a diabetic to use sugars (grains, carbs) as a primary source of fuel when we’ve spent hundreds of thousands, even millions of years evolving on fat-based diets that primarily burned ketones for fuel… If aliens invaded and put us in petting zoos they’d feed us mostly veggies and nuts/fish/meat, our natural diet – NOT grains or processed sugar, in the same way you don’t feed bananas to a cow, even if those bananas might cost less and offer a higher profit margin than what they normally eat…

      mm wrote on July 19th, 2010
    • Great comment, great question.

      First, we are not rats. The best a rat study can do is to turn our heads in a direction of study that looks interesting. Rats do not eat a high fat diet. They have not evolved on it. We are not rats. Secondly, the obese and high fat diet humans get that way because they eat a high fat high carb diet. It is the carb that forces the body to store excess fat and sugar. It is the worst diet. Everything in context…correlation is not causation with everything, including fat.

      http://drrosedale.com/blog/tag/insulin-resistance/#axzz2bdeQp8NS

      To understand more about fat and insulin resistance read…

      http://high-fat-nutrition.blogspot.in/2009/09/physiological-insulin-resistance-and.html

      “Everything must be looked at theu the lens of burning fat efficiently, not sugar. “Your health and longevity is detyermined by 1 equation :The more fat you burn inb your lifetime the healthier you will be…the more sugar you burn in your lifetime, the less healthy you will be.”

      Burn fat not store it. You do that by eating fat and very low carb, under 50 grams per day. That is the starting place of health.

      Andre Chimene wrote on August 10th, 2013
  3. One thing that is being overlooked here is insulin’s role in the anabolic process. Insulin’s role goes much further than just aiding in the muscles’ uptake of glucose. Of all the hormones, except testosterone, insulin is the most anabolic. So while it does have a role in fat deposition in the adipose tissue as well as glucose uptake, it is very important in post exercise muscle building. After a workout, your body is in a catabolic state. The main factor at work here is FoxO. In a catabolic state, FoxO is transported into the nuclease where it activates the formation of catabolic factors such as Murf that will break down muscle. While most of the research into this pathway has dealt with muscle wasting in patients with certain disease states, its role in post exercise muscle breakdown is just now being realized. At the same time however, there are anabolic factors working to increase muscle deposition and repair damaged muscle tissue. But, these gains in muscle deposition are negated by the breakdown. Insulin leads to the activation of a kinase called Akt. Akt then adds an inorganic phosphate to FoxO, barring it from entering the nucleus, thus negating its catabolic actions. There is a classic study looking at the effects of a post exercise insulin spike. In subjects who worked out and did not receive an insulin shot, the levels of muscle deposition and breakdown were basically the same, leading to net gain in muscle. In the subjects who did receive an insulin shot post workout, the muscle deposition was the same as the no shot group, but the muscle breakdown was much much lower, leading to an overall positive net gain.

    While I do agree that type II diabetes is a terrible disease that can be reversed non medically by lifestyle change, and that insulin spikes throughout the day are indeed bad, I feel it is unwise and unfair to demonize insulin the way you have. If anything, eating a decent amount of simple sugars immediately post exercise, the resulting insulin spike is extremely beneficial (and not only for muscle gain but as well as increasing glycogen storage, but that is another story).

    Again, I must emphasize that I have been a frequent visitor to this site for well over a year (a practitioner of the teachings for only a short time) and I agree with 95% of the information given, I do believe that insulin, while potentially bad, is very much necessary to achieve full fitness potential.

    And if anyone wants to inquire about my credentials, I am currently a grad student in exercise physiology where my thesis work deals with, you guessed it, post exercise supplementation and FoxO/muscle damage response.

    Phil wrote on June 3rd, 2010
    • It all depends on what your goal is. If you want to add muscle and improve athletic performance at the expense of longevity…then increase insulin and sugars. If you want a healthy, long, post reproductive life…then decrease insulin, leptin and sugars. We Diabetics want to get healthy first and foremost, not improve our athletic performance. When I was diagnosed, after 30 years as a Personal Trainer, all I wanted was the pain and impending death to go away. After normalizing my sugar, insulin and leptin, as a Type 1, the desire to work out and get stronger came back. It is a mental balancing act as well as physical.

      Andre Chimene wrote on April 11th, 2013
  4. Hey Mark,

    Awesome post! I was wondering, since you say fat doesn’t get stored as fat, but sugar does (which I totally agree with), what does excess fat, and protein for that matter, get stored as? I know it’s not too important to focus on calorie counting, but let’s say you consume an excess amount of fat and/or protein…. what does it get stored as? Thank you :)

    Brandon wrote on July 7th, 2010
    • I am also curious about the same thing….so much talk about the carbs and sugars, but not on the fat and proteins. What happens to them in this process? Thank you to all for all of this wonderful information!

      Lisa wrote on September 11th, 2010
  5. I found this site after looking for info on making pemmican,anyhow some good info kind mirroring all this is diabetes 101,an older gent wrote much about diabetes and the caveman diet.Think of what god would make,no twinkie trees or pizza plants!

    kapie9969 wrote on July 19th, 2010
  6. I think you can argue that its even more of an epidemic that more people don’t know that eating a raw food diet can completely reverse most diseases since they aid in repairing the bodies function and expel the toxins of our lifestyle which cause the micro-inflammation.

    Has anyone read “The China Study” by T Colin Campbell? I think his findings deserve national coverage.

    ahnteater wrote on August 26th, 2010
  7. I tried giving this to my parents because I think this is an EXCELLENT analysis of how this process works, in plain English – here is what happened.

    The phrase should read “Big Agra really couldn’t care less about you.” Right now it reads, “Big Agra could really care less about you.” – if they could care less, they would.

    The first things out of their mouths were along the lines of, “how can we trust someone who doesn’t get his grammar right?” I know it’s really off topic, but just wanted to put that out there.

    AM wrote on September 1st, 2010
    • Their loss, I guess. (And I know that wasn’t a complete sentence)

      http://dictionary1.classic.reference.com/help/faq/language/g09.html

      “…There are other American English expressions that have a similar sarcastic inversion of an apparent sense, such as Tell me about it!, which usually means ‘Don’t tell me about it, because I know all about it already’. The Yiddish I should be so lucky!, in which the real sense is often ‘I have no hope of being so lucky’, has a similar stress pattern with the same sarcastic inversion of meaning as does I could care less.”

      Mark Sisson wrote on September 2nd, 2010
      • Hi Mark,
        As a “grammar nazi” I just wanted to chime in to support your use of the phrase “could care less.” While literally it does seem more logical to say “could not care less,” your wording is indeed an accepted colloquialism…In any event, thanks for all you do, and I for one have been very impressed with your grammar and syntax!

        Elle wrote on February 25th, 2011
        • I know I come very late to this discussion. I can’t help but add my 10 cents-worth anyway. The remark makes sense if you read it with an unspoken caveat:

          “I could care less (but not much, so do go on, tell me your troubles. Soon I will care not at all.)”

          And thank you, Mark. Just found your site and loving the good sense it all makes.

          Barbara wrote on April 14th, 2011
      • I want to add that my parents are now true converts, and dad is off of statins. Thanks for that link – I showed them that and they laughed and think you are clever. Thanks for all that you do!

        AM wrote on February 25th, 2011
    • I’m an Aussie and we certainly say we “couldn’t care less” but I read a lot of books, and it appears that Americans say they “could care less”. Just like they say “look it” whereas in Australia we might say, “Look”. Anyway it seems a little silly to denounce something that is obviously written to not only inform but entertain. I wish more non-fiction used a bit of humour or conversational language to promote the message. It may make things easier to learn.

      Jane wrote on May 4th, 2012
  8. My niece linked your article on facebook quoting “paste it on your frig…send it to your aunt…” Since I am her aunt, I thought I should check it out. (But she has another aunt, my sister, who is a brittle diabetic, and she has a brother and a sister and a cousin who are also Type I diabetics!) Anyway, I thought I should check the article out. Excellent. I was just reading a book about how we need less carbohydrates so your article lined right up with that. Thanks, Amy

    Amy Hagerup wrote on September 29th, 2010
  9. I am a stumbler having stumbled across this Malibu cave site and now can’t even remember how or why. This odd interweb thing eh? I stopped watching TV and movies about 3 years ago when I realized it was all propaganda aimed at dumbing down the people. Prepping us for the great fall of the Republic is hard work as they love to say in their mighty halls. So it goes.
    I have struggled with being overweight, nay… FAT all my life. I would swing up and down in weight regardless of what I ate or how I lived. When I lived a frugal, simple life chopping wood, using wood stoves and walking with a big dog I felt good despite carrying a bit more weight. Last summer I spent my time clearing tons of dead shrubs, rose bushes and vines at this Addams family house I was renting n the Valley and draining, repairing and maintaining a pool that resembled a swamp when I began. I grilled steaks nearly everyday and lost a good 30 pounds and felt great. When I have a girlfriend I tend to lose the weight as well for obvious reasons, less eating and more sex. In between girlfriends or when I am busy with my car service here in LA I tend to put it all back on despite eating what I have been told are good things like fiber, vegetables and fruit. Usually they go bad before I can even get to eating them. Then I end up eating pasta, crackers or grain bread because I am told that is good. Now the weight is back on although for some reason my body doesn’t turn into those soft rolls of lard you see on the average obese Amerikan. Mine seems to go into solid masses probably due to my caveman past where I pretended to be living off the land cutting the aforementioned wood and exploring the wild parts of the midwest Ohio territories.
    I have come to the conclusion everything we are being told is simply more propaganda from the very corporate scumbags you describe like big agribiz, the chemical/pharma swine and the aristocracy who now seem intent on depopulating the planet for some insane reason. Long story short I want to lose this weight once and for all but find myself procrastinating for one reason or another. I go to the grocery and end up buying whatever is cheap and have to make a supreme effort to NOT pick up cheese and salami when my brain craves it. I am living on the other side of the Santa Monica Mountains from you and should go walking right up Mulholland to the Federal lands above me [a huge wilderness area of roads that NOBODY ever uses there] but again find myself hesitating because if my phone rings I have to zoom off to take some traveler to LAX or I don’t pay the rent. There always seems to be some mental block I create for myself that I just can’t get around. Even after reading your information I still have trouble digesting it although it speaks to me on a very primitive level as being the absolute truth, especially the hunter-gatherer aspect of eating and simple day to day physical effort. Last summer swimming in the pool and groundskeeping, eating steak and the occasional veggie proved that to me. I felt great but slid back when I moved back into the city from that place in the Valley. Now being out in the mountains I should be more active but its the nature [or anti-nature I should say] of the biz I am in that keeps me from going off every other day to commune with the coyotes up the road. I know I need another active girlfriend to inspire me as well as someone like Grok to remind me I am still the same big, hairy guy I was at 19. Just now I am turning 54 and shouldn’t be the lazy, big, hairy guy I tend to turn back into. Give me a boost here. That’s usually all I need, a challenge of sorts. How about this. You book my struggling car service occasionally over there in Malibu and keep me out of the poorhouse and I will document my attempt to follow your advice and get back to the Grok that I know is still within me.
    I realize I missed the big cow giveaway having just stumbled into your cave here. I await the next challenge.

    Howard Luken wrote on October 2nd, 2010
  10. I have everything you cited regarding Type 2 Diabetes, with the neuropathy, retinopathy and hypothyroidism. I find doctors only write many prescriptions, buit say nothing about nutrition or supplements.
    My pancreas was badly damaged with acute pancreatitus in 1995 and the outer portion was largely removed with an enveloping cyst in early 1996. That was the beginning of my diabetic journey. I have a “fatty liver” and also lost my gall bladder and other bits of plumbing along with the partial pancreotomy. Nephrology is present also.
    I am managing my diet about as well as I can. Any suggestions?

    David wrote on October 14th, 2010
    • Please buy Dr. Richard Bernstein’s book, The Diabetes Solution. Dr. Bernstein actually reversed the diabetic nephropathy (as well as many other complications) he had by getting his A1c down to 4.5. Do whatever it takes to get your A1C down to 4.5-5.0.

      Kathleen wrote on October 18th, 2010
      • I second Kathleen. Buy Dr. Bernstein’s book and buy his CDs on Type 1 or Type 2. Listen to them till you have them memorized and you will know more than your Endo about diabetes. He not only reversed his nueropathy but he was going into end stage kidney failure. HE is 76, Type 1 since childhood, started normalizing blood glucose at age 39, and to this day is still seeing reversals of complications he never thought would go away. Then read Dr. Ron Rosedale’s book for an explanation of the dangers of excess insulin. Keep reading Mark for the best, simplified understanding of these and all related problems.

        Andre Chimene wrote on November 19th, 2010
  11. I have a family history of Diabetes.
    Four years ago, I had a FBG of 118.
    A1C of 6.
    The doctor tells me not to worry.
    Huh ? WTF ? Is he kidding me ?
    I saw what they did or didn’t do for my dad.
    I’ve been exercising 3x+ a week since.
    And have also watched my diet.
    Vit D — at about a 60 level.
    Doing BHRT also.
    About three months now I’m 90% primal.
    My FBG this morning was 75.
    No thanks to the Medical Community btw.
    It’s sad that they’re so “preventitively” negligent.

    Louie wrote on October 18th, 2010
  12. Also, eating a high protein meal after exercise has shown to increase insulin sensitivity in your body.

    Jeff wrote on November 12th, 2010
  13. Can anybody tell me about how long it takes to normalize fasting blood glucose after adopting a very-low-carb primal diet? I know that it will take 3 months to see an improvement in HbA1C (due to the lifespan of the red blood cells), but how quickly can fasting blood glucose get down to normal levels? Thanks in advance for any input.

    Clarissa wrote on December 20th, 2010
  14. Thank you. A very informative article. But do you have to add the snarky comments such as..”Woo hoo”, “Fun” and, “Congratulations, you have graduated from Type 2 to Type 1 diabetes.”? Some of us are in pain and want to do the right thing for ourselves. We are already scared enough and a little compassion along with your knowledge would be greatly appreciated. Really though, I do appreciate your site, just not the attitude.

    Ari wrote on January 27th, 2011
  15. I am so grateful that I found Mark’s website. I knew my way around the insulin and glucose discussion, but this took it to a whole new level. I have PCOS and am insulin resistant and am trying to live a healthier life and conquer insulin resistance. I’m definitely bookmarking this as a reminder to exercise even on days that I don’t feel like it! I may even print it out and stick it on my fridge.

    Sara wrote on February 3rd, 2011
  16. Hi Mark,
    this is all very good stuff here. Thank you.
    I was wondering if you are familiar with Dr. Mercola’s website and the 3 Nutritional Types? #1 carb type, #2 protein type and #3 the mixed type. You seem to be suggesting that we are all protein types. I took the free test and found out that I am and hence can relate to your diet. But I can also imagine that other people from southern lattitudes are more of a primordial vegan, if you will. Have you ever considered such a thing?

    Morgan wrote on February 13th, 2011
  17. Hi Mark,

    I am a type 2 and have been controlling it with diet and excercise alone since i was diagnosed in 2008 with an a1c of 9.7. It is now 6.9, but there is still room for improvement. I’ve been eating about 180 g of carbs a day on average and excercising at least 4 days a week, big on recovery days, etc. My question is how can i get my fasting blood sugar down? Nutritionist recommended apple with peanut before bed. Something to do with protein and carb working together throughout the night, but i didn’t understand it.

    Can you go into how protein w/carb work differently than alone in your system in a way that I and others can understand?

    and, thankyou! I’ve started the “no grains” way just yesterday to see if it will help me get my weight down even more since I seem to be stuck at the same weight for over a year now even with excercise and diet.

    Susie

    susie wrote on March 17th, 2011
    • Susie, an apple is sugar and peanut butter is high in sugar. It is not a true nut but a legume. You should not be eating sugar or things that turn to sugar. Eat high fat/moderate protein/low carb. How low carb? Depends on how low you need to go to normalise blood glucose. Normal fasting…round 83. Keep it under 130 after a meal (1 hour). If it is over that, you ate too many carbs. Keep reading MDA and lets get you healthier than you have ever been in your life. You deserve “NORMAL” blood sugar.

      andre Chimene wrote on November 8th, 2011
  18. I have been diagnosed with T2 and working hard to exercise and change my diet thank you for explaining as doctors seem to put u on metforrin hate the thought .have only started 3 weeks ago on low carb and
    thanks so much

    Bernard Browne wrote on March 17th, 2011
  19. What’s with the “BITE ME, ADA” at the top?

    James wrote on March 28th, 2011
  20. CORRECTION:
    Being on insulin does not make you a Type 1 diabetic. T1s do not make insulin, or make very tiny amounts of it.

    I am a T2 on insulin. I still make insulin (verified by labwork), I just don’t make the huge amounts required to overcome insulin resistance after over 20 years as a diabetic.

    You CAN be both a T1 and a T2 – but just requiring insulin shots does not make you a T1.

    QUESTION: You said, “When your liver becomes insulin resistant, it can’t convert thyroid hormone T4 into the T3, so you get those mysterious and stubborn “thyroid problems”, which further slow your metabolism.”

    References? I found some a while back showing that all diabetics, both T1 and T2, seem to have elevated reverse T3 on diagnosis. But nothing about liver involvement per se…

    jpatti wrote on April 7th, 2011
  21. Thank you for this, massive help!

    Niall wrote on April 21st, 2011
  22. So I guess all those Chinese, Indians, and Asians are going to die off since they eat so much rice?

    Saab wrote on May 10th, 2011
    • Yes…India is now number 1 in Diabetes and heart disease and China is number 2. Same villians, wheat, corn, O6, sugar,, fructose, cutting sat fat and coconut for the Indians. Once you are sick…cut out the rice. You can no longer tolerate it. Obesity is exploding here in iIndia and China has an obesity epidemic of 6 months old. Yes…it is happeneing in both places.

      andre Chimene wrote on February 26th, 2012
  23. Why is it that when Westerners eat grains like rice, they seem to suffer from various diseases, while Asians on the other hand have been eating rice for centuries and have never suffered such problems in similar quantities?

    Is the Asian body more capable of handling carbohydrates than the European one?

    seljuk wrote on May 10th, 2011
    • Historically, they have eaten low levels of calories, while spending little time sitting, and utilizing their own bodies for transportation.

      However, obesity rates are rising for Asians.In only one generation, many Asians have gone from consuming between 1,500 and 2,000 calories a day to between 2,000 and 3,000 calories. Cars are becoming more common, with fewer people using mass transit, walking, and cycling.

      It’s a pretty simple equation involving caloric input, output, and activity level. I don’t think it has much to do with eating rice. If you burn off the carbs and calories that you ingest, they don’t get stored. And insulin production is affected by energy output (activity).

      Robin wrote on May 10th, 2011
    • Westerners eat rice with fried eggs and butter in it along with a huge slab of chicken and maybe a salad with olive oil and a dessert, maybe a coke too. Asians eat rice with some seasoning and a bit of meat or fish for flavor. Thats changing though with beef and western style diet growing. But its not the “rice”.

      Martinella wrote on June 28th, 2011
  24. Hey There!

    I have been reviewing your blog post and absolutely am loving it. Great discussions too. I being Type 1 for close to 30 years see amazing results from adhering to a primal lifestyle. When I am strict, my blood Glucose levels fall to that of a non-diabetics range. I would also suggest to those who are insulin dependent to review Dr Bernsteins Diabetes Solution for insulin adjustment advice. This coupled with your site and book are LIFE CHANGING! I am blogging my progress as well. Thanks again Mark!

    Trev wrote on June 3rd, 2011
  25. Just found this on google randomly searching for blood glucose levels after eating an apple; have to say, an excellent lay-mans definition of diabetes and the best way to get around it.

    Good job.

    Steve wrote on June 3rd, 2011
  26. You said it yourself “eat too many carbs”. The reason you overeat on carbs is you either eat processed carbs (sans the fiber) or you eat carbs in addition to high calories foods like fatty foods (meat). In addition excess fat blocks the insulin receptors. Every cell runs on sugar, even if you “burn fat” you turn it into sugar. And btw the only reason you burn fat is you’re cells are starving for sugar! Simple formula, body (liver, muscles) stores about 2000 calories of glycogen. Now isnt that amazing that happens to be the same amount recommended for sedentary men to eat? Eat more than 2000 than it gets converted to fat. Exercise and you need more than 2000 calories per day based on how much you exercise. Thats it. This detail on carbs and insulin only has to get analyzed because modern society eats so much fat, overeats really. This is always missing from paleos so called analysis. Every study including the only scientific study on diet, concluded none of the bad things happen when you eat mainly carbs as long as fat is 10% of total calories, meaning whole plant foods. As soon as you eat fatty foods, whammo. So I applaude the advice for those who will refuse to eat very low fat, but its not the healthiest nor the fittest advise.

    Martinella wrote on June 28th, 2011
  27. Martinella you sound like a lot of nutritionists I have talked to, but I have tried, very hard, that way( fat>10%, plant based) and my blood sugar still crept up- yet it dropped when I started eating 0 carbs and 0 fruit..would love to read something documented based on what you say, in practice it didn’t work for me..

    HeidiS wrote on June 29th, 2011
  28. I LOVE this article. This information is not new to me but reading about it again is very helpful. I have PCOS (polycystic ovarian syndrome) and in addition to the many unsightly symptoms (hair loss, weight gain) is insulin resistance! I am lucky that my weight has never been as bad as other women with PCOS but I was entering the overweight category when a specialist explained the insulin resistance issue to me. I was never a junk food eater and I thought I was being healthy eating according to the food pyramid. I only ate when I was hungry and I exercised. I couldn’t understand why my weight kept going up! After my “realization” I stopped eating refined sugar and starches and only eat whole grain. I also pair my carbs (grains and fruits) with a protein to try to control my blood sugar. I lost 13 pounds without making any other changes, it was amazing. I can’t believe I never realized how unhealthy I really was, I wasn’t hungry because I needed food, I was hungry because all that extra insulin in my system told me to “eat more carbs!”. I feel different, I have more energy, I do not get tired after meals anymore and have’t experienced any hypoglycemia. I am stuck though and still want to lose ten pounds. Reading this has reminded me of some things. I am still eating too many grains, even if they are whole grain, I need to monitor my carb intake more and I need to increase the veggies even more. Thanks for this information, it is a great motivator. Cake is just not worth it!

    Amelia wrote on July 18th, 2011
  29. Mark,

    I’ve just been reading your piece on insulin resistance and diabetes. Quite good indeed and very clear.

    One small error though… You state: “Eventually, the pancreas is so darn exhausted, it can’t produce any more insulin and you wind up having to inject insulin to stay alive. Lots of it, since you are resistant. Congratulations, you have graduated from Type 2 to Type 1 diabetes.”

    This is not exact. Type 1 and type 2 diabetes are two different diseases.
    In type 1 diabetes, because of an auto-immmune reaction (a virus at the wrong place and the wrong time, exposure to cow’s milk [there is a protein in milk that looks nearly identical to a protein in the pancreas] and the immune system develops antibodies against that milk protein. Because of their similarities, the antibodies get confused and attack the pancreas protein as well, destroying it. An hypothesis, but evidence in its favour is that kids that develop type 1 diabetes are heavy milk drinkers.

    You can read this in this article: N Engl J Med. 2010 Nov 11;363(20):1900-8.
    Dietary intervention in infancy and later signs of beta-cell autoimmunity.
    Knip M, et al. Abstract
    BACKGROUND: Early exposure to complex dietary proteins may increase the risk of beta-cell autoimmunity and type 1 diabetes in children with genetic susceptibility. We tested the hypothesis that supplementing breast milk with highly hydrolyzed milk formula would decrease the cumulative incidence of diabetes-associated autoantibodies in such children.

    This other article found on PUB MED can show you this interesting link: “Nestle Nutr Workshop Ser Pediatr Program. 2011;67:187-95. Epub 2011 Feb 16.
    Milk A1 and A2 peptides and diabetes.
    Clemens RA.

    Abstract
    Food-derived peptides, specifically those derived from milk, may adversely affect health by increasing the risk of insulin-dependent diabetes. This position is based on the relationship of type 1 diabetes (T1D) and the consumption of variants A1 and B β-casein from cow’s milk. It appears that β-casomorphin-7 (BCM-7) from β-casein may function as an immunosuppressant and impair tolerance to dietary antigens in the gut immune system, which, in turn, may contribute to the onset of T1D”

    So, having type 2 diabetes (insulin resistance with an EXCESS of insulin) is quite different from having type 1 diabetes (ABSENCE of insulin due to auto-immune destruction of the beta-Langerhans cells of the pancreas).

    The eventual need for insulin in type 2 diabetics is due to increased insulin resistance to the point where blood sugar levels are totally out of control – rather than working at the input (nutrition), we give MORE insulin to the body to force sugar into the cells. But this does not resolve the diet issue… Eventually, due to chronic overstimulation, the pancreas collapses and produces less and less insulin (but never to the point of type 1 diabetes). Because of the North American diet just pumping in more carbohydrates, there is then a need for extra insulin.

    So what you should have said is: “Eventually, the pancreas is so darn exhausted, it can’t produce any more insulin and you wind up having to inject insulin to stay alive. Lots of it, since you are resistant. Congratulations, you have graduated to insulin-dependant Type 2 diabetes.”

    Otherwise, an excellent article, clear and to the point. Cheers for your excellent work!

    Francois Melancon wrote on August 22nd, 2011
    • To correct you , a simple C Peptide test can determine the loss of beta cells to the point of needing insulin. Not because you are resistant to insulin but because you have killed off enough betas by chronically high BS, high insulin, or taking sulphonreas. I happen to be one of those new Type 1.5s or Type 3s…I have been labled both. You can kill off enough betas and slip into insulin dependance because you dont produce enough. Better terms are Insulin Dependant and Non Insulin Dependant. Better umbrella terms.

      andre Chimene wrote on February 9th, 2012
  30. I got type2 – that’s type 2 – in 1977, when I weighed 150 lbs (5’8″) and had run three miles a day for five years. My research points to at least three types of Type 2. Mine’s all genes. I’m now 315 lbs and insulin-dependent.

    I have been to the best specialists that America can afford and a couple of German geniuses, too. But it may be too late. Why? Because, I followed the instructions of the best dieticians in the business, who have basically told me to eat carbohydrates. They almost killed me.

    It is possible that the turnaround I have experienced by eating lots of lean red meat, fish, chicken, and green vegetables, and doing as much exercise as a 65 year old fat guy can do will keep me going a few more years. But your readers MUST understand, if you haven’t already convinced them; For many people carbohydrate intake, as proffered by the American Diabeties Association, is a death sentence.

    No two people are alike.

    Keep up the good work reminding people that pasta is not the way. And that exercise, a SMALL amount of carbos, and lean protein are.

    Dick Anderson wrote on September 30th, 2011
  31. I love this, like loving the game of basketball. This is a complete i opener.Thanks a lot.

    Samuel Emodiae wrote on October 29th, 2011
  32. I love this, like loving the game of basketball. This is a complete i opener.Thanks a lot.I will stay close to this site for more

    Samuel Emodiae wrote on October 29th, 2011
  33. This is the best description i’ve seen yet on type 2 diabetes… I’d like to know the role weak adrenals might play in the onset of type 2 diabetes. The same symptoms I have now with diabetes are the same (but on a smaller scale) as when I was a child. Is it possible to be born with weak adrenals?

    coo wrote on October 31st, 2011
  34. Thank you so much for the clarification. I was diagnosed as a type two diabetic and eventually was prescribed two different types of insulin. As it got worse, the insulin doses began to rise. For the world of me, I couldn’t understand why more insulin was the answer to the type two diabetic. My body was not utilizing insulin, why pump more into my body. Second, I exercise, try to eat right and turn into the muchie monster at night. Hence, great legs and a beer belly (no beer drinking involved). Still not clear on what this disease is doing to me. Any input? Thank you!

    Tracy wrote on November 2nd, 2011
  35. Great site
    However, you Americans REALLY need to get to grips with the phrase “could care less”.

    It’s “COULDN’T care less”.

    If you COULD care less, then you DO care.
    Get it?

    Back to topic ….

    Jas wrote on November 5th, 2011
    • THANK YOU!! – From A Concerned Canadian Living In America

      gilliebean wrote on November 6th, 2011
    • I can’t believe I’m not the only one who thinks this!

      Anna wrote on January 4th, 2012
  36. It’s appropriate time to make a few plans for the long run and it’s time to be happy. I’ve learn this post and if I may just I desire to recommend you few fascinating issues or tips. Perhaps you could write subsequent articles referring to this article. I desire to learn more things approximately it!

  37. I want to know when insulin inj is resortd to. My wife has recently become type 2 diabetic, with postparadial 300 and fasting around 200. She takes GP 2 and Glvus 50 twice, but when given the3rd dose after lunch, sugar level came to 220. She has dementia and aged 81.

    Dr.Seshadri Kannan wrote on November 13th, 2011
  38. Are there any animated-type videos or visual aides out there which could be used as a teaching aide to help people understand this whole process a little better?

    Jessica wrote on November 16th, 2011
  39. what is the average amount of insulin in body of person with diabetes and what is average amount of insulin in a insulin shot

    kyle sprain wrote on November 28th, 2011
  40. I have been browsing on-line greater than three hours today, yet I by no means discovered any fascinating article like yours. It’s lovely worth sufficient for me. Personally, if all webmasters and bloggers made just right content material as you probably did, the internet can be much more helpful than ever before.

    all about high fructose corn syrup risks wrote on December 4th, 2011

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