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!

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.

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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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. 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
  2. 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
  3. 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
  4. 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
  5. What’s with the “BITE ME, ADA” at the top?

    James wrote on March 28th, 2011
  6. 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
  7. Thank you for this, massive help!

    Niall wrote on April 21st, 2011
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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

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