Diabetes mellitus is on the rise around the world among young and old, rich and poor, men and women. The main reason for the rise in diabetes is the rise in weight gain and obesity.
Most diabetes is type 2 diabetes that is also sometimes known as adult-onset diabetes. It is chiefly related to weight gain and obesity. It used to be that type 2 diabetes became prevalent later in life after people had reached their 50s, 60s and 70s, and had not only aged, but also gained weight.
Today, type 2 diabetes is increasingly seen among young adults and even children and adolescents who are severely overweight. The health consequences of diabetes are severe.
Diabetes is often associated with elevated circulating blood glucose levels, but the disease is somewhat more complex than that. In type I diabetes, known as juvenile diabetes, the cells of the pancreas fail to produce the enzyme insulin that allows our bodies to process and metabolize nutrients, including sugars. The result is a sharp rise in the blood sugar level, or the circulating blood glucose level.
In type 2, or adult-onset diabetes, the picture is a little different. In this second and far more common form of the disease, which is usually associated with weight gain, the fat cells and other cells become resistant to the effects of insulin and other hormones that are important in processing nutrients, including sugars. The result is the same: circulating blood sugar levels rise. Over time both forms of this disease lead to severe damage of the blood vessels and nerves in the body. Blindness, heart disease, impaired circulation, amputations, and shortened life expectancy are the results of the progression of the disease.
To make matters worse, many of the medications used to treat diabetes also lead to further weight gain! For a more thorough discussion of the medications and weight gain, please see SasseGuide.com.
Weight loss is strongly associated with improvement in type 2 diabetes. Often, even modest weight loss such as 10% reduction of body weight, results in significant improvement or even resolution of diabetes. The more severe or longstanding the diabetes, the more difficult it may be to resolve. But nonetheless, just as weight gain and adding pounds adds to the prevalence and severity of diabetes, so too can weight loss reverse the disease.
Medically supervised weight loss is a tremendous tool in the battle against diabetes. The lower carbohydrates usually emphasized in medically supervised weight loss programs are especially helpful in reducing the circulating blood glucose and reducing the requirement on medications that promote weight gain. So, for most people with type 2 diabetes, the place to start is with a medically guided weight loss program that emphasizes exercise, reduced carbohydrate intake and a long-term plan toward behavior change and use of appropriate protein and vitamin-based supplements.
Weight loss surgery has also proven to be highly effective as a treatment for type 2 diabetes. In fact, studies demonstrate that 80-90% of type 2 diabetics experience resolution of their diabetes after Roux-en-Y gastric bypass surgery. For a larger discussion on this topic see The Emerging Role of Surgery in the Treatment of Diabetes
Weight loss surgery is felt to result in a cure of diabetes in two ways. First, it is usually highly successful in inducing significant weight loss, and this alone results in improvement or resolution of the diabetes. Second, gastric bypass surgery in particular, results in some hormonal changes that appear to be uniquely effective in boosting the cure rate of the diabetes.
One of the more intriguing findings that has resulted from studies in recent years, is that roux-en-Y gastric bypass surgery, and possibly other weight loss procedures, can result in the resolution of diabetes, even in people who are not overweight. This has lead to some re-thinking of the standard treatments for diabetes mellitus. In the near future, we may find that the treatment recommendations have changed toward the emphasis on weight loss, as the number one treatment, followed by medication therapy, followed by recommendation for surgical intervention, even in normal weight individuals. But for today, and for the vast majority of people with type 2 diabetes, the first and best step is usually to apply yourself with every resource at your disposal, to the objective of losing weight. This will be the best thing you can do for your health.
Of course, as with any serious health condition, it is important to discuss it with your doctor and proceed with treatments that your doctor supports.
Dr. Kent Sasse is a nationally recognized weight loss expert and the author of the Sasse Guide to Outpatient Weight Loss Surgery. He is the founder of the iMetabolic Institute, and the Medical Director of the Western Bariatric Institute.