It’s how Frederick Banting, the doctor who first administered insulin, defined diabetes. He described it as the body’s inability to burn carbohydrate, as well as protein and fat.
The carbohydrates we eat are the first nutrients our bodies use for energy. The body converts carbs into glucose, and then releases glucose into the bloodstream for use by the body’s cells. Glucose is the fuel that drives our bodies: it powers the body’s growth, allows organs to function, and gives us energy to get through the day.
But none of this can happen without insulin.
Insulin is a hormone produced by the pancreas that balances blood sugar levels. Think of insulin as a key that unlocks the body’s cells so that glucose can enter and be used as fuel. Insulin also allows the body to store excess glucose for later use.
In a person with diabetes, however, sugar is unable to enter the cells for one of two reasons: either the body doesn’t produce enough insulin to allow the sugar to access the cells, or the cells don’t respond to the insulin. In both cases, the outcome is the same: cell doors remain locked, and sugar gathers in the bloodstream, causing blood sugar levels to rise.
The kidneys will try to rid the body of excess blood sugar through urination, meaning patients will need to urinate more often, leaving them feeling hungry or thirsty. Patients may also experience weight loss as a result. The body will also work to dilute the excess sugar in the bloodstream by releasing fluid from the cells, causing dehydration and thirst.
When glucose levels remain too high for too long, health problems such as nerve damage, vision problems, and heart or kidney disease can occur throughout the body. Furthermore, because sugar is unable to enter the cells, the body doesn’t have the fuel it needs to function, causing fatigue or tiredness.
The result of this insulin trouble is diabetes.
Type 1 diabetes, formerly known as juvenile diabetes, results when the body doesn’t produce insulin. Because the immune system attacks the cells that make insulin, people with type 1 diabetes must take insulin to keep the body functioning properly. It can be diagnosed at any age but is usually diagnosed in children and young adults, and symptoms generally appear suddenly. Scientists suspect that it is caused by genetics and viruses that trigger the disease, but studies are ongoing. Only 5 percent of diabetics have type 1 form.
Type 2 diabetes accounts for 95 percent of the diagnoses of the disease, and risk factor depends on both genetics and lifestyle:
- Obese or overweight
- Family history
- Age 45 or older
- High blood pressure
- Sedentary lifestyle
- History of heart disease or stroke
- Low level of good cholesterol; high level of triglycerides
- History of gestational diabetes
- African American, Native Hawaiian, Pacific Islander, American Indian, Asian American, Hispanic/Latino
Type 2 diabetes develops slowly, sometimes over the course of years, and many people have no symptoms initially. In fact, many patients discover the disease because of resulting symptoms such as blurred vision or nerve damage. Type 2 often begins when the body’s muscle, liver and fat cells do not use insulin well, resulting in insulin resistance.
When insulin resistance occurs, the body produces additional insulin in an attempt to moderate blood glucose levels, so that initially, there are no symptoms of insulin resistance. Eventually, though, resistance worsens, and the pancreas fails to keep up with insulin production, and the cells that produce insulin wear out. It is also true that varying degrees of insulin resistance exist, and that patients who are more insulin resistant will struggle harder to keep glucose levels under control because of the resistance.
When symptoms do appear, they may include:
- Increased hunger
- Increased thirst
- Increased urination
- Blurred vision
- Numbness in hands or feet
- Unexplained weight loss
- Sores that don’t heal
But there’s another condition called prediabetes that is an important part of the discussion as well. The American Diabetes Association defines it as blood glucose levels which are higher than normal, but not high enough to be diagnosed as diabetes, and an estimated 86 million Americans have it. Typically, doctors recommend dietary changes and exercise for
patients who are diagnosed with prediabetes, which can reduce the likelihood of developing type 2 diabetes by 60 percent.
The problem, according to Ralph DeFronzo, Chief of the Diabetes Division at the University of Texas Health Science Center, is that these people already have diabetes; it just isn’t severe enough to meet the ADA’s definition yet. Furthermore, doctors don’t usually test for insulin resistance as part of a patient’s standard care, so indicators of the condition are often undetected until a problem arises.
In all of the above cases, the best way to combat insulin resistance is to make the cells more receptive to insulin, and exercise is the best way. Exercise causes the body to be more sensitive to insulin, and it builds muscle that can absorb glucose. It also provides an alternate means for glucose to enter muscle cells without insulin, reducing the body’s dependence on insulin.
Specifically, research demonstrates that a single instance of moderate exercise may increase glucose absorption by at least 40 percent. And although the benefits of absorption diminish within 48 to 72 hours, patients who exercise on a regular basis can extend these benefits by repeating exercise before the 72 hours lapse.
Aerobic exercise is proven to allow your body to use glucose immediately rather than storing it for later, so 2.5 hours per week is ideal. Additionally, strength training, which also positively affects insulin control, should be included in a workout regimen twice a week.
Finally, increasing the amount of nightly sleep can stabilize insulin levels. Aim for 7-9 hours a night, and improve sleep quality by turning off all electronics and eliminating caffeine at least three hours before bedtime.
Banting knew the power of insulin for the diabetic, so he sold the patent to the University of Toronto for 50 cents, in hopes that it would serve the greater good. Although it is impossible to defeat insulin resistance, patients can combat it with a combination of increased exercise, dietary changes and education.
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