My Type 2 Diabetes

My Objective

          I was over weight and obese with obvious belly fat. My fasting glucose levels were higher than normal, every now and then, but no doctor sent me for a check-up to see whether I am diabetic until recently my cardiologist said it is good to check for diabetes. My fasting glucose was 7.9 and after 2 hours of sugar drink became 17.3 mmol/L. The normal fasting level is 3.0 – 6.0 and after 2 hours should not exceed 4.0 – 7.7 mmol/L. He told me that I was not pre-diabetic but has been having Type 2 Diabetes for some time already.

         I can only assume that most doctors are not fully aware of Type 2 Diabetes or they do not see it as their responsibility to warn the patient about it. They are very up-to-date with their own specialization.

        Type 2 Diabetes is a very serious long-term disease.

         The reason why I went to the internet to learn more about Type 2 Diabetes was because 2 of my university colleagues were blinded by the disease, one has his leg amputated, one has stroke and another is on kidney dialysis. 

        From what I have learnt anyone who is obese with belly fat and over weight should check for Type 2 Diabetes. It is such a simple test—take the glucose test and drink the sugar water, wait for 2 hours and test for sugar level again. It is called the Oral Glucose Tolerance Test. It is good to make sure that one does not have Type 2 Diabetes.

Introduction

Type 2 Diabetes and obesity have reached an epidemic proportion in the world. WHO has stated that worldwide the prevalence of obesity nearly tripled between 1975 and 2016. 

The foods we eat are carbohydrates, proteins and fats. Carbohydrates when digested are converted into sugars. Glucose a component of sugars, together with fat, is the main source of energy for the cells.

Type 2 Diabetes is a condition that affects the way our body metabolizes glucose. With type 2 diabetes, our body either resists the effective functioning of insulin or doesn’t produce enough insulin to maintain normal glucose level.

 In other words, Type 2 Diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown. 

The Pancreas secretes insulin 

Insulin is a hormone that is secreted from the pancreas. The moment we eat, the pancreas secretes insulin into the bloodstream to lower the amount of glucose in our bloodstream. The flow of insulin enables glucose to enter into the cells of the body. 

In type 2 diabetes, instead of moving glucose into our cells, the glucose builds up in our bloodstream. As blood sugar levels increase, the insulin-producing cells in the pancreas release more insulin but eventually these cells in the pancreas become impaired and can’t make enough insulin to meet the body’s demands. When the glucose cannot enter into the cells, it is converted into fats to be stored in the body.

When we eat frequently, by snacking, our pancreas keeps producing insulin. Frequent eating produces more insulin. More insulin metabolizes the glucose into fat and more fat is thus stored in the body; the more stored fat, the more obese, particularly around the belly.

The Liver stores and makes glucose

         Glucose comes from two major sources: food and our liver.

          Our liver stores and turns sugar into glucose.

The liver breaks down the stored glycogen into glucose to keep our glucose level within a normal range.

         When we fast or have not eaten for a while, our body starts to burn the stored fats and glucose. 

         If we don’t eat, our body will simply “eat” its own glucose and stored fats for energy.

The Body exists in 2 states

         Very broadly, the body exists in two states:

1.     The feeding state—when the excess carbohydrates we eat are converted into fats and are stored to be used later and 

2.     The fasting state—where the stored fats are being burned as fuel and for growth.

Complications of Type 2 Diabetes

Type 2 Diabetes can be easy to ignore, especially in the early stages when we are feeling fine. But diabetes affects many major organs, including our heart, blood vessels, nerves, eyes and kidneys. Controlling our blood sugar level can help prevent many complications.

Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include:

• Heart and blood vessel disease. Diabetes dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
• Kidney damage. Diabetes can sometimes lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage. Diabetes increases the risk of serious eye diseases, such as cataract and glaucoma, and may damage the blood vessels of the retina, potentially leading to blindness.
• Slow healing. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation.
• Nerve damage (neuropathy). Excess sugar can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Eventually, you may lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Sleep apnea. Obstructive sleep apnea is common in people with type 2 diabetes. Obesity may be the main contributing factor to both conditions. Treating sleep apnea may lower your blood pressure and make you feel more rested but it’s not clear whether it helps improve blood sugar control.
• Alzheimer’s disease. Type 2 diabetes seems to increase the risk of Alzheimer’s disease, though it’s not clear why. The worse your blood sugar control, the greater the risk appears to be.
• Cancer. Cancer cell has a high craving for sugars. WHO states that some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon) could be the consequence of diabetes. Does consuming excess sugar cause cancer recurrences?

Current Treatments for Type 2 Diabetes

1. Medicines

• Metformin (Glucophage, Glumetza, others). 
• Sulfonylureas. These medications help your body secrete more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). 
• Meglitinides. These medications — such as repaglinide (Prandin) and nateglinide (Starlix) — work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they’re faster acting, and the duration of their effect in the body is shorter. 
• Thiazolidinediones. Like metformin, these medications — including rosiglitazone (Avandia) and pioglitazone (Actos) — make the body’s tissues more sensitive to insulin. 
• DPP-4 inhibitors. These medications — sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta) — help reduce blood sugar levels, but tend to have a very modest effect. 
• GLP-1 receptor agonists. These injectable medications slow digestion and help lower blood sugar levels. 
• Exenatide (Byetta, Bydureon), liraglutide (Victoza) and semaglutide (Ozempic) are examples of GLP-1 receptor agonists. Recent research has shown that liraglutide and semaglutide may reduce the risk of heart attack and stroke in people at high risk of those conditions.
• SGLT2 inhibitors. These drugs prevent the kidneys from reabsorbing sugar into the blood. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga) and empagliflozin (Jardiance).
• Insulin. Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it’s often prescribed sooner because of its benefits. Low blood sugar,hypoglycemia, is a possible side effect of insulin.
• Often, people with type 2 diabetes start using insulin with one long-acting shot at night, such as insulin glargine (Lantus) or insulin detemir (Levemir). 
• In addition to diabetes medications, doctors might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

2. Bariatric surgery – toreduce the size of your stomach to a small pouch.

There are 4 types of minimally invasive bariatric surgery:

• Gastric balloon involves placing a balloon filled with a saline solution in your stomach using an endoscope. 
• Laparoscopic adjustable gastric banding (LAGB) is used to manage morbid obesity. This surgery involves reducing the size of your stomach by placing a silicone band around the upper end of the stomach.
• Laparoscopic sleeve gastrectomy (LSG) is used to permanently reduce the size of your stomach to about 25% its original size, which then becomes like a sleeve or a tube.
• Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most complex bariatric surgery. It is used to reduce the size of your stomach to a small pouch by clipping off a section of it. 

3. Liposuction Surgery

Where fat cells are sucked out of the body by a cannula connected to a suction device. Liposuction’s main purpose is to remove fats via suction. 

4. Changes in lifestyle include:

         Lifestyle changes can slow or stop the progression or cure Type 2 Diabetes.

• Eating healthy foods. Choose low carbohydrate high fat diet (LCHF). Avoid sweet fruits, starchy vegetables, whole grains and refined flour.
• Getting active. Aim for a minimum of 30 to 60 minutes of moderate physical activity on most days. Take a brisk daily walk. Ride a bike. Swim laps. If we can’t fit in a long workout, spread our activity throughout the day.
• Losing weight. Losing 5 to 10 percent of our body weight can reduce the risk of diabetes. To keep our weight in a healthy range, focus on permanent changes to our eating and exercise habits. Motivate ourselves by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
• Avoiding being sedentary for long periods. Sitting still for long periods can increase our risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes.
• Enough sleep – minimum 7 hours sleep
• Avoid Cigarette Smoking
• Reduce Alcohol Consumption
• Reduce Stress  by TM, Yoga, Taichi or dancing.
• Attitude of gratitude—Give thanks more.
• Forgive more —I forgive you. Please forgive me
• Love more—Kindness, Compassion, Patience
• Service to others—Help others in need

5. Eat Less and Intermittent fasting

          I am obese and have Type 2 Diabetes but I am not in favor of surgery or medicine. Therefore, I decided to try to lose weight and cut down my belly fat by eating less and with intermittent fasting. I am doing this after I went to the Internet and read and listened to the following:

Diet Doctor Podcast with Dr. Bret Scher

Dr Aseem Malholtra on Dietary Changes and Heart Disease from YouTube

Dr Danielle Berlardo on Nutrition Round

Dr David Diamond on Deception in Cholesterol Research and Saturated Fat

Dr David Unwin on tablespoons of Sugar in food

Dr Dean Ornish on Reversing Chronic Disease with Lifestyle

Dr Eric Berg on Myth about Blood Sugar and Diabetes from YouTube

Dr Eric Westman on Low Carb and High Fat Diet

Dr Jason Fung How to Reverse Type 2 Diabetes

Dr Jason Fung on Intermittent Fasting

Dr Lewis Cantley on Cancer, Obesity, Diabetes

Dr Mark Hyman on What the Heck You Should Eat

Dr Mark Hyman with Functional Medicine

Dr Michael Mosley on Type 2 Diabetes from YouTube

Dr Nadia Mir Ali on Optima Diet for Humans

Dr Neal Barnard on New Approach to Type 2 Diabetes from YouTube

Dr Paul Mason on Diet from YouTube

Dr Roy Taylor on Type 2 Diabetes from YouTube

Dr Sten Ekberg on Keto Food Guide from YouTube

 Dr Sarah Hallberg on Reversing Type 2 Diabetes

My Weight Loss Results

On 4/9/19, I saw the diabetic and dietician nurses. My weight was 73.2 kg and I started to eat less and according to the dietician planned diet.

On 24/9/19 I saw the diabetes doctor at SGH and my weight was 71.3 kg.

On 17/10/19, I started to do intermittent fasting by not taking breakfast.  My weight on the morning of 18/10/19 was 68.9 kg a loss of 4.3 kg for the planned diet of 44 days.

On 25/10/19 my weight came down to 65.2 kg. In 7 days and with a 18:6 hours fast, my weight went down by 3.7 kg.

I use Accu-Chek to prick my finger for blood sample to monitor and LibreLink patch to monitor my glucose level continuously for 24 hours for 2 weeks every now and then. My glucose level was within the normal range of 4 – 10 mmol/L.

Written on 25 October 2019