The Causes of Type 2 Diabetes

xyzzy · May 28, 2012

I would like to hear other members thoughts about what has caused the global epidemic in T2 both say at a biological level and wider society based causes.

To get an idea of how prevalent T2 is becoming the UN did an emergency conference on it and the other and other non communicable diseases back last September

Here for the UN communique and links to the recommendations etc.

http://www.un.org/apps/news/story.asp?NewsID=39600&Cr=non+communicable+diseases&Cr1=

As far as I can see the UN is advocating that governments must take much more of a an interventionist stance such as was done in a Chinese study in 1997 that shows you can reverse the increase in T2D if you take an active interventionist approach.

The doc the conference was discussing can be seen here

http://www.un.org/en/ga/ncdmeeting2011/pdf/NCD_draft_political_declaration.pdf

If forum members were "the government" would they be interventionist like the UN suggests? What ways would you intervene?

On a biological level I think my own cause went something like this.

Over a period of years even though I ate a "good" diet I ate marginally too much and gradually put weight on.
As I put weight on I gradually increased my insulin resistance.
As my insulin resistance increased I had to produce more insulin.
The extra insulin produced laid down more fat.
Which made me heavier and my insulin resistance increased..
In the end I could produce no more insulin as therefore my blood glucose levels started to rise.
The rise killed off some of my Beta cells which meant I then produced less insulin but was still insulin resistant.
My blood levels still continued to rise until they went critical and I got T2.

I am now back to the weight I was at around 12 years ago pretty much before my weight began to rise. I am in the high end of the normal range for BMI (24.5) I was diagnosed full T2 with a BMI of (29.2) so I was never officially obese but was overweight.

Want I have no idea about is why I and millions of other people around the world seem to have all done roughly the same thing in the last 40 to 50 years.

For an idea of how DB is spread around the world then this is a good starting position.

Ever tried the IDF's Interactive Diabetes Atlas?

http://www.idf.org/atlasmap/atlasmap

jopar · May 28, 2012

An interesting fact, Friday it was announced that the average female waist measurement has increased by 6 inch's in the last 60 years!

Now if we look at how life has changed in this time spam.. Several things stand out

More food and easier available!
More time and labour saving gadgets
Easier availability of personal and easier access to public transport

Food..

Yes having a better access to a good diet is a very good thing.. But several factors which make this a double edge sword.

In bygone years, your diet was based around a seasonal availability..

Now wonder why, Starchy carbs, tend to be more abundant in autumn/early winter when you need to keep the body warm, and food is sparse.. Where foods that are less dense in carbs are freely available in spring/summer months!

Another factor

Processed foods, these tend to be higher in carbs and a lot easier to buy, cook and enjoy as snacks or meals with ease..

Another factor

Foods that once where consider treats are now everyday items!

Such as fizzy drinks, Chocolate and high sugary foods, all used to be reserved for high days and holidays

Labour saving Gadgets and Transport

In bygone years we burnt of a lot of energy but simple everyday tasks which had to be done... Even in industry the physical work is carried out or lessened by a gadget or two!

So it's a case of turning our perceptions around foods back a bit..

With teaching, moderation in everything is good, too much of one thing is bad!

And yes encouraging exercise to replace the manual labour we used to do..

But if you were talking to a Vegan

They will say, if you want to prevent T1, T2, Cancers and all sorts of things is to fully a Vegan diet as all our ill's are because we ate animal products!

Defren · May 28, 2012

Interesting question. I was so fit and active when younger, then at age 29 was struck down with AJA. That left me bed bound for moths at a time and also I needed to take steroids, and quite high doses at times. I developed the typical 'steroid moon face'. I did diet and lost quite a bit of the weight, but by then was almost completely wheelchair bound. I suppose as I could do less, I got heavier, this made me insulin resistant, and the more resistant I became, the less able my body was able to cope, until eventually my pancreas gave up and I became a T2. I had many symptoms for a lot of years before diagnosis, it was only when I moved practice, my current GP decided that at my age, my quality of life was insufferable and decided to begin testing for all manner of things, sugar eventually being one, and hence my diagnosis.

If I could put a message out to the world, it would be diabetes starts much earlier than you realise, not as full blown T2 but as insulin resistant. I would urge everyone to take a good hard look at their diet and lifestyle, give them the education I wish I had had, ban ready meals, and high carb foods, forcing manufacturers to produce lower carb products.

If only I had know then what I know now...

Robinredbreast · May 28, 2012

xyzzy said:
I would like to hear other members thoughts about what has caused the global epidemic in T2 both say at a biological level and wider society based causes.

To get an idea of how prevalent T2 is becoming the UN did an emergency conference on it and the other and other non communicable diseases back last September

Here for the UN communique and links to the recommendations etc.

http://www.un.org/apps/news/story.asp?NewsID=39600&Cr=non+communicable+diseases&Cr1=

As far as I can see the UN is advocating that governments must take much more of a an interventionist stance such as was done in a Chinese study in 1997 that shows you can reverse the increase in T2D if you take an active interventionist approach.

The doc the conference was discussing can be seen here

http://www.un.org/en/ga/ncdmeeting2011/pdf/NCD_draft_political_declaration.pdf

If forum members were "the government" would they be interventionist like the UN suggests? What ways would you intervene?

On a biological level I think my own cause went something like this.

Over a period of years even though I ate a "good" diet I ate marginally too much and gradually put weight on.
As I put weight on I gradually increased my insulin resistance.
As my insulin resistance increased I had to produce more insulin.
The extra insulin produced laid down more fat.
Which made me heavier and my insulin resistance increased..
In the end I could produce no more insulin as therefore my blood glucose levels started to rise.
The rise killed off some of my Beta cells which meant I then produced less insulin but was still insulin resistant.
My blood levels still continued to rise until they went critical and I got T2.

I am now back to the weight I was at around 12 years ago pretty much before my weight began to rise. I am in the high end of the normal range for BMI (24.5) I was diagnosed full T2 with a BMI of (29.2) so I was never officially obese but was overweight.

Want I have no idea about is why I and millions of other people around the world seem to have all done roughly the same thing in the last 40 to 50 years.

For an idea of how DB is spread around the world then this is a good starting position.

Ever tried the IDF's Interactive Diabetes Atlas?

http://www.idf.org/atlasmap/atlasmap

It's such a shame that Diabetes ( Type 2) has become an epidemic. Young and old, know that a sedantry lifestyle and eating too much of the wrong foods and lack of exercise is bad for us and a large amount of people will get Type 2 ( but I know 2 people, one male, one female who are Type 2, both in their 60's and they are slim and active)

Why different people have different medical conditions is confussing at times, I think is because the majority of people will get a medical condition in their lifetime, be it Asthma, Diabetes, Epilepsy, Tinnitus, Gastro problems, an addiction etc and so so many more conditions. I feel that our lives are mapped out for us when we are born, and maybe it's a lottery of what medical condition it will be ( but I'm not talking about Type 1 and there is no disrepect to people who do have Type 2 from me), but Type 2 research/ and lifestyle changes( possible prevention) has got to be dealt with quickly throughtout the world, not just the awful complications with this disease, but the overall long term cost.

xyzzy · May 28, 2012

jopar said:
So it's a case of turning our perceptions around foods back a bit..

Yes I agree with that my personal belief is things started to go horribly wrong in the 1980's with both the encouragement of "low fat" and the non regulation of the fast food industry.

However that's only my Western society view. The countries with the biggest T2 problems are China and India and it's thought Africa will be where the fastest increases will be in the next 20 years.

The only successful intervention campaign that worked that I know of to reduce T2D was one mounted by the Chinese government back in 1997 I'll try and find more info on that but I expect it was pretty radical.

Also the ratio of carbs, protein and fat also can't be relied upon as a predictor. Phoenix once pointed out early on after I joined the ratios in the UK, USA and Austraila are all different yet T2D is rapidly increasing in all three countries. I think she said her thoughts tended towards "too many calories" whatever ratio which I tend to think may have validity. If I'm wrong Phoenix I apologise for the mis quote.

lucylocket61 · May 28, 2012

Not all T2's are overweight at diagnosis.

Not all people who are overweight become Diabetic

Not all T2's have eaten ****.

Not all those who eat **** become diabetic

So the cause must be more complex than overeating **** and/or putting on weight.

Unbeliever · May 28, 2012

lucylocket61 said:
Not all T2's are overweight at diagnosis.

Not all people who are overweight become Diabetic

Not all T2's have eaten ****.

Not all those who eat **** become diabetic

So the cause must be more complex than overeating **** and/or putting on weight.

Think you're right Lucy Many of us are genetically predisposed to T2diabetes but noone yet understands the triggers. There are many possible triggers i suspect.
Obviously there is some sort of link with obesity or weight gain but i am sure this often just muddies the waters. It cannot be the cause , may well be a symptom .
As T2 and even late-onse T1 may well have gone undiagnosed in the past it is impossible to draw any meaningful conclusions about the so-called epidemic.
Just as with cancer i could be a consequence of people living longer. Or surviving strokes which would have proved fatal in earlier times Many sroke survivors seem to have developed diabetes after the stroke. I am sure environmental factorsalso play a part and certainly diet must do so.
Maybe diet at particular times in our lives. There are so many possibilities. It is such a pity that the stereotype seems to satisfy
those who should be searching for the causes.

RoyG · May 28, 2012

Maybe it's all of the above predisposition must play a part to a greater extent in the past people may well have been predisposed to getting DB but diet and life styles held it off, now sedentary lives are more pronounced due to all the time savers we have. few people take care of this wonderful machine called our body and it truly is a fantastic piece of Biology, capable of withstanding extremes yet fails sometimes for the simplest of reasons. I had a friend who died last Xmas very suddenly, he had a condition which was called amuloydosis not sure of spelling, it was a disease which laid proteins down on the nervous system and Organs and very rare, he had regular check ups and was classified as disabled and signed off sick, the reason being it could Kill him any second.
Now the twist to the story, I spoke with him on Xmas eve and he was fine and looking forward to his Xmas. Yet two days after Xmas he was found dead in bed, his wife went to work that morning oblivious to the fact he was dead and only found him when she returned 8 hours later.age 47. The thing that eventually took him was Swine flue coupled with pneumonia. I have wondered often, how can you be fine one minute then 3 days later end up dead with that?? After all he had gone through. His farther died young from bronchitics suddenly, his sister Died at 37 from renal failure after having cancer of the throat at Ten which went into remission but then developing a drink problem, predisposed hmm a mystery. The truth is the body is a strange mysterious thing, which has mountains left to discover.

Robinredbreast · May 28, 2012

RoyG said:
Maybe it's all of the above predisposition must play a part to a greater extent in the past people may well have been predisposed to getting DB but diet and life styles held it off, now sedentary lives are more pronounced due to all the time savers we have. few people take care of this wonderful machine called our body and it truly is a fantastic piece of Biology, capable of withstanding extremes yet fails sometimes for the simplest of reasons. I had a friend who died last Xmas very suddenly, he had a condition which was called amuloydosis not sure of spelling, it was a disease which laid proteins down on the nervous system and Organs and very rare, he had regular check ups and was classified as disabled and signed off sick, the reason being it could Kill him any second.
Now the twist to the story, I spoke with him on Xmas eve and he was fine and looking forward to his Xmas. Yet two days after Xmas he was found dead in bed, his wife went to work that morning oblivious to the fact he was dead and only found him when she returned 8 hours later. The thing that eventually took him was Swine flue coupled with pneumonia. I have wondered often, how can you be fine one minute then 3 days later end up dead with that?? After all he had gone through. His farther died young from bronchitics suddenly, his sister Died at 37 from renal failure after having cancer of the throat at Ten which went into remission but then developing a drink problem, predisposed hmm a mystery. The truth is the body is a strange mysterious thing, which has mountains left to discover.

That is such a sad story about your friend Roy, please accept my condolences. Your last sentence is so true.

Defren · May 28, 2012

lucylocket61 said:
Not all T2's are overweight at diagnosis.

Not all people who are overweight become Diabetic

Not all T2's have eaten ****.

Not all those who eat **** become diabetic

So the cause must be more complex than overeating **** and/or putting on weight.

I have to agree with this. There has to be at least one other factor. As you say not all diabetics are overweight, some are painfully slim, so what is the unknown factor? Genetics? I really don't know, but I do agree the media has latched onto the fat epidemic and see that as the cause, when clearly it isn't. I do believe it could be a symptom?

borofergie · May 28, 2012

jopar said:
They will say, if you want to prevent T1, T2, Cancers and all sorts of things is to fully a Vegan diet as all our ill's are because we ate animal products!

Yeah, we'll try telling that to Robin Gibb.

Robinredbreast · May 28, 2012

borofergie said:
jopar said:

They will say, if you want to prevent T1, T2, Cancers and all sorts of things is to fully a Vegan diet as all our ill's are because we ate animal products!

Click to expand...

Yeah, we'll try telling that to Robin Gibb.

The thought of being fully Vegan, makes me feel quite ill :cry: ( but I was a vegetarian for 2 1/2 yrs) about 15 years ago and then I succumbed to, well ermmmm, a bacon sandwich :roll:

xyzzy · May 28, 2012

So found the China research on a succesfull intervention program.

http://apjcn.nhri.org.tw/server/APJCN/Volume17/vol17.3/Finished/20_1176_JianqinSun_514-524.pdf

You can read it if you want. It looks like it got very good results but if you don't want to read it just note its conclusion

In conclusion, this study demonstrates that Chinese men and women with type 2 diabetes following an integrated intervention program including diabetes education, frequent blood glucose monitoring and daily use of a diabetes-specific meal replacement, can achieve significant improvements in glycemic control and markers of cardiovascular health.

So how did the Chinese do "intervention"

A lot of the intervenion appeared to happen at the workplace as far as I can tell

All study participants were provided diabetes education materials used for monthly group lectures lead by experienced nutritionists from Huadong Hospital. Participants received information on diabetes management, behavioral and lifestyle modification, physical activity, and other diabetes-related health care information, following “Diabetes A-Z,” an American Diabetes Association publication, 3rd edition, (Peking University Medical Center Press, Beijing, China). Additionally, subjects received healthy eating instruction (with sample meal plans) including concepts and applications of food exchanges and lowglycemic foods, based on American Diabetes Association and Chinese Diabetes Association guidelines.

Participants in the Intervention Group also attended weekly sessions at their respective worksites. For each session, lasting approximately 30 minutes, participants met with a research dietitian for diet consultations and a study physician from the company clinic for medical evaluation including assessment of adverse events, a review of blood glucose measurements and adjustment of medications, if necessary. Subjects in the Intervention Group also were provided with blood glucose monitors (Optium TM, Medisense, Abbott Diabetes Care, Alameda, CA) and accessories to encourage frequent testing. To facilitate adherence to the healthy eating plan, participants in the Intervention Group were also provided with a low glycemic, 12 diabetes-specific nutritional meal replacement (Glucerna® SR, Abbott Laboratories, Chicago, IL) that they used to replace breakfast food items such as milk, soymilk, rice soup, or congee at the morning meal. The nutrient profile of the nutritional meal replacement is outlined in Table 1. Cans of powdered formula were provided weekly; participants recorded daily intake on clinical record forms. Compliance to the product intake was assessed weekly by the return of empty formula containers and review of the product intake forms by the study dietitians at each weekly counselling session

So effectively the meals they ate at their workplaces were provided to them and they were re-educated to adopt a healthy lifestyle at weekly counselling sessions...

Obviously an approach that wouldn't go down too well in the West I would suggest BUT it did undoubtedly work...

RoyG · May 28, 2012

"Obviously an approach that wouldn't go down too well in the West I would suggest BUT it did undoubtedly work..." Don't think it would some how, I don't think the powers that be want people to live beyond 70 anyway, it cost the taxpayer to much !!

Anonymous · May 28, 2012

In my view I think that diabetes is rather complex and you can't 'stereotype' it like the media tries to do. Eg. we're all big fat peeps who have eaten wrong and not exercised... hence we have diabetes. Shame on you for living a sedentary lifestyle! That's simply not true!
I was diagnosed at the age of 25 back in the days (which really wasn't that long ago) where they called type 2 "mature onset diabetes" and they didn't recognise that people under 50 got the disease. They set about to figure out why I had the disease at such a young age. I was diagnosed with 2 conditions on the same day.... so it turns out I had a few precursors to diabetes. Ladies with pcos are highly likely to get diabetes I was told. But I also have a lot of ladies (not men) in my family who have diabetes. I also was overweight at the time... but they didn't think that was the big issue for me. So the rollercoaster ride started from there for me.
For me when I hear the causes of diabetes I get annoyed that they never mention that there are other things that can be the cause aside from your weight, food you eat, and whether or not your exercise.

IanD · May 29, 2012

I'm 5'8" so for a BMI=25 my weight should be below 12 st.
No diabetes in the family;
About 25 year ago (age 47) I was overweight & relatively inactive - 14 st - I couldn't run for a bus;
I was raising 5 sons, & driving 3/4 hour to work, so no time for personal exercise;
I became self employed & had time for exercise & chose an activity I felt I could enjoy & keep up - I joined a tennis club;
I became fit & lost 7 lb;
20 years Imperial College started a project to investigate the relative incidence of diabetes in Southall & Brent of immigrants compared with the indigenous population;
I passed the GT test & no potential problems were identified - even though my chol was 6.4 - no problem with your family & lifestyle, no diabetes potential;
In about 1998 I was driving back from Southampton when a French tanker changed lanes & spun my car round - from the middle lane, across the inside lane, across all 3 lanes & back across the hard shoulder where the edge of the road was a bank which slowed me down so I could stop safely on the hard sholder - thank you Lord for protecting me!
Profound shock - & within 2 years I was diabetic. The symptoms were numbness in one thigh, & chronic tiredness;
All this time I kept up my tennis, all the year round;
Also I have always been health conscious, & preferred a "sensible" diet - with plenty of whole carbs.

To substantiate the "shock theory" one of my tennis friends from teenage years died suddenly from diabetes - he saw an older work mate collapse with a stroke, collapsed himself & died from sudden onset of diabetes. He was fit & active - Hampshire doubles champion. AFAIK he wasn't diabetic before.

anna29 · May 29, 2012

Hi all.
Thought I would chip in with my thoughts here.
In 2008 I had pneumonia then a septis infection [lost 2 stone rapidly] I thought this
was down to the illnesses.
Then I was called in to my own GP's and told firmly that I was diabetic !
As I couldn't and wouldn't believe this .
My angle and question here is - doe's illness impact and contribute to cause of diabetes. :?:
I was totally drained and worn out with battling the 2 severe illnesses when
looking back I could have been so drained through the diabetes kicking in .
It took me 2yrs to get over all of this lot and on the right track of insulin therapy
to get me back the right way up again ! so to speak...
My diet has ALWAYS been that of a finicky fussy eater, due to non tolerances of
certain food groups, due to my diverticulitis bowel disease.
So it certainly 'wasnt' diet related thingy!
Always had to eat low carb foods as simply 'cant' tolerate fibre n wheat n oats n carbs well at all. :thumbdown:
Since being diagnosed I have become 'more' low carb aware and maintain this in my food planning.
Anna.

Scardoc · May 30, 2012

xyzzy said:
I would like to hear other members thoughts about what has caused the global epidemic in T2 both say at a biological level and wider society based causes.

I had a nice long reply but by the time I went to submit it made me log in again and I lost it (huff!) Shorter version:

The cause of T2 is far from being known. What the UN report and the Diabetes Atlas site both do is back what I already believe - that unhealthy living is the primary cause. Biologically, I think there needs to be huge investment into continuing the research to find out exactly what is triggering insulin resistance. Obesity is one cause of IR and this in turn leads to more weight gain = vicious circle and if untreated = T2 diabetes. However, not all T2 diabetices are overweight. Could visceral fat be playing a part? There is a strong indication that your waist size makes you more liable to develop T2. And what of genetics? Is there a T2 gene? Or are there genetic conditions that predispose some people to weight gain leading to insulin resistance and eventually T2? There's even talk of an immune response where weight gain = excess insulin which triggers a response to kill the insulin. It is hugely complicated but weight does seem to be the most prevalent factor involved.

If I was in charge then a huge investment would be made now to look for the causes and the expenditure would be outweighed by the saving when the reasons are known. I would predict that in 10-20yrs time we will have several different classes of T2 diabetes as the causes become known.

Sciologically, the developing world is producing more economic growth in countries such as India, a move towards urbanisation and Westernisation. This means the fast food culture is reaching all around the globe as is the tendancy to be more inactive and sit infront of one or several screens instead of exercising. People are exercising less, working in less physical jobs and eating worse. This equals weight gain = insulin resistance - etc etc. The developing world is also catching up with the West in terms of life expectancy and as more people live longer, they naturally become less active, gain weight and can develop T2.

The UN's report cites a major need to promote healthy living, diet and exercise and I think our country is doing this already but needs to take it further. There's always going to be exceptions to every rule but healthy living still seems to be the key factor.

I passed a KFC on Saturday and a child with a one year old balloon tied to his chair was getting tucked into fries - the salt intake?? The Olympics are being sponsored by who? Whatever the Government does, it sadly will always come down to human choice and you can't deny people from choosing what's on offer. If I was in charge I would want to intervene and would do wherever possible, especially where you can (ie) in schools. But then they've tried that and people don't like being told what their kids can and can't eat in school. We can only hope to educate people and until we know the exact causes we need to look at the correlations available and use them.

GraceK · Aug 30, 2012

Looking back at my family history - my father had his first stroke at 42, followed by several heart attacks and two more strokes; he had COPD and took about 25 tablets a day. I think he was diabetic from the start but it wasn't discovered. He had all the symptoms but we didn't have the information in those days so his symptoms were treated by the cause of them, diabetes, never was. I seem to have followed a similar pattern and like another poster here I can say, I've never eaten ****, I always cooked meals from basic ingredients, not fast food meals etc and I've led a very active life in terms of everyday activities like housework, maintenance, gardening, cycling, walking - in fact I rarely ever sat down until 10pm every night.

I would like to see some kind of research done into the correlation of diabetes with shock and trauma because my father was a concentration camp survivor too and of course he was malnourished and I would expect that to have an effect on the metabolism at some point, and perhaps that leads to a predisposition. I would guess that most of us posters were born during the post war years, who knows, maybe our DNA has been affected by our parents traumas? The fact is we don't know what damage was done to our parents DNA as a result of war, starvation, chemicals etc but it certainly needs looking into.

I can remember feeling exhausted from as young as 10 years of age and by the time I was 30 I had a definite feeling that no matter what kind of food I ate, it wasn't nourishing my body - I began to suspect myself that my body wasn't converting my food into energy but nothing showed up on tests. So it's been a long slow process of exhaustion, frustration, misdiagnosis and at times - despair to the point that last year I vowed if my doctor couldn't find out what was wrong with me, why I was so exhausted, I would ask him for a cyanide pill to do myself in.

phoenix · Aug 30, 2012

Hi Grace,
There are a lot of variables and I believe a lot of variants of both T1 and T2. There is certainly evidence that children born of parents that were malnourished during the war and conceived when in that condition are now more susceptible to metabolic diseases including diabetes,research though has focussed on the maternal.
http://www.dutchfamine.nl/index_files/results.htm
I don't know if your father was Jewish. There does seem to be a high genetic susceptibility in some groups of Jewish people, for example this study found a high incidence of a particular gene variant that seems to make people susceptble to T2 in Ashkenazi Jews living in Israel.
http://genome.wellcome.ac.uk/doc_WTD020821.html

changed second link for better one

The Causes of Type 2 Diabetes

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