Diabetes Explained

A review of type 2 diabetes and prediabetes

Chronic metabolic disease is rapidly becoming a national crisis. The Centers for Disease Control (CDC) states that almost 50% of the adult population in the United States is affected, with 11.3% suffering from type 2 diabetes and 38.0% with prediabetes. 

What about other conditions that result from insulin resistance and metabolic disease? Let’s take a look at these problems, starting with the basics.

Type 2 Diabetes 

Type 2 diabetes is characterized by more elevated blood sugar and insulin levels, as the body struggles to control blood glucose levels effectively. Diagnosis usually involves blood tests, with fasting blood sugar levels of 126 mg/dL or higher or Hemoglobin A1C of 6.5% or greater indicating type 2 diabetes. 

The root cause of type 2 diabetes is primarily insulin resistance, where the body's cells become less responsive to insulin. Insulin is a hormone produced by the pancreas that helps regulate blood sugar (glucose) levels by allowing glucose to enter cells for energy. When cells become resistant to insulin, glucose cannot enter effectively, resulting in elevated blood sugar levels. 

To compensate, the pancreas produces more insulin, but over time, the pancreas may not be able to keep up with the increased demand for insulin production. This leads to a buildup of glucose in the bloodstream, causing type 2 diabetes.

Common symptoms of type 2 diabetes include fatigue, increased thirst, frequent urination, blurred vision, persistent hunger, and weight gain. 

If the condition is not properly treated, it can lead to severe complications, including peripheral neuropathy. This comes with risks of infections and limb amputation. Cardiovascular diseases like heart attacks and stroke, and kidney diseases requiring dialysis or transplant can also result from metabolic disease. 

Other complications include eye problems (diabetic retinopathy, cataracts, glaucoma), dental and gum diseases, sexual problems like erectile dysfunction, cognitive decline, and autonomic neuropathy that can affect various organ systems.

Several factors contribute to the development of insulin resistance and type 2 diabetes. These include having a family history of metabolic disease. Certain genetic factors can increase the risk of developing insulin resistance and type 2 diabetes.

A diet high in processed foods, sugars, excessive carbohydrates, and unhealthy fats can contribute to insulin resistance and weight gain.

Lack of regular physical activity can also impair insulin sensitivity. Muscle is metabolically active, so having low muscle mass (known as being sarcopenic) can also promote metabolic disease. 

Being overweight or obese, especially with excess abdominal fat, increases the risk of developing insulin resistance and type 2 diabetes.

Metabolic Syndrome is a cluster of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat (which often precedes or accompanies insulin resistance and type 2 diabetes.)

The risk of type 2 diabetes increases with age, especially after age 45. In addition, certain medical conditions like polycystic ovary syndrome (PCOS), prediabetes, and sleep disorders can increase the risk of type 2 diabetes.

Some medications can contribute to the development or exacerbation of insulin resistance and type 2 diabetes. Examples include corticosteroids like prednisone, antipsychotic medications such as Olanzapine and Risperidone, certain HIV medications, immunosuppressant drugs such as cyclosporine and tacrolimus, and less frequently, some common medications like thiazide diuretics, beta-blockers, and statins.

The role of diet in type 2 diabetes

Diet is the main factor affecting blood sugar levels. The problem is that carbohydrates turn into glucose during digestion. The added glucose enters the bloodstream and requires insulin to move it out of the blood and into the cells. Protein intake can slightly affect glucose levels. 

Carbohydrates exist in starchy foods like bread and potatoes and in fruits, sugary beverages, vegetables, and candy. All carbohydrates are broken down by digestion and absorbed as sugar molecules, raising blood glucose levels. 

Whether the food is a bowl of rice, a slice of bread, a potato, or a sugar-sweetened soda, it becomes sugar (glucose) once the body digests and absorbs it into the bloodstream. Fructose is a carbohydrate, a sugar molecule, used in many sugary beverages, energy drinks, and fruit juices. 

One example is “high fructose corn syrup,” an extremely common sweetener. Fructose promotes fatty liver disease, worsens insulin resistance, and can accelerate the development of type 2 diabetes. 

Everyone has a limit to how much carbohydrate their body can process over time before the system is overwhelmed and insulin resistance develops. This is known as a personal carbohydrate tolerance level. 

Exceeding that level, i.e. eating more carbohydrates than the body can process correctly, results in an increasing need for insulin and the development of insulin resistance. Eating starchy or sweet foods provides such a high carbohydrate intake that the carbohydrate tolerance level is easily exceeded. 

It is important to emphasize that all carbohydrates, whether sugars, starches, or digestible fiber, are absorbed as sugar and contribute to exceeding the carbohydrate tolerance level. This is the reason that low-carbohydrate diets like the Revero nutrition therapy are a logical treatment for insulin resistance or type 2 diabetes. 

Revero’s low-carbohydrate diet targets this root cause of metabolic disease by reducing carbohydrate intake to low-carb ketogenic levels.

Insulin resistance is the root cause of type 2 diabetes and related conditions like metabolic syndrome, polycystic ovarian syndrome (PCOS), erectile dysfunction (ED), and heart disease. It may also be a factor in triggering inflammatory and autoimmune diseases. 

The typical treatment for type 2 diabetes involves lifestyle changes and medications to lower blood sugar levels. However, these treatments mainly address the symptoms and not the underlying causes, which are insulin resistance and inflammation.

Type 2 diabetes and inflammation

Type 2 diabetes is often seen in conjunction with inflammation and autoimmunity, resulting in significant impacts on human health. Chronic inflammation often goes unnoticed but plays a significant role in the development of both type 2 diabetes and autoimmune disease.

A research study examining health records of over three-quarters of a million people found that type 2 diabetes increased the chances of developing autoimmune disease, and autoimmune disease also increased the odds of developing type 2 diabetes. 

Consuming high levels of carbohydrates and sugars promotes elevated levels of insulin and glucose. This can lead to insulin resistance and type 2 diabetes. It can also lead to inflammation, increasing the risk of developing an inflammatory or autoimmune disease. 

Treatment options for type 2 diabetes

Four primary treatments have proven effective in treating type 2 diabetes. These are bariatric surgery, very low-calorie diets, GLP-1 weight loss medication, and very low-carbohydrate diets. 

While bariatric surgery promotes weight loss, a study has shown that between 37%-76% of patients regain significant weight within six years.

Reducing calories to near-starvation levels induces ketosis, which helps improve insulin sensitivity. However, this approach is not sustainable, so it isn’t appropriate as a long-term treatment for type 2 diabetes.

GLP-1s can be effective in certain cases, but they come with serious side effects like loss of appetite, nausea, vomiting, and diarrhea. Additionally, these medications are costly and still require lifestyle changes for full effectiveness.

Type 2 diabetes can be treated naturally through diet and lifestyle changes. Carbohydrate restriction has been extensively studied as an effective method for reducing A1c levels and medication dependence.

Type 2 diabetes medication options:

Metformin: This popular diabetes drug functions by reducing glucose absorption in the intestines, while reducing gluconeogenesis (glucose production) in the liver and improving insulin sensitivity. This is one of the better tolerated diabetes medications, but side effects do occur. These include: 

• Muscle pain 
• Difficulty staying warm 
• Dizziness or weakness 
• Vomiting 
• Slowed heart rate 
• Nausea  
• Diarrhea 
• Hypoglycemia is not commonly seen.

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Sulfonylurea: This class of drugs causes the pancreas to release more insulin, helping to lower blood sugar. Examples include glipizide, glyburide, and glimepiride. The primary side effects are all related to hypoglycemic episodes. Over time weight gain, fluid retention, and dangerous cardiovascular events are also possible.

Meglitinides: These stimulate the pancreas to release insulin by closing potassium channels in pancreatic beta cells. This allows calcium to enter and stimulate insulin secretion. Example: Repaglinide. Side effects include: 

• Diarrhea 
• Nausea 
• Vomiting 
• Stomach upset 
• Muscle pain
• Headaches
• Weakness or lethargy 
• In rare cases, hypoglycemia, tremors, joint pain, and respiratory tract infections can also occur.

DPP-4 inhibitors: These function by slowing the degradation of GLP-1, slowing absorption from the gut. They also stimulate insulin secretion while slowing gastric function and emptying, reducing glucagon and appetite. Examples include sitagliptin and saxagliptin. Side effects include: 

• Debilitating and severe joint pain 
• This led to an FDA warning about this class of drugs. 

Thiazolidinediones (TZDs): These bind to a receptor in fat cells to force them to store more circulating fat. This results in an improvement in insulin sensitivity. Example: Pioglitazone. The side effects include: 

• Fluid retention 
• Weight gain 
• Congestive heart failure 
• Bone fractures 
• Bladder cancer 
• Hepatotoxicity (liver toxicity)
• Macular edema
• Abnormal ovulation combined with increased risk of birth defects

SGLT-2 inhibitors work by inhibiting the reabsorption of glucose in the kidneys, making patients urinate out extra glucose. This has the effect of lowering blood glucose levels, although not as effectively as some other drugs. Examples: Sitagliptin, saxagliptin. Side effects include:  

• Urinary tract infections
• Genital yeast infections 
• Upper respiratory tract infections 
• Frequent urination 
• Hypercholesterolemia
• Joint pain 
• Thirst 
• Back pain 
• Flu-like symptoms 
• Constipation

GLP-1 receptor agonists promote the GLP-1 receptor, slowing stomach emptying, stimulating insulin release from the pancreas, and reducing glucagon production to slow gluconeogenesis from the liver. 

GLP-1 agonists also stimulate satiety, making your brain feel like you’ve eaten enough before you actually have. Examples: Semaglutide, liraglutide, exenatide. The side effects include: 

• Poor appetite 
• Nausea
• Vomiting 
• Diarrhea 
• Dizziness
• Tachycardia
• Headaches 
• Indigestion

Insulin is available in both short and long-acting. Injectable insulin functions just like the insulin produced by the pancreas. It causes glucose to move out of the bloodstream and into cells. It also blocks the release of energy from fat cells. Side effects are: 

• Worsening of insulin resistance
• Weight gain 
• Hypoglycemia
• Headaches 
• Lipodystrophy (pitted or swollen fat) 
• Fluid retention causing peripheral edema and elevated blood pressure

The importance of medical supervision

Medical supervision is crucial when treating type 2 diabetes with low-carb or ketogenic diets to ensure safety. Diabetes medications may need to be reduced or eliminated as normal blood sugar levels are achieved. The combination of a low-carbohydrate or ketogenic diet and these medications can result in blood sugar levels dropping to dangerously low levels.

Research has shown that many people with type 2 diabetes have the potential to reduce or eliminate their dependence on medication. Type 2 diabetes can be treated without the need for surgery or medication using the right treatment and medical support. Preventing, treating, or managing this condition is very important for public health.

Revero’s innovative model is designed to provide this type of treatment, offering a remote care model while providing patients with continuous support from health coaches and medical providers. They monitor patient biomarkers like weight and blood sugar, making ongoing recommendations for medication reduction.

A root-cause approach for treating type 2 diabetes

Recent research has validated that type 2 diabetes can be treated with a low-carb diet. This results in reduced weight, HbA1c, and blood pressure, and improved blood lipid profiles. The study also showed that a low-carbohydrate diet greatly reduces the dependence on medications.

Nutritional ketosis is a natural metabolic state where the body and brain burn fat and ketones instead of carbohydrates as their primary fuel source. It is a proven tool in sustainably treating type 2 diabetes. Low-carbohydrate diets can trigger nutritional ketosis if there is sufficient fat in the diet in combination with low carbohydrate intake.

Revero’s low-carbohydrate diet is designed to treat the cause of metabolic disease, with the goal of lowering blood sugar levels, reducing medications, and promoting weight loss. Reducing carbohydrate intake to low-carb ketogenic levels helps the body to become “fat-adapted,” and burn fat for fuel instead of carbohydrates.