What is Type II Diabetes Mellitus?
Type 2 diabetes mellitus (DM2) is a multifactorial disease, which accounts for approximately 90%-95% of cases with diagnosed diabetes mellitus. Essentially a permanent hyperglycaemia develops slowly and gradually. There are not a few cases where DM2 pre-exists long before it is diagnosed, as due to the slow rate of development, you do not notice any of the classic symptoms of diabetes.
In type 2 diabetes mellitus you will notice high blood glucose levels and at the same time relative insulin deficiency (unlike type 1 diabetes where insulin deficiency is absolute).
But why does this deficiency occur?
Type 2 diabetes is essentially a set of disorders that result in hyperglycaemia. The facts are as follows: not enough insulin is secreted by the pancreas to meet metabolic needs. DM2 includes the whole spectrum of cases from high insulin resistance with little insulin deficiency to a significant decrease in insulin secretion with less resistance. At the time of diagnosis of DM2, it is estimated that there is a 24% to 65% reduction in beta-cell function. Initially there is an excessive increase in insulin secretion (hyperinsulinemia), which maintains glucose concentrations in the normal or prediabetic range. However, at some point the pancreas becomes tired and is unable to continue to produce sufficient insulin. This leads to chronic hyperglycemia followed by a diagnosis of diabetes.
Can DM2 affect your weight?
It is a fact that most people with DM2 are obese. But the reverse is not true, i.e. it does not mean that just because someone is obese they will get DM2.
Unfortunately, higher weight has the potential to increase insulin resistance and contribute to more rapid destruction of pancreatic beta cells. However the exact mechanism of action remains unclear. Therefore, obesity combined with a genetic predisposition may be necessary for the development of DM2. However, other risk factors may also be responsible for the development of DM2 such as a family history of diabetes, older age, physical inactivity, previous history of gestational diabetes, prediabetes, hypertension or dyslipidemia.
Is there a treatment?
Proper diet and exercise is the answer you are looking for. If your weight is above the normal range, a 5% weight reduction goal will have beneficial effects (only and only if the weight is increased). The total fat intake from your daily diet should be <30% of your total daily caloric needs, and of that, saturated fat should be no more than 10%. It is very important to increase fibre with an intake of 25-35 g/day. Daily physical exercise is of utmost importance to maintain a healthy condition and to prevent diabetes attacks. The Hellenic Diabetes Society’s recommendations for 2021 recommend at least 30 minutes of moderate-intensity physical activity at least 5 times a week. A targeted, and meaningful lifestyle change will help you both mentally and practically.
Mentally, you will benefit from a sense of well-being, emotional fulfillment and the satisfaction of doing something for yourself.
Practically, long-term light physical activity leads to preventing or delaying the onset of type 2 diabetes.
Diet in the treatment of DM2
The role of the dietician is of major importance in the life of a person with diabetes mellitus. Proper nutrition education will give you a freedom of choice and “break” any restriction that you feel is suddenly present in your life. It will give you a quality of life and will not lead you to isolation or anti-sociality that any “bans” on certain foods may cause. A personalised diet should result in a 0.3- 2% reduction in glycosylated haemoglobin (HbA1c) in type 2 diabetes mellitus. The scientific data available to date do not recommend a specific carbohydrate intake in cases of DM2, as long as it is qualitative in terms of type. However, overall restriction of carbohydrate intake seems to be the most effective way to regulate glycaemia in diabetes, and it would be advisable to adapt it to the individual’s dietary plan. However, carbohydrate intake < 130g/day is contraindicated.
Sources: Krause and Mahans (15h edition), EDC 2021 guidelines