TraceyLin

Q:

I understand that in type 2 diabetes there are at least two things going on with insulin: not enough produced; and/or fatty deposits clog receptor sites. In the second case, does this mean that reducing adipose tissue will send diabetes into remission if this is the only deterrent to normal functioning pancreas and insulin output?

Patty Bonsignore

A:

When you reduce adipose tissue (or fat) your body needs less insulin and the insulin it does make works better. The inability of insulin to work well inone who has diabetes is referred to as “insulin resistance.” Insulin resistance occurs at the cellular level. Think of insulin as a key; when everything is working well, the key unlocks the door easily, but when you have insulin resistance, the key is rusty and does not work as well. Too many fat cells increase insulin resistance; by losing fat cells, you have less insulin resistance. Losing weight is one of the ways to help lower insulin resistance; eating less saturated fat is another way. And a third really important way is to increase your physical activity. Sometimes when a person loses a lot of weight, as can happen with gastric bypass, we do say the person is in “remission” from their diabetes. But remember, insulin resistance is not the only reason people have diabetes; the other reason is that the pancreas just can’t make enough insulin. We can’t fix this, so for some people losing weight will be enough to get their blood glucose back in target, but others, even with weight loss, will still need medications such as insulin to keep their blood glucose levels controlled.