The type II diabetes is a very different situation from the diabetes type I. Here, the pancreas does produces insulin, but the muscle cells seem that they are not capable of responding to its physiological effect, and the glucose in blood rises.
The insulin exercises multitude of functions in the organism. The most well-known is the regulation of the levels of glucose in the blood. The intestinal absorption and the liberation of glucose for the liver, they form the glucose “input” to the blood. The cells, especially, the muscular cells, are the main output of glucose of the blood. The insulin “blocks” the glucose liberation on the part of the liver and “favors” the entry of glucose in the muscular cells. Its action is to favor the lowering of the levels of glucose in the blood. In insulin absence, the liver liberates more glucose and the muscular cells scarcely can uptake glucose, therefore the glucose levels rise.
If in the diabetes type II there is insulin, the question that appears is: Why does the glycemia raise? The answer of the medical science is that the cells do not answer to the action of the insulin, especially the muscular cells. This is known as insulin resistance.
The following question would be then: What happens? Why takes it place resistance to the insulin?
As the diabetes type II definitely has a correlation with obesity, especially with the abdominal obesity, the possible interrelated mechanisms have been investigated.
It has been demonstrated that the obesity is a situation in which the organism enters chronic inflammation. It has been demonstrated also that the visceral adipose tissue liberates a lot of proinflamatory substances. These substances might interfere with the function of the insulin at a cellular level.
This way, more than to do emphasis on the suitable control of the glycemia, it would be necessary to do emphasis on the control of these states of chronic inflammation, which in turn are related to the abdominal obesity, which, as it is well known, is related to the cardiovascular risk.
Under this vision, it is no wonder that the studies that compare treatments with strict control of the glycemia have not demonstrated increase of the survival, when they are compared with other treatments where more lax control of the glycemia is allowed. The situation is complicated moreover, when in the treatment of the diabetes type II insulin is introduced as part of the therapeutic program. The insulin has the advantage that it obtains more strict control of the glycemia, but the disadvantage that the insulin itself is proinflamatory and that the persons tend to gain weight and to develop more abdominal obesity.
The medical treatment of the diabetes type II bases on diet, exercise, hipoglycemiants drugs, and insulin when all the above fail. An also, the correction of other disorders, since the type II diabetes is usually in the context of the so called metabolic syndrome, with hypertension, dislipemias, uric acid elevation, etc.
The loss of weight and the physical exercise offer a very beneficial effect in this situation, at all the levels. The medicines, supplements, natural remedies, etc., etc. they play a secondary role, but they can help very much.
Another big question, of difficult answer it is now: What is the cause of the obesity?
The simplistic answer: increase of the caloric ingestion and decrease of the physical activity, although, undoubtedly, they are a part of the history, are not the whole history. There are a myriad of factors, scarcely reflected in the Textbooks of Medicine, but very present in the Integrative Medicine, which there complete better the complexity of the obesity and the difficulties of its treatment: alteration of the food for the industrial production, food that we cannot digest (margarines), nutrient lacking food, the alarming absence of fibre in the modern feeding, food that there damage our mucinas, food that damage the intestinal cells (gluten), food with high glicemic index (sugar), the toxins and polutans (that alone they would need an Encyclopedia), capable of damaging the intestinal flora, the intestinal mucous membrane, etc. With the consequent syndrome of increase of the intestinal permeability (leak gut syndrome): pollution of the body and risk factor of autoimmune illnesses and a long etc. Y, also it is necessary to think, that depending on the composition of the diet, we can have acidating diets, proinflamatory, oxidizing, etc., that disturb severely the functioning of our organism.
Finally, we have the genes. They play a role. But a little one. The problem of the obesity, the metabolic syndrome and the diabetes type II is, especially, environmental, related with our life style and the such a poisonous world in which we live.
Joaquín Muñiz Girón, MD