My Notes From The Diabetes Summit
Interview with Sheri Colberg PhD
The book I co-authored called The Diabetes Breakthrough is based on a twelve week program that was created at the Joslin Diabetes Center in Boston. What I did was help people with diabetes effectively loose weight and keep it off. Anybody can loose weight the bigger problem is keeping it off afterwards and you don’t want to loose weight and loose muscle mass and then regain fat mass then you end up fatter than you were before even if you weigh the same. The program is not earth shattering it’s just a combination of things that they put together for that program that worked really well. Exercise is a big component of that, it also gets into looking at what types of medication some people take because some of them promote weight gain or prevent people from loosing weight effectively. There is a lot in there about how to talk to your health team about what medications and considering maybe using other ones, basically how to best manage every aspect of your diabetes to promote weight loss and weight maintenance. It’s written for the person who wants to loose weight with diabetes it focuses more on type 2 but we do have some examples for type 1 in there because many people with type 1 also wind up gaining weight. They actually get double diabetes they have type 1 but also have the symptoms of type 2 so we address that with exercise, medication management, maybe switching the type of insulin their on to promote weight loss.
With medications to make it simple because there’s so many classes of diabetes medications now anything with insulin or promotes the secretion of insulin tends to cause weight gain. It’s a lot of the older medications used for type 2 can promote weight gain it’s not a reason not to go on insulin it’s maybe a reason to pick a type of insulin. We have some tricks in the book instead of taking a set amount of insulin for your diner and taking way in advance of when you eat and then take your rapid acting insulin the exact amount to cover what you ate and that way you don’t wind up over doing it and causing hypoglycemia. Every time you have to cheat hypoglycemia your actually eating extra calories and those count too, unfortunately their medically necessary. The type of insulin there’s a little bit of difference between the basil insulin’s as to which ones promote more weight gain than others some are a little bit more adjustable. A lot of the newer ones especially to treat type 2 diabetes promote weight loss, some of the injectable that aren’t insulin can actually decrease appetite and help people eat less and feel more satisfied. Metformin that’s prescribed to almost everybody that’s insulin resistant is thankfully weight neutral it doesn’t have any effect on weight.
I prefer to use whatever you can with lifestyle management to promote weight loss after you get the medications figured out, then you look at what can I do in my life to promote weight loss. I’m not a proponent of an extremely low carb diet, you do have to think about how much insulin your body releases in response to the things you eat. If you give insulin you have automatic feedback to know if I eat a piece of cake it takes a lot of insulin to cover that, but if I eat some ice cream with a really high fat content there isn’t as much of a need for insulin. Trying to figure out maybe the lower glycemic index carbohydrates may be better choices because they don’t cause a need for a huge amount of insulin in a short period of time. People with type 2 cannot release that large amount that they need with type 1 it’s hard to completely match that normal response of insulin you end up getting low before you end up getting high later. Sometimes your eating extra calories you didn’t plan on just because you can’t exactly match your insulin with your carbohydrates. Personally I tend to stay away from the foods that cause an immediate spike in blood glucose because you know that’s going to require more insulin. Anytime you have a lot of insulin floating around it does make it harder to loose weight because insulin promotes the storage of fat.
Anytime you exercise you generally are going to have a heightened response to insulin that lasts for a period of time after that, you could get by with a lot lower insulin needs. Why that’s important not only to diabetics but if they look at the people with extreme longevity people over one hundred years most of them have low insulin levels, low fasting levels. It’s not because they can’t make insulin it’s just that their very sensitive to insulin the insulin works really well the insulin that their body has to release is very small. That seems to be really important in maintaining metabolic health having low insulin needs.
Some weight loss can help with insulin needs but what really works best is managing the amount of muscle that you have and how physically active you are. Think of it this way the muscle is like the gas tank, carbohydrates go into storage whatever you eat goes into that gas tank for when your going to exercise. If your just sitting around the gas tank is always full so when you eat carbohydrates their not going into the muscle because there is no room left to put them there. When your not doing regular exercise all the time the size of the gas tank shrinks over time, we all lose muscle mass as were aging so now you not only have a full tank you have a smaller tank. My idea is what can I do to get some of that gas out of that tank, which means I have to be physically active, what can I do to maintain the size of that tank or make it bigger. That’s where the exercise comes in, that’s where the choice of foods comes in, you don’t overload your body with carbohydrates that it has no capacity to store. Even when our muscle gets resistant to insulin the insulin still works to pack the fat away in the fat cells. We can be insulin resistant and the insulin still makes us fat and the carbohydrates they get converted into fat that goes into storage.
Exercise has an immediate impact you have to think how the glucose gets into the muscle cells at rest, insulin is the main thing that makes that happen. Insulin is like a key that fits into the lock that opens the door and lets the glucose in. What happens sometimes when you have insulin resistance is you’ll have plenty of insulin traveling around the bloodstream and the key doesn’t fit in the hole anymore, the key doesn’t work and the glucose stays in the bloodstream. Interestingly what exercise does is it gives you a different key, basically there is a separate mechanism Luki protein and these proteins get recruited just by contractions. Just by having your muscle contract your able to take up glucose into the muscle cell that helps fuel that activity and it’s completely separate from insulin it’s also additive. It’s not dependent on whether your insulin resistant or insulin sensitive the bad thing is if you have insulin that you injected or pumped in that you could not turn off during exercise. Now instead of them having one mechanism that’s lowering your glucose while exercising you have two you have the contractions and the insulin. That’s why sometimes people will drop precipitously while their exercising if they take insulin and the insulin dose is not reduced. It’s not a normal physiological response with insulin levels that high, during physical activity you can use that strategically to kind of play around. My levels are a little high so I need to go do some exercise and that will help remove some of the glucose directly from the bloodstream.
Generally an aerobic type exercise is going to have a glucose lowering effect on everybody, a caveat is if your doing very intense high intensity sometimes your bodies mechanisms that try to keep glucose levels available during exercise override your you. What I mean is your hormones that you release that raise hormones can cause a big increase in your glucose when your exercising that happens with high intensity intervals. Studies have been done on aerobic versus resistance found resistance compared to walking will raise glucose levels temporarily or at least they will stay stable, then afterwards say two to twelve hours you may actually drop a lot. During aerobic activity it tends to go down during activity and then levels off and may not drop as much afterwards. I find a combination of activities is the best thing to do . For me I find I get injured if I do the same activity everyday so I don’t do the same activity everyday. If you only have time for one activity I would do resistance training, people with type 2 find that when they start exercising they will need to lower their medication. I have had patients say I exercise in the morning before breakfast and I’m just walking and my blood glucose goes up what do I do, just eat something before your walk or exercise it reduces the amount of cortisol which makes you very insulin resistant in the morning. If you haven’t eaten and you go exercise your less likely to have low blood glucose but you are very likely especially if it’s more intense for your glucose to go up more than it would during any other time of day. If you eat a little bit and take a little insulin less than you’d normally take you could prevent that, you could get those hormones to decrease so your not resistant anymore. If you have the opposite problem and your high in the afternoon it’s a great time to exercise because it’s going to lower your glucose. I have all these tricks on my website Diabetes Motion.
Exercise itself has a natural anti-inflammatory effect reducing inflammation which may be why insulin works better after that. There are a number of antioxidant systems in the body, exercise itself causes oxidative stress in the body and the bodies response to that is to make enzymes that are going to squelch that down their really good at that. When you exercise regularly your immune system is better so not only do you reduce inflammation your less likely to get sick and that will effect your glucose these are all really good things. Diet is still number one because you can override exercise with a bad diet, if you over feed after exercise the effect goes away.
With heart disease research shows your better off doing resistance training because it increases the blood flow to your heart through your vessels. They always thought aerobic was better now they promote resistance as a better training. One thing I think is a big contributor to the development of diabetes is micronutrient deficiencies of vitamin D, magnesium and more. These vitamins and minerals all make our metabolism work well when you don’t have enough of them is it any surprise that things don’t work like their suppose do. With type 2 diabetes one of the keys is to eat fifty grams of fiber a day, you change the health of your gut, you change how your body does everything just by that.
Sheri Colberg PhD web page
Disclaimer: The information contained on this site is for educational purposes only and should not be used as a substitute for diagnoses or treatment rendered by a licensed physician. It is essential that you discuss with your doctor any symptoms or medical problems that you may be experiencing.
M. Scherker medical researcher