Double Diabetes | Does Type 1 diabetes hold the key to Reducing our Global Obesity & Type 2 diabetes Epidemic?
Feb 15, 2024Diabetes, both Type 1 diabetes and Type 2, is a growing health concern globally, with significant implications for public health. Type 1 diabetes, often diagnosed in childhood or adolescence, although now diagnosis is prevalent at any age, is an autoimmune condition where the body's immune system mistakenly attacks insulin-producing beta cells in the pancreas, leading to a lack of insulin production. On the other hand, Type 2 diabetes is characterized by insulin resistance, where the body's cells become less responsive to insulin, leading to high blood sugar levels as glucose from the blood is unable to be shuttled away into the cells.
Exploring the Relationship Between Obesity and Type 2 Diabetes
For a long time, it has been believed that the accumulation of an excessive amount of body fat can cause Type 2 diabetes, and the risk of Type 2 diabetes increases linearly with an increase in body mass index (BMI). Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of Type 2 diabetes. However, recent research suggests that the relationship between obesity and Type 2 diabetes may be more complex than previously thought.
Models Explaining Environmental Causes of Obesity Leading to Type 2 Diabetes
Two main models explain the environmental causes of obesity leading to Type 2 diabetes and insulin resistance: the Energy Balance Model (EBM) and the Carbohydrate-Insulin Model (CIM). The EBM suggests that modern processed foods drive weight gain through increased calorie intake, combined with a lack of physical activity, leading to fat deposition. It posits that to lose weight, the number of calories consumed must be less than the number of calories burned, typically through some form of physical activity or exercise.
The Carbohydrate-Insulin Model (CIM) proposes that diet composition, particularly rapidly digestible carbohydrates, influences fat deposits through hormonal pathways, particularly insulin. Insulin is considered as the 'fat' storage hormone as it shuttles glucose from the blood stream either for immediate use by cells, or is stored as fat for future use of energy.
Can Type 1 diabetes Settle the Debate?
Type 1 diabetes, characterized by a lack of insulin production, presents a unique opportunity to explore the relationship between insulin, obesity, and Type 2 diabetes.
How?
Let's explore whether the amount of insulin administered leads to obesity, manifesting to insulin resistance, Type 2 diabetes, and for those with Type 1 diabetes, Double Diabetes!
The landmark Diabetes Control and Complications Trial (DCCT) showed that achieving near-normal blood glucose levels in Type 1 diabetes lead to a reduction in complications via intensive insulin therapy (IIT).
The Impact of Intensive Insulin Therapy in Type 1 diabetes on Weight Gain
However, one of the drawbacks of intensive insulin therapy in Type 1 diabetes, which consisted of increased insulin administration, was weight gain. According to the Diabetes Communicator, a Diabetes Canada publication, Intensive Insulin Therapy “…can lead to excessive weight gain, especially abdominal obesity, and the subsequent development of insulin resistance, dyslipidemia, hypertension, and increased cardiometabolic risk.”
Addressing Obesity in the Type 1 diabetes Community
And unlike the threefold increase in obesity in the general population between 1975 and 2016, the Type 1 diabetes community is not spared from also following such trends. The incidence of overweight and obesity among our Type 1 diabetes population is equal to that of the general population, as discussed by Fellinger et al., and also by the Diabetes Communicator.
Strategies for Managing Type 1 diabetes to Reduce the Risk of Double Diabetes
Unfortunately, as recognized within the Diabetes Control and Complications Trial (DCCT) that intensity insulin therapy can lead to weight gain, Cantley et al., concluded that “Overweight/obesity is very common in adults with T1DM and is associated with double diabetes."
Cantley et al., went as far as to pinpoint the culprit of this obesity among adults with Type 1 diabetes by stating that "BMI is positively associated with the total insulin dose.” As we know from managing Type 1 diabetes, your insulin dose is related to your blood glucose excursions from the factor which has the greatest impact on your blood glucose levels: carbohydrates.
Deducing from the literature, a frequent, and increased consumption of carbohydrates, will lead to elevated blood sugar levels, which will require insulin administration to maintain normal blood sugar levels.
The more carbohydrates consumed, and the more frequent, the greater the blood glucose response, requiring large and more frequent doses of insulin to shuttle glucose from the blood stream into the cells either for energy or fat (energy) storage. As is the case with intensive insulin therapy, the larger and more frequent the insulin dose, the greater the weight gain!
And this cycle leads to obesity, insulin resistance, and eventually Double Diabetes for those with Type 1 diabetes.
Using Therapeutic Carbohydrate Reduction/Low Carb Nutrition Strategy
By understanding what leads to weight gain in Type 1 diabetes—total insulin dose, and how this weight gain can lead to insulin resistance and type 2 diabetes—we can implement a strategy to decrease the subsequent amount of insulin required to maintain normal blood glucose levels by controlling our intake of the very food which has the greatest impact on our blood glucose levels: carbohydrates.
Mechanisms of Action and Benefits
A Therapeutic Carbohydrate Reduction/Low carb nutrition strategy reduces the amount and type of carbohydrates consumed with the aim of limiting post-meal excursions, thus reducing the need for high levels of insulin. This approach has shown benefits not only for managing blood glucose levels in Type 1 diabetes but also for improving outcomes in Type 2 diabetes.
Alleviating and Avoiding Double Diabetes Diagnosis for someone with Type 1 diabetes
By adopting a Therapeutic Carbohydrate Reduction/Low carb nutrition strategy, individuals with Type 1 diabetes can reduce their insulin requirements necessary to safely achieve stable, normal blood sugar levels, which can lead to a prevention of weight gain.
This reduction in insulin needs can help avoid the development of insulin resistance, dyslipidemia, hypertension, and other complications associated with obesity, Type 2 diabetes, otherwise known as Double Diabetes for someone with Type 1 diabetes.
The development of double diabetes for someone with Type 1 diabetes can be disastrous. The life-saving medication necessary for someone diagnosed with Type 1 diabetes to live—insulin—becomes less effective as their body no longer responds to the administered insulin due to overuse from large doses over time, often due to a high consumption of carbohydrates.
Not only does double diabetes lead to a person with Type 1 diabetes being resistant to the life-saving medication they require, but a double diabetes diagnosis also increases their incidence of complications, such as cardiovascular disease.
As such, double diabetes should be avoided at all costs by someone already diagnosed with Type 1 diabetes.
Conclusion
By understanding what leads to weight gain in Type 1 diabetes—total insulin dose, and this weight gain can lead to insulin resistance and type 2 diabetes, otherwise known as Double Diabetes for someone already diagnosed with Type 1 diabetes—we can implement a strategy to decrease the subsequent amount of insulin to maintain normal blood glucose levels by controlling our intake of the very food which has the greatest impact on our blood glucose levels: carbohydrates.
By adopting a Therapeutic Carbohydrate Reduction/Low carb nutrition strategy, which reduces the amount and type of carbohydrates consumed with the aim of limiting post-meal excursions, we reduce the amount of insulin administered necessary to maintain normal blood glucose levels.
By reducing our insulin dose, as a result of reduced carbohydrates during meals, we are reducing the incidence of weight gain and therefore reducing our chance of developing Type 2 diabetes and subsequently, Double Diabetes!
Want to Improve Type 1 diabetes Management, Safely Achieve Stable, Normal Blood Sugar Levels?
If you are interested in improving your child's Type 1 diabetes management and successfully implementing a Therapeutic Carbohydrate Reduction/low-carb nutrition strategy, so you can safely achieve normal blood sugar levels, relieve stress, anxiety, and frustration, and nourish your child's growing body, visit:
https://www.t1dnutrition.com/
[email protected]
m.me/107379384792655
Follow T1D Nutrition
Website: T1D Nutrition
Facebook: T1D Nutrition Facebook Page
YouTube: T1D Nutrition YouTube Channel
#type1diabetes
#t1dnutrition
#lowcarb
#lowcarbhighprotein
#TherapeuticCarbohydrateReduction
#NormalBloodGlucose
#normalbloodsugar
#nutrition
#nutritionfortype1diabetes
#type1diabetesnutrition
#nutritionfortype1diabetes
References
- Cantley, N. W., Lonnen, K., Kyrou, I., Tahrani, A. A., & Kahal, H. (2021). The association between overweight/obesity and double diabetes in adults with Type 1 diabetes; a cross-sectional study. BMC Endocrine Disorders, 21(1). doi:10.1186/s12902-021-00851-1
- Fellinger, P., Fuchs, D., Wolf, P., Heinze, G., Luger, A., Krebs, M., & Winhofer, Y. (2019). Overweight and obesity in Type 1 diabetes equal those of the general population. Wiener Klinische Wochenschrift, 131(3–4), 55–60. doi:10.1007/s00508-018-1434-9
- Lau, D. (2020). Should curbing “double diabetes” become a priority in the management of Type 1 diabetes? The Diabetes Communicator, Spring 2020. Toronto, ON: Diabetes Canada.
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. (1993). New England Journal of Medicine, 329(14), 977–986. doi:10.1056/nejm199309303291401
